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What is the Women's Health Initiative?

The Women's Health Initiative (WHI) is a long-term study sponsored by the National Institutes of Health (NIH) that is looking at ways to prevent heart disease, breast and colon cancer, and osteoporosis.

The hormone therapy part of the study has two 'arms' (seperate portions) - one looking at estrogen therapy (ET) for women without a uterus and one looking at estrogen plus progestogen therapy (EPT) for women with a uterus. When they enrolled in the study, all participants were considered healthy, were past menopause, and had few or no menopause related symptoms. 

The EPT portion of the study followed 16,608 healthy women with a uterus, who were ages 50 to 79 when they entered the study, and who took either combined estrogen and progestin or a placebo. Prempro was the hormone used. The goal of this 8-year trial was to study the relationship between HT and its possible benefits for heart disease and hip fracture, as well as its possible risks for breast cancer, endometrial cancer, and blood clots. The trial was not intended to study the effect of HT on menopausal symptoms or on other conditions such as Alzheimer's disease.

On July 9, 2002 , the NIH halted the EPT arm of the trial after 5.2 years, concluding that the risks for the study group on combined HT outweighed the benefits. Another part of the WHI study that examined the use of estrogen alone in women who have had a hysterectomy was stopped in March, 2004. 

In the EPT arm of the study, the WHI investigator's reported 7 more cases of heart disease events (like heart attacks), 8 more cases of stroke, 8 more cases of breast cancer and 18 more cases of blood clots per 10,000 women per year in HT users compared to non-users.

Positive outcomes from the EPT arm of the WHI include a 24% reduction in total fractures and 34% reduction in hip fractures. This would result in 5 fewer hip fractures per 10,000 women. The risk of colon cancer was reduced by 37% in the HT group, which resulted in 6 fewer cases per 10,000 women. The benefit appeared after 3 years of use and became more significant over time.

The Estrogen-only arm of the WHI study was stopped in March, 2004 after a follow-up of 6.8 years revealed no effect on the risk of heart disease and a slight increase in risk of stroke. 10,739 postmenopausal women were enrolled between the ages of 50 and 79 who had undergone a hysterectomy. Twelve more cases of stroke per 10,000 women was observed during this trial. Six fewer hip fractures per 10,000 women was seen in the women taking estrogen. Importantly, there was no increase in risk of breast cancer in this arm of the WHI trial.

What is the controversy?

As the data has been further analyzed, limitations have become apparent and many questions are being raised about how to interpret the results. For instance, the average age of WHI participants was 63 years of age and 18 years from their menopause. This does not necessarily provide information for women and physicians seeking information who are younger in age and closer to the menopause transition. 

In fact, women with moderate or severe menopausal symptoms were discouraged from participating in the study. Only 12% of WHI participants reported moderate or severe symptoms. These quality of life altering symptoms are the primary reason many women use HT. Therefore, it is important for women to be aware of the limitations of this study as they contemplate the use of HT. It is certainly appropriate to talk to your doctor about the WHI results and the implications they may have for you as an individual.

Topical Therapy

1. Medications Delivered with Topical Therapy

2. Skin Conditions Treated with Topical Therapy

Medications Delivered with Topical Therapy
Many medications can be administered and absorbed through the skin for use by the body. It is widely accepted that a variety of creams and lotions can be prescribed for skin ailments, such as eczema, poison ivy and rashes. However, few people are aware of the numerous medications that can be used on the skin to achieve effects throughout the body. The benefit of topical therapies are numerous, and include ease of use and potentially steady blood levels. Steady blood levels will allow lower dosages to be used with consistent results.

The skin efficiently delivers medication to the blood stream since it does not have to first go through the GI tract and liver. Pills often require "extra" medication because a pill must be absorbed by the GI tract and liver first (called the "first pass liver effect") where it may be metabolized before entering the blood stream.

As the medication passes through the liver it may be converted into a less active form before reaching the blood stream to be delivered to target organs. This difference can lead to lower dosages of medication for the same relief of symptoms among topical users.

Examples of medications that can be delivered to the body with topical therapy include:

  • Blood pressure lowering medication, such as the clonidine patch
  • Sea sickness medication, such as the scopolamine patch
  • Angina medications, such as nitroglycerin patches and creams
  • Hormone medications, such as patches and gels.

MenopauseRx encourages you to talk to your health care provider about which medications can be administered topically.

For some women menopause symptoms become so troubling that estrogen therapy may be recommended. One effective way to deliver estrogen therapy is through the use of a medicated patch like Vivelle-Dot™.

With Vivelle-Dot™, the levels of plant-derived hormone entering the body are low, yet they are appropriate for treating moderate-to-severe menopausal symptoms and are similar to levels achieved in a phase of your menstrual cycle. That's true in part because the hormone in Vivelle-Dot passes directly through the skin and into the bloodstream.

Vivelle-Dot is the smallest estrogen therapy patch available for the treatment of moderate-to-severe menopausal symptoms and the prevention of postmenopausal osteoporosis.

The neat, discreet, petite Vivelle-Dot is applied to the lower abdomen just twice a week. Women find the patch stays on well and is comfortable to wear. Vivelle-Dot is designed to move with you as you move. This means that you can swim, bathe, and enjoy an active lifestyle while wearing the patch.

For more information (including patient brochure), please see VivelleDot.com or click here

Skin Conditions Treated with Topical Therapy

Aging Skin

“Many women will notice changes in their skin and hair during the menopause. Dry, thin and sagging skin are common complaints heard during menopause. The two main reasons for the change in skin are loss of estrogen during menopause and long-term exposure to the elements, namely sun and wind. Other symptoms attributed to the skin during the menopause and perimenopause transition include acne-type breakouts and unwanted facial hair.” – John Sunyecz, M.D.

Everyone realizes that skin shows increasing signs of aging as the years pass. It happens to women and to men. But what many don’t realize is that, on top of changes that are directly due to aging, hormonal changes associated with menopause cause additional problems for the skin.

Fortunately, there are things that can be done to help offset the changes in the skin due to aging and menopause.

Click Here to Read or Print This Virtual 'Skin Changes' Online guide to skin care for aging skin. (300KB PDF)

  Skin Changes and Menopuase

Unwanted Facial Hair

Unwanted facial hair can be different for every woman, from a few hairs on the chin, light growth on the upper lip or heavy and beard like. Menopause can be associated with facial hair due to the hormonal changes. Some medications (and certain hormone replacement products) may cause a certain degree of facial hair.

Over the years, good choices for solving the problem have been fairly limited. If there’s just a bit of facial hair showing up, the common response is to control the problem by plucking with tweezers or with some gadget or contraption that tweezes automatically. The problem with that, however, is that plucking actually can stimulate the hair follicle into an active growth (anagen) phase in which hair growth is quicker and thicker…something you obviously don’t want. Choices beyond plucking have their limitations as well. Shaving leaves a bristle and 5 o’clock shadow, and is something you have to actively keep up with once you’re committed. Electrolysis is expensive and painful. Laser is expensive and can be uncomfortable. We all know how painful waxing can be. Plus the cost adds up over time. The list of frustrations with current treatment can be pretty long.

That’s why we were so impressed when we learned about Reductase-5, a new product recently introduced by Trienelle Skincare. It’s a gentle lotion that you apply to the face twice a day, just like you would your daily moisturizer. The natural and nutritive ingredients are excellent for your skin…and, over time, your face hair problem fades away.

What’s fascinating is how it works. Trienelle has found a way to deal with the DHT problem, helping the hair follicle return back to normal vellus (fine, short, and barely noticeable) hair production.

DHT in the follicle comes from testosterone. There’s an enzyme in the hair follicle called 5-alpha reductase and it is responsible for making testosterone into DHT. Trienelle developed a way to slow down that process, so there’s less DHT.

With less DHT, hair returns back to the normal vellus hair. Which is lighter, shorter, finer…almost invisible ‘feminine’ hair.

Trienelle accomplished all of this while using natural, nutritive ingredients that are great for your skin. Some of the key ingredients in Reductase-5:

  • Retinol – lessens fine wrinkles and firms the skin; antioxidant; skin cell regulator
  • Wax Myrtle Extract – provides antioxidant protection
  • Chaparral Extract – helps protect skin from ultraviolet radiation
  • Organic Zinc – essential to healthy skin; antioxidant
  • Olive Leaf Extract – inhibits microbe growth; protects against free radicals
  • Vitamin B6 – enhances hair control
  • Salicylic Acid – removes dead skin cells, opens pores, improves skin tone
  • 16 additional botanicals and nutrients
  • Paraben-Free and Phthalate-Free
  Unwanted Facial Hair and Menopuase

Unwanted Facial Hair
Many women wonder about the relationship between menopause and unwanted facial hair. In fact, at MenopauseRx, approximately 40% of women who have registered with us tell us that unwanted facial hair is one of their frustrations with menopause.

Click Here to Read or Print this Virtual Survival Kit
(300KB PDF)