Über die Autorin bzw. den Autor

Winnifred B. Cutler, Ph.D., a respected scientific researcher credited with having codiscovered human pheromones in the 1980s, is the founder of the Athena Institute for Women's Wellness (www.AthenaInstitute.com). Dr. Cutler and her work have been featured in publications such as Time, the New York Times, and Self and on television programs such as Good Morning America and 20/20. She has authored or coauthored eight books, including Menopause, Hysterectomy, and Love Cycles.

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Were the panicky headlines about the dangers of hormone replace-ment therapy (HRT) true? Is "as low a dose as possible for as short a time as possible" really the only safe approach to HRT? How can you distinguish effective alternative therapies for menopausal symptoms from those that are no better than placebos? Is there anywhere you can turn for clear, sensible, science-based answers to these and scores of other crucial questions?

Yes. In Hormones and Your Health, renowned medical researcher and celebrated author Winnifred Cutler gives you the solid, succinct, in-depth information you need to take control of your health and work with your doctor to make the treatment decisions that are right for you.

Drawing on the latest scientific evidence, Dr. Cutler offers balanced information on mainstream and alternative approaches to women's hormonal issues and explains the connection between hormones, sexuality, bone and cardiovascular health, memory, and breast cancer. She demystifies complex issues and reveals why some of the most commonly prescribed regimens, while they may be great for "big pharma" and medical society interests, could be all wrong for you. She helps you decide which hormones to request and which ones to refuse and how to get the best possible support from your doctor before you make a final decision.

You'll discover what you need to know about the differences between synthetic hormones and bioidentical hormones and what that difference means for you. You'll learn how a carefully chosen long-term hormone therapy regimen can improve bone, brain, blood vessel, and even breast health as it helps you maintain an active sex life and keeps you feeling comfortable in your own skin.

Among Dr. Cutler's more controversial recommendations, she warns that not every woman benefits from the universally recommended annual mammogram. She argues that given the frequency of false positives, unnecessary biopsies and radiation exposure, and the stress that accompanies them, regular mammograms, while important for women at high risk of breast cancer, are not necessary for every woman.

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Were the panicky headlines about the dangers of hormone replace-ment therapy (HRT) true? Is "as low a dose as possible for as short a time as possible" really the only safe approach to HRT? How can you distinguish effective alternative therapies for menopausal symptoms from those that are no better than placebos? Is there anywhere you can turn for clear, sensible, science-based answers to these and scores of other crucial questions?

Yes. In Hormones and Your Health, renowned medical researcher and celebrated author Winnifred Cutler gives you the solid, succinct, in-depth information you need to take control of your health and work with your doctor to make the treatment decisions that are right for you.

Drawing on the latest scientific evidence, Dr. Cutler offers balanced information on mainstream and alternative approaches to women's hormonal issues and explains the connection between hormones, sexuality, bone and cardiovascular health, memory, and breast cancer. She demystifies complex issues and reveals why some of the most commonly prescribed regimens, while they may be great for "big pharma" and medical society interests, could be all wrong for you. She helps you decide which hormones to request and which ones to refuse and how to get the best possible support from your doctor before you make a final decision.

You'll discover what you need to know about the differences between synthetic hormones and bioidentical hormones and what that difference means for you. You'll learn how a carefully chosen long-term hormone therapy regimen can improve bone, brain, blood vessel, and even breast health as it helps you maintain an active sex life and keeps you feeling comfortable in your own skin.

Among Dr. Cutler's more controversial recommendations, she warns that not every woman benefits from the universally recommended annual mammogram. She argues that given the frequency of false positives, unnecessary biopsies and radiation exposure, and the stress that accompanies them, regular mammograms, while important for women at high risk of breast cancer, are not necessary for every woman.

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Hormones and Your Health

John Wiley & Sons

Chapter One

You are in charge of your health. No one else should do it for you. No one else can feel what you feel when your energy is soaring, your sense of joy is boundless, your bones and muscles are vibrant as you stand erect and move gracefully through your days, and your immune system is strong enough to fight off the never-ending bombardment of pathogens. Don't accept less than what is best for you. As a functioning, intelligent adult, you have many decisions to make that will affect both the quality and quantity of your remaining years. Let's start with the first decision you make: your choice of physicians.

Your Choice of Physician

You need and deserve a relationship with a compassionate physician who respects your intelligence, your dignity, and your time. If a doctor keeps you sitting in the waiting room for an hour past your appointment, without explanation or apology, that treatment is disrespectful. Find a doctor who respects you.

Most doctors simply do not have time to read all of the scientific papers I explain in this book. As a scientist, I have studied more than three thousand peer-reviewed, published papers, and I cite nearly nine hundred here as references. Your physician will appreciate the rigorous research that this book clarifies for both of you.

Your Doctor's Economic Dilemma

Contrary to a widely held view, your doctor may not be rolling in money. Medical school is hugely expensive: $200,000 for tuition and related costs is not uncommon. Malpractice insurance for gynecologists who perform even minor surgery can easily exceed $100,000 per year. Medical insurance companies and HMOs systematically reduce payments to doctors. To cover costs, more patients must be seen, with less "face time" being spent with each one.

Divergent Agendas and Interests

Your physician must rely on pharmaceutical sales representatives and Big Pharma-sponsored continuing medical education courses to stay up-to-date on essential information about drugs and medical devices. The reps and the speakers do present truthful, FDA-approved data, but they have no incentive to discuss their competitors' products. And funded speakers, as well as medical societies, are usually reluctant to pan the products of a drug company that has provided trips and money. Conflicts of interest are very serious, and they are endemic. On February 28, 2007, the Philadelphia Inquirer reported, "Ex-FDA Chief Must Pay $90,000 in the Stock-Disclosure Case"-stock in drug companies that he was regulating, which he forgot to disclose. This news is not reassuring. Similar disclosures have been in the news about journal presentations as well. Editors and medical society leaders who control which research gets presented to physicians and scientists should disclose, not hide, their own, as well as their protgs', funding sources.

Fearing malpractice attorneys, your doctor may practice "defensive medicine" by ordering redundant, expensive tests for you. Or sometimes doctors may stick to defensively postured practice guidelines that serve their, rather than your, best interests, in order to minimize their liability. You need to take charge of your own health and well-being; consult with the best medical people you can find and decide which recommendations to accept. And you need to identify the economic interests behind the recommendations that are offered to you.

Media Need Catchy Sound Bites

Have you seen articles titled "Estrogen Replacement Therapy Triples Risk of Breast Cancer"? This statement is more false than true and is definitely misleading. The "triple" actually meant an increase from 1 woman in 10,000 to 3 women! And the statistic applied only to a group of women taking a regimen of synthetic progestin every day with a horse-derived oral estrogen, a regimen I believe you should avoid. Don't be misled by catchy headlines that are designed in part to sell newspapers.

Alternative natural therapies abound. The FDA, however, does not evaluate herbal or other alternative remedies. Do not trust advertisements for such products and services that claim to "cure" serious diseases "with no side effects."

Generic Drugs Flourish

The FDA does regulate generic drugs and assures us that they are as reliable as brand-name drugs. But some recent published studies cast doubt on whether their quality is equal. If you can afford brand-name drugs, you might be better off buying them.

Your Power as a Health Consumer

As a patient, did you know that competition for your business is real? Consider the inherent conflicts when you get medical advice. Your doctor can help you only within his skill set. Will he or she refer you to another physician who can offer you a less-invasive or less-costly treatment? No law says that a doctor must do this.

From Age Forty Onward: The General Order of Things

The chapter topics in this book follow the order of health issues that women will encounter beginning in their early forties-or sooner, if they undergo a hysterectomy before then.

1. The perimenopausal changes that women experience from age forty to forty-eight (hot flashes, night sweats, and unexpected bleeding) signal the loss or decline of progesterone, followed by erratic changes (plummets and peaks) in estrogen. These early body signals are storm warnings that your sex hormone production is winding down for its eventual sharp decline.

2. There are two kinds of remedies to consider: hormones and alternative treatments. You will learn which hormones are being marketed and which ones you should know to request or avoid, and why.

3. The following pelvic problems and their prevention and correction are addressed because they occur in the majority of women.

Bleeding abnormalities that 80 percent of women experience in their forties drive them to doctors, who often incorrectly prescribe a hysterectomy. This actually exacerbates the hormonal problems and shortens the woman's lifespan.

A weakening of the pelvic floor and the consequent urinary incontinence (experienced by 30 percent of thirty-five-year-olds and 65 percent of sixty-year-olds) can often be prevented by taking appropriate hormones, beginning an exercise program, and cultivating other healthful habits.

Prolapse problems (65 percent of women will have them by age sixty) also lead doctors to suggest surgery, whereas exercise is more often a better remedy (it's cheaper, safer, and usually more effective than surgery).

Fibroid tumors (80 percent of women develop them) are related to the hormonal changes that begin in the forties, but fibroids are seldom life threatening. Many doctors will prescribe a hysterectomy, but it should be avoided, if possible, because more effective treatments are now available.

4. Waiting in the wings are the following dramatic but hidden changes that occur as a woman ages:

Bone loss begins around age forty for most women, just as their progesterone production is declining. This degenerative, crippling...