Dearest:  My guest tonight is Dr. Marcie Richardson, a board certified OB-GYN. Dr. 
Richardson is co-director of the Harvard Vanguard Menopause Consultation Service 
and on the advisory board of the Harvard Women's Health Watch, a monthly health 
newsletter for women. Marcie has a long-term interest in consumer education and 
has helped write many pieces for her group. 

Marcie recently helped Harvard Health Publications put out a special report, 
"Menopause; Managing the Change of Life." In practice in Massachusetts since 
1979, Marcie is not only professionally, but as a menopausal woman, is personally 
interested in the subject of menopause -- "Helping individual patients have more 
healthy lives is still my passion." 

Well, you have plenty of menopausal women you can help here, Marcie. It's great to 
have you back in Power Surge! 

Marcie, what would a menopause chat be these days without addressing the abruptly 
halted Women's Health Initiative study on the effects of HRT on women. Women 
participating in the study were written to and told to stop using the involved HRT, 
PremPro, immediately. Can you share your thoughts on why the study was halted and 
what we learned from the study? 


Dr. Marcie Richardson:  Well in a few words.... I think the study confirmed 
something many of has thought women should not be taking hormones like vitamins. 

It also showed that Prempro does not prevent heart disease in women 50-75.  However 
it did show Prempro prevents fractures and colon cancer, but suggests strongly that 
it either promotes or causes breast cancer.   But there are lots of unanswered 
questions too. 


RML:  Black Cohosh seems to be helping my hot flashes and heart palpitations but do 
I need to add HRT to help the "brain fog"? 


Dr. Marcie Richardson:  The relationship between HRT and cognitive function is 
really unclear.  Some women think it does help with cottonbrain (not a medical 
term, but you know what I mean).  You would have to try. 


Dearest:  Marcie, I just thought of something I hadn't thought of before, nor have I 
heard anyone else discuss it.  Regarding the study and Prempro, could there be 
any connection to the fact that the hormone used, Prempro, effected those results 
because it's derived from horse's urine? 


Dr. Marcie Richardson:  Well what Dearest is asking is Prempro different than other 
estrogens and the answer is yes. Do we know what these differences mean in women? NO. 


Dearest:  Thank you, Marcie. 


FlaHouseHunt:  I am 45 and a 3 year breast cancer survivor. Went into menopause, had 
very bad hot flashes, my doctor put me on 1/4 HRT patch (my cancer had not estrogen 
receptors) It worked great up until 2 months ago when I started having periods every 
2 weeks and spotting in between, should I stop the patch. This is not good for my 
sex life.  Should I schedule a visit with my doctor? 


Dr. Marcie Richardson:  You need to figure out why you are bleeding, and make sure 
there is not any build up in the lining of your uterus.  You may need to stop the 
estrogen, but definitely see your doctor. 


ListeningIn:  That cottonbrain, etc., is that mainly during perimenopause? Does the 
body balance out during post meno? 


Dr. Marcie Richardson:  I think "cottonbrain" sometimes gets better.


Dearest:  How did your menopausal patients react to the HRT controversy? Did they 
want to get off HRT immediately? And are you still prescribing HRT for your 
patients? 


Dr. Marcie Richardson:  To be honest, I always address with my patients on a yearly 
basis why they are on HRT and try to have them on the lowest dose they need. 
Also I don't use a lot of Prempro. So my patients wanted to see what I thought. 
Some came off, and many are still on. Estrogen is not poison.


ListeningIn:  So sometimes means maybe not? Does a woman just get wiser by nature as 
she ages so that cottonbrain becomes wisdom brain? 


Dr. Marcie Richardson:  I think women are always getting wiser. 


ListeningIn:  Do you recommend a vitamin while we are menopausal?


Dr. Marcie Richardson:  First I recommend you eat well - five or more fruits and 
vegetables a day. Women also need  calcium and vitamin D. (I am not a great typist). 
Beyond that I think a multivitamin can't hurt.


Dearest:  Listening, be sure to check out the Power Surge Recommendations area, 
where you will find many supplements to address your particular needs. 


FlaHouseHunt:  Back to my original question about spotting, what would cause the 
lining in the uterus to build up? 


Dr. Marcie Richardson:  Well, you have been on "unopposed estrogen" it sounds like. 


FlaHouseHunt:  What is that? 


Dr. Marcie Richardson:  Or you could have some growth in your uterus or even a 
precancerous lesion.  That's why you need to be checked out.


Guest11:  I am 48 years old. Complete hysterectomy 10 years ago. On patch since 
then. My M.D. says to remain on patch - low strength - due to my age. What do you 
think? I am totally confused as to what I should be doing.  


Dr. Marcie Richardson:  Well, it depends. I would have you try to taper the patch 
and see what your symptoms are. And it also depends how your bones are. 


MaryO:  It's no secret around Power Surge that I've had great success with Revival
Soy for over 4 years now. I feel much better than I did when I was on HRT and my 
cholesterol has gone down. Do you recommend soy to your patients? Why or why not? 


Dr. Marcie Richardson:  I do recommend soy to my patients. It doesn't work for 
everyone. 

 
Dearest:  How does soy work in both estrogenic and anti-estrogenic ways, Marcie?  
soy isoflavones, that is. 


Dr. Marcie Richardson:  Well soy has weak estrogens. So it can add a little estrogen 
to women in a low estrogen state. And it can block estrogen receptors in 
women with a high estrogen state. That's why I think it is good for 
perimenopause when hormones are all over the map. 


Dearest:  Can you explain to those who may not understand what you mean by "block 
estrogen receptors in women with a high estrogen state?" Thanks. 


Dr. Marcie Richardson:  Estrogens work on receptors - they combine with them. 
If the receptors are blocked by soy, then the estrogen itself has less effect. 


Guest11:  I have tapered my patch this summer to see if I noticed any difference. 
Nothing - to sweats or anything. But, then consulted M.D. and she recommended 
continuing it. 


Dr. Marcie Richardson:  Guest 11, you need to ask your MD why.


ListeningIn:  I heard mixing small dose of HRT with Revival is a good thing, would 
talking one femhrt pill a week be too small? Would that small a dose have any impact 
at all? 


Dr. Marcie Richardson:  I don't know. Femhrt is not very long acting. 


ListeningIn:  So maybe every 3 days?  I just am confused if I need to give it up altogether? 


Dr. Marcie Richardson:  I might take 1/2 .5 Estrace every day or every other day. 
You need to experiment and see how you feel.  One big piece of the equation when 
balancing the risks and benefits of estrogen is quality of life - how you feel. 


YoungOldMe:  I have seen recommendations for 3% progesterone cream ranging from 1/8 
teaspoon to 1/2 teaspoon per day. What would be your recommendation and why is there 
such a broad range? 


Dr. Marcie Richardson:  As for progesterone cream - it depends on the concentration 
and women absorb progesterone differently. 


Guest11:  Doctor says that estrogen has many benefits other than stopping hot 
flashes. Do you think estrogen contributes to anxiety or helps symptoms. I have 
dealt with a lot of anxiety since hysterectomy. Does hormone replacement have any 
effects on this? 


Dr. Marcie Richardson:  Estrogen has effects on mood that vary from women to woman.


AnnWolf:  I'm 50 years. old and have been on Prempro a little over a year. I have 
over a 10 lb weight gain, carrying most of the weight in my tummy (looks as though
I'm pregnant). My dad has heart disease seriously. Should I wean off the Prempro? 
My menopausal symptoms are mild now. However, I don't consider myself menopausal 
yet, have had a recent period. 


Dr. Marcie Richardson:  Well, why are you on Prempro?


AnnWolf:  I Was suffering hot flashes and was low on estrogen at my last physical. 


Dr. Marcie Richardson:  Actually it is common for women to have bleeding on Prempro. 
I often try to put women on low dose estrogen to treat hot flashes and it usually 
works.  Estrogen does not make women gain weight on the average but it seems to in 
some cases. Also many midlife women wage the battle of the bulge hormones or not. 


Dearest:  Marcie, if a premenopausal woman walks into your office, doesn't have any 
perimenopausal symptoms yet, is there anything you would recommend for her to start 
doing in order to, perhaps, make her menopause experience easier when she does 
start? 


Dr. Marcie Richardson:  I tell women about what may happen - irregular periods, hot 
flashes, vaginal dryness, and I talk to everyone about diet exercise and calcium. 


Marsa:  With what do you treat palpitations due to menopause? 


Dr. Marcie Richardson:  I think identifying triggers is a first step.  Estrogen can 
help - especially if the palpitations are part of a hot flash.  You should also 
check them out with your clinician.  But, I think they are often related to hot 
flashes. 


Guest11:  Do you automatically put hysterectomy patients on estrogen? 


Dr. Marcie Richardson:  It depends why they had the hysterectomy, whether they had 
their ovaries out (and I try to avoid taking them) and what their age and other risk 
factors are. You can't make rules about HRT. 


Guest11:  Chronic inflammation and bleeding. No cancer, but changes in cell 
structure. Ovaries and uterus removed. 


Dr. Marcie Richardson:  I would probably recommend hormones in that case.


Madge:  Can you explain why my hot flashes, night sweats, and irritable bowel 
symptoms got worse when I took soy. It's a mystery to me and Estrace brought back 
my headaches and triggered anxiety attacks, so my doc took me off. Very confusing.
I sometimes think all the DES injections I was given in the 70's to avoid miscarriages 
messed me up. 


Dr. Marcie Richardson:  Soy interacts with individuals differently.  For one thing 
we all have different bacteria in our gut and that alters the soy.  Many headaches 
are sensitive to changes in estrogen levels.  


Dearest:  And I can see where soy might irritate IBS. 


KMF:  What do you recommend for those of us who have severe symptoms such as 
migraines, heart palpitations, anxiety, to name a few. I am using estradiol 1 mg and 
have my progesterone compounded and use Revival soy. But I would like to be able to 
stop using the HRT. I think the migraines are the most troublesome, I get one every 
time my estrogen dips. 


Dr. Marcie Richardson:  I actually think if you feel better on the estrogen you may 
want to stay on it, or wean yourself very slowly.  


Dr. Marcie Richardson:  Sometimes migraines are better on HRT and sometimes not. 


Dearest:  Do the migraines get worse when on the hormones?


KMF:  No, they are better, but still there, varies month to month. 


Dearest:  I see. Well, many women aren't aware of the benefits of magnesium
in treating migraines -- 500 mg. at the first sign of a migraine (or even a headache).
They say, "If it spasms, give it magnesium." That can work for migraines AND palpitations.
You can check the Power Surge Recommendations pages for more info.
I also recommend  Charlotte Libov's transcript about her book, Migraines: 50 Essential Things To Do. 


ListeningIn:  Please, any advice on insomnia and wacked out sleep patterns?.  


Dr. Marcie Richardson:  I suggest a book... Say Goodnight to Insomnia.  You need 
good sleep habits and the book discusses them. 

I have been using a drug called Neurontin, and the antidepressant Trazadone can also 
help some women, but you need to find a clinician who knows about menopause and 
sleep. 


Dearest:  Also, check out Dr. Alex Lukeman's transcript,  author of Sleep Well, Sleep Deep: 
How Sleeping Well Can Change Your Life. 

Here's also a helpful article on  menopausal insomnia in this
newsletter (click here) and I'd recommend visiting the Message Boards where
there's an active forum on Insomnia / Sleep Disorders.


Marcie, you mention Neurontin. That's an anti-seizure drug, isn't it? 


Dr. Marcie Richardson:  Yes, and it is not approved for this use, but it helps my 
patients in low doses. 


Dearest:  As a mood stabilizer? 


Dr. Marcie Richardson:  Yes - it is used for pain syndromes. 


Dearest:  Thank you. 


SturdyWoman:  My hormones are all very low, I'm 47 and having trouble with anxiety, 
insomnia, and frequent periods. I'm looking for a new doctor right now & would like 
your advice on where to start on symptoms? 


Dr. Marcie Richardson:  Are you exercising, and practicing good health habits (no 
smoking, eating well)? 


SturdyWoman:  Yes! 


Dr. Marcie Richardson:  Birth control pills are also sometimes very helpful for 
women in perimenopause with irregular periods. 


SturdyWoman:  Tried them they don't help.


Dr. Marcie Richardson:  Sturdywoman - you're on the right track looking for a new 
doctor.


Dearest:  Marcie, do you hear many women complain of internal shaking / tremor-like 
feelings inside? What do you attribute those to? 



Dr. Marcie Richardson:  Dearest, women experience an incredible variety of sensations- 
foot pain is what I have been hearing about this week? And many of them we don't 
know why, including hot flashes. 


YoungOldMe:  When should we take calcium - with meals or on an empty stomach? 


Dr. Marcie Richardson:  Depends on the kind of calcium. 


YoungOldMe:  Liquid CA citrate with Magnesium. 


Dr. Marcie Richardson:  Citrate is OK any time.  But you only can take 500-600 mg of 
calcium at a time.  


Dearest:  And you must take vitamin D with it for proper absorption of the calcium. 


YoungOldMe:  Thanks!


Sherry1:  Hysterectomy one year ago, on Vivelle Dot. I lost libido completely, tried 
progesterone cream but didn't help.  Also having thyroid problems since my 
hysterectomy. How do I get libido back? 


Dr. Marcie Richardson:  Libido is a problem. Did you have your ovaries out? 


Sherry1:  Yes 


Dr. Marcie Richardson:  You may need testosterone.  I think soy is good for peri.


Dearest:  Marcie, how much testosterone does the average <if there's any such thing> 
peri-postmenopausal woman need. I've heard Dr. Susan Rako say that Estratest has 
too much testosterone for women. 


Dr. Marcie Richardson:  The ovaries make testosterone, and testosterone is related 
to libido. I don't like Estratest either. 


Dearest:  She says even the Estratest HS has too much testosterone. 
(HS being half strength)


Dr. Marcie Richardson:  I start with .5 mg daily if I am using methyl testosterone, 
but there are other options, and you need to find a doctor familiar with them.  


NestAway:  I have been taking Revival, black cohosh, and dong quai and have tamed 
almost all the symptoms except I still have uncontrollable RAGE that seems to occur 
whenever I skip or have a really long span between my periods. Any suggestions? 


Dr. Marcie Richardson:  Well, my main suggestion for rage would be exercise or 
counseling to try to sort out if it is hormonal or not. 


NestAway:  OK, thanks 


Dearest: There's an excellent message board with many women experiencing the same
thing as you, NestAway. It's the Mood Swings / Anger / Rage board. 


Dearest:  Marcie, don't we sometimes forget that everything is connected - that just 
because we're going thru menopause all our moods, anger, rage, depression -- isn't 
necessarily attributable to menopause? 


Dr. Marcie Richardson:  I agree - I think menopause can be a trigger for bringing 
out other issues in ourselves or our lives. 


KMF:  I also get pulsing in my head -- heart pulsing. An ENT was the only one I 
came in contact with that knew this was related to estrogen decrease (due to the 
congestion it causes). HRT has not lessened this enough and have to take Ambien to 
fall asleep. Once asleep, I'm all right. Have you any experience with this pulsing? 
Suggestions?


Dr. Marcie Richardson:  No. If you think estrogen made some difference, I would 
experiment with other estrogens or different doses.


Marsa:  Have you used Catapress for menopausal symptoms? If so, which symptoms does 
it help? 


Dr. Marcie Richardson:  Catapress works about 50% of the time for hot flashes but 
people have side effects. If you want a prescription non-estrogen drug I recommend 
Prozac, Paxil, Effexor or Neurontin. (Dearest note: Please see the transcripts of
Psychiatrist, Stuart Shipko, M.D.)


Kerry:  I have very bad foot pain, is this a symptom also? I had X-rays and was told 
nothing is wrong. 


Dr. Marcie Richardson:  Just as I said earlier, I have had a few women complain of 
foot pain recently.


Kerry:  Anything I can do to help it, Thanks! Just to hear other women have it too, 
Misery loves company!!


Dearest: Kerry, read the Power Surge Joint Aches & Pains Message Board. You'll find many women 
complaining of foot pain, joint aches and pains.


Starr1:  Is soy a good alternative to HRT for anxiety? If so how much? 


Dr. Marcie Richardson:  Soy can help with hot flashes - I recommend Nina Shandler's 
book Estrogen the Natural Way. 




Dearest:  Nina Shandler was also a guest in Power Surge. You can read her transcript 
here -- in the Library. 


Dr. Marcie Richardson:  Soy probably doesn't do much for vaginal dryness. It may 
help prevent heart disease, uncertain if it helps bones.  Doses are not in my head. 



Dearest: Revival Soy has helped my vaginal dryness since 
June of '98.


Criket:  I am post-menopausal. I am on estradiol and Prometrium and am having hair 
loss. I also have metaplasia of the vulva due to lack of estrogen. Does this ever go 
away? Also, minor bladder leakage. Estrogen helps that. Do you think hair loss is 
from HRT? I would like to stop it but think the metaplasia and leakage will be 
worse. Have had thyroid testing done and it turned out okay. Am really concerned 
about hair loss. Can you recommend a doctor in the Chicago area? 


Dr. Marcie Richardson:  The hair loss question comes up often, and I just don't 
know.  I have said that other times... hormones and hair are related, and my 
mother's hair dresser said it was going off estrogen that made her lose hair.

It does take 60 days to have an effect on hair. And there are other things that can 
cause hair loss.  Look on the web site of the North American Menopause Society. 
Menopause.org. 


Dearest:  I have a great deal of info on hair loss on Power Surge :) 
Or anyone can E.mail me and I'll point them to the right places. 


MarcyS:  When taking testosterone, do you need to use it for a while to get results 
for loss of Libido? 


Dr. Marcie Richardson:  Yes, I think it takes a couple of months sometimes. 


Chamonix:  Excess hair growth. Any natural way to lessen -- medications? 


Dr. Marcie Richardson:  Excess hair is sometimes genetic, and sometimes due to 
hormone imbalance. I recommend you see an endocrinologist, or gyn endocrinologist. 


Dearest:  Marcie, thanks for joining us tonight to field our questions about 
menopause and related midlife issues.  



Read another transcript with Dr. Marcie Richardson, Dr. Susan Love and 
Power Surge Founder, Alice Stamm
Read Dr. Marcie Richardson's first transcript



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aka Alice Stamm
Power Surge
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