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DETROIT
if/
3/12
_1999
Department
/Ind .."-(12X/yff Call The Sales
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JNArts & Entertainment
throw out her pills. Her side effects
were feeling bloated, sore and tender
breasts, and depression.
"I went back to my gynecologist
and said, 'Forget it,"' she recalls. "We
discussed some other options and
three years ago I started taking estra-
diol, a combination estrogen with a
more natural progestin. That's work-
ing!"
To her surprise, when she first
started the medication she had to fill
the prescription in Wisconsin and it
wasn't covered by her health insur-
ance. There are now pharmacies in
Michigan that provide the medication
but it still is not covered by all health
insurance policies.
"Elaine was fortunate that she
found something that gave her the
quality of life she was seeking," says
Dr. Benjamin. "Estradiol won't work
for everyone, but there are other
options. The decisions are very per-
sonal."
Joani Lesser of West Bloomfield
had a mastectomy 21 years ago. Now
in her early 50s, she was living with
hot flashes, night sweats, and having
trouble sleeping.
"I researched the topic knowing
that, because I had breast cancer, my
risks were greater than the average
person if I started on hormone treat-
ment. I discussed options with my
gynecologist, oncologist and family.
The result is I'm on a very low dose
of a plant-derived hormone and I feel
very comfortable. The jury is still out
on this approach to dealing with
menopausal symptoms because the
research has been sparse, but it seems
to be working for me.
"The thinking about hormone
treatment for breast cancer patients
has recently changed," says Dr.
Benjamin. "The prevailing direction
is toward some type of hormone ther-
apy if the cancer has not reoccurred
over a period of time, usually at least
five years. Joani was a good prospect
for treatment because she was healthy
and her tumor was found some time
ago.
Much of the push for HRT is
because physicians now know estro-
gen's effects are not limited to the
reroductive system, but also play a
role in determining the composition
of blood lipids, bone strength, memo-
ry, and the elasticity of skin and arter-
ies. Estrogen is versatile.
"The list of benefits of taking
hormones continues to grow," says
Dr. Stanley Dorfman, gynecologist
and menopause specialist in
=WISE NEWS
ni
"
Bloomfield Township. "Not that
long ago the treatment for irregular
periods and heavy bleeding during
this transition phase was periodic
D&Cs and sometimes a hysterecto-
my. Today it's finding out which
type of hormone therapy works best
for the patient."
It is now known that some sub-
stances mimic the effects of estrogen
while others block estrogen. This
helps explain why postmenopausal
Asian women are less likely to devel-
op cancer of the breast or uterus and
have less menopausal symptoms com-
pared to Western women. Their diet,
rich in soy, may be the key. Soy con-
tains a phytoestrogen.
Phytoestrogens are plant com-
pounds that have beneficial hormone-
like effects in the body. Sources of
phytoestrogens are soybeans, whole
grains, and fruits and vegetables.
Based on this, selective estrogen
receptor modulators (SERMs) have
been created that are more picky than
estrogen. The first SERM was tamox-
ifen (Nolvadex), which blocks estro-
gen receptors in breast-cancer cells so
they don't grow.
Additional SERMs, such as the
recently approved raloxifene (Evista),
are designed to mimic estrogen's pos-
itive effects, such as stimulating bone
density and raising HDL cholesterol
levels, and block its undesirable
ones.
"Women need to evaluate their
choices," says Dr. Dorfman. "Each
year, 107,000 women die from
breast cancer; 550,000 die from
heart disease; and over 1 million
become debilitated from osteoporo-
sis. In fact, more women die each
year from colon cancer than from
breast cancer.
"Hormone therapy is one of many
factors that may increase a woman's
risk of breast cancer, but not taking
hormone therapy increases a woman's
risk for heart attack and stroke."
Dr. Dorfman does warn about tak-
ing over-the-counter progesterone
creams, which are touted as a cure for
lack of sex drive and osteoporosis.
"They vary in dosage and don't reli-
ably protect women from uterine can-
cer. These products aren't regulated by
the FDA and there's no way to tell if
a woman is getting enough or too
much."
Whatever the decision, treatment
or no treatment, women should con-
sult a physician, map out a plan even
if it is trial and error, and maintain a
healthy and active lifestyle.