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 numerous national 
publications. 

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. 

Erika, it's wonderful to welcome you back to Power Surge :)  


Erika Schwartz, M.D.:  Thank you, it is a pleasure to be here. 


Dearest:  Erika, have you found in your practice that since the halting
of the Women's Health Initiative Study and the uproar (rightfully so)
over synthetic hormones that women are somewhat reluctant to try even 
natural hormones? 


Erika Schwartz, M.D.:  Not necessarily.  Many women understand the difference 
between the types of hormones.  For those who don't, we make sure we 
explain.  Hormones are good for you.  When you are young, you are full of 
hormones.  You have no heart attacks, no cancer, no wrinkles.  Then you get 
older, you run out of hormones and start getting heart disease, osteoporosis 
and cancer.  So, hormones are good, the question is what to use when they 
run out.  The answer is either nothing, or naturals, never synthetics. 


Dearest:  Following up on that, let me ask you this. I've frequently heard 
the remark during discussions about natural hormones, "Hormones are 
hormones!" How would you reply to that and besides being natural, plant-
derived hormones, what are the differences between the synthetics and 
naturals?


Erika Schwartz, M.D.:  First let me answer that "Hormones are hormones!" 
comes usually from a position of ignorance.  Hormones that are made by our 
bodies are usually great if they are in balance.  If they are not, they need 
to be addressed and balanced.  

Synthetic hormone replacement therapy is not so good.  It involves the use 
of substances that are foreign to the human body and are not recognized by 
the body as its own, thus create adverse reactions- like symptoms, bleeding, 
bloating, and worse, cancer. 

Natural hormones are called bioidentical because they are molecularly 
identical to the human hormone molecules and thus are identified by the
body as their own and create no reaction, only supplementation, and 
improvement of symptoms.  The naturals do not override the human hormone 
production system.


Airthatibr:  My GYN says recent studies are now saying the cancer causing 
hormone is progestin, have you seen these studies? 


Erika Schwartz, M.D.:  I certainly have seen the studies, and they are all 
reports of the WHI study- one study. Progestin is a synthetic progesterone 
and it is a source of many problems. Unfortunately, it is not the only 
reason why women in the WHI study got more cancers.  Provera, also known as 
progestin, was 1/2 of the study.  The other 1/2 was Premarin, the synthetic 
estrogen from pregnant mare's urine.  Together, progestin and Premarin made 
a bad combination. 


YoungOldMe:  I recently heard of a friend (both of us 53) using tiny amounts 
of estradiol patches (cut to .025 mg/day) plus Progest cream for 5 days 
every 3 months. I'm using cream about 10X that dose plus daily progesterone 
(15-30 mg). What do you think about such a vast difference? 


Erika Schwartz, M.D.:  I believe that using naturals is better than using 
synthetics or nothing.  Secondly, I believe that there is a lot of confusion 
out there about dosing.  Unfortunately most physicians are not very familiar 
or knowledgeable in dosing naturals so you find a vast range of dosing.  If 
it works, keep doing it.  If it doesn't, you need to find the right dose for 
you through a physician who knows how to do it. 


Gabby:  I have not been on hormones for a very long time, but have MANY 
symptoms, anxiety, hot flashes, tired, etc. Is there anything I can take 
NATURALLY for the symptoms since I am on Xanax for anxiety and think that
it is caused by hormone imbalance. Any suggestions?


Erika Schwartz, M.D.:  Yes, you can take natural hormones.  What you probably 
took before was synthetics.  Unfortunately they only make depression and 
anxiety worse.  I would consider naturals and some supplements to balance 
your moods.


Jillian:  Hi. I am 36. I recently had a saliva test done that showed 
elevated levels of testosterone, DHEA and cortisol, which I know are stress 
hormones secreted by the adrenal glands. Is it possible that these 
particular hormone levels could be elevated by a hormonal imbalance or 
extreme stress/anxiety? I'd like to think that it could be related to that 
rather than being something more serious? :)


Erika Schwartz, M.D.:  You are most likely your best diagnostician.  Most 
likely the saliva test, which is not the end all be all of hormone testing, 
reflected the imbalance between the stress hormones-elevated and the 
probably low estrogen/progesterone/thyroid.  The way to treat the situation 
would be to balance the estrogen/progesterone/thyroid/ while working at the 
same time with the causes for your stress and finding solutions to managing 
the difficulties in your life. 


Carol:  I am 42 and had a total hysterectomy. I need to know should I have 
pap smears or ultrasounds?  Also, can HRT (estradiol) make you gain weight 
if you're on the wrong dosage?


Erika Schwartz, M.D.:  The only reason to have ultrasounds after a 
hysterectomy is if you still have ovaries.  The PAP smear also would be 
indicated only if you have the cervix left in place.  Too much estradiol 
will make you bloated.  The balance between hormones is the key to success, 
not the individual hormone. 


PeggyMM:  I have been using natural progesterone for past 3 years, after 
reading Dr. John Lee's books. Felt fine until recently. Now having periods 
twice a month, or more, and feeling TIRED.  No hot flashes or other 
symptoms. I am 47. Should I try other natural hormones or simply wait it 
out? 


Erika Schwartz, M.D.:  As I was saying, it isn't about the individual 
hormone.  It is about the balance in the hormones and your question is 
actually the case in point. 

Dr. Lee, a pioneer in natural hormones, focused unfortunately only on 
progesterone and forgot about the critical importance of estrogen in 
obtaining the balance needed to actually feel better.  That is why after
a while all the women who follow his tenets need more.  They need estrogen 
and the balance is critical.


Dearest:  For the most part, Erika, don't the over the counter natural 
progesterone creams work more in the early stages of perimenopause when 
estrogen levels are still fairly decent?  If, in fact, it does work. Never 
did for me. 


Erika Schwartz, M.D.:  Progesterone cream in over the counter preparation 
works for a short period of time in young women only.  We have spent 
millions of dollars in trying to get the over the counter progesterone to 
fulfill all our hormone needs but unfortunately they never did.  We are in 
need of estrogen and progesterone in proper doses to get balanced and it
is all about balance. 


Judi:  What do you think about using Black Cohosh when you are past 
menopause? Thank you 


Erika Schwartz, M.D.:  I am not a big fan of black cohosh.  The only data
on it, NIH supported, showed a connection between black cohosh and increased 
incidence of breast cancer.  It also is uncontrolled by the FDA so when you 
buy it you never quite know what you are getting.  My advice, if you must 
try it, do it for a short period of time,  less than 6 months. 


CampRn:  What is the best way to replace estrogen, progesterone and 
testosterone, along with thyroid replacement for Hashimoto's? I have used 
different formulations,(bi-est, progesterone and testosterone creams) and
I end up wiped out. I am currently "Hypohormone".


Erika Schwartz, M.D.:  There are a few different schools of thought.
I personally find the best success with a combination of transdermal 
estradiol, micronized progesterone, micronized testosterone and cytomel 
and/or Armour thyroid. 


Judi:  What about the use of antidepressants for post menopausal women? 


Erika Schwartz, M.D.:  I don't like to use antidepressants unless there are 
serious life threatening problems and even then I prefer to only use them 
for very brief periods of time.  I prefer to work with whole life:  diet, 
exercise, stress management,  supplements and natural hormones. 


Judi:  I am over 60 and have gone off Premarin out of fear of all the hype 
and would like to take something. I have had a hysterectomy so at this point 
don't know what to do? Thank you. 


Erika Schwartz, M.D.:  I would recommend you investigate the natural 
hormones. They work  if properly administered. 


Dearest:  I'm appalled at the number of doctors who prescribe SSRI's 
(antidepressants) and anti-seizure medications for menopausal symptoms.
I'll bet you've never prescribed these medications. 


Erika Schwartz, M.D.:  I hate to admit but I did.  That was more than 10 
years ago when I knew nothing about how it feels to have hormone imbalances.  
I would rather stop practicing than ever write for them again.  They create 
more destruction and confusion and medical problems than the problem they 
started out being prescribed for. 


Vito45:  I'm 45 and menopausal. I was put on 0.05mg Climara patch and 100 mg 
of Prometrium after 4 weeks I started bleeding heavy. I stopped both. I've 
stopped bleeding now. Should I start taking it again? 


Erika Schwartz, M.D.:  NO!  You were taking synthetics. You should take 
naturals, they are less likely to make you bleed.


Amiga2:  I am 43 and perimenopausal. Just beginning natural hormone 
replacement. How do you achieve a balanced (estrogen dose/progesterone dose) 
therapy? Are there guidelines to apply to saliva and or blood hormone test 
levels? 


Erika Schwartz, M.D.:  I use multiple criteria and am in the process of 
putting together a manual for physicians.  Unfortunately, it will take the 
manual 5 years to filter down to the public.  So, for today there are no 
criteria.  I recommend using how you feel and baseline bloods and ultrasound 
as guidelines.  Then I work with definitive dosing and my patients report 
95% success rate.     The balance is achieved very 
easily in less than 3 weeks with the protocols I have been using for more 
than 7 years on more than 15,000 women. 


Claudine1313:  For how many years is it safe to take hormones?  I started 
menopause at 33. I'm 36 now.  I have been taking them for 4 months. 
(estradiol 2.5g/day).  I have a history of "endo".   And I'm still very 
moody.


Erika Schwartz, M.D.:  Sounds like you are not taking what you need to 
eliminate the symptoms.  You need estrogen/progesterone and maybe more like 
testosterone.  You are very young and that also goes into figuring out what 
you should be on. I would also recommend some omega 3 for you.  The amount 
of time you will need the hormones for is probably indefinite because they 
are the only things between you and rapid aging. 


Sue:  How do we know if our hormones are out of whack, and how to create
the balance? What is the most reliable test especially if we have been on 
provera/estradiol for a couple of years?  My doctor is saying since I 
haven't had a period in 7 months no sense going off now, wait till a year 
and then do testing and phase out.


Erika Schwartz, M.D.:  There are no tests to determine your balance.
How you feel is the only measure of your hormone balance.


Dearest:  To find out about the different types of consultations and 
receiving a free copy of Dr. Erika's book, you can always visit 
www.naturalhormonepharmacy.com


SpiritedDove:  Is everyone given the same dosage of hormone cream and over 
time does the cream dosages need to be adjusted?  You have been a g-dsend to 
me. Thank You 


Erika Schwartz, M.D.:  Not everyone gets the same combination.  I work with 
two main combinations and we can pretty much adjust within the dose to 
everyone's needs.  Sometimes we do need to change but the beauty of how we 
do it, is that I teach you how to become aware of your own body and learn to 
adjust it yourself. 


VeeBee:  What about black cohosh, is it good or is it bad for you? I heard 
it could it could speed up the progression of cancer if you have it and are 
unaware. 


Erika Schwartz, M.D.:  You are right. Black cohosh has been linked to breast 
cancer.   Clearly I don't advice you to use it. 


Gabby:  What about a cream that contains both Progesterone and estrogen that 
they have now. Do you recommend any specific cream or supplement for a 54 
year old that at times is armed and dangerous due to menopausal symptoms 
instead of the Xanax the MD has prescribed? 


Erika Schwartz, M.D.:  Yes, I do advise you to try the natural hormones in 
combination.  I worry about so many of us becoming armed and dangerous and 
instead of making the world a better place, becoming all zombied out on 
antidepressants and sedatives. 


Dearest:  Erika, taking natural hormones may help many women, but don't we 
have to look at the total picture - about how to stay healthy as we age? 
Like exercise, supplements, how we eat, etc? 


Erika Schwartz, M.D.:  Absolutely.  My next book that is coming out in 
January 2004 is about the 30 Day Natural Hormone Plan and it involves diet, 
exercise, sleep, stress, relationships and all life plans to make our lives 
better.  Hormone balance just opens the door.  The rest is up to you. 


Leslie:  What are some of the supplements that can help balance mood 
changes, and excess stress hormones? 


Erika Schwartz, M.D.:  Omega 3, L-carnitine, Coenzyme Q 10, Lipoic acid. 


Dearest:  There's a wealth of information at www.power-surge.com/recommend.htm
On the Recommendations page - everything you need during your peri and 
postmenopausal years. 


Debrikkia:  I received my first shipment of naturals  2 weeks 
ago.  The directions said to massage into upper chest area, in a circular 
motion the size of a quarter. My "quarter" ends up the size of a silver dollar.  
That won't affect absorption will it? 


Erika Schwartz, M.D.:  It certainly won't affect anything if you get it into 
your skin.   If you are having trouble, use your inner wrists and rub them 
together.  The only thing you must do, is stay with the same area all the time.  
So choose and stick with it.


Dearest:  Does that mean Deb has a more valuable chest? :) 


Erika Schwartz, M.D.:  I am sure she does 


SuperGirl:  I have been told by my doctor that I have low thyroid levels.
Does this cause irregular periods? Because I have them too. 


Erika Schwartz, M.D.:  Yes.  Your doctor should explain to you in detail what 
low thyroid levels mean and how they translate in the way you feel.  Just 
telling you you have low thyroid doesn't really mean much in real life.
  
Irregular periods and heavy periods are often caused by low thyroid levels and 
they are usually compounded by anemia. 


SuperGirl:  She wants to put me back on Provera but I don't because it gives
me migraines. 


Erika Schwartz, M.D.:  Don't go back on provera.  Go on natural estradiol/ 
micronized progesterone and make sure you are on the proper thyroid medication 
and supplements.


Carol:  What should I do for my gynecologist check-ups since you do not 
recommend paps or ultrasounds for pt. with no ovaries or cervix?


Erika Schwartz, M.D.:  A general examination of your vagina and breast exam 
should do. You could easily have an internist care for you now.


Julianna:  I started peri in mid 30's, I am on 1.25 mg of oral bi-est and 100 
mg topical progesterone. My skin looks like I am 10 years older (I'm 41) any 
suggestions as to why? I eat healthy etc.


Erika Schwartz, M.D.:  Too much estrogen and maybe low thyroid. 


Airthatibr:  Prior to prescribing testosterone would you recommend a blood test 
for "androgens" first. At 53 I still have oily skin, wrinkles and zits as it 
is!


Erika Schwartz, M.D.:  You are lucky.  Oily skin has fewer wrinkles.   Before 
prescribing testosterone I would need to know how your overall balance is and 
what do you hope to treat with the testosterone. 


Slalinh:  I am having a terrible time getting balanced on Biest. How long does 
this usually take and does a women have to be on this regimen for the rest of 
her life?  I am 59. I want a quality of life. This yo-yo business is terrible


Erika Schwartz, M.D.:  If it takes longer than 1 month, you are not getting the 
right combination of hormones. Unfortunately I cannot predict how long anyone 
will need to stay on hormones.  It's a matter of how you feel and what you want 
to accomplish. 


Dearest:  Erika, when is a woman considered menopausal or postmenopausal?


Erika Schwartz, M.D.:  I hate labels.  I believe a woman loses her hormones kind 
of irreparably when the symptoms of hot flashes, insomnia, night sweats, weight 
changes,  mood changes, anxiety, depression and loss of sex drive and loss of 
period accumulate.  Then you should do something about it or accept that you 
will get old and sick very quickly.


Dearest:  I know you hate labels, but medically and technically, isn't a woman 
considered postmenopausal when she's been without a period for one year? 


Erika Schwartz, M.D.:  Menopause is defined as no period for 1 year.  However, 
symptoms occur most often for many years before. 


Angel52:  Good evening Dr. Schwartz. I was taking 60 E1E2 0.25/E3 2/PRO 100mg. 
twice a day for more than 2 years. They were Bio-identical. I have stopped 
because of headaches and very bad heart palpitations. What are your thoughts on 
the dosage? I feel better now except for frequent hot flashes. Thank You.


Erika Schwartz, M.D.:  You were not taking a good combination.  Too much 
progesterone and estriol.  I would revisit with a different combination if you 
would like to reconsider taking them again and would like to get rid of the hot 
flashes. 


CDenise63:  I was on Vivelle dot only and had problems. What do you suggest?  
Thank you. 


Erika Schwartz, M.D.:  You need a combination of estradiol and progesterone.  
Vivelle dot is only estradiol.  By the way, another important fact to 
understand about taking natural hormones.  You should not stay on the same 
amount forever.  Stop every few months for a couple of days and adjust the dose 
according to how you feel. If you get symptoms at night, increase it.  Tinker 
with them they follow your body. 


Sue:  If I am close to menopause (no periods for 8 months) and on HRT 
(estradiol 0.5/provera 2.5). Should I stop now or wait a bit till the suggested 
12 month period when I am technically menopausal to make a change. My doctor
is questioning whether I should change now.


Erika Schwartz, M.D.:  Stop the provera and switch to naturals.  There is 
nothing magical about being menopausal and having no period for a year.
It serves to only confuse women.  Listen to your body and your symptoms. 





Judi:  If you have had a hysterectomy, but still have your tubes and ovaries
is it necessary to have a yearly pap smear over the age of 60? 


Erika Schwartz, M.D.:  NO!  A Pap smear should not be done yearly if you've had 
three consecutive normal Paps. 


Guest393:  Would you still recommend natural estrogen for a woman with serious 
risk factors for endometrial cancer and mid-cycle bleeding? I'm 45 and taking 
progesterone, which has helped but not eliminated the problem completely. 


Erika Schwartz, M.D.:  Absolutely, as long as it is taken with the progesterone 
and you have an annual pelvic ultrasound.

 


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