June 2010

Q. Hi--just read your great book, "Ask Dr. Marie" and learned about your own experiences with bioidentical hormones, which I've also been using for 10 years. Thanks for bringing this info about bioidenticals to women. For some of us, it's the only way to go b/c it doesn't involve enslaving pregnant horses to obtain their urine! Ugh!

A question: I began bioidentical HRT yrs. ago with drops under the tongue, but tired of it. Then, since the hot flashes seemed to be gone, my NP prescribed compounded vaginal cream for dryness (C-Estriol 0.1 , one gram 3 times per week). I still use it (prescription is from Kaiser, but get it from a compounding pharmacy). It helps somewhat with hot flashes, too. (Which unfortunately returned about 2 yrs. after I stopped the drops--the cream doesn't give me that much estrogen? but then it's safer, right?)

I have a friend who is thinking of starting on the cream b/c I've used it, and also I’ll be seeing my NP soon, and now want to inquire about switching to the system you use (Vivelle), which would be a more regular dosage, very convenient, not as messy, and probably cheaper. But more estrogen in the system, even at the lowest doseage? So would you recommend my switching now? Do you think my friend might want to investigate the Vivelle instead of just starting on the cream? (She really suffers from hot flashes.)

I'm 62, very good shape/weight/health except recently diagnosed with mild osteopenia (oh, and low thyroid --have taken Levothroid for 20 yrs.-- Vivelle & Levothroid don't mix? I take 0.88mg/day at the moment).

Any insights would be much appreciated-- and again, thanks for all you do

A. I am so sorry I am just getting to this email. Although the vaginal cream is helping your symptoms, usually very little gets absorbed and for most women won't control their hot flashes.

Although I can't recommend advice specifically for your friend, if she is young and healthy, just going through menopause, then I believe the scientific evidence supports the use of a transdermal (patch, gel, etc.) of estrogen to treat symptoms and potentially even protect from memory issues, cardiac problems, etc. and will also help vaginal dryness at the same time. She can start with a very low dose (e.g. 0.025mg) which may not be enough for her hot flashes however.

Q. My osteoporosis recent became much worse, although I've been eating healthier than ever and taking Boniva, Calcium citrate, Vit D and exercising. Now I read so much about all kinds of healthy foods that interfere with calcium absorption....green leafy veggies, whole grains, etc (exactly the kinds of foods I've increased in my diet)...and I'm wondering if my healthier eating could have worked against me! Now I'm trying to space out the taking of calcium supplements and drinking milk, each at least 1-2 hours before/after eating meals....not an easy thing to do at all Do you have any insights as to how to work with the calcium absorption issues and still eat healthily?

A. Please don't be discouraged from eating vegetables. While it is true that the calcium in many dark green leafy vegetables will not be absorbed, as long as you are getting plenty of vitamin D and taking supplements you should be fine. Vegetables will not interfere with your supplements or vitamin D. You need plenty of vitamin D because without D you can't absorb the calcium supplement - and of course you need about 1200 mg of calcium daily as well. Citrate is the easiest calcium to absorb and doesn't require stomach acid as the carbonate forms of calcium do. You are right to space out the calcium however as more will get absorbed. If your bones are really losing bone mass despite all you are doing, I am assuming you are post menopause without estrogen? And would make sure you don't have an overactive thyroid problem or a problem with your parathyroid gland leading to bone loss?