Uterine fibroids are benign fibrous tumors in the uterus that are fed by estrogen. They are extremely common- about 70% of Caucasian women and 80% of African-American women have fibroids by age 50. Most of them don’t cause any symptoms and women are surprised to find they have a fibroid. In many cases though, fibroids can cause heavy bleeding that can lead to anemia and quality-of-life issues. At that point, you would probably consider treatment. There are several treatments for fibroids, depending on the number, size and location of the fibroids, including:

• Hormone therapy: Since fibroids are fed by estrogen, progesterone can be used to counteract your body’s natural estrogen and shrink the fibroid.
• Progestin-releasing IUD: Effective in women with small fibroids, the progestin in the Mirena IUD has been shown to substantially reduce menstrual bleeding. In one study, 85% of all women with menorrhagia treated with a Mirena IUD had their bleeding reduced to normal amounts after 3 months. By 12 months, a full 40% of the women didn’t have periods at all.
• Myomectomy: Surgically removing the fibroid is one option to preserve the uterus while getting rid of the fibroid. It’s moderately effective…in a study of 196 women who had menorrhagia due to fibroids, 68% reported satisfaction with the myomectomy after 73 months. 32% of the women considered the results unsatisfactory. Another report followed 285 women treated with hysteroscopic mymectomy: additional surgery was required for 9.5% of them after 2 years and 26.7% after 8 years.
• Endometrial ablation: In women who are done with childbearing, but who wish to preserve their ovaries and natural hormones, an endometrial ablation is often an effective treatment for small fibroids. One year after the procedure, 95% of women with fibroids have a reduction in bleeding to normal levels; many women have no menstrual bleeding at all.
•  Uterine artery embolization: While UAE appears to be an effective treatment for many women for fibroids, it’s affect on premature ovarian failure, fertility and pregnancy is not clear. Complications of the procedure may lead to a hysterectomy, so if you are adamantly opposed to a hysterectomy, this would not be a good option for you. This procedure works by cutting off the blood supply to the fibroid. It typically requires an overnight stay in the hospital for pain management.
•  Hysterectomy: A woman with large fibroids or with multiple fibroids that haven’t responded to more gentle treatment may require a hysterectomy for definitive treatment. This is a major surgical procedure with the usual accompanying risks. The physician may just take out the uterus, or may take out the uterus and the ovaries. The latter would put you immediately into menopause along with the pesky symptoms and health risks that go with it. This should be the last resort for women as it is the most invasive and can put women at risk for cardiovascular disease and osteoporosis if her hormones are not replenished.

No one answer is right for every woman. Your treatment of fibroids should be personalized to fit your specific medical history, lifestyle, financial situation, and beliefs and comfort level. Talk to your physician about dealing with uterine fibroids. You don’t have to just “live with it”.

About ¼ of all non-pregnant women older than 20 years old have pelvic floor disorders –a weakening of the pelvic muscles and connective tissues of the pelvis. According to the National Health and Nutrition Examination Survey, 82% of women surveyed had insufficient levels of vitamin D. The women with the lowest levels were the ones reporting pelvic floor disorders and urinary incontinence, regardless of age. Higher vitamin D levels seem to maintain muscle and connective tissue health, reducing the pelvic floor dysfunction and urinary incontinence. Also improved by higher vitamin D levels was the risk of fecal incontinence, although the difference was not as drastic as with pelvic floor disorders and urinary incontinence. For minor incontinence and pelvic floor issues, a regimen of specific exercises and vitamin D supplements may be just as effective as medication. Speak to your healthcare provider for more information. [Badalian SS, Rosenbaum PF. Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey. Obstet Gynecol. 2010;115(4):795-803]

Women over 35 years old are typically less fertile than their younger counterparts, and their cycles can start to become irregular. This makes it hard for women to predict when ovulation occurs and often results in unplanned pregnancies. It’s important to continue some form of birth control until you’ve been period-free for a whole year. There are some risks that are more common in older women than in the under-35 women.  The greatest risk to women over 39 using hormonal contraception is venous thromboembolism or blood clots. The risk is approximately 4 times higher than for adolescents and is almost 8 times higher in obese women over 39. In these higher risk women, progestin-only pills containing levonorgestrel or norgestimate or an IUD are much safer options.You should also avoid birth control pills if you smoke, have hypertension, are diabetic, or have migraine headaches with auras. The pills can put you at risk for heart attacks and stroke. One rumored risk that turned out to be unsubstantiated was the idea that oral contraceptives increase your risk for breast cancer. In fact, several studies have shown no increased risk for women using combination pills or progestin only pills. Birth control pills have also been shown to reduce the risk of ovarian, endometrial and colorectal cancers to varying degrees.The Depo-Provera shot has been linked to bone loss and breast cancer in women, so is not recommended for women over 39 who are typically starting to lose their protective hormones.  Birth control pill use, on the other hand, has been shown to reduce the risk of hip fracture among postmenopausal women by 25% by increasing bone mineral density.Hormonal contraception may also ease hot flushes and other menopausal symptoms. The pills have low doses of hormones and are often an effective way of preventing pregnancy and controlling the occasional hot flush with one prescription.At what age should hormonal contraception be discontinued? The age at which you no longer need birth control will be different for every woman. An elevated FSH can be one sign of menopause, but that level can be artificially depressed by birth control pill use. Having no periods for one year would be a sign you no longer need birth control. Birth control pills are usually safe in healthy women up to 50 years old. Ask your doctor to be sure before you stop birth control.

It has been very widely talked about that estrogen, a natural hormone all woman produce before menopause, causes breast cancer.  If that were true, would you not think that it would be a disease of young women who have high levels of this hormone?   I do.

The most widely talked about study is the Women’s Health Initiative (WHI) which linked the medication Prempro to breast cancer.  To understand this fully, let us look at what Prempro is.  Prempro is a combination of synthetic hormones Premarin (taken from pregnant horses…yuck) and Provera which is a synthetic progesterone.  The research in  the WHI showed that the highest incidence of breast cancer was linked when the women took synthetic Progesterone in the pill Provera…not with Premarin alone!

According to the Center for Disease Control and Prevention (CDC), breast cancer currently ranks 6th on the list of the top 10 leading causes of death in women in the United States (US).  There has been no scientific link or studies that have proven that bio-identical estrogen or synthetic estrogen alone causes breast cancer.  The risk for breast cancer increases with age when women have no ability to produce estrogen on their own.  This again doesn’t support the thought that estrogen causes breast cancer.

Let us look outside the US.  If you looked at breast cancer incidence rates by country per 100,000 females, the statistics vary greatly.  China is one of the lowest at 8.8, Iceland is the highest at 39.4 and the US is in the middle at a rate of 21.1.  But wait!:  We all have the same hormones, the same equipment so why do we all not have the same risk factors?  Good question.  There are several factors that increase a woman’s ability to develop breast cancer.  Some include age, family history (first degree relative with a history of the disease), and lifestyle choices.  Having one alcoholic drink increases a woman’s risk of developing breast cancer six fold.  Not estrogen!

When reading studies, news reports, magazine articles and on the web, there is usually more than meets the eye and big pharmaceuticals with big money can generally twist and swing the argument the way that would benefit them.  Before believing it just because you heard it or saw it do some research and read the reports yourself.   You have the right to the full truth, the whole truth and nothing but the truth.

Your body produces 3 different estrogens: estrone, estradiol and estriol. Estriol (also known as E3) is the weakest of the 3 natural estrogens and was originally thought to have little significance. It has been virtually ignored by the mainstream medical community because it doesn’t have the quick, recognizable effects on the body that the stronger estrogens do. While estradiol (E2) will stop hot flashes within hours after applying to the skin, estriol takes much longer to affect you. However, current research has found that estriol offers a wealth of benefits without the dangers that sometimes accompany the stronger estrogens or the synthetic estrogens (such as Premarin).  Estriol can help relieve menopausal symptoms, protect your bones, rejuvinate vaginal tissue, benefit urinary tract health and correct vaginal dryness. It may also reduce cardiovascular risk and shows great promise in reducing brain lesions in multiple sclerosis patients.Estriol is the estrogen most commonly associated with pregnancy. In fact, during pregnancy levels of estriol are up to 1,000 times higher than normal when compared to non-pregnant levels. Women suffering from multiple sclerosis often see their symptoms get considerably better during pregnancy.But what about the risk of breast cancer? There have been lots of opinions and articles in the media relating estrogen use to increased risk of breast cancer. What they fail to tell  you is the type of estrogen studied. In a study funded by the U.S. Army and performed at the Public Health Institute in Berkeley, CA, researchers compared estriol levels during pregnancy with breast cancer incidence 40 years later. Results of the study showed that of the 15,000 women involved, those with the highest levels of estriol during pregnancy had the lowest incidence of breast cancer later on. Asian and Hispanic women typically have higher levels of estriol than other racial groups and interestingly have the lowest breast cancer rates.Estrogen has also been linked to endometrial cancer in the media. In one investigation, postmenopausal women were given oral estriol with no progesterone for 6 months. Oral estrone or estradiol are not advised because they can increase the risk of blood clots. Giving them unopposed (without progesterone) is not advised because it can increase the risk of endometrial hyperplasia (overgrowth…which can lead to cancer). However, all the study participants showed an improvement of symptoms; there were no strokes or blood clots and no endometrial hyperplasia (confirmed by endometrial biopsy). There were also no breast changes that would indicate a higher risk for breast cancer.Estriol has been shown to be the safest estrogen we can use to replace our body’s natural estrogens; it gives the most benefits with the lowest amount of risk. Ask your physician if estriol may be the right choice for you.

More than 80% of American women use some form of hormonal contraception during their reproductive years. But, do you really know what these hormones can do? Since their introduction in 1960, birth control pills (and the patches, injections, vaginal rings and implants that followed) have helped women in so many other ways besides preventing pregnancy. Some of the benefits that have been discovered with hormonal contraceptive use:

·         Menstrual cycle regulation

·         Treatment of menorrhagia (heavy periods, often with clots)

·         Treatment of dysmenorrhea (painful periods)

·         Stopping periods all together to improve lifestyle

·         Treatment of PMS

·         Prevention of menstrual migraines

·         Decreasing the risk of endometrial, ovarian and colorectal cancer

·         Treatment of acne

·         Treatment of hirsutism (excessive growth of body or facial hair)

·         Improved bone mineral density

·         Treatment of pelvic pain due to endometriosis

Your doctor should look at your lifestyle, medical conditions, and goals for treatment before deciding which method of birth control is right for you. Maybe you have PCOS with painful irregular periods, acne and some extra hair growth…a birth control pill taken continuously (with no placebos) may be just right for you. Or maybe you have an irregular schedule and don’t plan on having children any time soon…an IUD might be much more convenient. Speak to your doctor about your options. Make your birth control multi-task as well as you do!