Archive for the ‘Educate Yourself’ Category
I was going through old email and found this from 2009. Some of the information is old and some of the links may not work anymore but it’s still a good letter 🙂
This is a one-time mailing to introduce you to and guide you around the award-winning Power Surge Community for women at Midlife. You won’t receive masses of E.mail. We all get too much E.mail as it is. In fact, due to all the spam and anti-spam programs today, the Newsletters have been archived and are available for your convenience.
I realize this is a long letter, but menopause is a LONG process! It’s essential to educate yourself about menopause, about the remedies, tips and various methods of treating menopause symptoms to spare you as much discomfort as possible during this stage of life. I recommend spending 10 minutes of your time reading the information provided in this letter and saving it as a reference. Having created and maintained this community since 1993, I know it blind-folded, so I’ve provided information and direct links to the most important places first, and then you can explore on your own 🙂
I’m Alice Lotto Stamm, aka Dearest, founder of Power Surge. It’s important to know the quality and reputation of the site you’re visiting and depending upon for accurate information.
It’s my personal pleasure to welcome you to this community (created on America Online in 1993) for women at midlife and in menopause celebrating its 16th year online — the only menopause community with such longevity — and as a multi award-winning Web site since 1996. Power Surge contains a wealth of information and resources, and is internationally praised as a powerful support community for women — It is rated the most popular menopause site by Amazon.com‘s, Alexa; a Forbes Magazine“Best of the Web“ site, Forbes says, “Power Surge is one of the top sites for women looking for support and education during a turning point in their lives, menopause;” has consistently, since 1996, been the #1 and only reviewed menopause site in the Yahoo! directory; is called by Health Magazine, “One of the 25 best health sites for women; Prevention Magazine says, “Power Surge is an internet lifesaver;” the April, 2005 issue of Today’s Christian Woman recommends in their “Managing Menopause” article — “For cutting-edge meno-info, visit the leading website, Power-surge.com; the Spring, 2004 issue of Living Fit Magazine calls Power Surge “The premier online community/resource for midlife women — a decade on the cutting edge;” MORE Magazine praises Power Surge as a successful mentor site for women in menopause, Dr. Chris Northrup says, “This site is invaluable.” Dr. Susan Love, among many other medical luminaries, says, “Power Surge is the first, best and most informative menopause site for women.” A small sampling of newspaper and magazine articles about Power Surge.
However, the most important praise comes from the *women* (and men) who’ve visited and participated in Power Surge. A Sampling of women’s and men’s testimonials can be read here.
Now… About YOU!
I know you’re concerned about and interested in learning more about menopause and related midlife issues — in what’s happening that’s suddenly turning your life upside down. Yes, menopause is a “natural” experience, but as natural as it may be, it can be sheer misery. Although menopause isn’t an illness to cure, for many women it can be a great deal of discomfort to endure. Menopause sometimes feels as though a woman, one day vibrant, energetic, feeling fine, suddenly finds herself feeling as though she’s physically and emotionally trying to pull herself through the eye of a needle.
Among women in menopause, it’s common to hear things like, “I don’t know what’s wrong with me. I feel worse than I’ve ever felt in my life!” “Am I losing my mind?” — “My body feels like it’s betraying me!” — “How long does this last? — “Am I ever going to feel normal again?” . . . Well, it does end eventually, but it can take quite a few years. Remember, you’ve been having a menstrual cycle for years. It doesn’t go away overnight and for many women, it often it goes out with a ROAR!
Remember, too, that menopause doesn’t happen in a vacuum. Everything in our lives is connected. Whatever we had to cope with physically prior to menopause is frequently exacerbated BY menopause. Whatever emotional issues we had before often feel like they’re pushing us to the edge of our patience, and cause us to wonder if we possess the ability to endure what can be long and tedious transitional years. Equally, whatever relationship problems we had with our spouses/partners/children/parents/co-workers can all become exaggerated, often intolerable while we’re coping with all these changes. For many, menopause can be so overwhelming, they find themselves turning to almost anything for comfort — their spiritual natures becoming more fine tuned than ever. I know it’s difficult not to become disillusioned, but patience is something you must learn in order to get past this experience and move on to the next stage in life.
Because menopause touches so many areas of our lives, in Power Surge we address not only the physical “changes” associated with menopause, but the psychological and spiritual, empty nest syndrome, relationships at midlife, weight gain, intimacy, nutrition, diet and fitness issues and how to cope with our aging parents while we’re being tested to the max. We address the whole nine yards about “getting older.” Believe it or not, many women find themselves going into menopause loathing the idea of losing their period AND getting older, but I can promise you one thing, once you’ve found a method of treatment that helps your symptoms and once you’re over this passage, you’ll welcome becoming postmenopausal and getting older.
So, pour yourself a cup of relaxing herbal tea (without caffeine) while you click on the blue links that will help you navigate to and around Power Surge. You’ve *finally* found the most supportive community to answer all your questions and unparalleled support to help you through this passage 🙂 And “community” is what it’s all about! You’ll find a list of convenient links at the bottom of this welcome letter.
Navigating the Power Surge Web Site:
Once on the main page of the Web site, you can click on various links on the “Menu” at the top of the page, or throughout the page, OR you can use the handy site map.
Guest Announcements and Monthly Newsletters:
You’re receiving this E.mail because you’ve either registered for the message boards, or signed up for the mailing list directly. If you’re receiving this for some other reason, you can sign up for the mailing list by one of the above two methods to receive weekly announcements of prestigious guest experts who visit Power Surge to answer your questions and the bi-monthly Power Surge newsletter. Your E.Mail address and personal information will be kept private and used only for the Power Surge mailings. Power Surge has a very strict privacy policy.
It’s a BIG Place – WHERE Do I BEGIN?
I recommend starting with What Is Power Surge About? It will give you an idea of the purpose of this community, where you are, where you’re going, and why I created Power Surge back in 1993.
There’s a wealth of information on the Web site, so sometimes it’s difficult to know where to begin. What with hundreds of guest transcripts, informative and motivational articles, newsletters, message boards (see list of links below). Here are a few sample articles from Educate Your Body: There are many, many more articles to read, but these are the best to start with:
- Menopause Survival Tips
- A Menopause Primer – What Is Menopause And What Are The Symptoms?
- What’s A Hot Flash?
- Selecting A Healthcare Practitioner
- Naturally Compounded, Bioidentical Hormones
- Recommendations for Treating Menopause Symptoms
- Menopause, Libido, Vaginal Dryness/Relationship
- About Your Hormones
- Hair Loss And Thinning
- Tips For Menopause-Related Dry Skin
- The Signs of Menopause:Tests To Ask For
- Phytoestrogens, An Exciting Alternative
- Sleep Disorders / Insomnia During Menopause
Many women are more confused than ever since the most current controversy surrounding synthetic HRT (hormone replacement therapy), such as Premarin and Provera (Prempro), so you may want to begin with this information I’ve compiled regarding the important issue of the HRT Controversy. Power Surge has *never* endorsed synthetic hormones, but only bio-identical, natural, plant-derived hormones for women desiring to use hormone supplementation. Everything Power Surge has been concerned about regarding the synthetics was brought to light with the abrupt halting of the (WHI) Women’s Health Initiative Study in 2002.
A wealth of information can be found in the Recommendations area; Educate Your Body Library, the Newsworthy Articles; Guest Transcripts; Resources; Newsletters and on the very active and supportive Web site Message Boards. You’ll find all these links at the bottom of this E.mail.
Recommendations:
A very popular area is the Recommendations page, replete with various methods of treatments for your particular menopause issues — soy isoflavones, herbs, vitamins, minerals, amino acids, anti-oxidants, naturally compounded, bioidentical hormones and numerous other suggestions can be found on this comprehensive list. Don’t be overwhelmed!No one is expected to use everything in the recommendations area. and Being The Best You area. You select what you need to deal with your personal issues. Every woman is different. You discover what works best for your symptoms. Everything you’ll find recommendations page is natural. Power Surge recommends nothing without first trying it. As most women will soon find out, finding the right method of treatment involves trial and error. Sometimes, in severe cases, there may be times when certain medications may become necessary to get you “over the hump” of the depression and/or anxiety often associated with menopause.
Message Boards
There is no shortage of Power Surge message boards where you’ll find support on every imaginable subject and camaraderie with other women going through similar experiences. The Web site message boards have been rated by Forbes Magazine as the “Best of the Web Menopause Boards.” Women can network 24/7 to read, post and engage in real-time chat with other women in menopause in the Insta-Chat. The subjects cover a host of subjects. Registration is required to participate in the Power Surge Message Boards for the purpose of keeping out multi-level marketing people whose only purpose is to clutter the boards with advertisements. The boards are a haven for friendship, information and support.
Chats
Power Surge is the only menopause site that for 14 years has had regular guest chats in the area of menopause, women’s health and midlife-related issues. Every Thursday night, I host guest chats at 9:15 PM, ET in the Power Surge chat room where YOU have the opportunity to interact with medical luminaries and women’s health experts you wouldn’t likely have the opportunity to chat with about your menopause issues. Power Surge also gives away free books and/or gifts at the guest chats. For information about the guest chats, click here for the guest schedule. The Web chat and Insta-Chat chat on the message board are open 24/7, 365 days a year. Use them whenever you wish.
Transcripts of Guest Chats and Newsletters
There are hundreds of wonderfully informative transcripts of hundreds of prominent guest experts who’ve appeared in Power Surge’s guest chats, a very small sampling of whom are: Dr. Robert Atkins, Dr. Susan Love, Dr. Christiane Northrup, Dr. Isadore Rosenfeld, Dr. Bob Arnot, Dr. John Lee, Dr. Susan Rako (The Hormone of Desire), Dr. Elizabeth Vliet (Screaming To Be Heard); Dr. Pamela Peeke; Authors, Gail Sheehy (The Silent Passage), Rona Jaffe, Nancy Friday, Lonnie Barbach (The Pause), Health Educators, Judith Sachs, Nutritionist, Ann Louse Gittleman, Linda Ojeda; Fitness gurus, Denise Austin, Kathy Smith; Actress, Linda Dano; Relationship Experts, Steven Carter (Men Who Can’t Love), Barbara De Angelis and hundreds more! They can be found in the Transcript Library . Next to each guest’s name is their area of expertise. You might even find it easier going through the Guest Schedule which includes short bios of guests since 2000 and links to their transcripts. For comprehensive newsletters, articles, FAQ’s, resources of relevance to women in menopause, visit the Power Surge Reading Room
Ask The Experts
A very popular area on the Web site is Ask The Power Surge Experts. Power Surge is renowned for the experts with which it associates because… We Believe Only In The *Best*
OB-GYN, Ask Gynecologist, Phillip Warner, M.D. an OB-GYN with years of experience, whose area of expertise is women, menopause and who does not believe in synthetic hormones. Dr. Warner has spoken out for years against Premarin and Prempro, the synthetic estrogen and estrogen/progestin combo derived from horse urine.
Psychiatrist and Neurologist, Anxiety, panic , depression and stress-related medical conditions doctor, Ask Stuart Shipko, M.D., a board-certified Psychiatrist and Neurologist, founder of The Panic Disorders Institute and author who has treated more than 2500 patients with panic attacks/disorder and whose practice focuses on anxiety, panic, depression and stress-related medical conditions.
Intimacy expert, Ask Dr. Sandy Scantling — a clinical psychologist and author whose practice focuses on intimacy and sexuality problems which frequently occur during the transitional years.
Weight Issues expert, Ask Dr. Denise Lamothe — a clinical psychologist who’s area of expertise is eating disorders. Dr. Lamothe is the author of the book, The Taming Of The Chew.
Before posting a question to our experts, I suggest you check each expert’s area’s archived answers, plus there’s a search in each expert’s area if you’re looking for specific information.
Books For Women At Midlife and in Menopause
A comprehensive list of recommended books can be found in the Power Surge Bookstore. The list can be a bit overwhelming to newcomers, so here’s Power Surge’s list of favorite menopause books. New books are always being added.
Site-wide Search
The Web-site search engine contains a very comprehensive search feature where you can not only search the entire Web site, but individual areas, such as the guest transcripts, newsletters, articles sections and the individual experts in the “ask the experts” areas. A handy “tip” I’ve learned from years of using search engines is to locate exactly what I’m looking for when there’s more than one word, such as “hot flashes,” to put the phrase inside “quotation marks.” This works well with all search engines as well.
Contact Us
If you need any help, feel free to: Contact the Power Surge Team. Please make certain you select the right contact person.
Important About Your Privacy & E.mail:
Because there is so much spam mail these days, Power Surge chooses to protect your privacy by sending its mailings BCC (blind carbon copies). In this way, others on the list can’t see your address. We have no way of knowing if someone who has subscribed to our mailing list is looking to harvest E.mail addresses for marketing their products or selling addresses and bombarding you with E.mail. However, because our mailings are sent BCC, many ISP’s (Internet Service Providers), may interpret it as “spam” mail and may drop Power Surge mail into a “spam” or “junk” mail folder even though it’s something to which you’ve subscribed. Therefore, you may want to check your spam/junk mail folders for Power Surge newsletters. If you don’t receive our weekly mailings, you might try contacting your ISP to find out why you’re not receiving it.
AOL User E.mail Information:
In AOL versions 8.0 and 9.0, AOL is providing anti-spam features, where it allows you to configure E.mail you wish to receive. If you wish to receive the Power Surge mailings, it will be necessary to add PowerSurgeWoman@aol.com to the mail you accept, or it will be treated as spam and you may never see it.
Convenient Links
Power Surge has many areas. Here are some convenient links to help you navigate Power Surge and find all the information you’re seeking:
Power Surge has many areas. Here are some convenient links to help you navigate Power Surge and find all the information you’re seeking:
- Stop By And Meet Dearest
- Power Surge Recommendations
- Web site Message Boards & Insta-chat
- Ask The Experts
- Power Surge Live! Web Chat
- Guest Schedule
- Guest Chat Transcripts
- Educate Your Body
- Resources, Newsletters, FAQ’s
- Newsworthy Articles
- Power Surge In The News
- Being The Best You!
- Your Feedback
- The Poll Vault
- Testimonials
- Recommended Reading
- Women’s Midlife Greetings
- he Women of Power Surge
- The Male Point of View
- Sign up for the mailing list
- Unsubscribe from mailing list
- Contact the Power Surge Team
- Site Map
(You can unsubscribe from the mailing list at the bottom of
the newsletters you receive by clicking on “Manage Your Subscription”
I can’t tell you how pleased I am that you’ve found Power Surge. I know you will garner excellent information, strength and support from this multi award-winning community, plus make wonderful friends with other women going through the same transition.
We’ve been here for 15 years helping to empower women to take charge of their bodies. So, as we sojourn through this transition, some of us in our own little cocoons, remember — “If nothing ever changed, there’d be no butterflies.” 🙂
Power Surge
In Our 16th Year informing & supporting women through menopause!
Alice Stamm
(aka Dearest / PowerSurgeWoman)
The Power Surge Community For Women
At Midlife And In Menopause
Celebrating Our 16th Year Online
http://www.power-surge.com
Founder, Facilitator
E.Mail: Dearest@aol.com
* FORBES Magazine: “Best of the Web”
(featured in cover article on the accuracy of
Internet Health sites, “Use With Care”)
* LIVING FIT Magazine’s Spring, 2004 Issue calls
Power Surge, “The premier online community/resource
for midlife women — a decade on the cutting edge”
* HEALTH Magazine selected Power Surge
one of “The 25 Best Health Sites for Women”
* PREVENTION Magazine: “Power Surge is an
Internet Lifesaver”
* SUSAN LOVE, M.D.: “Power Surge is the first, the
best and most informative menopause site for women”
* TODAY’S CHRISTIAN WOMAN: April, 2005 article,
“Managing Menopause,” says, “For cutting-edge
meno-info, visit the leading website, Power Surge.”
* CBS Healthwatch: “Power Surge has had a
powerful effect on the mental and physical
health of women”
* MORE Magazine praises Power Surge as a
“Valuable Menopause Mentor” in its April, 2003 issue
* CHICAGO TRIBUNE: “If your mom’s not around to offer
advice on hot flashes as you enter menopause, head for
a Web site called Power Surge.”
Copyright 1994-2009 Power-Surge.com, Inc.
All Rights Reserved
Reproduction in whole or part without permission is prohibited.
From Power Surge, written by Dearest
Bone health is a primary concern for women as they advance in age. Bone is a dynamic, living tissue subject to breakdown, repair, and rebuilding, like any other tissue in the body. Bone loss occurs when the rate of bone dissolution exceeds that of bone formation. Women actually achieve maximal bone density by their mid-thirties. In fact, skeletal bone mass naturally starts to decrease after about age 40, so it is never too early to address bone health. In addition, research has shown that it is never too late to begin preventative steps against excessive bone loss.
For many women and their health care providers, concern about bone loss is one of the main arguments for supplementing with estrogen. Estrogen replacement, however, brings with it its own concerns, and is only part of the story when it comes to bone health. Estrogen can inhibit the cells whose job it is to break bone down. This means estrogen slows down the rate of bone loss, but it will not build new bone. Testosterone and progesterone, however, appear to stimulate the cells that build bone, thereby possibly stimulating bone growth.
Hormones play a pivotal role in the process of remodeling bone, but several vitamins and minerals are indispensable for optimal bone health as well. The formation of healthy bone has two fundamental aspects: First to increase bone mass, and second to create a healthy infrastructure (known as the bone matrix) around which bone can form. Supplementing with key nutrients, along with a balanced diet and exercise program, are integral to any regime for promoting the health of your bones.
The proper nutrition for bone health goes beyond simply supplementing with calcium. Calcium deficiency may only contribute to 25% of all incidences of heightened bone loss. The form of calcium used is also important. Studies to determine the recommended daily intake of 1200-1500 mg for menopausal women used calcium carbonate. Calcium carbonate is a form of calcium our bodies may find difficult to absorb, particularly in an environment that is low in stomach acid. In addition, this recommendation includes calcium derived from dietary sources. Most women eating a standard American diet get about 700 mg of calcium from food intake. Calcium as an amino acid chelate is currently the most absorbable form of calcium available. As we age, we tend toward hypochlorhydria (low stomach acid). Calcium amino acid chelate does not require an acidic environment for absorption, but it is a good idea to supplement with a bone health formula that includes hydrochloric acid, as it can aid in the absorption of calcium and other nutrients from the diet.
Magnesium is important for the formation of a functional bone matrix. In addition, magnesium converts vitamin D to its active form, D3. This is imperative for calcium absorption. Many women with poor bone health may be deficient in the active form of vitamin D. Menopausal women in general tend also to be deficient in magnesium. Folic acid and vitamin B6 (pyridoxine) together perform a vital role in engendering the health of bone tissue. They help the body metabolize and excrete a substance known as homocysteine. High homocysteine levels are associated with defective bone formation (and, incidentally, with cardiovascular disease). Interestingly enough, menopausal women show an impaired ability to metabolize and excrete homocysteine. Furthermore, they tend as a group to be low in folic acid and vitamin B6.
Manganese, silicon, and vitamin K are all necessary for the construction of the bone matrix around which bone mineralization occurs. Vitamin K is another nutrient that is found to be low in individuals with significant bone loss. Too much vitamin K can potentially interfere with blood clotting, so it is important not to exceed approximately 200 micrograms a day of this nutrient.
Zinc and copper are also important minerals for bone health that tend to be low in menopausal women. Both minerals enhance the effectiveness of vitamin D, which promotes the absorption of calcium. Zinc and copper must be supplemented in the appropriate ratio, as imbalances may affect the proper formation of bone. Supplementation with the micronutrient boron has been shown to reduce calcium loss in post-menopausal women. Vitamin C is well known for its role in immune support, but it is also a crucial nutrient that the body needs to build bone matrix and healthy connective tissue. Vitamin C deficiencies are widespread, even with those ingesting the full RDA.
Increasing evidence points to a link between soy intake and bone health. Most of the studies that suggest dietary soy intake is associated with a decrease in the rate of bone loss are either epidemiological or based on an animal model. The amount of soy actually required for this positive effect on bone health is still undetermined. One important study that was conducted on postmenopausal women concluded the amount of isoflavones (the phytoestrogenic component of soy) needed to slow down the rate of bone loss is between 55 and 90 mg/day for at least 6 months.
Ipriflavone is a synthetic isoflavone derivative. Ipriflavone has been shown to inhibit the rate of bone loss and promote bone formation in postmenopausal women, particularly in the spine and wrist. As noted, there are many key nutrients vital for the health of our bones. A comprehensive program that encompasses proper diet, nutritional supplementation, and exercise may prove to be invaluable in preventing or minimizing bone loss.
Burnell JM, Baylink DJ, Chestnut CH, and Teubner, EJ. “The role of skeletal calcium deficiency in postmenopausal osteoporosis.” Calcif Tissue Int. 1986; 38(4):187-92.
Recker RR. “Calcium absorption and achlorhydria.” N Engl J Med 1985; 313(2):70-3.
Ivanovich P, Fellows H, and Rich C. “The absorption of calcium carbonate.” Ann. Intern. Med. 1967; 66(5): 917-23.
Heaney RP. “Absorbability of calcium sources: the limited role of solubility.” Calcif Tissue Int.1990; 46:300-304.
Blumenthal N, Betts F, and Posner A. “Stabilization of amorphous calcium phosphate by Mg and ATP.” Calcif Tis Res 1977;23:245-50.
Shikari M, Kushida K, Yamazaki K, et al. “Effect of 2 year’s treatment of osteoporosis with 1 alpha-hydroxy vitamin D3 on bone mineral density and incidence of fracture: a placebo-controlled, double-blind prospective study.” Endocr J 1996; 43(2):211-20.
Editorial. “Vitamin D Supplementation in the elderly.” Lancet 1987; 1(8528): 306-7
Brattstrom L, Hultbnerg B,and Mardebo J. “Folic acid responsive postmenopausal homocysteinemia.” Metab 1985;34:1073-1077.
Masse P, Vuilleumier J P, and Weiser H. “Is pyridoxine an essential nutrient for bone?” Int. J. Vitam Nutr Res 1988;58(3):295-9.
Joosten E, van den Berg A, Riezler R, et al. “Metabolic evidence that deficiencies of vitamin B12, folate, and vitamin B6 occur commonly in elderly people”. Am J Clin Nutr 1993;58(4):468-76(addendum 1994; 60(1):147).
Carlisle EM, “Biochemical and morphological changes associated with long bone abnormalities in silicon deficiency.” J Nutr 1980;110(5):1046-56.
Leach Jr R, Meunster A, and Wien E. “I. Studies on the role of manganese in bone formation. II Effect upon chondroitin sulfate synthesis in chick epiphyseal cartilage.” Arch Biochem Biophy 1969;133(1): 22-28.
Hart JP, Shearer MJ, Klenerman L, et al. “Electrochemical detection of depressed circulating levels of vitamin K1 in osteoporosis.” J Clin Endocrinol Metab 1985;60(6):1268-9.
Calhoun N, Smith J, Jr. and Becker K. “The effects of zinc on ectopic bone formation.” Oral Surg 1975;39(5):698-706.
Wilson,T, Katz JM, and Gray DH. “Inhibition of active bone resorption by copper.” Calcif Tissue Int 1981;33(1):35-9.
Yamaguchi M, and Sakashita T. “Enhancement of vitamin D3 effect on bone metabolism in weaning rats orally administered zinc sulphate.” Acta Endocrinol 1986;111(2):285-8.
Holden JM, Wolf WR, and Mertz W. “Zinc and Copper in self-selected diets.” J AM Diet Assoc 1979;75(1):23-8.
Nielsen F. “Boron – an overlooked element of potential nutritional importance.” Nutr Today 1988 Jan/Feb:4-7.
Hyams D, and Ross E. “Scurvy, megaloblastic anaemia and osteoporosis.” Br J Clin Pract 1963;17:334-40.
Kalu DN, Masoro EJ, Yu BP, et al. “Modulation of age-related hyperparathyroidism and senile bone loss in Fischer rats by soy protein and food restriction.” Endocrinology 1988;122:1847-1854.
Brandi ML. “Natural and synthetic isoflavones in the prevention and treatment of chronic diseases.” Calcif Tissue Int. 1997;61(7):5-8.
Erdman J, Stillman R, Lee K, and Potter S. “Short-term effects of soybean isoflavones on bone in postmenopausal women.” Second International Symposium on the Role of Soy in Preventing and Treating Chronic Disease. Brussels, Belgium, 1996.
Agnusdei D, Crepaldi G, Mazzuoli G, et al. ” A double blind, placebo-controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss.” Calcif Tissue Int. 1997;61(2):142-7.
Adami S, Bufalino L, Cervetti R, et al. “Ipriflavone prevents radial bone loss in postmenopausal women with low bone mass over 2 years.” Osteoporosis Int. 1997;792);119-25.
By Power-Surge contributor:
Dr. Holly Zapf
Have you recently experienced a major stress in your life, be it illness, job, death, children, etc? After this stress, have you felt as though you just cannot seem to get yourself together, or at least back to where you used to be? Are you usually tired when you wake up, but still “too wired” to fall asleep at night? Is it hard for you to relax or to get exercise? Do you find that you get sick more often and take a long time to get well? If so, then you, like many other Americans may be experiencing symptoms of Adrenal Fatigue.
Adrenal fatigue is not a new condition. People have been experiencing this condition for years. Although there is increasing physician awareness, many are not familiar with adrenal fatigue as a distinct syndrome. Because of this lack of knowledge, patients suffer because they are not properly diagnosed or treated.
Adrenal fatigue is a condition in which the adrenal glands function at a sub-optimal level when patients are at rest, under stress, or in response to consistent, intermittent, or sporadic demands. The adrenal glands are two small glands that sit over the kidneys and are responsible for secreting over 50 different hormones—including epinephrine, cortisol, progesterone, DHEA, estrogen, and testosterone. Over the past century, adrenal fatigue has been recognized as Non-Addison’s hypoadrenia, subclinical hypoadrenia, neurasthenia, adrenal neurasthenia, and adrenal apathy.
Generally patients who present with adrenal fatigue can often be heard saying, “After______, I was never the same.” The onset of adrenal fatigue often occurs because of financial pressures, infections, emotional stress, smoking, drugs, poor eating habits, sugar and white flour products, unemployment and several other stressors. After experiencing many of these events over a long period of time, the adrenal glands tend to produce less cortisol, the body’s master stress hormone. Cortisol’s main role in the body is to enable us to handle stress and maintain our immune systems. The adrenal gland’s struggle to meet the high demands of cortisol production eventually leads to adrenal fatigue.
Patients with adrenal fatigue have a distinct energy pattern. They are usually very fatigued in the morning, not really waking up until 10 AM, and will not usually feel fully awake until after a noon meal. They experience a diurnal lull in their cortisol (the stress hormone produced by the adrenal gland) and as a result, they feel low during the afternoon, generally around 2-4 PM. Patients generally begin to feel better after 6 PM; however, they are usually tired after 9 and in bed by 11 PM These patients find that they work best late at night or early in the morning.
Some key signs and symptoms of adrenal fatigue include salt cravings, increased blood sugar under stress, increased PMS, perimenopausal, or menopausal symptoms under stress, mild depression, lack of energy, decreased ability to handle stress, muscle weakness, absent mindedness, decreased sex drive, mild constipation alternating with diarrhea, as well as many others.
Although there no specific tests that will provide a true diagnosis of adrenal fatigue there are tests that may contribute to an assessment, such as a postural hypotension test, an AM cortisol test, or an ACTH stimulation test. It is customary for a physician to assess the adrenals together with thyroid tests to rule out insufficiency, which sometimes occurs in long-standing hypothyroidism.
A single determination of plasma cortisol or 24-hour urinary free cortisol excretion is not useful and may be misleading in diagnosing adrenal insufficiency. However, if the patient is severely stressed or in shock, a single depressed plasma cortisol determination is highly suggestive. An elevated plasma ACTH level in association with a low plasma cortisol level is diagnostic.
Treatment for adrenal fatigue is relatively simple. Lifestyle modifications can be initiated to treat this condition. Simple changes such as more laughter (increases the parasympathetic supply to the adrenals), small breaks to lie down, increased relaxation, regular meals, exercise (avoiding any highly competitive events), early bedtimes and sleeping until at least 9 AM whenever possible can all benefit those experiencing adrenal fatigue.
A diet that would be conducive to treating adrenal fatigue includes one that combines unrefined carbohydrates (whole grains) with protein and oils (nuts and seeds) at most meals—olive, walnut, fiber, flax and high-quality fish oil. It is also important for patients to eat regular meals, chew food well, and eat by 10 AM and again for lunch. Patients should look to avoid any hydrogenated fats, caffeine, chocolate, white carbohydrates, and junk foods. Diets should have a heavy emphasis on vegetables. It may be of additional benefit that patients add salt to their diet, especially upon rising and at least a half-hour before their lowest energy point of the day. (Preferably, 1/8 to 1/2 teaspoonful of sea salt, Celtic salt, or sea salt w/kelp powder added to an 8 oz glass of water). In adrenal fatigue, one should not follow the USDA’s Food Guide Pyramid, as these patients tolerate fewer carbohydrates and need more protein.
The addition of nutritional supplements may also offer additional benefits to patients experiencing adrenal fatigue. They should consider the addition of:
- Vitamin C 2,000-4,000 mg/day Sustained Release
- Vitamin E w/mixed tocopherols 800 IU/day
- Vitamin B complex
- Niacin (125-150 mg/day) – as inositol hexaniacinate
- B-6 (150 mg/day)
- Pantothenic acid (1200-1500 mg/day)
- Magnesium citrate (400-1200 mg)
- Liquid trace minerals (zinc, manganese, selenium, chromium, molybdenum, copper, iodine)– calming effect
- If depression is present – Add SAM.e 200 mg bid; DL-Phenylalanine (DLPA) 500 mg bid
Some herbal remedies that have been noted as possible therapies include Licorice, Ashwagandha, Maca, Siberian Ginseng, Korean Ginseng. Note: Licorice can and, if taken over time, does have a propensity to elevate blood pressure. It should not be used in persons with a history of hypertension, renal failure, or who currently use digitalis preparations such as digoxin.
Under the supervision of a physician hormone supplementation with DHEA, Pregnenolone, and Progesterone may also offer some benefits. There are several glandular extracts on the market that contain adrenal, hypothalamus, pituitary, thyroid, and gonadal that are also often recommended.
Sometimes the initiation of hydrocortisone (Cortef®) may be necessary as a replacement hormone when cortisol is not being produced by the adrenals. While the initiation of corticosteroids, such as hydrocortisone may have quick and dramatic results, they can sometimes make the adrenals weaker rather than stronger. As a result, the initiation of hydrocortisone is usually a last resort. It is important to note that patients may have to undergo treatment for 6 months to 2 years.
While a cortisol measurement may be helpful to confirm any thoughts or ideas that a patient may have decreased adrenal function, typically blood cortisol levels would be tested along with blood levels of potassium, and sodium. If the pituitary gland is the cause of adrenal failure electrolyte levels are usually normal. Practitioners usually pay attention to extremely low cortisol levels, which generally diagnoses Addison’s disease—a condition in which the adrenal glands are completely depleted, also considered a medical emergency.
From http://www.power-surge.com/educate/adrenalfatigue.htm
by Dearest
Women “pausing” in Power Surge often ask one another what remedies they’ve used to address their menopausal issues. I had the good fortune to be made aware of nutrition early on in life by my dearest friend and savvy mother, Anne, who went through a difficult menopause and prepared me for what to expect. The general consensus is that your menopause is likely to be similar to your mother’s menopausal experience.
I was astonished when she told me that she had menopause-related high cholesterol of 400, which she lowered only with soy lecithin — 40+ years ago. She’s 95 today. That’s when I started researching ways of naturally lowering cholesterol and exploring the many benefits of soy protein and isoflavones.
Realisitcally, like you, I do not live on vitamins alone. I don’t buy organic foods. I eat the wrong things more often than I should, and oftentimes the joints ache too much to exercise. Do the best you can because nobody can help YOU through this transition as much as yourself!
Read, educate yourself, ask questions and learn tips that will help you “survive” this transition of life.
Time-Tested TIPS from Power Surge. You’ll find specific remedies in the recommendations area.
Menopause is a time fraught with physical, hormotional and spiritual changes.
For those concerned with weight loss, perimenopause is hardly the time for strict dieting. You have enough on your plate already (no pun intended). It’s enough to cope with the extreme hormonal upheavals. However, one can and should try to observe the best eating and exercise habits because they can be extremely helpful during peri and postmenopause, and can help to eliminate many of the problems you experience and form the foundation for a healthy future. It’s wise to begin a mild strength-training program to prevent muscle and bone degeneration later in life.
Did you know that exercise is one of the most effective measures in lowering cholesterol? Lowering your LDL (the ‘bad’ cholesterol) and raising your HDL (the ‘good’ cholesterol) AND lowering your triglycerides, too!
Did you also know that a few minutes of exercise can stop a panic attack dead in its tracks? Reduce anxiety? Decrease and even eliminate depression? Exercise does more than boost your mood and energy level, it also has a long-lasting calming effect. You don’t need elaborate equipment or gyms. The best equipment you have is your own body. Studies show that people feel less anxious while they are exercising and then for the next several hours. You don’t need to do an hour of heavy aerobics. A review of dozens of studies determined that you need to exercise for only 20 minutes for this natural tranquilizer to kick in. It’s a known fact that the best exercise is walking — even a twenty minute walk a day. The important thing is “consistency.” So, if you do 20 minutes of exercise even three times a week, it can be instrumental in establishing optimal health and, yes, lessening the severity of menopausal symptoms.
Brown Bagging It! Increased anxiety, hyperventilating and even panic attacks are common complaints during the perimenopausal years. You’ll find numerous suggestions all over the site about how to handle anxiety/panic. Sure, there are herbs, vitamins, tranquilizers, antidepressants and the exercise mentioned above. However, Power Surge also recommends brown bagging it, especially in emergency situations. You ask, “What is brown bagging it?”
Get yourself a small paper bag. Squish (yes, squish) the top together as though you were going to POP IT! Take the gathered top part of the bag and place it tightly over your nose and mouth, preventing outside air from getting in. Now, inhale deeply! When you feel you can’t inhale anymore, inhale just a little… bit … more. Next, slowly… exhale … and when you feel there’s no breath left … exhale just a little … bit … more. Do this for no longer than 30 seconds and see how you feel. Should you feel light-headed, don’t continue. However, most people have no problems and can do this exercise for one minute. The idea behind this is that by breathing into the paper bag, you’re inhaling carbon dioxide, which serves as a relaxant to your body’s organs, rather than oxygen which acts as a stimulant. Therefore, this exercise can be excellent for palpitations, anxiety, hyperventilation and general stress. Carry a brown bag in your purse. Stick one in your car’s glove compartment. You’ll be amazed at how simple and effective this procedure is!
Speaking of palpitations, should they hit, try taking 500 mg. of magnesium. They say, “If it spasms, give it magnesium.” The same holds true for migraines. If you feel a migraine coming on, try 500 mg. magnesium. You’ll find more info about magnesium on the Recommendations page.
Take one aspirin tablet per day (325 mg., 1/2 a regular adult dose) as a natural anti-coagulant. Antiplatelet therapy reduces the risk of any serious vascular event by about one quarter; risk of non-fatal heart attack by one third, non-fatal stroke by one quarter, and vascular death by one sixth. If heart attack (or stroke) symptoms occur, take one aspirin immediately as its anti-coagulant effects can mean the difference between life and death.
Become more aware of nutrition — what you put into your body. The types of oils you use in cooking, the way you prepare your foods. Canola, Sunflower, Safflower and Olive oils are the best. Sunflower oil actually serves as a cleanser of your arteries to remove plaque and prevent more plaque from forming. Certain fats are good for your body, while others are bad.. As you are aging your skin, hair and nails are likely to become drier and more brittle and lose their natural oils. Moisturize your skin and deep-condition your hair. And eat lots of fruit and fiber.
Avoid processed foods, nicotine, caffeine, artificial sweetners and “junk” food. These are no-no’s for menopausal women. Try to cut down or, better yet, stop drinking carbonated drinks, especially diet sodas – and more especially, those made with aspertame (Nutrasweet). The carbonation can cause bloating. I can’t even begin to tell you what sort of side effects you can experience from aspertame and so many low-calorie foods are made with it. It wouldn’t surprise me if you stopped using aspertame and some of the symptoms you attributed to menopause disappeared.
Keep a journal. Journalling can be extremely useful. A suggestion — when you have a hot flash, mood swing, palpitations, bout of binge eating, sudden elevated anxiety, panic attack, or any number of repetitive behavioral problems, take a pen and paper (or treat yourself to an actual journal) and write down:
- What you were doing
- What you were thinking
- What you were feeling
- With whom you were interacting
- What they said to you
- What you ate just prior to the onset of the problem
… and anything else you can think of that might be useful in identifying your triggers.
By keeping a running journal of the ‘changes’ you experience, you’ll be able to identify those circumstances, foods, people, thoughts, activities that may have triggered the physical and emotional changes. Through examination, you can see if there’s a pattern to the emotional UPS and downs, you can utilize the process of elimination in pinpointing the cause of the problem! You can keep your own menopause blog/journal, a free feature when you sign up for the Power Surge Message Board.
Dress in thin layers. When a hot flash hits, you can peel off the top layer (without getting arrested) and wear cotton as it is the most absorbent and cool of all fibers.
Additional suggestions:
- Drink a glass of cold water or juice at the onset of a flash
- At night, keep a carafe or thermos of ice water or an ice pack alongside your bed
- Use cotton sheets, sleeping garments, lingerie, and clothing to let your skin “breathe”
Believe it or not, one of the quickest remedies for hot flashes and sweats is in your own refrigerator. Open the freezer and pull out a bag of frozen vegetables. Place it on your face, neck, inner arms and wrists. It’s refreshing and often can thwart a hot flash instantly. When unanticipated hot flashes or sweats hit, especially while travelling, a handy item to have is a mini portable personal fan. I’ve kept one in my glove compartment since I started perimenopause. It’s inexpensive and effective. Remember, this isn’t a taboo subject any longer. There’s no need to be embarrassed. It’s a natural occurrence. So, use your frozen veggies, or whip out your hand fan and, uncomfortable as it may be, try to find the humor in it. Everyone else will, too.
Eat lots of garlic!. Garlic is excellent for blood pressure and cholesterol. You can also take garlic in in a gel tablet – odorless, too. Also, eat lots of broccoli. It’s loaded with phytochemicals, vitamins and contains the highest amount of antioxidants than any other vegetable. Stacked with protective compounds , such as isothiocyanates and sulforaphane, as well as indole-3-carbinol (I3C), a substance that is said to have anticancer actions, broccoli tops the list of ‘must serves’. The entire Brassica family of vegetables, (which includes Brussels sprouts, cauliflower, cabbage, Chinese cabbage, bok choy, kale and collard greens), contains a compound that activates certain enzymes in the human body to protect cells from genetic damage.
Try adding cinnamon and ground flaxseed to your morning oatmeal. It’s been discovered that cinnamon is very effective in lowering hyptertension. Ground flaxseed blends nicely with oatmeal and is one of the most important things you should take. Flax is good for your heart, for maintaining healthy cholesterol and triglyceride levels, one of the “good fats” our bodies need, has anti-carcinogenic properties to protect us from various forms of cancer. Flaxseed is an excellent source of fiber and especially Omega 3 Fatty Acids. A 2 tablespoon serving provides 2400 mg of Omega 3. Read more about flaxseed.
When our estrogen levels dip, our cholesterol levels often become elevated. It’s not something to be alarmed about, but it is something to take action to treat. Your health care practitioner may immediately suggest going on statins, such as Lipitor, Zocor, etc., to lower your cholesterol. Remember, this is probably a temporary condition and there are many ways to lower cholesterol naturally before resorting to prescription drugs — especially getting involved in a regular exercise programl. See Power Surge’s Recommendations.
Avoid fried, rich, spicy foods and too much sugar. As we go through the menopause transition, women are more likely to develop heartburn, acid reflux, gallstones, so avoid spicy and fatty foods.
You know how we suddenly develop cravings for chocolate? They’ve said that chocolate is the “feel good” food – probably raising seratonin levels. However, while it may make us feel good for a short while, chocolate and all sweets can bring on hot flashes, raise insulin levels, cause palpitations, anxiety and even depression in some, so while everyone’s exalting chocolate to the sky, remember it’s not good for every peri and postmenopausal woman.
Avoid toxic situations and people! Menopause can be likened to Murphy’s Law — whenever anything can go wrong, it does! Our patience is tested to the max while we’re coping with all these changes. It seems all our demons, every unresolved issue of our life, hits us right between the eyes during perimenopause. We each know at least one someone who pushes all our wrong buttons. If you know certain situations or people are invariably going to cause you grief, do everything within your power to avoid them. Avoid inconsequential arguments. Many women who have passed through Power Surge have discussed issues with anxiety and anger — oftentimes, inappropriate anger — even feelings of rage. This isn’t uncommon during perimenopause while our hormones are ebbing and flowing, up and down until we feel like an alien has taken over our body. There are simple things you can use from the breathing exercises above to taking lots of vitamin B, especially inositol, which is known as “nature’s own tranquilizer.” Many women are helped by using St. John’s Wort. It’s not only good for depression, but helps anxiety as well. You’ll find numerous suggestions on the Recommendations page and in the Being The Best You area of the site. There’s also a very helpful article, A surprising new health tip: When you’re angry, let it show. Here’s a helpful article about anxiety.
Let the light in. Turn down the noise. Find a quiet, peaceful place to regroup, or simply to read, to sew, to relax, to be free from all the stresses of the world. Perhaps you can use that time to boot up the computer and share with other women going through the same thing as you! And, DO turn off the news! One of the most contributing factors to high stress levels is watching the local news. Whether you live alone, or with your family, explain that you need some time and space for yourself. If they love you, they’ll understand what you’re going through. Explain that it has nothing to do with them, but that you simply need to tune out some of those things that cause you to feel worse.
The bottom line: LEARN TO P-A-M-P-E-R yourself!
Look at all the “TO DO” lists you’ve accumulated! I recetly printed out just one of my to do lists and ended up with 15 printed pages. You know as well as I that many of the notations on your to do list have been there for weeks, maybe months (maybe years). I could wallpaper my entire house with all the post-its scattered about my computer room/office. IF you must keep appointments organized, put them in your cell phone’s notepad. If you don’t want or can’t afford an expensive cell phone/PDA, you can purchase a less expensive PDA such as the Palm z22 PDA or the Palm Tungsten E2 100.
If you drink alcoholic beverages, do so in moderation (a glass of red wine daily is good for your health). Once I entered perimenopause, I had to stop enjoying my glass of red wine because of the havoc it wreaked on my body. If you smoke, stop, or, at least, cut down to a minimum. You already know why without my telling you.
Alcoholic beverages can contribute to hot flashes and palpitations, plus raise your triglycerides as alcohol is converted to sugar in the body. Sugar and alcohol are two of the worst offenders during perimenopause and elevated triglycerides is one of the greatest contributors to heart disease.
High carbohydrate foods can also cause hot flashes, palpitations, anxiety and depression, plus elevated insulin levels which can exacerbate menopausal symptoms, plus too many carbohydrates can cause weight gain.
For the nausea often associated with perimenopause and PMS, try a cup of boiling water with 2-3 tsp. of lemon juice (from concentrated lemon juice). Sip it slowly and it should work like a charm every time. Ginger is also supposed to be helpful. However, using ginger itself may cause stomach problems. They say to add ginger to food, but really, who wants to eat when they feel nauseous? I would also recommend drinking some warm ginger ale (soda). You can also try peppermint or camomille tea, but not too much (I still prefer plain water and lemon).
Try to keep your sense of humor. I’ve always said in Power Surge, the moment we lose our sense of humor about life in general is the moment that life becomes unmanageable.
If you’re dealing with hair thinning and/or loss, there are some excellent tips in Hair Loss and Thinning at Menopause.
If you’re suffering from dry skin and other midlife and/or menopause-related skin disorders, you’ll find good information and tips in Tips for Midlife Dry Skin. There’s additional information about vaginal dryness here.
It’s really okay after years of playing superwoman to take time for yourself. You’ll be amazed at how well everyone manages to get along without your constant attention. Take time to regroup. Make “quiet time” for yourself. Go for a walk. Learn meditation. Reacquaint yourself with your inner child! She’s yearning to be heard. Find that peaceful place within yourself that so many of us seem to sequester away at some point in our lives, perhaps during times of stress, confusion, fear, frustration and pain — just when we need it. In my moments of anxiety and stress, music has soothed me. I have found peaceful moments with the help of Power Surge friend, Christine Magnussen’s Harp recording, “On Wings Of A Dove.
Of course, medication has its place in treating various conditions — many specifically related to perimenopause and menopause. However, medication isn’t always the answer. Not all, but many of the answers may lie within you and, believe it or not, how you “translate” everything that’s happening in your body. Own your body. It’s within your power.
Read and understand. You want to know more about menopause – visit Educate Your Body. If you’re interested in complex medical abstracts the averge woman doesn’t understand, this is not the place for it. We strive to make information you need about this rite of passage — simple and understable. There are menopause primers all over the site. There’s a list of prestigious experts in the area of menopause and women’s health a mile long, all of whom have appeared in Power Surge to answer your questions. Learn from their wisdom. They all talk in plain language. Glance at all the wonderful praise that’s been bestowed upon Power Surge and you’ll know you’re in a safe and caring place.
Become friends with your body. Listen to the messages it gives you. Your body will instinctively tell you more about what’s going on, especially during peri and postmenopause, than test results –and you can learn how to instinctively respond to it. Remember, if you treat your body well during these transitional years, it will treat you well in return… and long down the road. Own your body!
Be sure to check out the transcript library and other areas of the site for more information on menopause symptoms, methods of treatment, recommendations and Ask The Experts areas. There’s also the comprehensive Power Surge Search Engine to find specific information on any subject you’re looking for.
And, by all means, if you want to commiserate with other women — women who truly understand what you’re going through, the Power Surge Message Board and Insta-chat are best places to find them!
Other good “starter” articles are,
What Your Doctor May Not Tell You
About Autoimmune Disorders
By Stephen Edelson, M.D.
Read the transcript of Dr. Stephen Edelson (Coming soon)
What Is Autoimmunity?
An Excerpt from Dr. Edelson’s book,
What Your Doctor May Not Tell You About Autoimmune Disorders
You’re alone, walking down a dark alley late at night. You’re feeling strong and confident; there’s a spring in your step, and you’re striding with determination. Suddenly, out of nowhere, you’re attacked from behind. Immediately you burst into action. You maneuver your way out of the stranglehold bear hug. You turn and quickly release a strategically placed kick. You send the invader to his knees, then pin him down just as reinforcements arrive to haul him away. And you didn’t even break a sweat or a nail. You just did what you were trained and ready to do: protect yourself.
THE IMMUNE SYSTEM
Protecting and preserving your health is exactly what your immune system is designed to do. Your immune system is a complex network of organs, glands, and special cells that encompass your entire body. Its purpose is to guard you against invaders that can harm you or compromise your body’s ability to function in a healthy way. When your immune system is operating optimally-when all its components are healthy and alert-it can effectively fight off many different types of enemies, such as bacteria, viruses, parasites, and fungi, and the harmful effects of stress, household chemicals, secondhand smoke, pesticides, and food additives. Like a well-placed kick, the immune system fights back . . . and you win.
Unfortunately, people with an unhealthy immune system don’t feel like their immune system is kicking back. Bea, a thirty-three year-old mother of two girls, says she felt like she was the one being kicked. “I was exhausted and achy all the time,” she says. “I felt like I was letting my husband and kids down because I was always too tired to go out. They were always going to the mall and to the park without me. I even missed my daughter’s school play because I was too tired and depressed to leave the house.”
“I was embarrassed to make any more excuses to my friends,” says Lila, a forty-two-year-old graphic artist. “I had to make sure I was near a bathroom everywhere I went, because I never knew when the stomach cramps and diarrhea were going to hit me. It was safer to just stay home.”
Bea and Lila are not alone. Millions of people are burdened with chronic, life-altering symptoms that often are manifestations of something gone awry with the immune system, causing it to turn against the body’s cells. In Bea’s case, the fourth doctor she saw diagnosed her with lupus before she came to see me. Lila found her way to the Edelson Center before getting a diagnosis, which we identified as Crohn’s disease. Both women responded well to our treatment program.
What makes the immune system turn against the very body it inhabits? To understand this process, it helps to first know how the immune system works when it’s healthy.
Meet the Players
The number and types of players involved in maintaining a healthy immune system are great-greater than can be described in detail here. But a basic knowledge of how they operate is important to understanding autoimmunity and any symptoms you may be experiencing. Therefore we explain the purpose of the main players below, since they are referred to again and again throughout this book.
Just as you would use a certain move to shrug off a bear hug and another to ward off an attack to your face, these players have specific moves that contribute to keeping your body functioning optimally. For example:
- Thymus. This is the master gland of the immune network. Located above the heart, it secretes various hormones that are responsible for regulating immune system functions. It also produces T-cells, which are another major player in immune system functioning (see below). The thymus is extremely susceptible to damage from stress, environmental toxins, infections, and chronic illness.
- Skin and mucous membranes. Your body’s largest organ is the skin, which is also its first line of defense against intruders. Whenever it is compromised, say, with a cut, burn, abrasion, or puncture, there is an open door for disease-causing organisms to enter. The mucous membranes of the gastrointestinal tract, lungs, vagina, nose, mouth, and so on, are the body’s “internal” skin, and are also a line of defense against invaders.
- Bone marrow. The center portion of bone is an area rich in blood vessels and other substances. It is here that many types of immune cells are manufactured.
- Spleen. This dark red organ, located on the left side of the upper abdominal region, manufactures lymphocytes, attacks bacteria, and recycles damaged blood cells.
- Lymph nodes. These tiny, glandlike structures are found throughout the body, including under the arms, in the groin, and behind the ears. If you’ve ever had “swollen glands,” what you actually had were inflamed lymph nodes. And the reason they were swollen is because the lymph nodes act as an inspection station for foreign substances, which they remove from the body’s tissues.
The lymph nodes prevent these substances from entering the bloodstream and finding their way to the organs.
- Lymphatic system. This network consists of lymph vessels, lymph nodes, and lymph, a thick fluid that is made up of fat and white blood cells. While the circulatory system is the transportation system for blood, the lymphatic system carries immune cells to parts of the body where they are needed.
- Lymphocytes. A type of white blood cell, lymphocytes are produced in the bone marrow and are found in the blood and in the spleen, lymph nodes, thymus, and other tissues. Lymphocytes perform four primary functions, all of which must work properly for a healthy immune system. They (1) recognize the invaders; (2) prepare a line of defense; (3) communicate with other essential immune system cells by producing cytokines and deploying them to act against the invaders; and (4) stop the action of the immune cells once their job is done. If any one of these steps goes awry, disease, including autoimmune conditions, can be the result. You’ll be reading more about lymphocytes and their role in autoimmune conditions later. For now, here are some of the major types of lymphocytes and what they do:
B-lymphocytes (B-cells) work along with T-cells as the main line of defense for the body. They look for invading foreign proteins (called antigens) and “tag” or mark them with proteins called antibodies. This tag lets other immune cells know that an invader is in their midst so they can destroy it.
T-lymphocytes (T-cells) reach maturity in the thymus and then circulate throughout both the lymphatic system and bloodstream. They initiate attacks against antigens, direct the fight, and then stop the destruction. T-cells are divided into several types. The ones we will concern ourselves with here are CD4 (helper T-cells), which act as cheerleaders and urge other immune cells to attack; and CD8 (suppressor cells), which make sure the helper T-cells don’t overreact.
Natural killer cells perform the dirty work. While B-cells simply “tag” the invaders, natural killer cells live up to their name and destroy them. They also produce hormonelike chemicals called cytokines.
Macrophages are known as the recyclers of the immune system, because they consume invading organisms, tumor cells, and dead red blood cells. They also produce cytokines.
- Immunoglobulins. Each B-lymphocyte produces a specific antibody, or immunoglobulin. There are five main types of immunoglobulins, which are named according to their presence in the blood: IgG, IgA, IgM, IgD, and IgE.
- Interferon. Interferons are a type of cytokine that you will read more about later in this book. There are several types of interferons, including alpha interferon and gamma interferon. For now, it’s important that you know that interferons are powerful antiviral substances and that they are often used to treat cancer and hepatitis.
COMMUNICATION IS THE KEY
These components, along with dozens of others, make up the immune system network. It’s easy to see why with so many components, it would be easy for things to go wrong. For the most part, the immune system functions well because its cells communicate with each other, the brain, and other parts of the system. Their method of communication involves cytokines, hormonelike substances that transmit information among immune cells. Although immune cells don’t have ears, they can detect minute changes in cytokine production, which in turn stimulates them to respond in certain ways, say, by launching an attack against certain invaders.
Some cytokines communicate not only with immune system cells but with nerve cells as well. These specialized cytokines, called interleukins, perform many critical and interesting tasks, some of which help support the idea of the mind-body relationship in medicine. Scientists know, for example, that the brain (a part of the nervous system) plays a key role in controlling our immune system and physical health. (In fact, the microglia in the brain is part of the immune system.) This is obvious when we consider the effects emotional stress and tension have on our body, causing headaches, neck and back pain, stomach distress, and many other symptoms. Thus, interleukins link the immune and nervous systems, a concept that will become more obviously important later when we discuss the effects of stress in people with autoimmune conditions.
Speaking of autoimmune conditions, now let’s talk about when something goes wrong with immune system functioning.
WHEN THINGS GO WRONG WITH THE IMMUNE SYSTEM
Let’s go back to that dark alley. This time your head is down and you’re dragging your feet. You’ve been working hard, you’ve been eating lots of processed fast foods, and you’ve been spending too much time in smoky nightclubs. This time when you’re attacked, the mugger gets the best of you. Your immune cells fight back, but they’re not as effective as they could be. So you get to spend a week feeling miserable with the flu, a stomach virus, or a bad cold.
No one’s immune system operates perfectly all the time. It’s virtually impossible to find a person who has never had a cold, suffered with the flu, had a toothache or ear infection, or gotten an infection from a cut or burn. But in most cases, the body’s immune system eventually overcomes the invaders and the body returns to relative harmony.
Autoimmunity
Unfortunately, there are millions and millions of individuals whose immune systems do not respond normally to an attack. Instead of attacking foreign invaders with antibodies-substances produced by the immune system to fight invaders-the immune system components attack the body’s own healthy cells-perhaps bones, joints, blood, brain, nerves, or other body parts-as if they were the enemy. When the immune system reacts in this way, it is producing autoantibodies-substances that attack healthy cells instead of foreign invaders. This situation is known as an autoimmune response.
More than eighty separate medical conditions have been recognized as being the result of an autoimmune response. Some of them are quite common; others are rare. In this book we concern ourselves with the more common conditions, including rheumatoid arthritis, lupus, multiple sclerosis, hypothyroidism (Hashimoto’s thyroiditis), hyperthyroidism (Graves’ disease), Crohn’s disease, ulcerative colitis, type 1 diabetes, autism, chronic fatigue syndromes, ankylosing spondylitis, autoimmune hepatitis, autoimmune kidney disease, polymyositis, scleroderma, silicone immune toxicity syndrome, Sjögren’s syndrome, and vasculitis.
On the surface, these conditions seem to be quite different. The symptoms of rheumatoid arthritis (inflamed, painful joints, limited mobility) are different from those common to Crohn’s disease (chronic diarrhea, abdominal pain, fever). Yet the vast majority of autoimmune diseases share several important similarities:
- a genetic susceptibility for specific autoimmune conditions. It is unknown how many people have a genetic predisposition for autoimmunity and who will experience an autoimmune response; and
- environmental toxins that trigger the autoimmune response
It is these similarities, which we will discuss in the pages that follow, that have drawn me and other like-minded health professionals to successfully treat these autoimmune conditions using techniques not normally employed by conventional physicians. While conventional medicine simply treats the symptoms, we heal the body by going directly to the origins of the disease-the autoimmune response at the cellular level. To get a better understanding of how we do that, it’s first important to understand why autoimmune conditions develop in the first place. The reason, I believe, is simple: direct damage and free-radical damage to cells from environmental toxins (heavy metals and chemicals).
Free Radicals
Free radicals are highly charged molecules that have an unpaired electron in their outer orbit. They are naturally present in the body and, in relatively small numbers, they perform essential tasks, such as destroying harmful bacteria. But when they increase in number, they can damage DNA, cell membranes, enzyme systems, and immune system functioning.
Because the natural order of the universe is toward balance, and free radicals are unbalanced molecules, they constantly steal electrons from other molecules, which in turn creates more free radicals. Unfortunately, our environment is increasingly becoming tainted with free radicals because of environmental toxins, such as pesticides, radiation, household chemicals, viruses, secondhand smoke, toxic waste, food additives, alcohol, and drugs. When these and other free radicals invade the body, they go on to create even more free radicals and thus have the potential to cause much damage to the body’s cells. The damage that free radicals cause is called oxidation. (Such damage can be avoided or reduced if the body produces or takes in enough protective molecules called antioxidants.
Our bodies are constantly under attack by negative environmental factors, which means we are constantly fighting the effects of oxidation. Being in this state of oxidative stress is what makes us sick. For some people, for various reasons we will discuss later, free-radical damage and oxidative stress cause an autoimmune process and autoimmune disease.
By Power-Surge guest:
Stephen Edelson, M.D
Read the transcript of Dr. Stephen Edelson (Coming Soon)
Natural Hormone Replacement Therapy (NHRT): If you are currently on or considering the use of Hormone Replacement Therapy (HRT) and you think individualized, natural HRT makes more sense than a “one-size-fits-all” approach, then you may want to look into naturally compounded, bio identical, plant-derived Hormone Replacement Therapy. Compounding is preparing medicines tailored to patients’ individual needs. Compounding is the preparation, mixing, assembling, packaging, or labeling of a drug as the result of a practitioner’s Prescription Drug Order based on the pharmacist-patient-prescriber relationship. Compounding offers patients their choice of drug, strength, dosage form, excipients, or lack of and can be decided on a case-by-case basis. This process allows for medical treatments that otherwise might not be possible.
With an individualized approach to hormone therapy, you can know exactly what your hormone levels are, compare the benefits vs. risks of all possible therapies, and choose the ideal replacement protocol to bring your hormones back to their proper balance. If your doctor is willing to prescribe conventional HRT, s/he should be more than willing to prescribe naturally compounded HRT.
Estradiol, the principal estrogen found in a woman’s body during the reproductive years, is produced by the ovaries. Estradiol is very effective for the symptomatic relief of hot flashes, genitourinary symptoms, osteoporosis prophylaxis, psychological well-being and reduction of coronary artery disease.
Because it is much more potent than estriol, it can be more effective for symptomatic relief than estriol. When Estradiol is replaced using a parenteral (sublingual, percutaneous, or transdermal) route, it is not subject to first pass metabolism by the liver, and therefore does no produce high levels of estrone. Using these routes of administration a woman can mimic the physiologic release of estradiol from the ovaries, thus receiving natural hormone replacement.
ESTRIOL (E3)
Estriol is the weakest of the three major estrogens. In fact it is 1000 times weaker in its effect on breast tissue. Estriol is the estrogen that is made in large quantities during pregnancy and has potential protective properties against the production of cancerous cells.
An important article in the 1966 Journal of the American Medical Association by H.M. Lemmon, M.D., reported a study showing that higher levels of estriol in the body correlate with remission of breast cancer. Dr. Lemmon demonstrated that women with breast cancer had reduced urinary excretion of estriol. He also observed that women without breast cancer have naturally higher estriol levels, compared with estrone and estradiol levels, than women with breast cancer. Vegetarian and Asian women have high levels of estriol, and these women are at much lower risk of breast cancer than are other women. Estriol’s anticancer effect is probably related to its anti-estrone properties-it blocks the stimulatory effect of estrone by occupying the estrogen receptor sites on the breast cells.
Estriol is the estrogen most beneficial to the vagina, cervix and vulva. In cases of vaginal dryness and atrophy, which predisposes a woman to vaginitis and cystitis, topical estriol is the most effective and safest estrogen to use. Because of this estriol is better than estradiol for the treatment of urinary tract infections.
None of the American drug products contain Estriol, so it is not available in most drug stores, although it has been used widely in Europe for over fifty years. Because estriol cannot be patented it does not hold much interest for the pharmaceutical industry. Its availability through compounding has caused its use to grow rapidly throughout the country.
ESTRONE (E1)
Estrone is the estrogen most commonly found in increased amounts in post menopausal women. The body derives it from the hormones that are stored in body fat. Estrone does the same work that estradiol does, but it is considered weaker in its effects.
BI-EST
Biest is a combination of two estrogens: estriol and estradiol. It is most commonly found in a ratio of 80:20, estriol to estradiol. This combination allows for all of the protection of estriol while providing the cardiovascular and osteoporosis benefits along with the vasomotor symptom relief of estradiol.
TRI-EST
Triest is a combination of three estrogens: estriol, estradiol and estrone. It is most commonly found in a ratio of 80:10:10, estriol, estradiol, and estrone. This combination is very popular and contains all of the three major circulating estrogens. It is slightly weaker in its effect when compared to biest. However, this can be compensated for by increasing the strength or by slightly changing the ratios.
PROGESTERONE
Progesterone is produced by the ovaries and the adrenal glands in women and, in smaller amounts, in the testes and the adrenal glands in men. One of its most important functions is in the female reproductive cycle. Progesterone prepares the lining of the uterus for implantation of a fertilized egg, then helps to maintain it during pregnancy. If pregnancy does not occur it signals the uterus to shed this lining.
Progesterone also plays an important role in brain function and is often called the “feel good hormone” because of its mood enhancing and antidepressant effects. Optimum levels of progesterone can mean feelings of calm and well being, while low levels of progesterone can mean feelings of anxiety, irritability and even anger. Current research shows that progesterone may pay a role in the maintenance of the nervous system, the sense of touch, and motor function.
PREGNENOLONE
Pregnenolone is a superhormone that is key to keeping our brains functioning at peak capacity. Some scientists believe it is the most potent memory enhancer of all time. Perhaps what is even more amazing are the studies that demonstrate pregnenolone enhances our ability to perform on the job while heightening feelings of well-being. In other words, this superhormone appears to make us not only smarter but also happier.
Like the other steroid hormones pregnenolone is synthesized from cholesterol. In a complex series o steps, cholesterol is broken down into different steroid hormones as the body needs them. It is first synthesized into pregnenolone and used by the body in that form. What is not utilized undergoes a chemical change that “repackages” it into DHEA. DHEA in turns used by the body as DHEA and is also broken down into estrogen and testosterone. This chain of hormones is known as the “steroid pathway.” Because pregnenolone gives birth to the other hormones, it is sometimes referred to as the “parent hormone.”
Pregnenolone was studied extensively in the 1940s. It was shown to be beneficial in elevating mood, improving concentration, fighting mental fatigue, improving memory and relieving severe joint pain and fatigue in arthritis. Pregnenolone has vast therapeutic potential and is currently undergoing further studies in these areas.
DHEA
Short for Dehydroepiandrosterone, DHEA is a steroid hormone distinguished from others by its unique chemical structure. DHEA is produced by the adrenal glands (located just above the kidneys) as well as by the brain and the skin, and is the most abundant steroid in the human body.
As newborns, we have an extremely high level of DHEA, but within a few days after birth, our DHEA level drops to nearly zero. Then between the ages of six and eight, we experience the even called “adrenarche” in which our adrenal glands begin to stir and gear up for puberty. At the same time our DHEA level begins to rise steadily and continues to rise until it peaks at around age twenty-five to thirty. From that point on in declines at a rate of about 2 percent a year, and we begin to feel the result of this decline in our mid-forties. By eighty our DHEA level is only fifteen percent of what it was when we were twenty-five. This drop in DHEA levels correlates dramatically with the signs and “symptoms” associated with aging.
DHEA is currently the focus of some of the most exciting medical research of this century. Researchers at distinguished medical centers all over the country are studying the properties and promise of DHEA. It is proving to be a potent protector against cancer. It protects against heart disease by lowering blood cholesterol and preventing blood clots. Studies also demonstrate that DHEA improves memory, strengthens the immune system, prevents bone loss, and may even protect us from diabetes and autoimmune disease. It has been shown to fight fatigue and depression; it enhances feelings of well-being and increases strength. DHEA alleviates symptoms of menopause, reduces body fat, and is even known to enhance libido.
Because DHEA is showing such tremendous promise in so many areas, and because of the limited amount of space provided here, we recommend further reading on the superstar of superhormones. An excellent resource for more information is the book “The Superhormone Promise” by W. Regelson, M.D., and Carol Colman.
TESTOSTERONE
Usually considered a male hormone or androgen, women also produce testosterone although in much smaller amounts than men do. Testosterone works differently in the bodies of men and women, but it plays a very important role in the overall health and well-being of both sexes. Often called the “hormone of desire” because of its powerful effect on libido, testosterone is also important in building strong muscles, bones, and ligaments as well as increasing energy and easing depression. Low levels of testosterone have been known to cause fatigue, irritability, depression, aches and pain in the joints, thin and dry skin, osteoporosis, weight loss, and the loss of muscle development.
As with all of the hormones, testosterone must be dosed properly to be effective without causing unwanted side effects. The dose in women is generally one-tenth that used in men. Because testosterone is not effective when it is taken orally it is usually prescribed as a topical gel, cream or as a sublingual tablet. Although testosterone was discovered more than sixty years ago, only very recently have we begun to fully understand and appreciate the power of testosterone.
HUMAN GROWTH HORMONE – HGH
HGH is one of many endocrine hormones, like estrogen, progesterone, testosterone, melatonin and DHEA, that all decline in production with age. While many of these hormones can be replaced to deter some of the effects of aging, HGH reaches far beyond the scope of any of these hormones. Not only does it prevent biological aging, but it acts to significantly reverse a broad range of the signs and symptoms associated with the aging process.
The decline of growth hormone with age is directly associated with many of the symptoms of aging, including wrinkling, gray hair, hair loss, decreased energy and sexual function, loss of muscle and increased body fat, cardiovascular disease, osteoporosis, and overall lower life expectancy.
The good news is that there is now clinical evidence which demonstrates that by replacing growth hormone we can dramatically reverse all of these symptoms. Although this may appear to be too good to be true, the more closely the scientific evidence is examined the more clear it becomes that everything that we associate with aging may be due totally or in part to the decline of HGH levels in our bodies.
Until recently, the only way to increase HGH levels in the body, was to use injectable HGH. These injections are very effective, although they are costly and difficult to use. Now, there are natural substances that have been well documented to increase growth hormone by stimulating the bodyís own production of HGH. According to researchers, these cutting edge natural secretagogues may have the ability to more closely mimic the bodyís youthful GH secretion patterns.
These natural substances which stimulate the body’s own production of HGH are known as secretagogues. They can be introduced into the body in two ways: orally or transdermally (topically applied to the skin).
The oral secretagogues are very popular and have shown to be very effective. They include such products as Pro-HGH®, Rejuvamin®, Rejuvamax® and Medi-Tropin®. Though effective, all of these except Medi-Tropin® are available without a prescription. Achieving consistent results with the oral products can be difficult due to changes in absorption from the stomach and the necessity for the stomach to be empty for four hours prior to use.
Trans-D Tropin ®
Trans-D Tropin ®, a transdermal product that is now available by prescription only, provides a very efficient delivery system and an ease of administration that leads to better patient compliance and consistent results. Trans-D Tropin ® is a natural complex which mimics growth hormone releasing hormone(GHRH). The transdermal delivery system allows frequent dosing, up to four times daily, which more closely resembles the body’s own natural response. Imitating this natural response results in an effective and superior release of the body’s own growth hormone.
Saliva Test for Hormones
Adequate levels and an appropriate balance of the steroid hormones (estradiol, progesterone, testosterone, DHEA, cortisol) are necessary for maintaining optimal health and well being in both females and males. This family of steroid hormones supports a wide range of essential physiological functions, including blood lipid balance, bone mineral density, fertility, sexuality, a general sense of well being, as well as certain aspects of brain functioning. The saliva test measures levels of specific hormones that are produced in the body, consumed as foods, dietary supplements or medication. Saliva yields a direct measure of “free hormone ” level and is comparable to that measured by blood. Also, timing of the test can be precisely controlled and levels can be determined at optimum times. Saliva testing provides a means to establish whether or not your hormone levels are within the expected normal range and it is simple and non-invasive. It is appropriate to monitor and titrate doses to minimize side effects and risks without compromising the benefits of replacement therapy.
Estradiol
Estriol
Progesterone
Testosterone
DHEA
Cortisol
Melatonin
Total Estrogens
Total Progestins
PyriLinks-D (urine sample)
* must be ordered by a physician
Medical insurance may pay for testing
You are one of a special group of women who have a report of an inconclusive or abnormal PAP smear. About 3% of all women will develop these changes in a lifetime. You have been advised to have a colposcopy performed for more evaluation.
What is a Pap smear?
A pap smear is a routine screening test done by your provider during a pelvic exam. The surface of the cervix (mouth or neck of the womb or uterus) is scraped with a spatula and the scraped-off cells from the cervix are fixed on a glass slide. This slide is called a pap smear and is sent to a special lab where it is processed and evaluated by highly trained technicians and doctors. By improvement in technique, the pap smear has become very sensitive in picking up early changes in the cervix. Consequently, we have many more patients with inconclusive or abnormal pap smears to evaluate than we had just a few years ago.
Does a report of inconclusive or abnormal pap smear mean you have cancer?
Almost never! The pap smear will detect early abnormal changes in the cells of the cervix long before cancer develops. This is the purpose of the pap smear. The majority of patients referred to the colposcopy clinic have a final diagnosis of either “mild to moderate dysplasia” or “normal” cervix. Mild to moderate dysplasia means that there are early changes in the cells of the surface layer of the cervix, which have a potential for developing into cancer many years from now. A few patients will have a diagnosis of carcinoma-in-situ. This condition is a little more advanced than severe dysplasia, but does not mean invasive cancer. It, too, has a potential for developing into invasive cancer, if left untreated.
How do you get a diagnosis or know what’s wrong?
Specially trained providers use an instrument called a “colposcope” to examine your cervix carefully. The colposcope is similar to a microscope. It is attached to a floor stand and magnifies the cervix under a powerful beam of light. By using this instrument, the doctor can locate any suspicious areas on the surface of the cervix that are not visible to the naked eye. The provider will take small tissue samples (biopsies) from these areas. The specimens are sent to the pathology lab for processing and evaluation. Upon receipt of results of biopsy, you will be contacted by your provider who will then read the report and discuss the treatment advised.
Does taking a “small sample” of the cervix cause pain?
Yes, though discomfort is probably a better word. Such discomfort is generally minimal and lasts only a few minutes. One of the biopsies includes going into the cervical canal and can cause cramps.
Are there any complications after cervical biopsy?
Generally, complications are rare. You will have vaginal spotting of blood for a few days. Rarely, you may bleed heavier than a menstrual period within a few hours after having the biopsy. You should call your provider if you bleed excessively- more than one sanitary napkin/tampon per hour.
Will I be restricted in my activities after a cervical biopsy?
No. You can carry on your normal activities, although you should avoid intercourse for 14 days while the cervix is healing.
What is a “mild to moderate” dysplasia diagnosis on a cervical biopsy?
“Mild to moderate” dysplasia is the earliest abnormal change in the cells within the surface layer of the cervix. It has potential, if left untreated, of progressing to a more severe change after several years.
What is Colposcopy?
It is an examination of the cervix through a special instrument called a colposcope. The examination is done to gain a more detailed knowledge of the abnormality so that decisions can be made about the best form of treatment, should this be necessary. The colposcope resembles a microscope and it enables the doctor to have a magnified view of the outer cervix. The examination does not take long, possibly ten or fifteen minutes and is done while you are awake in the rooms.
How is Colposcopy Performed?
The colposcope is placed between your legs which are apart and resting in supports. The doctor will use a spectulum to hold the walls of the vagina apart making it possible to see the cervix.
What Happens Next?
What follows depends on the appearance of the area. It may be that after closer observation it is decided that nothing will be done.
A Pap smear may be taken to check for consistency with the earlier “positive” smear. Then the doctor will dab a little acetic acid on the cervix which shows up the abnormal area clearly.
It may be that a biopsy is required, and if this is so, a tiny sample of the tissue will be taken. Women do not always feel this but some women certainly experience pain at this point. There may be a small amount of bleeding afterwards and period like cramps may occur for a day or two. The specimen taken at biopsy will be sent to pathology to help decide on the treatment required or to confirm the diagnosis.
Throughout the examination your doctor will explain what is going on and afterwards will discuss the finding as far as he is able at this stage. If minor changes only are seen, you may be told that treatment is not necessary but you will be reminded to report again for a Pap smear after a certain period of time. If an abnormality (dysplasia) is confirmed, arrangements will be made for treatment. If a biopsy has been taken it may be three days before the results are available.
What is a “mild to moderate” dysplasia diagnosis on a cervical biopsy?
“Mild to moderate” dysplasia is the earliest abnormal change in the cells within the surface layer of the cervix. It has potential, if left untreated, of progressing to a more severe change after several years.
What, exactly, is Dysplasia?
Dysplasia, or CIN (cervical intraepithelial neoplasia), are the words used to refer to a condition that occurs when the cells on the surface of the cervix are replaced by abnormal cells. This is not a cancerous condition but, if neglected, it has the potential to become cancerous.
There are three levels from mild to severe.
- CIN 1 = Mild dysplasia
- CIN 2 = Moderate dysplasia
- CIN 3 = Severe dysplasia
CIN 1 and more minor changes are also termed low grade abnormalities, whereas CIN 2 and 3 are termed high grade abnormalities.
What About Treatment?
The treatment chosen will depend on the extent of the problem diagnosed. The aim of any treatment will be to destroy or remove abnormal cells (dysplasia).
Can “mild to moderate” dysplasia be treated in the office? And how?
The majority of patients with “mild to moderate” dysplasia can be treated with cryosurgery. This method is a way of treating the cervix. Because the abnormal cells are found in the surface layers of the cervix, the freezing technique destroys the surface layer, which is cast off. The cervix then will produce a new surface layer of normal cells. Think of the freezing as similar to a burn on the skin of your hand (without the pain). The surface layer is destroyed and cast off like a blister; then a new “skin” replaces the old.
Possible treatments are:
- Electro-diathermy which destroys the cells by using a heat producing electric current.
- Laser treatment, where a high intensity light beam is used to destroy the abnormal cells.
- Cryotherapy, where a freezing technique is used to destroy the affected area.
- Cone biopsy – a procedure where a cone shaped wedge containing abnormal cells is removed from the cervix. This procedure will assist in the confirmation of the diagnosis and remove the abnormal tissue at the same time.
- Diathermy loop excision (LEEP or LLETZ) where an electric current running through a wire loop is used to excise the abnormality.
Usually treatment takes place at a Day Surgery Unit or in the doctor’s rooms. Some treatments take place under general anaesthetic and other treatments are performed under local anaesthetic, which means you will be awake during the treatment.
You should feel well enough for your normal work the following day. Any cramping or period-like pain you may experience should be relieved by a mild pain killer. As the area treated heals over the next few weeks, there may be some pinkish vaginal discharge. Intercourse should be avoided over the next four weeks as healing is taking place.
If the more serious condition of cancer is diagnosed, other treatment will be recommended by your doctor. This may mean surgery or radiotherapy or both. Early treatment means complete cure for most women.
Follow Up:
Your doctor may ask you to come back for further colposcopic examination to make sure healing has taken place and that treatment has been effective. These are important visits which ensure your good health and feeling of confidence so do not neglect them. You may be advised to have Pap smears more frequently than the usual two years.
What is Carcinoma-in-situ?
Carcinoma–in-situ is a more advanced lesion, affecting the cells within the surface layer of the cervix. However, it is not a true cancer. But if left untreated, it has the potential for developing into cancer. If you have carcinoma-in-situ you will be referred to a gynecologist for further treatment.
What is cryosurgery?
Cryosurgery is a procedure in which abnormal body tissues (sometimes referred to as lesions) are destroyed by exposure to extremely cold temperatures.
When is it used?
Cryosurgery is used to treat skin lesions such as freckles (for cosmetic reasons), hemorrhoids, warts, and some skin cancers.
It is also used to treat skin changes from genital wart virus and precancerous changes on the surface of a woman’s cervix. These precancerous abnormalities are usually found from a Pap smear. (The lesions are also called “dysplasia”, CIN, or cervical intraepithelial neoplasia.) Sometimes freezing is not an option if the abnormalities are too large.
How do I prepare for cryosurgery?
Most likely you will not have to do anything to prepare for cryosurgery. It is a simple procedure and it is done in a short time in your health care provider’s office.
What happens during the procedure?
Your health care provider will use a probe-like tool to treat the affected areas. A very cold gas, usually nitrous oxide, is pumped through the probe. The gas makes the tip of the probe very cold.
Your provider will touch the tip of the probe to the affected area. When the cervix is treated you probably won’t feel the cold sensation. Most women tolerate this procedure well, and leave the office with no discomfort.
How long your provider keeps the probe touching the skin or cervix depends on the size and type of the lesion and what type of gas is being used. For some abnormal tissue, such as genital warts, the procedure works best if the tissue is frozen quickly, allowed to thaw for a few minutes, and then frozen again.
Is cryosurgery painful?
Generally not. It can cause mild cramping. Occasionally, it is accompanied by a temporary feeling of lightheadedness and flushing.
How long does it take?
About ten to fifteen minutes in the examining room.
Does it ever have to be repeated?
Yes. A second treatment is necessary in 10 to 20% of cases, if the changes persist.
What are the after effects of cryosurgery?
You will have a very watery vaginal discharge for 2 to 6 weeks. This may be mixed with some blood. You may need to use many sanitary napkins during these first few weeks. However, cryosurgery will not affect your menstrual cycle or cause infertility. Complete healing of the cervix takes about 3 months.
Are there any restrictions to activities?
You can carry-on your normal activities; however, you should avoid intercourse or douching for at least 2 weeks during the time of heavy watery discharge. The cervix is undergoing a healing process. Irritation to this area should be avoided, as bleeding can occur.
What happens after the procedure?
For skin lesions such as warts, a small blister will form. The blister will later become a scab or a crust. Your health care provider will tell you how to care for the wound.
There are usually no complications from this procedure. However, occasionally women who are having cervical cryosurgery have hot flushes or faint. If you have cryosurgery of the cervix, you will be asked to stay in the health care providers office for at least 10 minutes after the procedure. Although it is rare, sometimes women faint more than 10 minutes after the procedure, so it is a good idea to have someone take you home. Many women have mild abdominal cramping after cervical cryosurgery. Many women also have a watery discharge from the vagina after the procedure.
Some abnormal tissues may need to be treated more than once. Your health care provider will tell you how often you need to be checked for recurrence or retreatment. You will need a follow-up visit to check healing and to see if any abnormal tissue still remains.
If you have cervical cryosurgery for an abnormal Pap smear, your health care provider will tell when you should have your next Pap smear.
Follow your health care provider’s instructions for checking back for problems, questions, and your next visit.
What are the benefits of cryosurgery?
Cryosurgery is very effective and is less expensive than other treatments. It can be done in your health care provider’s office and anesthesia is not necessary.
What are the risks associated with cryosurgery?
If you are being treated for a cervical lesion, during or after cryosurgery you may experience: – fainting – hot flushes – lower abdominal cramping.
If you are being treated for a skin lesion, you may have: – discoloration of the treated area – damaged hair and sweat glands in the treated area – minor scarring.
When should I call the doctor?
Call your doctor’s office if:
- The treated area is bleeding or not healing.
- The lesions reappear.
- The treated area develops symptoms of infection.
- You have abdominal cramps after cervical cryosurgery that last longer than
24 hours.
- You have a foul-smelling vaginal discharge after cervical cryosurgery for
longer than your doctor told you to expect.
About Fibroids
Uterine fibroids are the most common pelvic tumors in women, occurring in approximately 30% of women over the age of 35. Although fibroids are benign (non-cancerous), they may produce a wide variety of symptoms including excessive bleeding leading to iron deficiency anemia, pain and pressure sensations, and even obstruction of the bowel or urinary tract. Women with fibroids often complain of painful intercourse, and the presence of fibroids may result in pregnancy loss. Each year, approximately 200,000 hysterectomies are performed in the United States for uterine fibroids. Despite this large number of operations, the vast majority of women with symptomatic fibroids are “silent sufferers.”
Until recently, the only effective treatments for fibroids were hormonal therapy and surgery. Because fibroids grow in response to the female hormone estrogen, anti-estrogen hormones such as progesterone can shrink fibroids and may result in dramatic improvement in symptoms. However, these hormones have many untoward side effects including menopausal symptoms and osteoporosis (softening of the bone). Consequently, hormonal therapy can only be used for a short time and, unfortunately, once it is discontinued, symptoms usually return. Therefore, hormonal therapy is most useful in shrinking fibroids prior to surgery.
There are two general types of surgery available for fibroids, hysterectomy and myomectomy. Hysterectomy is the complete removal of the uterus with or without removal of the ovaries. In some cases hysterectomy can be performed through the vagina, avoiding an incision through the abdominal wall. However, with large fibroids, an abdominal hysterectomy (that is, a hysterectomy through an abdominal wall incision) is often necessary. Abdominal hysterectomy is a major surgical procedure requiring general anesthesia, approximately 6 days of hospitalization, and at least 6 weeks of recuperation. Obviously, pregnancy is no longer possible following a hysterectomy.
Myomectomy is an alternative surgical procedure for the treatment of fibroids. The object of myomectomy is to remove only the fibroid while leaving the uterus intact and preserving reproductive potential. Depending on the location and size of the fibroid, myomectomy may require an abdominal incision or may be done through a laparoscope (a telescope-like instrument inserted through an abdominal wall puncture) or a hysteroscope (a telescope-like instrument inserted through the vagina). With larger fibroids, attempted myomectomy frequently results in hysterectomy due to uncontrollable bleeding in these highly vascular tumors. Even when successful, myomectomy offers only temporary improvement in about one-third of patients because smaller untreated fibroids continue to grow.
Frequently Asked Questions About Fibroids
Q: After menopause, how does estrogen/progesterone therapy affect the growth of uterine fibroids?
A: In a menopausal woman who chooses not to take hormonal replacement therapy, existing fibroids usually shrink because the body is producing less estrogen. New fibroids are unlikely.
Q: How common are fibroids?
A: Up to 40% of women past the age of 40 have fibroids and about 75% of women will never be aware of their existence unless they cause a problem.
Q: Do fibroids move to another part of your body?
A: Fibroids typically grow attached directly to the inside or outside wall of the uterus.
Q: I recently had very excessive vaginal bleeding from fibroids, which required a myomectomy and blood transfusions. Could this happen again?
A: In some cases, fibroids can return, even after a myomectomy. It is important that you have annual examinations with your physician (or sooner, if symptoms return). Bleeding can again cause anemia and should not go unchecked.
Q: I am 46 and have a uterine fibroid tumor that has been shown to be 6 inches in size as measured by a hysteroscopy and ultrasonography. My OB/GYN has recommended a hysterectomy. I do not intend to have children. Should I consider myomectomy or uterine artery embolization alternatives?
A: Your physician may be recommending a hysterectomy due to your history, the size, location, and/or your specific anatomy, etc. S/he may feel this is the best recommendation for your situation. As you are also aware, there can be other options and it would be to your benefit and mental ease to discuss this with your doctor or health care practitioner. If you feel that you want to pursue discussing the other options more thoroughly, you can always seek a second opinion. Second opinions reinforce or offer alternatives, depending on your specific situation.
Q: I have fibroids. My OB/GYN has suggested a treatment of Lupron. Do you have any information?
A: Lupron is a synthetic form of a natural hormone (LH-RH). LH-RH stimulates the production of testosterone in men and estrogens in women. However, when the synthetic LH-RH is given, it actually stops natural production of hormones. As a result, in women who are premenopausal, menstruation will stop. Essentially, it induces temporary menopause. That is the reason why it works for endometriosis and fibroids. That also explains why it works for advanced prostatic cancer-by stopping the hormone production, the tumor growth also stops.
Q: I have fibroids. My doctor put me on a low estrogen pill to regulate me. I’m still having irregular periods, feeling bloated, and bowel problems.
A: Fibroids can cause irregular bleeding, pain, and a swollen abdomen (bloated). The size and type of fibroid(s) can also be varied, as the hormone fluctuations in your body take place. Your physician probably prescribed the low estrogen to help regulate your hormone balances We recommend that you return to your physician and discuss your continued symptoms and further evaluate if your symptoms are related to the same fibroid(s) or any other underlying causes. Further testing may be warranted.
Q: Does natural progesterone have any effect on fibroids?
A: Natural progesterone may be used when a woman’s primary symptom is bleeding. This helps to prevent the endometrial lining of the uterus from building up too much. This may be an option when women are unable to modify their diets or when their symptoms aren’t alleviated by dietary changes (low-fat, high-fiber, even vegetarian). A low-fat, high complex carbohydrate diet may halt the growth of fibroids and in some cases, result in their disappearance.
Q: What’s the difference between a cyst and a fibroid?
A: A fibroid is a solid tumor containing mostly smooth muscle bound together by fibrous tissue commonly found within and around the uterus. A cyst is a fluid-filled pouch located on or in an ovary. Both are usually benign.
Q: Is a golf-ball sized fibroid considered large or small?
A: It could depend on the location of the fibroid and whether it is causing symptoms. Fibroids can be either much smaller or much larger.
Q: How are large fibroids surgically removed?
A: How fibroids are removed varies, depending on size, location and preference of the surgeon. The recovery period varies, depending on some of above variables.
Q: How reasonable is it to resist having a hysterectomy due to large fibroids?
A: Because fibroids tend to shrink after menopause, it depends on how close you are to menopause and also how severe your symptoms are. Also there is a relatively new technique that cuts off the blood supply to fibroids and causes them to shrink.
Q: If I wait until menopause, what are the chances my fibroids will shrink?
A: Even if fibroids do not shrink (and they often do) after menopause, at least they should stop growing.
Q: What is the most common symptom of fibroids?
A: Often the first indication is an increase of the amount of menstrual flow, including blood clots. Discomfort or pain may also accompany fibroids.
Q: How fast do fibroids grow?
A: Fibroids usually grow very slowly, however they grow more rapidly during pregnancy, or when taking oral contraceptives.
Uterine Artery Embolization
Embolization (embolotherapy) is a procedure used to block blood vessels from the inside. Embolotherapy is performed by Interventional Radiologists, physicians who specialize in the treatment of a variety of diseases using catheters (tiny tubes) and medical imaging techniques. For nearly thirty years, embolotherapy has been used as a means of stopping uncontrollable bleeding from the uterus due to cancer, blood vessel malformations, trauma, and complications of pregnancy. In the early 1990’s, investigators in France began using embolotherapy of the uterine arteries to prevent excessive bleeding in women about to undergo myomectomy for uterine fibroids. A surprising and wholly unexpected result of these uterine artery embolization procedures was that many of the patients had such significant improvement in their symptoms that surgery was postponed. Over the course of months it became clear that the improvement noted in these women was not only significant, it was durable. Consequently, a pilot study was begun to evaluate the long-term results of uterine artery embolization for the primary treatment of fibroids.
In the initial pilot study, 85% of women undergoing uterine artery embolization experienced significant improvement or complete resolution of symptoms. In 75% of cases the size of the uterus decreased by 20-80% within 3 months, and these results remained stable with an average follow-up of more than 18 months (11 to 38 months). In a second study from UCLA, 77% of patients reported “significant improvement” or “complete resolution” of their dominant fibroid symptom at 2 to 9 months follow-up. In this group, 2-month follow-up revealed an average 40% (22-61%) reduction in uterine volume with the dominant (largest) fibroid decreased by an average of 58% in 55% of the patients studied. In one-third of the patients the fibroids were no longer visible by ultrasound.
On the basis of these studies, uterine artery embolization programs for the non-surgical treatment of fibroids have been established at several academic medical centers in the United States. The experience gained at these centers will optimize treatment protocols and provide in-depth answers to questions regarding the durability of symptomatic relief and preservation of reproductive function.
The Uterine Artery Embolization Procedure
The uterine artery embolization procedure is performed by an Interventional Radiologist in the radiology department of the hospital. Although patients are awake for the procedure, they are sedated and often have no recollection of events during the embolization. The procedure itself consists of introduction of a tiny tube (catheter) into an artery in either the left arm or the groin under a local anesthetic. Except for the injection of the local anesthetic, there is little or no discomfort associated with the catheter insertion. Once in the artery the catheter is manipulated into the uterine arteries and angiography is performed. Patients may experience a mild sensation of warmth during the angiogram. When the catheter is positioned well within the uterine artery, tiny pellets of a material called PVA are injected. (Note: the chemical name for PVA is polyvinyl alcohol, but it is neither vinyl as in flooring nor alcohol as in alcoholic beverages. It is merely an organic [i.e., carbon-based] synthetic compound with properties that make it a useful embolic agent.) The PVA is carried by the flow of blood into the uterus and all of the fibroids present. The particles eventually impact in the very small arteries and produce blockage. Deprived of their blood supply, the abnormal cells in the fibroids die and are slowly removed by the body. Meanwhile, the body restores circulation to the normal tissue by both the in-growth of new arteries and the removal of a portion of the PVA from some of the existing vessels.
Immediately following the embolization procedure the catheter is removed and pressure is applied to the entry site for about 15 minutes to stop any bleeding. Almost all patients experience crampy abdominal pain following the procedure. Consequently, we provide patients with on-demand pain medicine through a device called a PCA (patient controlled analgesia) pump. Many studies have demonstrated that patients experience far less pain, yet actually use far less pain medication when this device is used. Patients are admitted to the hospital overnight and can usually be discharged home the morning following the procedure. Most patients can return to work within a few days. At the current time, we ask patients to return for an ultrasound examination two weeks and two to three months after the procedure to assess results. The patient will also be asked to complete a short mail-in questionnaire one year after embolization. Additional follow-up may be requested in the future
Frequently Asked Questions About Uterine Artery Embolization
Q: What are the risks associated with uterine artery embolization?
A: The potential risks of the procedure include bleeding from the catheter entry site, infection, adverse reactions to medications or contrast media, blood vessel injury, inadvertent embolization of other tissues. The risk of a significant complication is less than 0.5%.
Q: Does uterine artery embolization result in significant clinical improvement?
A: In all studies to date, embolization has resulted in significant improvement or resolution of symptoms in more than 75% of patients treated. With improvements in technique, it is anticipated that perhaps 90% of women treated will have substantial improvement in symptoms.
Q: What impact does uterine artery embolization have on reproductive function?
A: Most studies published thus far have focused on women who did not desire pregnancy. However, pregnancies have occurred and been carried to term following uterine artery embolization for fibroids. Small studies of women who underwent uterine artery embolization to control bleeding complications of labor and delivery have shown the return of normal menses within a few months in all cases and all women desiring subsequent pregnancy conceived and were successful in carrying to term. Since the presence of fibroids already has a negative impact on pregnancy, determining the impact specific to embolization will be difficult and will require a very large number of patients.
Q: Does uterine artery embolization preclude other potential treatments?
A: In the setting of uterine fibroids, this procedure began as a preoperative measure to control bleeding during myomectomy. Preoperative embolization is commonly used in a variety of settings because it makes surgery easier and safer. Since the only other definitive treatment for fibroids is surgical at this time, the only impact embolization would have on such treatment is complementary.
Q: Is uterine artery embolization cost-effective compared with conventional therapy?
A: The overall procedure cost is significantly less than abdominal hysterectomy and moderately less than hysteroscopic and laparoscopic myomectomy. When one takes into account the potential economic losses during a 6-week recovery from abdominal hysterectomy, the cost differential becomes astronomical.
Q: Are results obtained with uterine artery embolization durable?
A: Published reports have shown stable results with follow-up of more than 3 years in a few cases. For women approaching menopause, the results may well be permanent since estrogen production is declining and estrogen is required for fibroid growth. There is insufficient data at this time to predict the long-term durability in younger patients because estrogen secretion will continue for many years and, theoretically, may stimulate the formation of new fibroids. It may be several years before sufficient data is compiled to assess long-term results in younger patients. On the other hand, if fibroids do recur after several years, it should be possible to treat them with repeat embolization.
Q: Where can I find more information about uterine artery embolization?
A: You should first discuss this procedure with your primary care physician or gynecologist. Unfortunately, many physicians are unaware of this alternative treatment for fibroids despite the fact that this procedure has now been used to treat well over a thousand patients in the United States. For specific information on this procedure you should contact an Interventional Radiologist in your locale. For Kansas, Missouri, Arkansas, Oklahoma and adjacent areas of neighboring states you may find a local Interventional Radiologist in the MIRS Physician Listings. Additional information and Interventional Radiologists in other locales can be found at the Society of Cardiovascular and Interventional Radiology (SCVIR) site on the World Wide Web.
As a society, we are acutely exposed to daily stresses, be they emotional, physical, or mental. Work situations, family changes and obligations, changes in our bodies and in our health–all of these can contribute to the stress demands on our bodies. Our bodies respond to these stresses in a similar fashion despite the source. Physiologically, each time we are exposed to stresses, our adrenal glands respond by producing certain hormones. One part of the adrenal gland, the adrenal cortex, responds to long and short-term stresses, while the adrenal medulla responds to sudden or alarm situations, producing our “fight or flight” response. With the amount of stress we are exposed to each day, you’d think our adrenal glands were of considerable size, but that isn’t the case. Our adrenals weigh about 5 grams each and reside in our bodies just above our kidneys in the low back area. For small glands, they play an enormous role in our health. Their function also tends to decline over a person’s lifetime, leading some researchers to coin a new term “adrenapause” to define this loss. As such, we need to have ways in which we can keep our adrenal glands healthy.
From a preventive standpoint, we can reduce our exposure to certain stresses, as well as change the degree to which we allow stresses to affect us. This involves making choices about what we subject ourselves to, as well as how we respond to situations we can’t avoid or change. The amounts of hormones, specifically glucocorticoids and catecholamines, that are released by the adrenal glands are directly related to the amount of stress the body endures, and these hormones can affect nearly all the tissues in our bodies. Individuals exposed to long-term stress have higher circulating glucocorticoids than a person who is unstressed does. Certain lifestyle changes, such as exercise, meditation, breathing exercises, and yoga, have all been demonstrated to ease our response to stress. Those who incorporate one or more of these into their days are noticeably more resilient to daily stresses.
We can also address adrenal health through nutritional support and herbs. Vitamin C and the B-complex vitamins are crucial to adrenal health. Being water-soluble vitamins, they are easily depleted and may need regular supplementation, especially in times of stress. Vitamin C is stored in high concentrations in the adrenal glands, which is evidence of its need for this important vitamin. It has been shown that a person’s need for vitamin C varies, depending on what their body is going through at the time. Infection, for an example, can increase the body’s need for vitamin C considerably. Herbs which address adrenal health are referred to as adaptogens, because they help the body adapt to changes, or stresses. Some of the most notable herbs utilized for adrenal support are licorice, ginseng, and astragalus. Astragalus has long been used in Chinese medicine as a tonic. Research has demonstrated its value in enhancing immunity through multiple mechanisms. Ginsengs are commonly prescribed to increase energy and support adrenal function. Research has demonstrated improved functioning under stress as well as increased working capacity following ginseng use. For women, Siberian ginseng appears to be the most appropriate of the ginsengs, as from a Chinese medicine perspective, it is more cooling (less likely to induce hot flashes) and can be used on a regular basis. Borage leaf also provides specific support to the adrenal cortex and can be used daily to support adrenal health.
Diet is another factor that plays a strong role, as it can supply the body with nutrients as well as deplete the adrenals, depending on what choices are made. For example, sugar and caffeine tend to draw energy from the adrenal glands, so stay away from them during times of stress or if you are working at improving adrenal health. In contrast, nutrients that are found in fresh fruits and vegetables supply healthy support for the body. Nutrient-rich foods, like kelp and other seaweed, are good sources of key vitamins and minerals important to glandular health.
A balanced program for supporting adrenal health includes scheduling time to exercise and taking some time for you to be mindful of your stress level and facilitate adjustments when necessary. Remember that treating health holistically means addressing mental, physical, and spiritual aspects of one’s life, for they all affect one another and can contribute to health as well as disease.
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- Fulder SJ. “Ginseng and the hypothalamic–pituitary control of stress.” Am J Chin Med, 1981;9(2):112-8.
- Bensky, D, Gamble, A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seattle, Washington, 1993.
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THE MANY MYTHS OF hypothyroidism
By Kenneth Blanchard, M.D.
Read the transcript of Dr. Kenneth Blanchard (coming soon!)
Thyroid disorders are extremely common and, in my opinion, are often undiagnosed or poorly treated due to a total reliance on laboratory testing and some-long standing but fundamentally flawed principles of treatment. Of the many standard teachings in this area, I believe the most common mistake physicians make in every day practice is to “rule out” hypothyroidism on the basis of laboratory tests .alone, especially use of the TSH (thyroid-stimulating hormone) test. There are few teachings in medicine more sacrosanct than an elevated TSH test as the “gold standard” for a diagnosis of hypothyroidism. I believe that there are millions of patients (mostly women) who would benefit from thyroid hormone but who are not treated because of results from this test.
A common story in popular magazines is “The Diagnosis your Doctor Will Probably Miss”. The story is that many individuals (mostly women) with symptoms like fatigue, depression, muscle aching, constipation, etc., see a physician who orders a T4 test and, on the basis of this, are told that hypothyroidism has been “ruled out”. The “smarter physician” also orders a TSH test because this is more sensitive and often reveals an abnormality even when T4 results are normal. While this scenario can happen, I believe it is far more common to find both T4 and TSH tests registering normal in the face of significant clinical hypothyroidism. In my practice, if the medical history and physical findings are highly suggestive of hypothyroidism, patients are treated with a therapeutic trial of the hormone and the results are overwhelmingly positive. As of early 2001, opinion in this field is still that the TSH test is absolute, although the upper limit of normal has been questioned, which is starting to include more individuals in this diagnosis.
Another common teaching that I believe to be fundamentally wrong is that all treatment should be done with 1OO% T4 hormone L-thyroxine (Synthroid, Levoxyl, etc.). The normal secretion of the thyroid gland contains small amounts of the T3 hormone (triiodothyronine) and I believe that giving some T3 is an important part of effective treatment for most individuals. The standard medical view is the T3 is unnecessary because T4 is converted to T3 in the body. But many patients taking the standard 100% T4 hormone report chronic fatigue, depression, menstrual abnormalities, fibromyalgia, irritable bowel syndrome (IBS), restless legs and other complaints, and these complaints are almost always better when some T3 is added. This particular teaching in medicine has been breached by a paper appearing in the New England Journal of Medicine in 1999 in which patients on standard 100% T4 were given some T3 and all patients felt better mentally and physically. The use of T3 has been standard in my practice since 1990 and I am quite sure it will be routine in the near future, although many physicians at this point still do not use T3 in addition to T4.
Thyroid hormone activity has a variety of complicated interactions with other hormones. For instance, I believe that thyroid hormone treatment is effective in PMS (premenstrual syndrome) despite the fact .that there are major studies in the literature which say this is not true. It is most likely that PMS fundamentally represents a deficiency of progesterone production prior to menstrual flow, but I believe that normalization of thyroid deficiency enables the woman to make more progesterone, thus relieving the symptoms. The woman in her mid-forties who is just starting to have irregular periods and notices some hot flashes, sweats and sleep disturbance at night can often be treated simply by optimal thyroid replacement, specifically including some T3. While such symptoms are commonly regarded as estrogen deficiency and will respond to the use of estrogen, I find that many such women have normalization of symptoms on proper thyroid therapy alone. The fundamental reason for this may well be that normalization of thyroid function enhances estrogen production by the ovaries themselves and by, the increased production of estrogen in fat tissue from adrenal hormone precursors.
If a woman at this age has frequent migraine headaches that are clearly related to the menstrual cycle (essentially premenstrual), these will often respond to balanced T4- T3 treatment, again possibly because of raising and/or stabilizing levels of estradiol. While clinical depression is not an integral part of menopause, there are many issues at this time of life that can cause emotional upset or depressed feelings. Again, use the T3 hormone in a physiologic way can be very helpful. Indeed, much of the current use ofT3 is in the hands of psychiatrists, who. use it as an adjunctive treatment for depression that is not responding well to standard antidepressants. Although this can be extremely effective, psychiatrists tend to use pharmacologic doses rather then physiologic doses. In other words, they exceed the amount needed to reproduce normal hormone balance. For virtually every purpose, a physiologic dose is desirable since excessive doses yield no additional benefits. I also disagree with the use of Armour thyroid by itself for the same reason, that it does not contain a physiologic balance of T4 to T3. The human thyroid produces roughly 95% T4 and 5% T3. Armour thyroid is an animal thyroid that contains 80% T4/20% T3. People who take Armour thyroid usually feel better for a short period of time because they were deficient in T3 but, after a period of time, the Armour thyroid will cause a T4-T3 imbalance at tissue level and a variety of undesired symptoms can then develop over time. One can get a better balance by giving some T4 with the Armour.
Some doctors are reluctant to prescribe (and some women reluctant to take) thyroid hormones in the belief that this will somehow increase the risk of osteoporosis. . I personally do not believe that there is good evidence for this, although my guess would be that excessive thyroid hormone does contribute to bone loss. Since there is no benefit in going above the normal physiologic levels of thyroid hormone, following the TSH result and clinically monitoring the patient will prevent overdose and resultant adverse effects.
Every organ system in the body is affected to some degree by treatment with thyroid hormone. I believe that the proper treatment of hypothyroidism with physiologic amount ofT4 and TI is critical in managing many complex medical problems at mid-life. If treatment is carefully monitored, there are no adverse effects. Management of hypothyroidism with T4 and TI is significantly more complicated than the standard 100% T4 therapy that has been used for the past 30 years or so. TI dosage must be monitored and altered precisely for optimum effect and this must be done by the use of compounded T3 time-release capsules. These are almost always made in units of 1OO capsules for practical reasons. Patients are initially seen every three months in order to adjust the dosage for the next prescription of T3. Another practice that will eventually become standard in this field is the adjustment of thyroid dosage for seasonal change, i.e., higher dosage in the colder weather and reduced dosage in the warmer weather.
Once dosage has been adjusted over 3 to 5 3-month visits and everything appears stable, visits are done at 6-7 month intervals. Patients must be ready to keep their appointments and take the medication exactly as directed. At the present time, there are many patients on a waiting list so that patients who drop out of the treatment plan fall back to the end of the list. Patients who have difficulty with the practices outlined above should stay with their current therapy.
By Power-Surge guest:
Kenneth Blanchard, M.D
Read the transcript of Dr. Kenneth Blanchard (coming soon!)
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