Q & A with Dr. Judith Reichman continued
Q: What is your opinion about natural progesterone vs. synthetic progestins?
A: I deal with it quite a bit in the book, but what I basically say is that the PEPI Study has shown that some of the benefits that estrogen gives women, as far as raising the HDL and lowering the LDL is somewhat diminished with the synthetic progestin. But, the natural progesterone doesn't have that same adverse effect.
Additionally, women who sometimes get PMS or headaches or breast tenderness on the synthetic progestin--feel better with the natural progesterone. One that is on the market, and FDA approved, is Prometrium.
Q: Is testosterone beneficial for women over 60?
A: First of all, if a woman has a complaint of low libido and she's on hormone replacement therapy; chances are that her testosterone is low. We check free testosterone because that's the testosterone that has the effect on libido.
We know that if they're on hormone replacement therapy, what happens is estrogen causes an increase in the protein that binds up male hormone. So, on the one hand you're giving estrogen and that makes the vagina more lubricated and sex more comfortable.
But, the estrogen is causing a decrease in the free testosterone. And that's why women will sometimes take HRT and say, 'Oh, this is great. Sex doesn't hurt anymore, but I don't feel like having it.' And those are women that would benefit probably by adding on very small amounts of testosterone. There is a product that combines estrogen with testosterone and that's called Estratest.
Now, if a woman is not on hormone replacement, but she's six years menopausal or more--with time, her ovaries make less and less testosterone. She too might benefit from testosterone. But, I hesitate to give it without estrogen because estrogen has a beneficial effect on our lipids--testosterone many have a slightly non-beneficial effect.
So, if I give them together I sort of feel like I am canceling it out. Also, if a woman is not on estrogen and she's menopausal, I question her as to whether there is vaginal dryness and some of her lowered libido is because she hurts when she has sex. If something hurts, you don't want to do it.
Now in some of my patients-- especially those who have had breast cancer-- what I may do is give them an estrogen ring (Estring). That builds up the vaginal mucousa, and then let them add on testosterone either as an ointment or lozenge under the tongue, and that has to be made by a compounding pharmacy.
Q: What is a good free testosterone level?
A: It depends on the lab. The doctor has to look at what the norms are for the lab. So I hate to give you a number because each lab has its own scale.
Q: Are monthly breast self-exams and mammograms still important over 60?
A: Monthly breast self exam, and annual mammogram should be done in women over sixty. Actually, the older we are the higher our risk of developing breast cancer.
Q: Is there anything else that you feel it's important for women over 60 to understand?
A: In my intro (to her book), I talked about the fact that we are often made to feel useless, and not powerful, and somehow in a lessened position when we turn 65. Maybe part of that is because we go on Medicare. But, our sixties are still viable, wonderful years--and so can our seventies be. And there is something called aging, in my book I talked about how you can eat with the ability to continue a significant part of what you have been doing with your life.
What I don't want women to think is any new symptom, any complaint, can be simply dismissed with the phrase, 'Well, you're getting older what do you expect.' I think that what we have to expect is that our symptoms will be taken seriously by our physicians, and that appropriate testing be performed if we do have symptoms to figure out what the underlying problem is, and what can be done, if anything, about it. I don't like the fact that we tend, in our society, to both reject and neglect women as they get older.
Want to know more about women's health over 60, as well as during each decade of a woman's life? Read Dr. Reichman's latest book, "Relax This Won't Hurt: Painless Answers to Women's Most Pressing Health Questions."
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