Having dedicated her life to eradicating breast cancer and educating patients on women's health issues, Dr. Love is one of the founders and a board member of the National Breast Cancer Coalition, and was appointed by President Clinton to the National Cancer Advisory Board. She is an Adjunct Professor of Surgery at UCLA and the Medical Director of the Santa Barbara Breast Cancer Institute, a nonprofit organization. She is the author of Dr. Susan Love's Breast Book and Dr. Susan Love's Hormone Book. Dr. Love lives in Pacific Palisades with her partner, Helen, their daughter, one dog and two cats.

The proper role of HRT

Sue:
As a well known breast surgeon and strong women's health advocate, how do you address the many concerns women have, particularly those associated with breast cancer, about taking an estrogen product to relieve hot flashes, mood swings etc... and other noted signs of perimenopause and menopause?

Dr.Love:
As most women know from Dr Susan Love's Hormone Book and my website, I do not espouse HRT for everyone.

There are two different reasons to consider HRT one is for symptom relief and the other is for prevention.

• Symptom Relief
  The symptoms of perimenopause, hot flashes, mood swings etc..., are transient and are actually not caused by low estrogen but by the fluctuations in hormones that occur as the ovaries are gearing down. They are really puberty in reverse and as in puberty they last about two to three years. Hormone use for this short period of time appears to be safe. After three years a woman might well want to taper off the hormones gradually over 6-9 months.
• Prevention:
  The other reason to consider HRT is long term use for prevention. We know that estrogen can slow bone loss and this is one of the reasons that women might consider it. There are many alternatives to estrogen for osteoporosis prevention, however. These include most importantly calcium, vitamin D, and exercise (aerobic and weight training). fosamax is as good as estrogen at stopping bone loss and calcitonin is another option. Evista has some benefits for the bones as well although it is not as good as fosamax or estrogen (3% improvement in bone density versus 8-10% for the others).

HRT & heart disease
Finally there is data that starting estrogen at a low dose (3mg) at age 70 may be just as good as taking it from age 50 on.

The benefits of estrogen for heart disease is more iffy. Most of the data has been observational...meaning that they look at women who are on hormones for whatever reason and compare them to women not on hormones. The women on hormones have less heart disease but are also more likely to go to the doctors, treat their high cholesterol, exercise and eat a good diet. It is not clear whether hormones make you healthy or healthy women take hormones.

The most recent study was randomized and looked at women who had heart disease. It showed no benefit of taking HRT. luckily there are alternatives here as well. Certainly diet, exercise, and quit smoking are good first steps. The statins which are used to lower cholesterol have been shown in randomized controlled studies to prevent deaths from heart disease so they are a much surer bet. The data for Alzheimer's and other diseases is even less proven.

HRT & Breast Cancer:
Finally there is growing data to support the notion that HRT causes breast cancer if taken long enough. The study last week demonstrated an 8% per year increase in breast cancer for women on premarin and provera. Again short term use is probably okay but taking hormones for 10-20 years comes with a definite risk.

Estrogen & Breast Cancer Survivors

Sue:
What options does a woman, who has survive breast cancer, have when she faces hot flashes, sleeplessness etc... when she hits perimenopause/menopause? Is she a candidate for estrogen?

Dr.Love:
For all of the reasons I mentioned above I would be very reluctant to let a woman who has had breast cancer take HRT.

All of the risk factors for breast cancer involve estrogen and progesterone. The newer approaches to treatment are all aimed at blocking estrogen. Luckily there are many alternatives.

The best is soy protein which has been shown in a randomized controlled study to reduce hot flashes. It also helps fuzzy thinking and vaginal dryness. Melatonin is good for sleep. Acupunture has been shown to help flashes as well.

Soy & Perimenopause/Menopause

Sue:
What do you think the role of soy is for women in perimenopause and menopause?

Dr.Love:
I think that soy protein is the natural SERM (selective estrogen receptor modulator). It lowers cholesterol and seems to be benefitcial for the heart. It is okay for bone (sort of like Evista) but it decreases hot flashes and fuzzy thinking while not stimulating the uterus or the breast. Like anything it should not be over done. It is important to use soy portien and not isoflavone pills which have not actually been studied. Either eat more soy in your diet or take one of the soy proteins Try soy protein (not the isoflavone pills) either by eating more soy or using one of the protein powders. Although there has been some concern for women with breast cancer, the preliminary data would indicate that it is safe.
from Dr. Love on Black Cohosh

Sue:
You have been very open and honest about your own perimenopause experience. What if anything have you learned about yourself through this experience?

Dr.Love:
I think the worse part of being perimenopausal is the unpredictability of it all.

I had a spate of two months of very heavy bleeding and went to a gynecologist thinking that it would last forever. She told me I needed a hysterectomy but I couldn't fit it in my schedule. Lucky for me. Those were the only two months of heavy bleeding I have had. I would have had a hysterectomy unnecessarily. Likewise I would like to know how long these flashes will last. I can tolerate them for six months or even a year...it's not knowing that makes it difficult.

Sue:
Thank you Dr. Love for taking the time to be with us today. We agree with you wholeheartedly, that the Internet is a wonderful place for women to learn from and help each other.

Essay by Dr. Love - Making the diagnosis

Breast Cancer Beyond Convention:
Complementary and Alternative Medicine
by Mary Tagliaraferri, M. D., L.Ac., et al
hosted by Sue Spataro, RN, BSN
As advances in breast cancer research move forward, more treatment options are available than ever before, which is great news -- but how can you determine the course of action that is right for you? Mary Tagliaferri, M.D., L.Ac., is one of the founders of the Complementary and Alternative Medicine Program at the University of California. In this interview, we explore with Mary how her book is different than many books on breast cancer and how her personal journey shaped her views. In addition, we have an FREE excerpt of the book from noted author Dr. Susan Love which provides with an extensive FREE guide helping you to understand breast cancer, see how different forms of treatment can help, and most importantly how to assemble the right group of people to help you.

Breast self exam
The instructions are simple and come with illustrations. Please take a look and print out a copy for yourself. You are worth it. Make a copy for your best friend, your mom and your sister. Put it into a card and tell them how much you care about them. Do it, before it’s too late.

more Breast Cancer Books
more Women's Health Books
FREE Breast Cancer Awareness articles

Interview with author
Linda Ojeda
more Healthy Living Books

Personal Massager with Heat

more Spa & Wellness

The Menopause Cookbook:
How to Eat Now and for the Rest of Your Life
by Hope Ricciotti, Vincent Connelly, Carol B. Ricciotti

also see
Sue's Meno & Soy Recipes
Susan Love, M.D., author of Susan Love's Hormone Book and Dr. Susan Love's Breast Book says:
This is a wonderful guide to cooking with phytoestrogens. Although the book is titled The Menopause Cookbook, the whole family will enjoy these recipes which answer the oft-repeated question: How do you cook with tofu and flaxseed?

How much is enough soy?
Soy and its powerful components called isoflavones have been given credit for reducing hot flashes to preventing heart disease to lowering cholesterol levels.   Isoflavones are phytoestrogens, plant based estrogens.  They have been shown to help lower the risk of many human diseases, particularly those that are hormone related.
How much is enough to get the long touted soy health benefits? Find out more.

Faqs All About Soy Isoflavones and Women's Health
by Victoria Dolby, Jack Challem

also see:
The Joy of Soy
FREE recipes & more
This series of compact volumes answers the FAQs (frequently asked questions) about the major nutritional supplements making headlines today. How a traditional Asian soy-based diet decreases menopausal symptoms is just one of the topics covered in this book.

HotFlash FAQ:
How can birth control pills help symptoms of perimenopause?
There is a whole new group of BCPs like Loestrin that were created especially for women over 35 years of age.  Not only do they function to help with the often disruptive symptoms of perimenopause, they work as an effective means of birth control.  They contain just enough estrogen and progesterone to prevent pregnancies and help with perimenopause. Find out more.

Estrogen & Breast Cancer
Stephanie Bender, MA, the author of Power of Perimenopause says about the risk of breast cancer in women taking estrogen, "We consider how the woman is feeling and what her risk of developing long term disease is- like osteoporosis and heart disease. There are many estrogen products and they can be used in very small doses to give women good results."
Estrogen & Cancer?

Estrogen Therapy & Cancer Risk
by Sue Spataro, RN, BSN
The National Cancer Institute published the results of their hormone replacement study on January 26,2000.   This study, Menopausal Estrogen and Estrogen-Progestin Replacement Therapy and Breast Cancer Risk, caused quite a stir in the medical community and sent a shock wave through women taking or considering taking any form of HRT (hormone replacement therapy).

• How much is real and how much is hype.
• If you do take hormones, should you stop?
• How big is the risk?
• Find out more