Help for that Misbehaving bladder

Posted By on August 29, 2013

Many women suffer from bladder issues that range from urgency and the need to empty their bladder frequently; many times this is helped by bio-identical hormone replacement.   However, many other women suffer the embarrassment of a falling bladder that leaks with a laugh, a sneeze or a cough, and bio-identical hormone isn’t enough.  Now there is a way to get that bladder function back in the confort and privacy of your own home.  In-Tone is a medically supervised biofeedback device that allows every woman the ability to retrain their pelvic muscles and bladder to work normally; and all it takes is a trip to your doctor, an in-office evaluation and 12 minutes a day in the privacy of your own home. 

Patients do need their doctor to qualify them; so why wait?  Haven’t you wanted to get rid of your pads and embarrassing bladder leaks?  Let us help you strengthen your pelvic floor.  Contact us to set up your consultation!


A new test for Estrogen metabolism and patients with higher risk of breast cancer

Posted By on August 15, 2013

Estrogen has multiple positive effects on every organ system in the body from head to toe, allowing women to maintain their cognitive skills, ability to sleep, controlling hot flashes/night sweats, muscular strength, bladder function, libido, emotional evenness, migraine prophylaxis, GI tract motility and function as well as helping control hair loss from our head, excess hair to upper lip/chin and even our metabolism to help us maintain our weight.  However, a small percentage of women have a higher amount of an estrogen metabolite or byproduct in their urine that shows they are at higher risk for estrogen-related cancers.  There is now a test available through our office that will help measure this risk; that along with your blood levels of Estradiol, Progesterone and Testosterone help us balance your female/male balance and keep all of your organ systems at their best.

There are also dietary modifications that patients can easily incorporate into their daily routine that exert favorable effects on estrogen metabolism and reduce cancer risk.  Cruciferous vegetables and indole-3-carbinol or diindolymethane (DIM) as well as omega-3 polyunsaturated fatty acids and lignans in foods such as flaxseed  exert favorable effects on estrogen metabolism.



New studies seek causes of early onset dementia

Posted By on August 15, 2013

An online JAMA Internal Medicine study published Monday, 8/12/13 looked at 2 new studies that utilize the population base of approx 500,000 Swedish men from their late teens to middle age to discern possible triggers of early-onset Alzheimer’s (prior to age 65).  Researchers found that patients with high systolic blood pressure, low cognitive function and short stature in late adolescence were significantly more likely to develop early onset dementia.  Other factors included paternal dementia, occurrence of alcohol or other drug intoxication, stroke, antipsychotic meds and depression.  Young men with at least 2 of these risk factors and who ranked in the lowest one-third in terms of cognitive function had a 20 fold greater likelihood than average to develop early onset dementia.  Hypertension in midlife has been associated with later dementia but now high blood pressure in adolescence may be another risk factor to early onset dementia.

Taken from the Milwaukee Journal Sentinel Wed 8/14/13


Whole-grain, fiberand disease prevention

Posted By on August 11, 2013

A local article in the Milwaukee Journal sentinel Sunday, Aug 11,2013 discusses the truth behind ‘whole grain’.  Many foods are marketed as whole grain and told that they have an 18% to 40% lower risk of diabetes, stroke and heart disease.  However, it’s important to realize that whole grains + fiber achieve these protective results since whole grains alone are only 1/2 of that equation. 

Information below from that article states: Whole grains consist of the outer, fiber-rich bran, the oily germ and the starchy endosperm.  But before 2006, there was no official definition of what constituted ‘whole grain’. with research studies usine different part of either the whole intact kernel and others just the bran parts.  In 2006, the US FDA and food companies agreed on a definition that lumped together all products containing the componenets of a whole grain into the ‘whole grain’ category.  That means foods are now called ‘whole grain’ even if the grains are not whole or intact.  The whole grain can be sliced, diced, partially processed or ground.  As long as the bran, endosperm and germ get recombined in proportions that are roughly the same as in an intact grain, it counts as whole grain. 

‘It can be tricky because foods can be labeled ‘whole grains’ that aren’t 100% whole grains’, said Susan Nitzke, a professor emerita of nutritional sciences at UW-Madison.  ” ‘100% whole grains’ is whole grains but ‘made with whole grains’ is less than that”.   To know how much fiber you are actually eating, check the back label.  Women need approx 25 gm of fiber/day; men need approx 38gm of fiber/day.  A good rule of thumb is to shoot for 1gm fiver per 10gm of carbohydrates.

Bran can contain about 4gm giver per Tbsp or 25gm per cup for wheat bran.  Beans are a great source of fiber with 10gm per cup. Canned pumpkin has 13 gm per half cup (excellent in hearty winter soup base and sauces).  Flax and sesame seeds as well as nuts are good but watch the fat content vs fiber.  A diet rich in fruits and vegatables in addition to whole grains is highly recommended over fiber pills or supplements due to the addition of natural vitamins in food.


New HRT Guidelines from the British Menopause Society

Posted By on August 10, 2013

The British Menopause Society (BMS) and Women’s Health Concern has issued updated guidelines on hormone replacement therapy (HRT) to clarify its use, benefits and risks.  The new recommendations were published online May 24 and in the June print issue of Menopause International.

Lead author Nick Panay, BMS chair states  “Our aim is to provide helpful and pragmatic guidelines for health professionals involved in prescribing HRT and for women considering or currently using HRT.  With these updated recommendations, it is hoped that HRT will once again be used appropriately and provide benefits for many women in their menopause.”

When first introduced more than a decade ago, HRT was considered to be the ‘elixir of youth,’ but accumulating evidence has highlighted associated risks precluding widespread use.  Findings from the Women’s Health Initiative (WHI) in 2002 and the Million Women study in 2003 made use of HRT controversial, despite the known benefits.  The evidence base for the new guidelines includes a reanalysis of the Women’s Health Initiative and Million Women study trials and additional studies.

The updated recommendations provide advice regarding optimizing the menopause transition and beyond, using lifestyle and dietary interventions, complementary therapies and HRT.

New Guidelines from the BMS:

1.  After receiving sufficient information from her health professional to make a fully informed choice, each women should decide whether to use HRT.

2.  The clinician should individualize the HRT dosage, regimen and duration and reassess risks and benefits annually.

3.  One of the main indications for HRT in postmenopausal women is relief of vasomotor symptoms, which are most effectively relieved by estrogen.

4. If menopausal symptoms persist, the benefits of HRT usually outweigh the risks.  Therefore, the duration of  HRT usage should not be subject to arbitrary limits.

5.  When prescribed to women younger than 60 years, HRT has a favorable benefit/risk profile.

7.  Women with premature ovarian insufficiency  must be encouraged to use HRT, at least until the average age of the menopause.

8.  If women older than 60 years opt for HRT, they should start with lower doses, preferably via the transdermal route.

9.  Routine management of all women in the menopause transition and beyond should include optimization of diet and lifestyle.

10.  Pharmacological alternatives to HRT may include selective serotonin reuptake inhibitors such as fluoxetine and paroxetine for vasomotor symptoms, venlafaxine, gabapentin and possibly clonidine.

11.  Phytoestrogens offer some benefits for symptom relief and on the skeletal and cardiovascular systems.

“It is imperative that in our aging population, research and development of increasingly sophisticated hormonal preparations should continue to maximize benefits and minimize side effects and risks, the guidelines authors conclude.

comments from Medscape Medical News and Menopause International.



Dietary Guidelines Aim to Reduce Alzheimer’s Risk

Posted By on August 10, 2013

New guidelines have been developed by the Physicians Committee for Responsible Medicine (PRCM).  PRCM is a nonprofit organization that advocates preventive medicine and good nutrition with clinical research seeking higher ethical standard in research.  The new guidelines were released mid July at the International Conference on nutrition and the Brain in Washington, DC.

PCRM president Neal Barnard, MD states “The current generation of clinicians is in a battle over food – especially Alzheimer’s promoting foods such as those which contain saturated and trans fats.”

The guidelines are very similar to the habits that prevent heart disease , recommending foods that avoid saturated and trans fats, grounding the diet in plant-based foods and adding sources or Vitamin E and B.  “Combining this diet with physical exercise and avoiding excess metal, such as iron and copper in multivitamins, can maximize protection for the brain” per Dr. Barnard.

The 7 Dietary Principles to Reduce Alzheimer’s Risk:

1.  Minimize saturated fats and trans fats.

2.  Vegetables, legumes, (beans, peas, and lentils), fruits and whole grains should be the primary staples of the diet

3.  One ounce of nuts or seeds (one small handful) daily provides a healthful source of Vitamin E.

4.  A reliable source of Vitamin B12, such as fortified foods or a supplement providing at least 2.4mcg per day for adults) should be part of the daily diet.

5.  Choose multivitamins without iron and copper, and consume iron supplements only when directed by your physician.

6.  Avoid the use of cookware, antacids, baking powder or other products that contribute dietary aluminum

7.  Engage in aerobic exercise equivalent to 50 minutes of brisk walking 3 times per week.


Breast Cancer and Hormone Replacement Therapy; is there really a Link or is hormone replacement saving lives?

Posted By on July 21, 2013

Breast Cancer and HRT; is there really a Link?

There are some fascinating findings coming out in research lately.  The Journal of Family Planning and Reproductive Health Care published a 13 section article called ‘Does Hormone Replacement Therapy (HRT) Cause Breast Cancer?’  An Application of Causal Principles to Three Studies in which the authors examine the data from the Women’s Health Initiative (WHI), the Collaborative Reanalysis (CR) and the Million Women Study (MWS) shows there are statistical problems with the assumptions that the researchers made and that the conclusions do not fit with the published finding of an increased risk of breast cancer with HRT.  Interestingly, Dr. Wulf Utian, a founder and past president of the North American Menopause Society states “This is not the first paper to demonstrate that the way the WHI interpreted their results and presented them to the media has resulted in far more death and disability than it prevented”.  He further states that these results are part of an ongoing effort to repair damage caused by early reports from the WHI.

Another study soon to be published (published online ahead of print July 18, 2013) in the American Journal of Public Health by Dr. Philip Sarrel from Yale University examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years old; this is the same age group of preliminary data that were studied by the WHI researchers in 8/2002.  However, the conclusions from Dr. Sarrel’s work show that over a 10 yr span, starting in 2002,and examining national hospital discharge data, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET).  His paper concludes that ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall.  Their data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years.  Thus informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.

Dr. Holly Thacker, Cleveland Clinic comments that the results show that clinicians should not be reluctant to prescribe estrogen for women who have undergone hysterectomy and are estrogen deficient. Dr. Thacker was quoted by MedPage Today: “It’s not only going to improve the quality of their life but likely the longevity of their life.  It’s really kind of a game changer, in that we’re not just talking the use of estrogen for the lowest dose for the shortest amount of time for treatment of symptoms.  We’re also thinking in terms of prevention and lifespan and quality of life and work productivity.  Women and their doctors need to stop being fearful of treating estrogen deficiency.”

A New WHI Analysis by Charles Bankhead from MedPage Today states “In fact, a subgroup analysis in 2004 showed a reduction in mortality risk among WHI participants who had undergone hysterectomy and were treated with estrogen alone.  Follow-up analysis in 2001 confirmed a decreased morality risk of 13 per 10,000 per year among hysterectomized women 50 to 59 treated with estrogen.”

Dr. David Katz, co-author with Dr. Sarrel states ‘The finding is so dramatic – reporting thousands of women dying every year – if this gets the attention that it deserves, we hope it will change clinical practice.  We hope that clinicians will start routinely talking to their patients who have had a hysterectomy and bringing up the issue that taking estrogen may save your life.  We have the data to show that it can save your life.”

Interestingly, this new data are all coming out about estrogen alone.  Dr. Wulf Utian has publicly stated that the type of progesterone used in the WHI trial was responsible for the increased risks (of breast cancer, heart attack and stroke) and that natural progesterone in lower doses can minimize these risks (from Wall Street Journal, Sept 27, 2011).  The European based research has already shown that Estrogen plus natural progesterone (Prometrium) has a 0% incidence of breast cancer in a Swedish 10 year study; and the American KEEPS study, presented at the North American Menopause Society (NAMS) annual meeting 10/04/12 demonstrated many beneficial effects across multiple body systems in a 4 year study with transdermal estradiol (estrogen) and Prometrium (see previous blog entry on KEEPS study).  Interestingly, the British Medical Journal (BMJ) on 10/09/12 also published a 10yr study of 1,000 Danish women using a triphasic estradiol (compounded) and a synethetic progesterone (different synthetic than the Provera used in the WHI); this study concluded that the early postmenopausal women in this study showed a significantly decreased mortality without any apparent increased risk of cancer, blood clot or stroke.  This is a powerful conclusion; however the studies need to be done to show how natural progesterone impacts women’s health.  Researchers have successfully challenged the conclusions of WHI and other major studies regarding estrogen; now we need to take a hard look at challenging these same conclusions regarding progesterone.


Hormone replacement therapy in early menopause pt shows significantly reduced cardiac disease without any apparent increase in risk of cancer, CVA or blood clot

Posted By on October 24, 2012

BMJ (British Medical Journal pubslished in October 9, 2012 edition a study of 1,006 health women age 45-58 recently menopausal or perimenopausal women followed for 10 years.  After 10years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure or myocardial infarction (heart attack) without any apparent increase in risk of cancer, blood clot or stroke.


KEEPS study; a new direction in women’s menopausal health

Posted By on October 17, 2012

There’s a new study that puts hope back into women’s menopausal health, and that’s the KEEPS study or  Kronos Early Estrogen Prevention Study, presented at the 23rd annual meeting of NAMS in early October.  This study has not been released to the public yet but already there are waves of optimism that it will impact women’s health positively.  The study looked at 727 newly menopausal women and for the first time studied the micronized bio-identical Progesterone  called Prometrium, leaving out the synthetic Progesterone Medroxyprogesterone acetate or Provera that was linked to the increased risk of breast cancer, heart disease and stroke in the Women’s Health Initiative.  KEEPS  also studied the options of bio-identical Estradiol in Vivelle (transdermal patch) and bridged the WHI study by including Premarin but at a lower dose of 0.45mg.   This study focused on quality of life parameters, noninvasive imaging of atherosclerosis of carotid and coronary arteries, cardiovascular risk factor changes and biomarkers, cognitive function, mammographic breast density and several other outcomes.  Overall, KEEPS showed many favorable effects of hormone therapy by demonstrating a substantial reduction in multiple menopausal sx’s (hot flashes, night sweats) and also some improvement in bone mineral density.  Blood pressure systolic parameters were not increased as they were in the WHI (Women’s Health Initiative).  Estradiol as transdermal had a neutral effect on lipids but a favorable effect on insulin resistance as measured by glucose and insulin levels, the best way to predict future trending toward diabetes than a fasting glucose alone.  Non-invasive imaging of carotid and coronary arteries showed less development of coronary artery calcification than women taking placebo but this data is only over 3years and needs longer follow-up.  A highly significant finding is there was a neutral effect in cognitive function vs the deleterious effect seen in the WHI; this is a highly significant finding that has huge implications for the future of Alzheimer’s in women in this country.  Lastly, mammography suggested less follow-up testing on Premarin (equine based) vs those on Vivelle (bio-identical transdermal estradiol patch) but these findings are preliminary.  Lastly, mood and sexual function as well as quality of life were seen as showing benefits and an overall favorable benefit risk ratio.

The most surprising statement made in a videotaped comment on the KEEPS study is that the findings in this study are not going to change the prescribing habits or practice patterns of  GYN’s.  As the KEEPS study is actually a bridge between the WHI (equine estrogen + synthetic Progesterone) and European based studies (Estradiol + Prometrium), what needs to be emphasized is that the KEEPS study actually shows multiple areas of Benefit to patients in both medical and quality of life parameters vs increased risk in medical parameters; how could this not change prescribing habits or practice patterns?  Are doctors not interested in actually helping their patients with both quality of life and medical parameters?  Are they actually sacrificing their patients health because they won’t take the time to educate their patients?  As physicians, we are also trained to critically read and examine the research in our field and come to our own conclusions about the results.  So ask yourself  and your doctor about the evidence in the KEEPS study vs European research vs WHI and to give their opinion as to what is best for you, the patient.  This is the most important study in women’s health to come out in the past 10years because it not only highlights quality of life issues but also several top medical issues that are in the top leading morbidity and mortality issues in women’s health; so yes, this is ground-breaking news!  Let’s get the word out about this important new direction in women’s health research; yes, there is hope for quality of life after menopause and we should let women know they can indeed remain vibrant, healthy and happy!


Perimenopause in a patient told ‘had hyst and both ovaries removed’

Posted By on September 28, 2012

N. O. is a 36 yo female who had a hysterectomy at age 29, then both ovaries removed 10months apart at age 33.  Pt was placed on non-bioidentical hormone and never felt it was helping.  Pt seen in this office for 2nd opinion consultation with multiple moderate menopausal symptoms.  Pt was trialed on bio-identical hormone replacement but her blood levels weren’t responding as would have been anticipated.  After several levels and HRT adjustment, we recognized that her hormone graph mimicked that of a typical perimenopausal female in her late 40’s.  That could only mean that she still had functional ovarian tissue that was left behind and she needed to be followed as if a typical perimenopausal female!  Her bloodwork was put on a different time schedule and her hormone medication was adjusted; for first time she had significant improvement in many of her symptoms and now has hope that she can get on top of her multiple issues.