Women's Health Issues

Episode 203

In this episode our guest was Dr. Shera Raisen. Dr. Raisen is a board certified Family Practice physician who provides Western and complementary holistic medical care to the whole family. She earned her M.D. at Mount Sinai Medical School in New York City and completed a residency program in Family Practice in Los Angeles.

Dr. Raisen practices Integrative medicine, which is really a marriage of Eastern medical ideas (from Chinese medicine and Ayurveda) and conventional Western medicine. As we both agree, this is a great example for what medicine could be and hopefully is a model for what modern medicine will become in the future.

We discussed some common women's health issues and barely scratched the surface on a lot of this because its such a vast area. She is incredibly knowledgeable and had some great insights to offer. Here's a recap of some of the issues we took a look at:

Heart Disease:

Heart disease is the number one killer of women over the age of 25. In fact, t is the cause of death in twice the number of women than all varieties of cancer combined. One in ten American women ages 45 to 64 has some form of
heart disease. That increases to one in five for women over age 65.

Here's a rundown of risk factors:

Unchangeable Risk Factors- * Being age 55 or older * Having a family history of early heart disease

Changeable Risk Factors- * Cigarette smoking * High blood pressure * High blood cholesterol * Overweight * Physical inactivity * Diabetes

Don't Do This

Hormone Replacement Therapy:

Until 2002 HRT was the standard treatment for menopausal symptoms. t also appeared to protect women from osteoporosis and heart disease. hen the National Institutes of Health discovered there were more health risks than benefits for women. Prempro (a combo estrogen-progestin therapy) increased he risk of heart disease, breast cancer, stroke, blood clots and dementia; and it didn't improve the menopausal symptoms for many women.

The rate of breast ancers was 26% higher among those receiving HRT as opposed to those getting placebo. The rate for heart disease was 29% higher. Stroke rates ere 41% higher, and blood clot rates were more than twice as high in those getting HRT. Premarin (estrogen alone) as less risky, but still increased the risk of stroke.

Dr. Raisen uses low dose "bio-identical" hormones (those closest resembling human hormones vs. others made from the urine of female horses) because they are closest to a women's own hormones. She also recommended a Chinese herb called Man Jing Zi (Vitex) which can be quite effective for hot flashes. I often use some modification of a formula called Zhi Bai Di Huang Wan which is a kindey tonic, but also clears heat from the body.

Birth Control Pills that Completely Suppress Menstruation:

The development of the new birth control pill, Anya (also marketed under the name Lybrel),has instigated a hot debate over the topic of menstrual suppression. Dr. raisen pointed out that this is really nothing new, doctors have used this techniques for many years. They simply substitute actual hormones for the placebo pills that are taken around the time of your period. By doing this the period is eliminated.

Supporters believe that Anya will offer women more freedom and choice when it comes to their reproductive selves. Instead of being tied down to a harsh 13-period-a-year schedule, Anya allows women to experience life without that monthly curse. Researchers also note that Anya may actually have many health benefits , helping to prevent anemia, migraines, ovarian cancer.

Many women balk at the idea of having no more menstrual periods. Some believe that Anya only propagates the historical belief that menstruation is messy, wrong, and immoral. Researchers also worry about the long-term health effects that Anya may have on women. The menstrual period has been shown to wash away bacteria from inside the reproductive tract, and also helps the body to get rid of excess iron, which can help lower a woman’s risk factor for cardiovascular disease.

The suppression of menstruation may also interfere with breast and bone development as well as long-term fertility. For example, Depo-Provera, which also suppresses the menstrual cycle, has been found to cause irreversible bone loss, so Anya may be found to do the same.

In addition, the daily, nonstop use of the potent estrogen in the birth control pills designed to do away with menstrual periods results in a woman’s having LESS AVAILABLE NATURAL TESTOSTERONE in her body. The consequences of this state of testosterone deficiency can be subtle to severe. One thing that women taking pills to do away with their periods notice is that they have significantly less interest in making love, and experience less pleasure in sex.

PMS

Breast Tenderness

Caffeine can make it worse, vitamin E may help, in TCM (Traditional Chinese Medicine ) we use liver formulas, esp. Xiao Yao San.

Abdominal Bloating

Aldosterone, a hormone that regulates levels of sodium and potassium in the body may be the cause. There is often an upswing of this hormone after a woman ovulates.

The surprise remedy for abdominal bloating is to drink up to 8 glasses of water a day. Reduce salt intake. IN TCM we use: Chai Hu Shu Gan San. Digestive herbs and liver harmonizing herbs. For example: fresh ginger or tangerine peel.

Mood Swings, Irritability, Anxiety

These premenstrual symptoms are related to changing levels of brain chemicals called endorphins. Endorphins are the “feel good” hormones that contribute to cheerful moods and make people less sensitive to pain. Scientists believe the natural ups and downs of female hormones can affect your endorphins and, in turn, can affect your moods.

So what can you do to get those endorphins pumping? Exercise can be beneficial, relaxation techniques, laughter (see our Laughter Yoga episode, Episode 111), EFT , Emotional Freedom Therapy (check out that episode too, Episode 108) . In TCM we use the same formula: Xioa Yao San, Jia Wei Xiao Yao San-Secara makes a great formula called Herbal Stress Relief that is a modification of Xiao Yao San.

Food Cravings/Weight Gain

High-fat or sweet foods are a quick way to raise the level of serotonin, a brain chemical that affects your mood. Instead of eating processed carbs like chips and cookies try to eat complex carbohydrates, which include whole grain bread, pasta, cereal, sunflower seeds, peanut butter and plain yogurt. These foods can help you feel good, and they’re good for you.

Cramping

Many women turn to over-the-counter drugs like naproxen to reduce the pain of cramps. A hotwater bottle or heating pad is a time-honored remedy. Stretching may help. In TCM we use Blood moving formulas: Most famous is Tong Jing Wan. It is very effective, in some cases can eliminate painful periods all together.

Back pain- same as cramping. Try acupuncture (or cold laser) or massage. Also good with TCM blood moving formulas.

Acne-Many dermatologists also believe that birth control pills can help some women with acne by regulating their estrogen levels. If acne is part of your PMS profile, you should also make sure you bring it up to your regular doctor to see if birth control pills could help.

Naturally, it’s always important to maintain a good skin care regimen. Just remember that if you scrub your face too long and more than 2 or 3 times a day, you will dry out your skin. This causes the oil glands to overcompensate and produce too much oil, causing you to break out. (Check out Episode 202, we visited with a great TCM dermatologist)

Headaches-Premenstrual headaches, just like any headache, respond well to good old-fashioned aspirin, or acetaminophen. Or if you don't like to use medication, give acupuncture or laser therapy a try. You can also drink more water.

Migraine headaches are another story. These are intense, long lasting and debilitating headaches that may involve visual disturbances, nausea and increased sensitivity to noise and light. Many women have migraines a couple of days before and sometimes during their periods. These are some of the most difficult issues to treat in the clinic and can often require multiple angles of attack.

HPV Vaccine:

In 2006, the FDA approved use in girls/women ages 9-26years. The vaccine is given in a series of 3 shots given over 6 months. Cost $350-450. Some states are considering making it a mandatory vaccine by law. New Hampshire and Alaska offer the vaccine free on a voluntary basis.

HPV stands for Human Papillomavirus. There are over 100 viruses, which cause benign tumors and warts. The vaccine protects against 4 types that are responsible for 70% of cervical cancers and 90% of genital warts.

HPV is the most common sexually transmitted disease, with 20 million Americans currently infected. Half of those infected are young adults, ages of 15-24 years. 80% of women will become infected by the time they are 50 years old.

Here are some of the issues from those who oppose the widespread use of this vaccine.

1) GARDASIL is a vaccine for 4 strains of the human papillomavirus (HPV), two strains that are strongly associated (and probably cause) genital warts and two strains that are typically associated (and may cause) cervical cancer. About 90% of people with genital warts show exposure to one of the two HPV strains strongly suspected to cause genital warts. About 70% of women with cervical cancer show exposure to one of the other two HPV strains that the vaccine is designed to confer resistance to.

2) HPV is a sexually communicable (not an infectious) virus. When you consider all strains of HPV, over 70% of sexually active males and females have been exposed. A condom helps a lot (70% less likely to get it), but has not been shown to stop transmission in all cases (only one study of 82 college girls who self-reported about condom use has been done). For
the vast majority of women, exposure to HPV strains (even the four bad ones” protected for in GARDASIL) results in no known health complications of any kind.

3) Cervical cancer is not a deadly nor prevalent cancer in the US or any other first world nation. Cervical cancer rates have declined sharply over the last 30 years and are still declining. Cervical cancer accounts for less than 1% of of all female cancer cases and deaths in the US. Cervical cancer is typically very treatable and the prognosis for a healthy outcome is good. The typical exceptions to this case are old women, women who are already unhealthy and women who don’t get pap smears until after the cancer has existed for many years.

4) Because the tests included just four years of follow up at most, the long term effects and efficacy of this vaccine are completely unknown for anyone. All but the shortest term effects are completely unknown for little girls. Considering the tiny size of youngster study, the data about the shortest terms side effects for girls are also dubious.

5) GARDASIL is the most expensive vaccine ever marketed. It requires three vaccinations at $120 a pop for a total price tag of $360. It is expected to be Merck’s biggest cash cow of this and the next decade.

To summarize, this vaccine was just approved in June, 2006. It was never tested on pre-teens except in a tiny trial run with at most 18 months of follow up. Even if we subscribe to the theory that HPV causes cervical cancer, there is ZERO hard data showing that this vaccine reduces cervical cancer rates or cervical cancer mortality rates, which are both already very low in the US and getting lower every year.

As usual, so much great information, so little time.

Your Intrepid Host,

Marc