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 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:
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:
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.
I was so proud of myself for about 5 minutes. I narrowed down the malware to 21 pages on the boards and closed that area down.
I resubmitted the site to Google.
Then, I messed up. I thought I’d check out the database but I had to change the password to do that. Unfortunately, the host company didn’t ask for the old password first so I changed it…and the boards can’t connect to it anymore at all.
I sent a request to tech support and I hope he has the original password.
At least the malware message may be gone tomorrow…
Sorry about that!
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!)
Read the Power Surge disclaimer
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