Dr. Erika | Bioidentical Hormone Expert

Breast Cancer: We hold the key to its prevention through a better perspective

October is Breast Cancer Awareness Month and along with the rest of us, I’ve been watching the incredibly positive results of superhuman efforts to raise awareness and money in search for the cure.

In the past 20 years, the most success surrounding breast cancer has come from the commitment to raise money for research and the incredible tenacity and dedication of women who have suffered with the disease or just plain care.

Women are wonderful human beings. Our commitment and passion allow us to give selflessly and completely. When we believe in a cause, we make things happen. Breast cancer is one of the places women are showing who they are.

I have been taking care of women for 30+ years and breast cancer has become our nemesis. Although statistically we don’t primarily die of breast cancer, we obsess about it, we fear it more than anything else, even death.

This fear is so big and so strong that it often turns us into victims and that is not a good position to be in.                  

When we look at the breast cancer situation we are faced with a huge dilemma. In spite of hundreds of millions of dollars going into academic research for more than 20 years, we have no cause nor do we have a cure.

More women die of side effects of chemotherapy and radiation than of the actual cancer. Those are the scarier facts, if you ask me.

Integrative and alternative medical therapies address prevention as the number one way to eliminate breast cancer. It makes sense to me. I want to prevent any disease I can prevent. I want to teach everyone I come across how to live without fear. Prevention actually allows us not to live in fear.

Unfortunately the concept of eliminating fear has not yet made it to the mainstream.

I become uncomfortable when I watch TV and see 20 and thirty year old women talking about their experience with breast cancer. That is enough to scare any young woman. Why are these women getting the cancer?

Could it have something to do with our changing environment? Stress? Toxins? Radiation? Diet? Genetics?

Most women who are diagnosed with breast cancer are over 50.  They are mostly menopausal and have lost their hormones that serve as disease protectors and youth extenders when we produce them and they are in balance. They also may be women who have been on synthetic hormone replacement therapies known to cause breast cancer.   

If we look at breast cancer as a disease of aging we know it is caused by inflammation caused by wear and tear, oxidative stress, toxins, drugs, HRT, genetic predisposition and too many years of our terrible eating habits and sedentary lifestyles. So we know what causes breast cancer in most of us older women.

With this knowledge, doesn’t it follow that we should focus our energies and finances on research and education about prevention? Shouldn’t we be stressing the importance of healthy diet, supplements, exercise, sleep and stress lowering tools as a primary focus to us and our young women?

Yes, a mammogram may be helpful after 40 or sooner... Regular check-ups are good to keep you aware and in a great relationship with a caring doctor who will listen to you. Medicine is there to serve you and should do so without intimidation and abuse. Overdoing testing or biopsying every lump in your breast will not protect you and is likely to harm you. It’s never too late to change your diet, start exercising, getting your hormones in balance, learning to say no to toxic relationships and focusing on sleeping 8 hours a night.

Prevention is even more important for our young women.  If we teach our daughters by example from the very beginning to avoid eating junk, drink less alcohol, eliminate soda, do not allow them to take birth control pills or any other synthetic hormones, help them develop a healthy self- image, exercise regularly and sleep, we will be doing them a much bigger favor in the long run- we just may eliminate breast cancer! I don’t think any of us need any study to prove the truthfulness behind this statement.

Instead of limiting our focus on those who have gotten cancer and died or were fortunate and survived, or waiting for the next woman to get the dreaded diagnosis, let’s spend serious time and serious money on those who should not and will not get cancer if they learn how to prevent it.

A Word about Testosterone for Women

Women ask about the use of Testosterone to balance hormones and, of course, to bring back their sex drive.

Here is the 411 on testosterone so you can decide how and if it applies to you and your particular needs.

The conservative medical community does not address testosterone as a necessary hormone for the wellbeing of women.

The first book on the importance of testosterone to women, The Hormone of Desire by Susan Rako, came out in 1996. Dr. Rako linked decreased sexual desire around menopause to decreasing levels of testosterone in the blood stream.

The book was big news back then. The medical community didn't even consider the fact that women had significant testosterone levels circulating in their bloodstream, let alone that sex drive may somehow be connected to testosterone levels.

To this day too many people still think testosterone is the male hormone and all things male are tied to testosterone. So when you consider taking supplemental testosterone you are conditioned to worry that your voice will get lower and your chin will sprout a beard. More than 10 years after Susan Rako's book I still have women coming to the office wanting testosterone yet worried about turning into small males. Not a chance.

For women who want to know the facts and who believe testosterone may be helpful to them in their quest to feel great and stay young without placing themselves into danger, here is what you need to know:

- Testosterone is the third sex hormone (estrogen, progesterone and testosterone). All sex hormones are made from cholesterol and they are present in women and men. The difference lies in the amounts of hormones made by the body. Women have more estrogen and progesterone, men have more testosterone.

- Testosterone is the sex hormone responsible for muscle mass development, sex drive, outlook (positive), drive, and aggression (positive and negative). It has the same effect in men and women. It may appear to have different effects but that is only due to the different amounts present in the body and the balance between the three sex hormones.

- Testosterone is made in the ovaries and adrenal glands in women and the testicles and adrenal glands in men. (Look at a dog that has been neutered; after the testicles are removed, the dog still humps. Where is the testosterone coming from? Instinct and of adrenal glands of course)

- When we get older (not that any of us do or should if that means becoming chronically ill and without hope) our thyroid, estrogen, progesterone, all sex hormone levels decrease - and that includes our testosterone. As testosterone production decreases, our sex drive, muscle building capacity, outlook, drive, etc. also decrease. You don't have to be a woman to figure this out. Look at your 40+ year old hubby on the couch growing a beer belly and giving up on making plans to change the world. That is not just too much drinking and not enough exercise, it is low testosterone.

- Testosterone is safe and helpful if you want to bring back your libido, feel a little friskier especially as you enter the early menopause years and you don't want your skin to sag too soon. As you find yourself being transformed into a testosterone fan keep in mind it's all about balance and that means testosterone alone doesn't quite take you all the way to your mid 30s or 40s. You need estrogen, progesterone, thyroid and lots of other good things to get you in real balance.

Testosterone Supplementation
Testosterone supplementation is available in
1. cream
2. gels
3. spray
4. intramuscular injection
5. patches
6. implants under the skin

Testosterone does not work in tablet form. The stomach destroys the testosterone and the body does not get what it needs.

Injections are painful, difficult to self-administer and thus not highly recommended.

Patches (Androderm) are usually made of synthetic testosterone and their absorption is unpredictable and often causes rashes. Keep in mind they are also made for men so the doses need to be significantly lowered to obtain good results without negative side-effects.

A formulation of testosterone implanted under the skin is available (Sotto Pelle) which distributes testosterone over time directly into the blood stream. My reservation with this method is that it delivers testosterone continuously into your blood stream and the potential for side-effects like bleeding and irritability are higher than with creams. Also, in real life the human body does not produce testosterone continuously.

Do not use synthetic preparations of testosterone.

Natural/bioidentical testosterone is available from compounding pharmacies. Your doctor can write the prescription for you. Bioidentical testosterone is made from soy and yam oils just like bioidentical estradiol and micronized progesterone. Pharmaceutical processes of concentration and purification transform the oils into testosterone powder which is mixed into transdermal creams, gels and other formulations your doctor and you can easily create to serve your needs. This individualized way of obtaining testosterone insures proper absorption and it's easy to apply.

In my patients I use .5- 1 mg testosterone in transdermal creams applied to the clitoris and the area outside the vagina three to five times a week.

The location serves us well for two reasons: there are lots of receptors in the area for testosterone and the application stimulates the area and increases sexual desire.

While testosterone may only be one hormone of desire (you need to be sexually attracted to your partner and you may also need to have a lot less stress in your life), it is a good start.

Try it and let me know how you feel!

Deadly Ignorance - or Distrust of the Medical Profession (aka. Survival Instinct)

Here's a survey that has left the media wondering whether "women are crazy and lacking common sense" - or as I see it; simply letting the medical system that's treated us as second class citizens for far too long know we no longer want to accept their tactics.

The American College of Obstetricians and Gynecologists has found that one in five women don't want to know if they have cancer.

"Rather than seek early detection and possible cure, these women would prefer to remain in the dark," according to a New York Post report on the study (October 15, 2007).
The study, which surveyed 1,664 women online between Oct. 1 and Oct. 3, also found that 63 percent of us women think that if we have no family history of cancer we are unlikely to develop the disease. Proof positive to the study's authors that we are lacking common sense.

Eighteen percent think regular mammograms and Pap smears are unnecessary, and 7 percent say they're "a waste of time."

It's no surprise to me that an ever increasing number of women would rather not have tests to find out if they have cancer because they don't trust the tests, the interpretation and the treatments. Who can blame them, given the fear, intimidation, misinformation and brutal manipulation they are subjected to by our present healthcare system? Not to mention the brazen advertising directed at scaring women into submission (drugs, drug companies, treatments, hospitals, centers of excellence, etc.).

And how about the ever increasing numbers of unnecessary mastectomies that are inflicted on unsuspecting women - sometimes as a "precaution" on those who don't even have the disease?

The treatment of cancer is BIG business - for hospitals, pharmaceutical companies, physicians and for the manufacturers of surgical and radiographic equipment and other devices. And how can anyone forget the TV networks, newspapers and magazines cashing in on all the advertising from those who make money off our fears?

When did you last hear or see an ad telling women how to avoid getting cancer?
How many ads tell you that birth control pills may be causing you breast cancer? Why are women still being prescribed synthetic hormones 40 years after it was first discovered they cause cancer?

Apparently it is better to let women get sick, so the system can make a buck from keeping the sick and scared and perpetually treating them.

Women who get cancer are left to fend for themselves - adrift in a sea of sales pitches, dubious tests, dangerous drugs, bombardment by threats from results of studies funded by drug companies and hospitals competing with each other for market share.

No wonder we'd rather not know we have it. It's not that we don't want to know about it blindly and without common sense. We would rather not know about it from people we don't trust, from a system flawed with the primary goal of making money, not taking care of us.

Under the present circumstances, we're better off living our lives without fear or intimidation and learning how best to prevent it even if that means staying away from the medical system!

Bioidentical Hormone Patch Shows Benefit Over Pill

Great News! Finally the WSJ reports on a study published in Circulation about the superiority of patches over pills for hormone replacement therapy when it comes to risk of blood clots. I would like to draw your attention to the extremely important fact that the patches studied contain BIOIDENTICAL hormones- estradiol specifically. An oversight by the WSJ but nevertheless the truth is finally out! Please read and send this note on to everyone you know.

Best DrErika

Hormone Patch Shows Benefit Over Pill
For Menopausal Women, Risk of Blood Clots
Depends on Form of Therapy, Research Suggests
Overcoming the Icky Factor
By TARA PARKER-POPE
February 20, 2007; Page D1

In a twist in the debate about the safety of menopause hormones, new research suggests the real problem may not be the hormone itself, but the fact that it's typically swallowed as a pill.

This week, the medical journal Circulation offers some of the strongest evidence yet that the risks of hormones are dramatically reduced when the drugs are absorbed through the skin in patches and gels rather than taken as pills. The study by French researchers showed that one of the most serious risks associated with hormone use -- blood clots -- could be virtually eliminated if women switch to a skin-delivery system like the patch. It's estimated that more than four million U.S. women use menopause hormones to relieve hot flashes and other symptoms. Although hormone drugs come in pills, patches, creams, gels and rings, the vast majority of U.S. women use the pill form.

Among the 881 women studied in the Circulation report, researchers found that women who took hormone pills were four times as likely to suffer a serious blood clot. Women who used hormone patches or gels were at no higher risk for blood clots than women who didn't take hormones at all. The research, collected from a continuing study called ESTHER (which stands for Estrogen and Thromboembolism Risk), was funded primarily by French government health agencies but also received some support from drug companies that make patch treatments. The women studied were taking either estrogen only or an estrogen-and-progestin combination.

Although hormone patches are popular among European women, the sticky, tan or clear patches aren't widely used in the U.S. The most popular brands include Climara, made by Berlex of Wayne, N.J., and Vivelle-Dot from Novogyne, a joint venture of Novartis and Noven Pharmaceuticals. Estrogen gels and creams, which are rubbed on the arms and legs, also aren't big-sellers. Part of the reason is that doctors here are simply more accustomed to prescribing hormones in pill form. Another issue is that the patches, typically worn on the abdomen or buttocks and changed once or twice a week, can irritate the skin, get dirty or collect lint around the edges. For some women, the bigger issue is that they don't want such a visible reminder of their menopause treatment.

"Many women think a pill is just easier," says Alan M. Altman, assistant clinical professor of gynecology at Harvard Medical School, who says more than 80% of his own patients use the patch. "When you wear a patch, some women feel there is a tattoo on them that says 'I'm post-menopausal.' " He has received consulting fees from hormone makers, including patch makers.

But the latest research adds to the evidence that patch or other skin-delivered therapy can dramatically reduce some of the most serious risks of menopause hormones. The Circulation study also noted that blood-clot risk varied depending on the type of progestin used, although the highest-risk types studied aren't typically used by women in the U.S. Even so, the fact that women in France had different risks depending on the type of progestin and delivery system they used signals that far more research is needed to understand the differences in the various hormones now prescribed to women.

A spokesman for Wyeth, maker of the best-selling pills Premarin and Prempro, couldn't be reached for comment on the study, which came out on a holiday. However, the company has said in the past that the main advantage of Premarin and Prempro compared with new drugs is that they are the most-studied hormones available to women.

While the evidence is strong that hormone patches lower blood-clot risks, doctors warned that the new data don't address other risks and benefits of hormones.

Several studies show that while menopause hormones relieve hot flashes and protect women's bones, they also may slightly increase risk for stroke and breast cancer. But clearly one of the most common health risks associated with hormones are blood clots, which can block blood vessels and cut off the blood supply to important organs. In the most serious cases a clot causes pulmonary embolism, which occurs when a blood clot travels to the lungs from another part of the body.

The reason hormones delivered through the skin by patch, gel or cream may cause fewer blood clots, doctors say, is that the drug doesn't have to pass through a woman's liver and instead enters the blood stream directly, much like her own natural hormones do. When a woman swallows a hormone pill, the drug must first be metabolized by the liver before it enters the blood stream. This "first pass" through the liver triggers some unwelcome side effects, stimulating the liver to produce too many triglycerides and blood-clotting factors, among other issues. The lower clotting risk of patch therapy hasn't been shown with birth control pills, likely because contraceptives use far higher doses of estrogen.

The differences in clotting risks between menopause hormone patches and pills has prompted questions about the results of another major study, the Women's Health Initiative. That much-discussed study was halted in 2002 after older women taking the combination hormone drug Prempro were found to be at higher risk for heart attacks, blood clots and strokes. Although the big concern about the WHI is that it studied older women long past menopause, another criticism is that it studied only conjugated equine estrogen pills, the most popular hormone used today, which is derived from the urine of pregnant horses. Hormone patches use 17-beta estradiol, which is a chemical match to the dominant estrogen found in premenopausal women.

Harvard professor JoAnn E. Manson, a WHI researcher who co-authored an editorial about the Circulation study, says the new data suggest that the balance of risks and benefits shown in the WHI might have been dramatically different if patches were studied instead. In the WHI estrogen and progestin study, at least 44% of the adverse events were related to blood clots, suggesting that a woman who uses a patch instead of a pill can eliminate nearly half the risks associated with the drugs, says Dr. Manson.

"If you're talking about women who are recently menopausal, the patch could be enough to very dramatically change the benefit-risk ratio," says Dr. Manson, who doesn't receive funding from any hormone makers.
While earlier studies have also shown that blood-clot risk is lower with hormone patches compared with pills, most experts say the message hasn't gotten to many doctors or women themselves. Part of the problem is that blood-clot data tend to get published in cardiology journals that may not be read by internal medicine doctors or gynecologists who typically prescribe hormone drugs.

Another problem is that no large clinical trials comparing oral, patch and other forms of hormone drugs have been conducted. Even the data from the Circulation study isn't considered conclusive because it's based on observational evidence, rather than a clinical trial where a specific treatment is studied against a placebo.

And it is too soon to say definitively that hormone patches are better than pills in every way. Because oral estrogens pass through the liver, they actually do a better job of raising a woman's good cholesterol, lowering her bad cholesterol and lowering blood sugar, suggesting there could be differences in heart and diabetes risk among pill and patch users.

"I very much would like to believe the patch is safer, but in order to know that we need better data," says Susan Hendrix, a WHI researcher and professor of obstetrics and gynecology at Wayne State University Medical School in Detroit. "Look at the numbers of women who need these therapies. ... I think there's a public outcry for the need for this kind of research."

More answers about the differences in risks and benefits of various hormone drugs and delivery systems will come from the Kronos Early Estrogen Prevention Study, or KEEPS, which is now recruiting women who are within three years of menopause. Women in the KEEPS study (www.keepstudy.org <http://www.keepstudy.org/> ) will be given different forms and types of estrogen and progestin, including patches and pills. The study, at eight major medical centers, is funded by a nonprofit institute in Phoenix. "Whether hormone therapy is in vogue or out of vogue, there will be many women with impaired quality of life who will be seeking treatment for menopause symptoms," says Dr. Manson. "We need to push for more research for women so they will have clear answers to these questions."

Write to Tara Parker-Pope at tara.parker-pope@wsj.com

http://online.wsj.com/article/SB117193377486713149.html?mod=hps_us_at_glance_health

Thank You For Your Input; Keep It Coming

Dear Friends:

            Thank you for the thousands of great suggestions you have sent in. The recommendations, ideas and thoughts you so kindly shared with me are helping the development of the on-line magazine enormously.

            We have started meeting with the content team and your input is being introduced and used to make it your magazine. The process is exciting and with your help and support I am sure we will soon create a safe, honest and kind place where women will become not only smart and powerful, but also learn to have fun in their lives.

            Please keep writing and sending me your thoughts, there is plenty of time to educate and help our creative team.

            Thank you again and have a great day!

DrErika

I Need Your Help With The Online Magazine

You are so kind to always ask for my opinion and I am so honored to answer your questions. This time I am reversing the roles.

I am now writing to ask your opinion about the Online Magazine we are planning to launch on the www.drerika.com site next month.  Your input is crucial to the success of this exciting new endeavor. My goal is to bring us together and create a strong and smart community of women who can and will change the way healthcare is delivered in our country.  So please write to me with your ideas and your thoughts on what you want to see in this new publication.

I want the online magazine to reflect and answer your questions, your needs for support and to rise above the noise by giving you my truthful and caring answer to as many of your questions as possible. No special interests and no marketing tricks.

We will create an interactive situation. But until we do, I need you to let me know where you feel the highest need is. I don’t want this magazine to pigeon hole us yet again. Not only about hormones, or menopause, or beauty or men, but rather about all that is so beautifully us: women of the year 2007.

Please write and let me know!

All the best

DrErika

A Message Of Hope And Good News For 2007

The year 2006 was highly eventful for women's health.

As a result, for the first time in many years I am fuelled by more than just my eternal optimism about the promise of a brighter, smarter and more hopeful future.

We started the year with the usual status quo on bioidentical hormones. Conventional doctors would not even consider getting informed about them as an option. Anti-depressants and birth control pills ruled.

Every time I tried to get into the media with information and requests for conventional medicine to look at bioidenticals, I hit a brick wall.

Media misses the point on Breast Cancer Decline Data

Great NEWS! In 2003 breast cancer cases in the US dropped by 7%, says a new study from the M.D. Anderson Cancer center in Houston. Headlines across the country touted this information.

The researchers believe the reason for the decline may be that millions of women abandoned their synthetic hormone replacement therapy the previous year after the Women¹s Health Initiative spotlighted the danger.

Like the warning labels on medication, this bit of information needs to be taken with caution.

The Case Against Birth Control Pills

Dear Dr. Erika,

Thank you for keeping me up on this valuable information.  I am currently taking Activella.
I have a question for you - I am concerned for my daughter who is 25 - she like many of us,
has been taking birth control for many years.  Are the hormones in birth control the same harmful
"non-bioidentical" ones used for menopause?  I would assume they must be.  How can we protect our girl's futures, as they become mothers, and older women?  My generation was the guinea pig on birth control and now on menopause.  I would like to look into the future for our daughters.

Thank you,

Betty Richards

Larry King Live!

As some of you know our recent letter to Suzanne Somers has caused quite a stir. My main motivation for writing that letter was to protect women and keep bioidentical hormones as a viable and safe option in the treatment of hormone imbalances.

I have always been very supportive of the work Suzanne has done by raising awareness of bioidentical hormones. However what concerns me most is T.S. Wiley’s dangerous protocol and its endorsement by Suzanne's most recent book.

Last night on 'Larry King Live' we had an opportunity to set the record straight and to ensure women are not misled by celebrity or become victims of uninformed or misinformed physicians.

Hopefully you caught the show and came to your own conclusions.

I'd love to hear your thoughts.

DrErika