Dearest:  Erika Schwartz, M.D. is a healthcare pioneer, a woman's physician, a 
researcher and expert on all things hormonal. Dr. Schwartz is the author of
two books, "Natural Energy," and "The Hormone Solution." She has appeared on
TV shows like The View and has been quoted in Newsweek, Vogue, The Wall Street 
Journal, USA Today and Self Magazine, fielding questions about hormones and 
stress, hormones and aging, hormones and the life  cycle.

Montefiore Medical Center sponsored and aired a four-year television program 
produced and hosted by Dr. Schwartz, Health Horizons, the first program in
the greater metropolitan NY area directed at bridging the information gap 
between physicians and patients.

Dr. Schwartz has a true passion and commitment to empower and educate women
to be the healthiest they can be. She's been practicing medicine for over
20 years, specializes in women's health and founded the International Hormone 
Institute to research and educate the public about natural hormones which is 
currently conducting a study, in conjunction with HEALTH Magazine, on natural 
hormone therapy.

Dr. Erika also founded the Natural Hormone Pharmacy to fill the needs of women 
using natural hormones.

Dr. Erika, welcome back to Power Surge :) 


Dearest:  Erika, so, we've had another stunning (?) revelation about combination 
"synthetic" HRT in that it's not only NOT protective against dementia, as we 
were told in the past, but that it actually precipitates dementia. Can you 
share your thoughts on this, please?


Erika Schwartz, M.D.:  Sure, my pleasure.  The revelation is nothing new. 
The WHI study, the one that was stopped in July 2002, the study that was 
conducted by the NIH and sponsored by Wyeth pharmaceuticals (the manufacturer 
of synthetic hormones, Prempro and Premarin) had a small portion (2000 women) 
who were above 60 years of age who filled out a questionnaire at the beginning 
of the study 6 years ago on their mental state- the results were tabulated and 
they revealed that the women on Prempro had a 2:1 chance of getting dementia 
and progression to Alzheimer's vis-a-vis placebo.  Terrible facts but no news 
since the data that said that Prempro protected from dementia, never really 
existed. 


Dearest:  I have a feeling there will be plenty of news to follow. Thanks, Dr. 
Erika :) 


Leslieananda:  Many doctors disagree on whether or not to take any type of 
progesterone if you've had a total hysterectomy. Some say it is not needed; 
some say it is imperative. What are your views?


Erika Schwartz, M.D.:  More will come out as the WHI study results get
analyzed in depth. I believe that progesterone is key to total hormonal health 
just because you no longer have your uterus does not mean you don't have 
progesterone receptors on all other organ cells so unequivocally you should 
take progesterone. 


Dearest:  Erika, wasn't it the "old school" thought that after hysterectomy, 
progesterone wasn't needed? Isn't it thought today that balancing the hormones 
is important, despite whether a woman has had a hysterectomy or not? 


Erika Schwartz, M.D.:  Absolutely Dearest.  The old school did not realize that
hormones work in combinations and it is their balance that produces desirable 
or untoward effects, not the individual hormone. 


Dearest:  Thank you, Erika. Just out of curiosity, have you had many women sign 
up for your study, in conjunction with HEALTH Magazine, on natural hormones? 


Erika Schwartz, M.D.:  We are doing well. But we need more women for the 
placebo and natural hormone combo part of the study.


HSpec:  Is gastrointestinal distress a common occurrence during perimenopause? 
I have changed my diet, been to the doctor and as far as I can tell there is no 
other reason that I can come up with. the distress tents to occur when I should 
be getting a period and instead have a phantom period.  Thank you. 


Erika Schwartz, M.D.:  Not unusual at all.  Many women experience changes in 
their digestion and increased gas and intestinal irritation a diet change to 
remove coffee, spicy food and alcohol will be helpful.  Also, eating late at 
night will worsen the situation. 


CindyTree:  My ob/gyn has had me on a 10% compounded natural progesterone
cream (twice daily) for almost two years, but I can't tell any difference
in using it. My periods have become increasingly irregular despite using it.
I have just about every perimenopausal symptom on the list. I'm 46. What
should the progesterone be doing for me and should I feel/see a difference?
I'm tired of feeling lousy but am not sure what else to do. Help!  


Erika Schwartz, M.D.:  It is in response to the enormous need I find and the 
little availability women have to doctors who know how to prescribe the 
hormones.You need a combination of estradiol and micronized progesterone the 
reason you are not better is because you are not getting the right hormone 
combination take advantage of my free consultation and I am sure I can get you 
feeling much better in no time. 


Bray9946:  I had a hysterectomy in February. My doctor said there was no need 
to do any hormone testing because my ovaries haven't been working for 2 years, 
as I haven't had a period. I feel I need something and had saliva hormone 
testing done. I haven't gotten the results yet. I am 52 with no uterus and no 
ovaries. Any ideas on what I might need? Also, he started me on Synthroid for 
hypothyroidism. I just got a new prescription for Amour. Is that better in your 
opinion? Thanks. 


Erika Schwartz, M.D.:  You need estradiol and progesterone at a minimum.  
Armour is OK for some but I find many women do not react enough to it.  I 
prefer cytomel for thyroid problems in menopause. 


Sbhamee:  I am starting to have hot flashes I think not sure, what can I
take that is natural and won't harm me? I'm in perimenopause and I don't
take hormones. I haven't had a period for 3 months. I'm 49. 


Erika Schwartz, M.D.:  Natural hormones are bioidentical.  They look like your 
own body's hormones and they are not harmful.  They are the best bet for your 
symptoms. 


Pat50:  I was on estratest 11 years. I am worried about problems for being on 
it so long like their showing with other HRTs? Had a hysterectomy 11 years
ago at 40. I am now using natural progesterone.  


Erika Schwartz, M.D.:  Pat, you need estradiol in addition to progesterone. 


Leslieananda:  I've read of some individuals hormonal imbalances alleviated
by a rare trace mineral, Indium. Indium appears to provide enhancement to
the master hormone producers, the pituitary and hypothalamus glands. Also,
it is believed that an increase of Indium triggers the body's uptake of "good" 
metals: copper, chromium, manganese, and zinc. Have you studied Indium or
have any comments on this? 


Erika Schwartz, M.D.:  I read most reliable scientific information on hormones 
and Indium does not appear in the literature I am familiar with. 


Jane25:  I know there have been studies on how dangerous synthetic hormones 
are.  Have there been studies done on natural one's and if so what are the 
conclusions?


Erika Schwartz, M.D.:  Natural hormones have been studied in small studies 
since 1986.  All the data has been consistently positive.  A portion of the 
PEPI trials which was a governmental study studied natural progesterone and 
found that it protects form heart disease. 


Mariah:  I am a 56 year old woman who had a hysterectomy at the age of 32. 
About 6 months ago my MD told me to stop taking Premarin because of the
hormone scare and history of breast cancer in my family.  Was this a good 
decision to make at my age?


Erika Schwartz, M.D.:  Your physician isn't really helping you. You don't need 
synthetic HRT but you do need hormones to feel good and stay young. You need 
natural hormones. 


Jimi:  Firstly, Thank you for my copy of the hormone solution from your
last visit to PS.  I have read it from cover to cover. I was using
naturally compounded progesterone creme but found it caused depression
so I have stopped.  


Erika Schwartz, M.D.:  Progesterone alone will cause depression. You need 
estradiol with it. 


Jimi:  I  am now using nothing and feeling great.


Erika Schwartz, M.D.:  Then do stay on nothing but just know you have options.  
IF it works for you, it would be fine. 


Pat50:  Would tri-est 1.25mg/ml cream be fine along with the natural 
progesterone cream. 


Erika Schwartz, M.D.:  If you feel well on it, it is.


Dearest:  Are there any circumstances or "time of life" under which you'd 
recommend a woman using natural hormones on an "as needed" basis? 


Erika Schwartz, M.D.:  Always. 


Dearest:  Do you want to elaborate, Erika?  Re the "always". 


Erika Schwartz, M.D.:  I believe you should take all medications and vitamins 
or supplements only as needed meaning if they help you take them, if you
aren't sure, stop and see how you feel. 


Dearest:  Why do you prefer the "transdermal cream" delivery of natural 
hormones instead of one of the other delivery systems, such as pills,
gels, patches. 


Erika Schwartz, M.D.:  Transdermal creams are absorbed the best into your blood 
stream, they are easily tolerated, they protect your liver and they are user 
friendly if they are standardized in unit dose like the ones provided by the 
Natural Hormone Pharmacy.  


Kataneena:  Would you agree that taking the lowest dose of HRT to alleviate 
symptoms is wise, and would having osteoporosis be reason enough to up your 
estrogen dose?


Erika Schwartz, M.D.:  I agree that using the lowest dose is the best as long 
as it works. Osteoporosis should be treated with hormones and exercise.


Bray9946:  Is soy (Revival) bad for you if you are hypothyroid? 


Erika Schwartz, M.D.:  Soy in moderation is fine.  It won't help your thyroid 
or harm it if you only use soy in moderation.  It helps with symptoms of 
hormone imbalance for a while. 


Jane25:  I haven't had a period since last Sept. I was starting to feel 
horrible. Mostly not sleeping and sweats at night keeping me awake. I found
a link on this site for natural Progesterone Cream. I have used it for 2 months 
and honestly got relief within a week. I am thrilled!


Erika Schwartz, M.D.:  I am thrilled for you.  As long as it works keep taking 
it.  When you need more come to me and I will add estradiol to your regimen
and make you feel even better. 


Dearest:  Don't you think over the counter natural progesterone creams only 
work in the early stages of perimenopause when a woman still has a decent 
amount of estrogen?  If, in fact, it does work then. 


Erika Schwartz, M.D.:  Absolutely correct as usual, Dearest OTC progesterone is 
fine for a while when you are making enough hormones on your own and just
need a little help when you get into more depletion, you need prescription 
combinations that's where I come in. 


Leslieananda:  Because of a hysterectomy and losing your parts, is it "natural" 
to have a your abdomen change shape into a buddha type belly when you were 
previously thin? GA :-) 


Erika Schwartz, M.D.:  Not uncommon but not necessary.  Lack of hormone balance 
will get you the buddha belly.  What you need is to send it to the buddha and 
take some natural hormones, exercise and get rid of it. 


Dearest:  I had abdominal surgery last year and have experienced the same thing 
after never having a stomach, Leslie. 


Fran:  I am 41 years old and have had experiencing hair loss for a year now. 
I have lost 75% of my hair and recently a doctor did blood work and my 
progesterone level is .05 and my FSH level is 35. I was given a "troche" for 
Progesterone 1.75mg and Triest 1.75mg will this help me. I am at my wits end.
I just started this two days ago. 


Erika Schwartz, M.D.:  Not surprising unfortunately.  It might help, but it 
sounds like you need more estradiol then the contents of Triest and maybe some 
thyroid too. 



Jimi:  What are your thoughts on troches as opposed to cremes?  Also is it 
usual to feel better once you are post - over the hill so to speak? 


Erika Schwartz, M.D.:  I prefer creams because they are smoother.  Their 
absorption more predictable and they create better blood levels then troches.  
I believe some people get better in time, while others need significant 
hormonal support for a long time.  It depends on what you are looking for. 


Dearest:  I prefer to refer to postmenopausal women as over the "hump" but 
hardly over the hill :) 


Erika Schwartz, M.D.:  Agreed. 


Naenae:  My doctor prescribed Premarin and progesterone for hot flashes
just this week. No period in 2 years and 50.  What naturally would you
have prescribed?  I'm still flashing after 4 days. 


Dearest:  Premarin - say no! 


Erika Schwartz, M.D.:  Your doctor needs to read up on HRT.  I would prescribe 
estradiol and micronized progesterone and can actually do it for you if you 
call me.


Dearest:  Erika, who funded the studies that yielded the "unexpected" results 
of the women's health initiative study on synthetic hormones causing heart 
disease, breast cancer, etc.
And now dementia? 


Erika Schwartz, M.D.:  Wyeth pharmaceuticals, the manufacturer of Premarin and 
Prempro and our government (the NIH) took the money and did the study without 
looking at any other options for the millions of women desperately needing 
help! 


Dearest:  Can you explain to the women who may be interested how your study
on natural hormones works in case they're interested in signing up?


Erika Schwartz, M.D.:  We randomly assign women to either get a combination of 
natural hormones in cream form for three months or they get placebo for three 
months at the end of the study, we compile the results and publish them. 


Kataneena:  Would having osteoporosis be reason enough to up one's estrogen 
dose? You once told me to quit running because of my osteoporosis.


Erika Schwartz, M.D.:  Muscle strength building and flexibility training are 
the best for osteoporosis. I would not increase estrogen without increasing 
progesterone. 


Pat50:  I just found out that I have high number on my liver SGPT/ALT (Liver 
enzyme function test) of 121. could being on estratest for 11 years have 
anything to do with that. I also have a problem with cholesterol 250. I am
51 and I am 5 foot 8 inches and weigh 136 lbs. so I don't have a weight 
problem.  Cholesterol is hereditary.


Erika Schwartz, M.D.:  Estratest could do liver damage. That is one of the 
reasons I work with creams, they protect the liver.  Cholesterol goes down on 
natural estradiol and micronized progesterone. 


Dearest:  Not only that, but Estratest is known to have too much testosterone 
for a woman, even the half strength Estratest. 


Christine413:  Dr. Erica, I am weaning myself off HRT, by September I should
be completely off, I will start using my natural progesterone cream 
immediately, what is the advisable dosage and when in my cycle should I start 
using it and for how long?  I was on Premarin and Medroxyprogesterone the last 
12 days of the month.


Erika Schwartz, M.D.:  Why are you taking so much time to go off the poisons?  
You need to switch now to estradiol and micronized progesterone.  Don't wait. 


Christine413:  I have started, that is why I am here.


Erika Schwartz, M.D.:  Good.


BarbiLynn:  Dr. Erika, do you believe it is safe for a woman that has had 
breast cancer (5 years ago) to take natural hormones?  I haven't had a period 
since my chemotherapy.


Erika Schwartz, M.D.:  There's no reason not to take natural hormones
if you had cancer.  Just make sure you take progesterone with it. 


ASRubin:  Do natural hormones help with vaginal dryness? 


Erika Schwartz, M.D.:  Absolutely yes! 


Debrikkia:  Do you ever prescribe testosterone in combination with estradiol 
and micronized progesterone in your natural hormones? If not, why? 


Erika Schwartz, M.D.:  I do prescribe lots of testosterone.  I prescribe it 
separately and it is applied to the clitoris and outside the vagina. It works 
great to improve lubrication, increase libido and make you feel good in 
general. 


Debrikkia:  I think I need to change my natural hormones!! Thanks.


Kataneena:  You keep recommending estradiol, what about bi-est that is mostly 
estriol?


Erika Schwartz, M.D.:  I don't work with biest because many women do not react 
well to estriol.  Estriol is the estrogen of pregnancy and many women do not 
feel so great when they are pregnant. 


Christine413:  Dr. Erica, what should I do now? In the weaning process. 


Erika Schwartz, M.D.:  Get the naturals and then discontinue the synthetics 
over one week. 


Dearest:  Christine, you'll find a comprehensive article on weaning off HRT
at http://www.power-surge.com/educate/weanoffhrt.htm. It also includes 
comments by Dr. Erika along with others.

Is not using estriol part of your philosophy of "keeping it simple?" 


Erika Schwartz, M.D.:  Yes. I use Estradiol, not estriol.  
Estriol complicates things. 


BarbiLynn:  Have you worked with many breast cancer patients?


Erika Schwartz, M.D.:  Yes, I have worked with all too many women who have
been unfortunate enough to have breast cancer. 


Christine413:  Dr. Erica, I am leaving for vacation tomorrow any suggestions on 
this weaning process until I get back in a week.


Erika Schwartz, M.D.:  I am not sure I know what exactly you are doing now? 


Christine413:  So should I just use the progesterone cream, and how much?


Erika Schwartz, M.D.:  No, use estradiol and progesterone.  Progesterone alone 
will not cut it for you.





Kataneena:  What do you mean by "not react well to estriol". In what way?


Erika Schwartz, M.D.:  Bloating, irritability, palpitations.


Dearest:  Erika, thank you for another very informative chat about natural 
hormones for treating menopause.  I also recommend Dr. Erika Schwartz's book, 
"The Hormone Solution." 


Erika Schwartz, M.D.:  Thank you for having me join you.

  
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