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Nov 30

Hormone Headlines May Be Confusing!

You may have noticed startling headlines recently stating “Hormone Therapy Not Recommended” and “Hormone Therapy Not for Prevention of Chronic Conditions.”  The US Preventive Services Task Force (USPSTF) recently posted recommendations on the use of menopausal hormone therapy for the prevention of chronic conditions including cancer, cardiovascular disease, cognition and osteoporosis. Unfortunately, the succinct headlines and incomplete reporting methods surrounding the topic by media may easily be misconstrued by patients and practitioners alike --- feeding the confusion that already surrounds hormone therapy.  To clarify, this document by the USPSTF states two recommendations pertaining to postmenopausal women over the age of 50 who are considering the use of hormone therapy for the primary prevention of chronic medical conditions, not those who are considering hormone therapy for the management of menopausal symptoms.  To those practitioners well versed in hormone balancing, these recommendations are not new, as they are largely based on the Women’s Health Initiative (WHI) study from 10 years ago:

  1. The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women.
  2. The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy.

What these recommendations don’t address is the use of progesterone for prevention of chronic medical conditions. Unfortunately, people perusing the internet or viewing their nightly news programs will see only “Hormone Therapy Not Recommended; Gov’t task force warns against long-term treatment.”  As a provider specializing in hormone balancing, my role as teacher is a crucial one as I educate my patients on the benefits of hormone replacement.   Long term hormone therapy can certainly be effective in reducing the risk and incidence of chronic disease, however the type of hormone used, the dosage, the combination with other hormones and the route of administration all matter.  It's all about balance! Important points to consider are:

  • Progesterone is not the same as progestin
  • Progesterone has protective effects to the uterine lining
  • When used with estrogen, progesterone has not demonstrated an increased incidence of breast cancer (unlike combined estrogen and progestin [synthetic hormone] therapy)
  • Progesterone use by women has been associated with a decreased risk of:
  • Estrogen dependent cancers including breast cancer
  • Cardiovascular disease
  • Osteoporosis
  • Alzheimer's disease
  • The WHI study used oral estrogens.  Topical administration of estrogen has been shown to have significantly reduced cardiovascular risks.
  • Over ½ of all postmenopausal women in the US report having used some form of hormone therapy.  

It is my job to serve as an essential resource for patients in what can be a confusing journey.  

Fournier A et al. Breast Cancer Risk in Relation to Different Types of Hormone Replacement Therapy in the E3N-EPIC Cohort. Int J Cancer (2005); 114(3):448-54.
Holtorf K. The bio-identical hormone debate: are bio-identical hormones (estradiol, estriol, progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine. 2009; 121(1): 1-13.
Fitzpatrick LA, Pace C, Witta B. Comparison of regimens containing oral micronized progesterone or medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J womens Health Gend Based Med. 2000;9(4):381-387.
Menon DV, Vongpatanasin W.  Effects of transdermal estrogen replacement therapy on cardiovascular risk factors. Treat Endocrinol. 2006;5(1):37-51.
Vongpatanasin W, Tuncel M, Wang Z, Arbique D, Mehrad B, Jialal I.  Differential effects of oral versus transdermal estrogen replacement therapy on C-reactive protein in postmenopausal women.  J Am Coll Cardiol. 2003 Apr 16;41(8):1358-63.
Abbas A, Fadel PJ, Wang Z, Arbique D, Jialal I, Vongpatanasin W.  Contrasting effects of oral versus transdermal estrogen on serum amyloid A (SAA) and high-density lipoprotein-SAA in postmenopausal women.  Arterioscler Thromb Vasc Biol. 2004 Oct;24(10):e164-7.
Shifren JL, Rifai N, Desindes S, McIlwain M, Doros G, Mazer NA. A comparison of the short-term effects of oral conjugated equine estrogens versus transdermal estradiol on C-reactive protein, other serum markers of inflammation, and other hepatic proteins in naturally menopausal women.  J Clin Endocrinol Metab. 2008 May;93(5):1702-10. Epub 2008 Feb 26.


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Nov 18

How to Talk to Your Teen About Marijuana

Surrounding states have legalized marijuana in recent years. There's a popular belief that marijuana poses no danger and is now acceptable in our society. Some of my patients have voiced their concerns about it to me recently. I came across a couple of articles focused on talking to teens about marijuana and wanted to pass this information on to you. Educating our teens and providing support can reduce the likelihood that they will abuse cannabis, or try any other dangerous substance. This is not a topic where a one-time conversation will do. This is a conversation that needs to be repeated especially during the pre-teen and teenage years. Because the brain does not fully mature until the age of 25, young people are more likely to engage in risky behavior, including cannabis use. Cannabis use in adolescence, when the brain is undergoing critical development, may have neurotoxic effects. Research reveals that cannabis use in teens affects:

  • Cognition and IQ
  • Working memory
  • Spatial memory
  • Growth
  • Cortisol production and secretion patterns
  • Neurotransmitter secretion patterns
  • Mood and motivation
  • Cancer risk
  • Propensity to try other drugs

Help your teen(s) sort fact from fiction: Start early. You want your message to be there ahead of the other messages they are going to be getting. Begin the conversation by asking, “Okay, so tell me what you know about marijuana”. Let your child talk, uninterrupted, until they tell you all they know. If some of their information is incorrect, before supplying them with the correct information, ask them the following questions:

  • "I'm curious how you got that idea about marijuana?"
  • "I hear you saying that marijuana isn't that bad for you because John said it's legal, but where do you think he's getting that information?"
  • "I know a lot of people think that marijuana isn't as bad for you as alcohol but there's a bit more to it than that. I think we should talk about it."

Let your kids know you are with them every step of the way:
What do I do if I am tempted?

  • Make it very clear to your kids that you are always open to talking to them at a moment's notice if they feel pressured or tempted to say 'yes' to marijuana.
  • Let them know that if they are at a party or a friend's house and marijuana is present, they can call you to be picked up regardless of the time or day.
  • Also, while you may think your child knows how you feel about using marijuana, make sure to express what your expectations are around substance use while they are teenagers.
  • You can tell your child, "We expect you not to use any substances because we know how harmful they can be to your health. If something comes up and you need help, we're here for you no matter what."

Suggested responses to temptation:

  • "Nah, I'm trying to quit." (then change the subject)
  • "My parents can smell that stuff a mile away. They'd kill me, dude."
  • "I've got so much to do tomorrow (sports event, studying, musical show). Can't do it."

Talking to your child about marijuana use doesn’t have to be a scary or intimidating experience. Greater communication can create a stronger bond between parent and child; one that brings mutual trust and respect.

References: Hiatt K. Talking to Teens About Marijuana--9 Dos and Dont's. US News & World Report Health. Accessibility verified 9/7/2016
Marijuana: Facts Parents Need to Know. NIH: National Institute on Drug Abuse. Accessibility verified 9/6/2016

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