Paging Dr. Thornton » Hormone replacement therapy

Early Menopause is Bad News for Women and Their Bones

yvonnethornton — Mon, 07 May 2012 13:49:45 +0000

Let’s face it. None of us looks forward to getting old, but we try to do it with as much grace as possible. For some women though, menopause, a hormonal change that should come later in life, comes sooner than expected. Instead of dealing with hot flashes, night sweats, mood swings and all the other symptoms of menopause in their 50s, they’re facing it in their 40s or even younger. And as if early menopause isn’t bad enough, studies now show that it increases their risk for osteoporosis and even shortens their life expectancy.

Swedish researchers from Skane University Hospital in Malmo conducted a study of almost 400 women over the course of just under 30 years. They found that of the women who started menopause before the age of 47, 56 percent developed osteoporosis compared to just 30 percent in the women who started menopause later in life. Women suffering from osteoporosis are at greater risk for bone fractures, bone pain, and loss of height due to bone loss. Their findings also showed that women who had undergone early menopause had a greater risk of fragility fracture and death with a rate 17 percent higher than the women with later menopause. The rate of fractures in women with early menopause was 44% compared to 31% in those women who entered menopause later.

The cause of early menopause is not yet clear, though there seems to be a link between it and premature ovarian failure, hysterectomies, chemotherapy, and possibly even stress. Premature ovarian failure has been associated with Fragile X syndrome, so there may be a genetic link. Unfortunately, preventing and reversing early menopause is not yet possible, but there are ways to decrease your risk of osteoporosis. The bone masses of most women peaks in their 20s. You can increase yours by getting plenty of calcium, vitamin D and exercise. A balanced diet and thirty minutes of weight training or other moderate exercise every day can make big difference when it comes to your bone health.

The association found between early menopause, osteoporosis, and death is causing some to call for more studies to determine a more definite correlation. The higher mortality rate in women with early menopause does need further study in order to address the confounding variables, such lifestyle, medications and smoking. In the meantime, we should take the results as a warning to take care of our bodies, particularly our bones, as early as possible.

— Yvonne S. Thornton, M. D., M. P. H.

Why your Ob-Gyn should be board-certified

yvonnethornton — Wed, 22 Jul 2009 15:39:29 +0000

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

- Yvonne S. Thornton, MD, MPH

Danish study links hormone replacement therapy to ovarian cancer. Should you worry?

yvonnethornton — Tue, 14 Jul 2009 09:57:06 +0000

In the news today is a Danish study, published in the Journal of the American Medical Association (JAMA), that indicates there may be an increased risk of ovarian cancer among users of hormone replacement therapy.

While this may sound like scary new information, it’s not actually news. Thirteen years ago, for my masters degree in public health, I wrote my final epidemiology paper on the link between hormone therapy and ovarian cancer.

Other studies link hormone replacement therapy, especially estrogen alone rather than estrogen plus progesterone, to breast cancer and endometrial cancer.

After reviewing the available information, you and your doctor may still decide that estrogen’s benefits outweigh any risk. Or you may want to try a different tactic to alleviate menopausal symptoms. As I mentioned in a previous blog post, other treatment options, including SSRIs and blood pressure medications, may work as well and cause fewer concerns.

- Yvonne S. Thornton, MD, MPH

“Is it hot in here – or is it just me?”

yvonnethornton — Fri, 12 Jun 2009 21:35:56 +0000

If you’ve ever gotten a hot flash, you know how odd it can feel. Usually, hot flashes don’t have a major impact on a woman’s life but some women suffer more than others. About 80 percent of women experience hot flashes and night sweats, which are short bursts of intense heat of the face and neck. Usually they begin in the early years of the transition to menopause and peak one or two years after the last menstrual period, remain for several years and then resolve over a period of time. I’ve had patients come in to see me feeling downright miserable due to pre-menopausal and menopausal symptoms. Some complain of waking up dripping wet at 2:00 a.m. with night sweats or feeling like tiny bugs are crawling all over them.

These symptoms will pass as your hormone levels adjust but what do you do in the meantime? Other than buying a small hand fan, there’s no single answer. Treatment has to be individualized for each woman. Avoidance of triggers, such as cigarette smoking, hot beverages, foods containing nitrites or sulphites, spicy foods and alcohol, may help limit hot flashes. Blood pressure medications have been prescribed off-label with some success. SSRIs (selective serotonin reuptake inhibitors) such as Prozac^® and Zoloft^® or antidepressants such as Effexor^® (venlafaxine) also offer relief. Oral estrogens or transdermal estrogen patches have been found to be very effective in reducing the incidence and the intensity of hot flashes. However, if estrogen is used, unless you have had a hysterectomy, an additional hormone, progesterone, must be added to the estrogen in order to decrease your risk of developing uterine cancer. Relaxation techniques, such as deep slow breathing, may also help with hot flashes.

Some women think first of herbal remedies such as dong quai, evening primrose oil or red clover. However, I discourage my patients from using herbs as they’re often ineffective. Soy (a phytoestrogen or plant estrogen) has been touted as a remedy for hot flashes. However, there is no conclusive evidence for its benefit and there are no long-term safety studies. If you are convinced that you want to go the herbal route, I strongly urge you to discuss these remedies with your doctor beforehand. Don’t assume that because you get it over the counter, it’s safe. Herbs are not regulated through government health agencies and can have potent unintended effects, and may interfere with other medications or cause harmful interactions.

- Yvonne S. Thornton, MD, MPH

Oprah and medical advice

yvonnethornton — Thu, 04 Jun 2009 12:34:11 +0000

Let me start by saying that I love Oprah. And I am forever grateful to her for having me on her show because appearing on Oprah helped me introduce my memoir, The Ditchdigger’s Daughters, to a huge audience. I’m sure it contributed to making my book a bestseller.

All that said, I have to agree with this Newsweek article. The authors argue that the medical advice given by some of the guests on The Oprah Winfrey Show is dubious at best, especially the claims about bio-identical hormones made by celebrities with no medical knowledge or training.

- Yvonne S. Thornton, MD, MPH