1. Does hormone replacement therapy (HRT) cause cancer?

Most experts believe the answer is NO. Estrogen may be a weak stimulator of breast cancer that is already present. There are obviously other important factors, including genetics and diet, in whether or not women get breast cancer. Some studies show an increase in breast cancer for women on estrogen, while other studies show no change, or a decrease. In the studies that do show an increase, it is probably about 1 case per 100 women per 10 years. Several studies suggest that women who develop breast cancer on estrogen therapy actually have a higher cure rate than women not on hormones. It is also important to know that women on estrogen and progesterone have a lower risk of uterine cancer, and women on estrogen seem to have a decreased risk of colon cancer. As with any medical therapy, the benefits of therapy must be weighed against the risks. To put things in perspective, it must be remembered that the combination of breast cancer, ovarian cancer, and uterine cancer are responsible for 7-8% of female deaths each year. Osteoporosis is responsible for 6-8% of female deaths per year, and cardiovascular (heart) disease is responsible for 40-45% of female deaths.

2. How can I improve my sex drive ? Is there a medication I can take?

Libido, or sex drive, is regulated by a complicated interaction between the brain and sex hormones. It is largely determined by the individual's past history and relationships with parents and peers, and by one's beliefs about sexuality. The capacity for arousal is moderated by sex hormones.

The first thing a couple should do if libido is diminished is to sit down and discuss their sexual relationship, including activities that enhance arousal. If sexual problems are severe, counseling or psychotherapy may be necessary.

There are a couple of medications (prescription and non prescription) that will sometimes enhance libido. We would be happy to discuss these with our patients.

3. What are the health benefits of birth control pills?

In addition to being a safe and effective form of birth control, birth control pills (oral contraceptives) have many non-contraceptive benefits. First of all, women on the pill have lighter, more regular, and less painful periods. They also have less ovarian cysts, fewer problems with fibroid tumors of the uterus, a lower rate of pelvic infection, as well as a lower rate of ovarian cancer in later life. "The pill" may also improve mood changes some women experience each month before their period.

4. How long can I take birth control pills?

Most experts now feel that there is no absolute age at which women should definitely stop birth control pills, especially if they contain low dosages of hormones used in modern pills. If you smoke, you should not take the pill after age 35 due to a definite increased risk of heart attack. Especially if you need continued birth control, many experts now feel that, as long as you don't have any risk factors, you can safely take the pill up to age 55. The pill will commonly prevent a lot of the bleeding problems many women experience before menopause.

5. Tell me about IUD's (IntraUterine Device)

IUD's are a very safe, effective form of birth control. They are especially suited to women who have had children, who don't want to take a pill everyday, and who are not ready for a permanent method of birth control. The currently available IUD's are as effective as tubal ligation (above 99%). They are very safe when used in properly selected patients. IUD's are not as commonly used in this country as other countries, mainly due to problems associated with on older IUD that is no longer available. The IUD has the highest satisfaction rate of any form of birth control - around 94-97% of women who use an IUD are pleased with this form of birth control. A new IUD that has recently become available in this country has the added benefit of reducing or completely stopping menstrual blood flow in up to 80% of patients.

6. When should I have my cholesterol checked?

Heart disease remains the leading cause of death in women in this country. The incidence increases after menopause. Cardiovascular screening in asymptomatic women consists mainly of assessing risk factors followed by counseling aimed at decreasing risks. Risk factors for heart disease includes elevated cholesterol, diabetes (high blood sugar), and hypertension (high blood pressure). Lifestyle factors that contribute to heart disease include smoking, obesity, nutritional habits, stress, and lack of exercise. Discuss your risk factors with your provider at your next visit. In general, cholesterol levels should be measured at least every 5 years, beginning at age 20.

7. Am I at risk for osteoporosis, and how can this be checked

Osteoporosis is a disease that causes your bones to become thin and weak. The end result may be broken bones, especially in the spine, wrist, and hip. Up to 20-25% of women that experience a hip fracture die from complications relating to the fracture. Of the women who live, up to 50% may need assistance in walking. Risk factors for osteoporosis include lack of estrogen, lack of calcium in your diet, certain medications, use of alcohol or tobacco products, and lack of exercise. Race and weight are also factors in risk of osteoporosis. A simple, comfortable, screening test for osteoporosis is available in our office. There are a number of options available for both prevention and treatment of osteoporosis.

8. How can I lose weight?

A healthy lifestyle will help reduce risk factors for many diseases, and keeping your weight in a normal range is important. Weight management not only includes weight loss, but also includes a healthy approach to eating. Better eating means not only reducing fat intake, but also a diet rich in vegetables and fruit, low-fat protein, and fewer carbohydrates from sugar. A diet low in fat and cholesterol and rich in calcium helps prevent heart disease and osteoporosis. Talk to us if you have concerns about your weight and nutritional status. There are also medications available to help with weight loss.