(Dr. Susan Love's First visit to Power Surge)

Official Transcript

Copyright 2001 America Online, Inc.

OnlineHost:	Dr. Susan Love has entered the room.

OnlineHost:	Dearest has entered the room.
 
 
OnlineHost:	Dr. Susan Love's Breast Book changed the way
women thought about breast cancer and helped launch a political 
movement. Now the famous doctor, author, and advocate takes on 
menopause with her new  "Dr. Susan Love's Hormone Book : 
Making Informed Choices About Menopause." As 20 million 
baby boomers (including herself) rush headlong into this period 
of change, Power Surge and America Online are proud to introduce 
Dr. Susan Love.
 
Dearest:  Dr. Love, it's my pleasure to welcome you to this expanded 
edition of Power Surge in an AOL Live auditorium.


Dr. Susan Love:	Thank you. It is a pleasure to be here


Dearest:  Let me begin by asking you -- are women being told the truth 
about hormone replacement therapy today?


Dr. Susan Love:	I think women are being told only part of the truth. We only hear 
what is good about HRT and nothing about its risks. Sometimes I think it is 
just wishful thinking.  We wish it will work and be safe , so we think if we wish 
hard enough it will be. The problem is that we haven't proven that it is good for 
prevention.  And we don't yet know what all the risks will be.  It is still an 
experiment.

 
Dearest:  Before we get to the queue, let me ask you, what about natural
hormones. Women are being told *natural* is okay. What are your thoughts 
on natural hormones like Estrace, estradial, etc?


Dr. Susan Love: The word natural is used in many ways.  It either means more 
like the hormone your own body makes, or it means not made in a laboratory.
The problem is that most of the "natural hormones" are natural premenopausally, 
and not postmenopausally. It is not natural to have progesterone postmenopausally 
for example. It is not natural to have estriol or estradiol postmenopausally.  So I 
really don't know what natural means.  The risks are the same. The first question 
is whether to take hormones and then what flavor?


Dearest:  Thank you, Dr. Love.


Question: Dr. Love, I have fibrocystic breasts.  Does this condition predispose me to 
breast cancer?
 

Dr. Susan Love:	No. Fibrocystic disease is a garbage term for lumpy painful breasts. It does 
not increase the risk of cancer in most cases. There is one condition which is only 
diagnosed microscopically that may increase risk.  This is called atypical hyperplasia...
it doesn't cause lumps or pain and is rare.


Dearest:  Dr. Love, isn't it true that women have to take HRT for ten years before it is 
effective in preventing heart disease?


Dr. Susan Love:	You have to be on HRT for it to have any effeect.  That means you have to 
be on it when you have your heart attack. In addition you have to be on it for it to 
help yourbones and you have to be on it to increase your breast cancer risk 
(about 5-10 years at least) Some people are starting to suggest that we take it 
briefly if we need it around menopause and then taper off.  then we look at the 
situation again when we are in our late 60's. If you start at 68 or 69 your bone 
density at 80 is almost the same as if you had started and you will be on it 
for your heart attack (74) and the breast cancer won't  come until your 80's.


Dearest:  Thank you, Dr. Love.


Question:   I started menstrating at age 14.  Does it mean I will start to menopause
 early?


Dr. Susan Love:	Not necessarily...It depends on alot of factors.


Question:  Please address the matter of progesterone and its effect on women
with a history and/or diagnosis of depression.


Dr. Susan Love:	There are some women who find that provera increases depression
There is less of an effect with progesterone (the "natural stuff)... It is always hard 
to know what is the cause but if someone feels that a drug is making them feel 
bad they should stop taking it.


Dearest:   Dr. Love, what are your thoughts on OTC (over the counter) hormones,
such as DHEA?


Dr. Susan Love:	I am quite worried about DHEA. We have very little scientific data about 
what it does and what the risks are I have seen some suggestion that it will increase 
breast cancer. I think we have to be careful of jumping on bandwagons. If it sounds 
too good to be true it probably is.


Question:   What are the signs of menopause?


Dr. Susan Love:	You have made me chuckle. The signs are as varied as women are.
Basically menopause is puberty in reverse and so the symptoms are similar mood 
swings, sore breasts, PMS to the max, hot flashes, heavy bleeding, acne... you name 
it and some woman has had it, but it is important to realize that one third of women 
have no symptoms at all,  and another third do not have enough symptoms to need 
a treatment.


Dearest:   Why do you suppose Premarin has dominated the market since its
inception in the 1940's?


Dr. Susan Love:	Good question. The drug company,  Wyeth Ayerst, have spent a lot of 
money making sure it will. They advertise strongly to the doctors, they fund studies 
and supply the drug then the doctors say "well in the study they used Premarin so I
better too," and they spend alot of money preventing a generic version.


Dearest:  What about all the equine hormones and chemicals... are they good
for women's bodies, and	do women's bodies even know how to translate such 
hormones?


Dr. Susan Love:	This is the big question. We don't know what it is that has an effect but 
horse estrogens are not natural. Sometimes I think it is the soy that we feed the 
horses that is the real benefit.


Question:   I am 49 and experiencing bleeding most of the month. My doctor has
suggested a hysterectomy.....I am not thrilled with that idea.  Any suggestions?


Dr. Susan Love:	One out of three women in this country have had a hysterectomy by
age 60. This is much higher than in Europe and is due to our medical system
which pays doctors to operate. You should get a second opinion and shop around
there are several good ways to treat heavy bleeding and fibroids	short of a 
hysterectomy.
 

Question:  Is it unusual for a woman going through menapause to have increased
sexual desires?


Dr. Susan Love:	Some women have increased sexual desires and others have decreases
both are normal...menopause is a time of rebalancing and as the hormones
fluctuate they often give a variety of symptoms.


Question:   Do you feel having had a radical mastectomy at age 42 was the cause
of my having almost immediate menopausal symptoms and having my last period 
within 15 months?
 

Dr. Susan Love:	Sometimes a shock will bring on menopause often chemotherapy will 
induce menopause prematurely and finally Tamoxifen will sometimes cause 
menopause in some women.  Any of thesecould be the culprit, but the good news is 
that it may help. Before the days of chemotherapy we used to treat premenopausal 
women with breast cancer by out their ovaries.  It worked almost as well as 
chemotherapy. Breast cancer doesn't grow as well without estrogen and 
progesterone.


Dearest:  Dr. Love, why aren't women cautioned that drugs like Provera cause
increased LDL (the 'bad' cholesterol and hypertension.. and put them at risk for
heart disease and stroke?


Dr. Susan Love:	Provera was added to the mix to counteract the uterine cancer caused
by giving estrogen alone.  Funny though we pretend that it only affects the uterus 
and no other organs...In fact it counter acts many of the good effects of estrogen.
Progesterone is probably a better choice but it is not readily available and most 
doctors are not familiar with it.


Dearest:  Thank you :)  If you're in or approaching menopause, be sure to read, 
 "Dr. Susan Love's Hormone Book : Making Informed Choices About Menopause 


Question:  How do you address the issue of getting free of hormone therapy after 
a total hysterectomy 6 years ago, I am 47 years old and have been on 2mg estrace for 
that long;  is it possible to do it gradually?


Dr. Susan Love:	Absolutely!!!  what you want to do is very slowly taper off over six to nine 
months or even longer.  If you stop abruptly you will get symptoms. Monitor your body 
and drop to one half a pill every other day alternating with one and if you feel ok after 
a month or two go to one half every day and so on you can't do yourself any harm and 
will feel better this way.


Question:  Is a major depression part of menopause for most women?


Dr. Susan Love:	No most women do not have major depression it is a difficult time with 
kids grown and parents dying etc and that doesn't help.  Nonetheless the studies 
have not shown an increase in major depression. I also think that women who 
get depressed post partum may also have difficulty with menopause.


Dearest:  You talk in your book (The Dr. Susan Love Hormone Book. Random 
House, 1997) of the about the "scare tactics" the pharmaceutical industry is 
levelling at women in menopause - all the baby boomers. Can you elaborate, 
please?


Dr. Susan Love:	 They have us all feeling that once we hjit 50 we will immediately have a 
heart attack or hip fracture.  Menopause is called a disease that needs treatment
It is normal...women have been going through menopause forever (and yes we are 
supposed to live this long).  There may be reasons for some women to take hormones 
for symptoms relief or even if they have a disease, but the notion of taking a drug for 
30 years as prevention when there are other ways to prevent diseases, is crazy in my 
book.  If you quit smoking, eat well and exercise you can decrease heart disease 90% 
and not have the additional risk of breast cancer.
 

Dearest:   Yes, it's normal, but I can see all the women of Power Surge out
there saying they never felt worse in their lives! How to deal with the symptoms if 
HRT isn't recommended?


Dr. Susan Love:	There are many ways including increasing the amount of soy and
flaxseed in your diet which will reduce symptoms and help prevent heart disease.
You can try herbs, acupuncture is good for hot flashes, there are many ways to deal 
with the symptoms...and for those women who are really suffering they can take 
hormones 	for three to five years and then taper off.  the symptoms are transient 
and go away once our hormones are rebalanced.


 Question:  I am a husband and want to educate myself better about female
menopause--any suggestions?
 

 Dr. Susan Love:  Sure, talk to your wife and read. I know of at least one good
book you could try!!!  


Dearest:  Haha!


Dr. Susan Love:  I should have said listen to your wife rather than talk to her.


Question:  Do you still advise against estrogen with breast cancer?


Dr. Susan Love:  I am very worried about the growing use of estrogen in women who 
have had breast cancer.  we know that all of the risk factors for breast cancer 
have to do with estrogen and progesterone and in the test tube breast cancer 
will not grow without estrogen.  We really do not know how it works but i think 
the risk of a recurrence or of a second cancer far outweighs any benefit.


Question:  What are the downside risks of having a hysteroctomy?


Dr. Susan Love:	I don't believe in taking out any body parts unless it is absolutely
necessary the ovaries do not stop functioning with menopause but keep on
making hormones well into our eighties.  we are startin to see research that the
uterus may have a postmenopausal function as well.  Women who have had a
hysterectomy have more heart disease, more osteoporosis than women who 
do not.


Dearest:   Dr. Love, what are your thoughts on Fosomax for osteoporosis?


Dr. Susan Love:	Fosomax is a great drug for women who have had a fracture or have
very very	low bone density.  It hasn't been around that long and I would be
careful about using it for prevention.  I hear of some women who have had breast 
cancer and the gyn says  "you can't take estrogen so here is fosomax"  that is crazy. 
Most of us will not get osteoporosis (it is probably genetic) and can strengthen our 
bones with exercise and weight training, calcium and vitamin D.


Dearest:   Bless you for your forthrightness, Dr. Love :)


Question: Dr. Love, Are you aware of any connection between migraines and early
menopause?  Particularly, headaches that happen monthly during the menstrual
cycle?


Dr. Susan Love:	Yup, migraines are definitely hormonal. Some women have them 
premenopausally and they stop with menopause and others	get them with 
perimenopause (I am in the latter group). They are probably related to the 
hormonal variations and should leave once the symptoms and hormones settle 
down.  If they are really bad you can try horomones as an experiment and see if it 
helps.


Question: How come our mothers never had any problems without HRT, my mom is
75 and never had any HRT, and she was fine, why this new idea?


Dr. Susan Love:	Because there are big bucks to be made. Premarin is the biggest selling 
drug in America and the baby boomers	are just starting to reach menopause...just 
imagine if they can convince us all to take Premarin for thirty years...it boggles the 
mind!!!


Dearest:  Amazing when you think the entire country is in menopause. 


Question:  Hi Dr. Love, as a hormone- triggered migraine patient, can I look
forward to menopause for relief from migraines??


Dr. Susan Love:	Yes, they should stop as long as you do not take HRT.


Question:   Is vitamin E safe for hot flashes for someone with estrogen
positive breast cancer.


Dr. Susan Love:	Hard question to answer. I think it is but there is some data in
one study which contradicted that.  I would try other things first but I would
certainly try Vitamin E before I would consider estrogen.  soy is good too...it acts 
like Tamoxifen and seems to prevent breast cancer even in ER positive women. 
By the way there are now at least one and maybe two other Estrogen receptors in
breast cancer that we didn't know about so even women who think they are 
negative may  actually be positive. 


Dearest:   And women who've had a history of hypertension must remember to
 talk with their doctors before taking vitamin E, yes?


Dr. Susan Love:	Absolutely, we are much too cavalier about vitamins in this country.


Dearest:   Dr. Love, on behalf of Power Surge, Thrive on AOL, I'd like to thank you 
for spending this time with us. Your book is wonderful, full of information, and women
everywhere are very grateful for your work!


Dearest:  Thank you :)  If you're in or approaching menopause, be sure to read, 
 "Dr. Susan Love's Hormone Book : Making Informed Choices About Menopause 
(Random House. 1997)


Dearest:   Good night, everyone. Thanks for coming :)


THRVeem: Thank you Dr. Love! You're fantastic!


Dr. Susan Love:	 It has been a pleasure!!!  I am off to eat my tofu :)


Dearest:  It's been our pleasure. Enjoy your tofu :)



Read Susan Love's second transcript
Read Susan Love's third transcript
Read/Listen to Susan Love's fourth transcript
 with Dr. Love, Dr. Marcie Richardson and Dearest



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Dearest
aka Alice Stamm
Power Surge
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