Volume 4, Number 1: Spring Equinox, 2002

A Sample of Questions and Answers from Dr. J.C. Prior's July 23, 2002 Presentation at Vancouver Hospital - BC Endocrine Research Foundation

Q: Is bone loss the same thing as osteoporosis?

A: There are many stages in bone loss. Ostopenia is the lesser form, but when bone density gets really low its call osteoporosis. After menopause there is natural bone loss, and if you can prevent that bone loss you can prevent osteoporosis.

Q: When you talk about estrogen, what kind of estrogen are you talking about?

A: There are three types which the body makes. There’s estrodiol, estrone and estrogen. Estrodiol is the weakest of these three, but when I talk about estrogen in general, I am referring to all the three different types.

Q: Are there any long term benefits in taking progesterone?

A: Progesterone does increase bone formation. Taking etidronate or Fosamax helps (and the two work better together). Progesterone also helps with sore breasts as progesterone taken through the skin increases the cell turnover in the breasts.

Q: Can you use birth control pills instead of the standard treatment (of estrogen/progesterone)?

A: In menopause estrogen levels are already high and the birth control pill increases it even more.

Q: What can you do about a flagging libido?

A: That’s an extremely complicated problem to try to sort out. Most women in perimenopause simply aren’t very interested in sex, but many say that once they’ve reached menopause, they’re once again feeling more interested.

Q: What about using testosterone?

A: Testosterone gets turned into estrogen in the body, and that’s what you want to avoid. It’s known to increase hot flushes, and causes acne. We’re trying to see if progesterone can overcome testosterone induced hot flushes.

Q: Will these hot flushes ever end?

A: Hot flushes have a life of their own. Reducing stress is essential. Vitamin E is also helpful. Make sure you have maximum progesterone – prometrium at night, just before bedtime and medroxyprogesterone in the morning.

Q: You say you have three good reasons for Ovarian Hormone Therapy. What are they?

A: 1. Early or surgical menopause; 2. Osteoporosis or low bone density at menopause; 3. Persistent sleep-disturbing night sweats.

Q: Is there a safer way to take hormone therapy drugs?

A: Yes, the transdermal estrogen patch, a gel or a cream is better. Medications which must go through the liver before they get to the bloodstream increase other health risks. Because transdermal medications go directly to the blood stream, they do not impact the liver.

Q: Should I stop taking estrogen every month?

A: Yes. In a normal cycle, the body stops producing such high levels of estrogen for a few days every month, so stopping it is copying the normal cycle your body goes through.

Q: You say you don’t like the term “Hormone REPLACEMENT Therapy”? What do you call it then?

A: I want everyone to come away from the concept that we need to replace something. Menopause is a natural phase of getting older. I’d like to have it referred to as “Ovarian Hormone Therapy” – that’s the right way to talk about it. Let’s move away from the concept that we need to “medicate” menopause.

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Board Members: Dr. Keith Dawson, Dr. Jason Kong, Dr. Ehud Ur, Dr. Jerilynn Prior, Dr. Tom Elliott, Dr. Breay Paty, Dr. Sandra Sirrs

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