Belmar Pharmacy, Charles Hakala, R.Ph., Lakewood, CO (Denver area) Phone 800-525-9473 Fax 303-763-9712
Charles has been a pioneer in compounding prescriptions for patients with challenging medical problems such as chemical sensitivities, multiple allergies to dyes/binders, in addition to his outstanding reputation in the field of compounding natural, bio-identical hormone preparations for thyroid, ovary, and adrenal hormones. He uses micronized natural forms of estradiol, testosterone, progesterone, and DHEA derived from soybeans and wild yams, and will make prescriptions in whatever form is needed for best results. Although I don’t recommend estriol and estrone as desirable forms of hormone therapy, Charles does make these compounded prescriptions for those women who wish to use these types of estrogen. Belmar pharmacists will make up prescriptions using lactose-free hypoallergenic formulations with no dyes; they also make vaginal creams that are hypoallergenic and omit some of the common irritants found in most commercial products.
For those of you with thyroid problems, it may be helpful to know that I have been working with the addition of T3 to Synthroid (T4) since about 1985. Since commercial preparations containing T3 were fixed dose combinations that did not allow the “fine-tuning” that many people need, I turned to Charles many years ago to help me with hypothyroid patients who needed a reliable, sustained-release form of T3 when they could not tolerate the short-acting Cytomel. After seeing my patients do so well, Charles’s formulation is the one I personally use and trust. Charles is also knowledgeable about important differences between the more reliable serum methods of hormone testing versus methods such as saliva and urine that commonly give misleading results. He will discuss these issues with both consumers and physicians.
Spence Pharmacy, Daryl Spence, R.Ph., Ft. Worth, TX (Dallas metroplex) Phone 800-209-7364 Fax 817-625-8103
Daryl Spence is a dedicated and reliable compounding pharmacist who has created innovative topical pain relief medications, in addition to his work with bio-identical, natural micronized hormones such as estradiol, testosterone, progesterone, DHEA. Although I don’t recommend estriol and estrone as desirable forms of hormone therapy, Daryl does make these compounded prescriptions for those women who wish to use these types of estrogen. In trying to find testosterone options for women, Daryl and I have collaborated on forms that will provide sustained effects over the day, and I am pleased with the success of his formulations for my patients. Daryl’s sustained-release testosterone capsule formulation is the one I have personally found works the best for my own testosterone replacement, since I no longer have ovaries to make it. Spence Pharmacy will also make up prescriptions using lactose-free hypoallergenic formulations with no dyes, and no preservatives that are potentially irritating or may aggravate allergies.
Both Belmar and Spence Pharmacies are full-service pharmacies with ability to fill all of your prescription needs, not just compounded prescriptions. Both pharmacies also work with many major health insurance plans. In addition, I have found that both of these pharmacies often have better prices on common commercial prescriptions (such as estradiol patches) than my patients find at the big chain drugstores. I encourage you to do a little price-shopping to decide where you want your prescriptions filled before you automatically assume the big chain drugstores are cheaper.
There are many pharmacies around the country that are now providing compounding services. There are several important reasons I have continued to collaborate primarily with Belmar and Spence pharmacies on prescriptions for my patients. First, both of these pharmacists have many years’ experience in the art and science of compounding and are not just starting these services in the wake of the revived interest now. Second, each compounding pharmacist has his or her own formula for making the various forms of prescription hormones, and each formulation will vary in how it is metabolized in the body. Therefore, each formulation will act somewhat differently in a given person and adds yet another variable to the equation of trying to solve the problem when a person has side effects. It is difficult enough clinically to sort out individual differences in metabolism and response when I know the pharmacology of a given preparation. If the preparation also varies, it can become almost impossible to sort out the Gordian knot of factors that could alter a person’s response. That’s why I prefer to work with brand name products instead of generics, and to limit my prescriptions to just a few compounding pharmacists whose preparations I can rely upon.
Third, I have seen a disturbing trend in recent years as some compounding pharmacies have begun to move into the area of advising patients on dosing of hormones, which violates the laws governing pharmacy practice. I have treated too many patients who have been significantly overdosed on hormones when getting their information from pharmacists making the dose changes, and I have chosen to put my prescriptions at pharmacies where the pharmacists do not engage in this practice.
Disclaimer: I have no financial interest in any of these pharmacies or their products. I provide this information as a service to you and your physician because reliable information on these topics has been difficult for the average consumer to obtain. Compounded and “natural” hormones are not new, in spite of all the recent marketing of such products. Many of these options have been around for forty years or more. I have been a longstanding advocate for the use of bio-identical, “natural” human forms of hormone preparations, and I have seen over many years of my practice the marked positive difference that occurs when women change from the animal-derived, conjugated estrogens and synthetic forms of progestins.
Women often ask, “Are these compounded hormones FDA-approved?” The answer is no, because the individual compounded prescriptions are not manufactured and distributed for sale in quantities that would require FDA-approval. At reputable compounding pharmacies, the ingredients used are pharmaceutical-grade (U.S.P.) bases that are then made up into tablets or creams or suppositories to your individual needs. Individual pharmacists operate within their training and state licenses when they prepare (compound) individual prescriptions based on your own physician’s decision about dose and type of medication best for you. Pharmacists are not, however, licensed to determine the dose that is correct for you; that function is by law the task of the physician. The two pharmacies above are resources I have depended upon to provide individual prescriptions for my patients and family; we have been pleased with the results. These pharmacists are skilled, knowledgeable, and committed to providing quality service to you and your physician. I have found them to be ethical and responsible in working with the physician. Neither of these pharmacy owners allows their staff to go outside the bounds of pharmacy licensing and make dose changes on their own. I am increasingly concerned at the degree to which some pharmacists are now practicing medicine by adjusting women’s hormone doses based on questionable test methods, such as saliva and urine hormone levels, without having access to other laboratory measures that need to be included in decision making about appropriate hormone dose and route.
Although many types of medications used to be compounded individually, it is no longer advantageous to do so with the current quality of manufactured products widely available. Much of the current use of individual compounding is for patients with allergies, marked sensitivities to dyes and binders in commercial preparations, patients who need smaller doses, and in particular, women who want to take natural, bio-identical human forms of hormones that aren’t yet available in commercial products at regular drugstores. Natural ovarian hormones have been in widespread use in Europe, Australia, Canada, Japan and other countries for many years, generally with better clinical response and fewer side effects than the synthetic progestins, conjugated equine estrogens, and synthetic methyltestosterone compounds used in the United States. When these natural, or bio-identical, forms of hormones are not available commercially at the chain drugstores, the compounding pharmacies can make up ones similar to those available in Europe and other countries.
For estrogen, however, there are several brands of the natural human form, 17-beta estradiol, available in the United States that are FDA approved and made by commercial pharmaceutical companies: Estrace tablets and vaginal cream, Alora, VivelleDOT, Climara and Estraderm transdermal (skin) patches. All of these products contain the same natural, bio-identical form of 17-beta estradiol that our ovaries made before menopause. These products are made with the precursor, or building block, molecules that come from soybeans. The primary difference in the various patches is the type of adhesive (which may affect frequency of skin rash and how well it stays on your body) and the duration of effect from the patch. We work with whatever brand a woman likes best. There are also now available several generic versions of 17-beta estradiol tablets now that Estrace has gone off patent. Unfortunately, I have found that the quality varies widely from one generic manufacturer to another, so I don’t usually recommend the generic estradiol tablets. I have had many patients who had marked relapse of their symptoms when switched to a generic form of estradiol.
In addition to the commercial estradiol products, there are now two new FDA-approved commercial products for natural progesterone: Prometrium tablets and Crinone vaginal gel. You no longer have to turn to compounded natural progesterone products that are often not covered by insurance plans. Both Prometrium and Crinone are available through regular drugstores and are usually covered by most health plans that provide prescription plans. Both of these commercial products are made from yam and soybean precursors and are micronized for optimal absorption. They both work well for endometrial protection, so the choice of which product for your use depends on such aspects as personal preference and side effects, which will vary depending on whether progesterone is taken orally or is absorbed vaginally and therefore bypasses the liver “first-pass” metabolism.
We do not have a major pharmaceutical company in the United States that has yet developed natural micronized testosterone preparation approved by the FDA for widespread consumer use. A testosterone patch for women is in development by several companies, but it is not yet on the market in the United States. The testosterone patches for men are quite good, but the dose is too high for women to use. It is my hope that as we understand more about the important differences between the native human forms for hormones and the synthetic or animal-derived ones, the women of this country will have better options widely available. Until that time, you may ask your physician to work with reputable pharmacists to compound the natural testosterone to suit your needs.
Initially, I thought saliva tests had some promise for ease of use and convenience, and I prescribed these tests for my patients through both Aeron Labs and Diagnos-Techs. I had to stop using the saliva tests several years ago because they simply were not reliable and did not correlate with women’s descriptions of their symptoms. The saliva tests also did not correlate with the blood serum tests, yet the serum tests were the ones that fit closely with what the women themselves described regarding symptoms. I tried to figure out these discrepancies and I repeatedly asked both companies to provide me any data they had correlating serum and saliva results in the same patient. I never received this information from either company selling saliva test kits.
Another problem is that saliva results provide only part of the picture we need in order to determine optimal hormone dose, since they only measure the free hormone, rather than the combination of total and free hormone available for the body to use. The most useful clinical information to guide you and your physician in determining the optimal hormone dose comes from looking at the total hormone available, as well as other laboratory parameters that provide an indirect measure of hormone effect. When needed, the free fraction of a given hormone can also be done with serum, and is a more reliable measure than the amount that is “excreted” into saliva. Just think about all the kinds of variables that affect your saliva production: Everything from what medicines you take, whether you use antihistamines, whether you chew gum, whether you are stressed, and a host of others. Then you will understand why measuring hormones excreted into saliva isn’t the best way to go when you are trying to decide a complex matter like what hormones to take and how much to use. Your blood system is much more stable over time, and the components in the blood are more finely regulated by the body’s balancing (homeostasis) mechanisms. Plus, keep in mind that the hormones are constantly moving back and forth from free to bound state as they interact with cellular receptors, so knowing the level of the total hormone available becomes quite important in deciding what you may need.
As I researched the saliva tests further, I found that colleagues in reproductive endocrinology (fertility specialists) had also encountered difficulty with the wide variance in saliva tests and with the lack of correlation with other hormone measures used to determine hormone balance for fertility. The international menopause studies use serum hormone levels, and the serum hormone tests are considered the gold standard hormone assay in international research. Over the years since I first wrote Screaming to Be Heard, I have treated too many women who got into significant difficulty when relying just on saliva tests, and I no longer recommend this test or pharmacies and practitioners that promote these test kits. If you are going to invest the time and money to get hormone levels checked, I encourage you to use the serum tests that are the most reliable methods at this time.
When you have your hormone levels done, be certain that you have them drawn at the appropriate time of your menstrual cycle (if you still have one), or at appropriate intervals from your last hormone dose or patch change. In chapters 4, 5, 6, and 15, I have provided target ranges for serum hormone levels that I have found in my practice over the years correlate well with when women feel their best and their symptoms have improved or resolved. Once you have reviewed the information on ranges that are desirable for optimal well-being, your own physician can order these tests and then use the information to guide you on dose adjustments for your hormone prescriptions.
There has been an explosion of information in women’s health since the first edition of Screaming to Be Heard was published. It is impossible to list all of the good resources here, and I encourage you to first turn to the Web sites and publications of the national not-for-profit organizations dedicated to providing reliable educational resources for women. A few key ones are listed in the material that follows. As you try to evaluate the plethora of women’s health books now available, remember to retain a healthy skepticism for books by authors who are also trying to sell you products such as nutritional supplements, hormone creams and various types of test kits. Many of these books have a primary focus of selling the author’s products and are not always the most up-to-date or accurate on the scientific information. Keep in mind the analogy I used earlier about buying a car from a used car salesman, and ask yourself the question: “Do I unquestioningly accept the pitch from the salesman, or do I want an independent opinion from someone who has nothing to gain financially?”
For each of the following books, I have provided my comments about strengths, weaknesses, content overview or other aspects I think may be relevant for you to consider in selecting ones to read. These are my best opinions from my own extensive reading of both the scientific literature and many consumer books, and from our patients’ feedback as to which resources are both practical and helpful. I have listed reading materials that, in my professional opinion, are both useful and reliable in the medical information presented. I have updated some of the suggested readings below, but I also decided to keep in the list some of the more meaningful classics that I included in the first edition of Screaming to Be Heard. Further reading suggestions are listed chapter by chapter, and in some cases, I have also included Web site information.
CHAPTER 1: SCREAMING TO BE HEARD: LISTENING TO WOMEN’S VOICES
1. Woman As Healer. Jeanne Achterberg, Ph.D., Shambhala, Boston, 1991, paperback. Dr. Achterberg examines the role of women and their pivotal roles in healing traditions in ancient cultures, as well as the loss of the feminine influences in the Western medical traditions. A profoundly moving and inspiring book that helps us understand women’s vital contributions and influence in the past, and sheds more light on the problems in the world today, medicine in particular. I was deeply moved as I journeyed through the pages of this book!
2. Medicine Women, Curanderas, and Women Doctors. Bobette Perrone, H. Henrietta Stockel, and Victoria Krueger, University of Oklahoma Press, Norman, OK, 1993, revised edition. Presents ten Southwestern female healers from three cultures (Native American, Hispanic, and Western) and provides an in-depth analysis of alternative healing methods along with remarkable insights about the profound impact of the psyche/soul on physical illness. Inspirational reading about our rich history as women healers.
3. BACKLASH—The Undeclared War Against American Women. Susan Faludi, Anchor Books/Doubleday, New York, 1992. Ms. Faludi makes a compelling case that whenever women make progress in their efforts for equality, an antifeminist backlash strikes on all fronts—in the media, politics, fashion, and the workplace. Many of these issues are even more prevalent today than when the author first wrote this book, so I encourage you to read it.
4. Women & Self-Esteem-Understanding and Improving the Way We Think and Feel About Ourselves. Linda Tschirhart Sanford and Mary Ellen Donovan, Penguin Books, New York, 1992. An excellent overview of issues affecting women, still relevant today. Helps women understand cultural sources of low self-esteem and provides practical approaches for building an enhanced self-esteem; a valuable resource.
5. “Still Killing Us Softly” 1995 Update: Advertising’s Impact on Women. Cambridge Documentary Films, Inc. 617-354-3677. Resource for rental or purchase of Dr. Jean Kilbourne’s films Killing Us Softly and STILL Killing Us Softly as well as other important documentary films on significant topics of interest to women and their families. Although these films were made several years ago, the issues they raise are still quite current, and Dr. Kilbourne has a wonderful presentation style that I found provocative and entertaining. I highly recommend these films and encourage readers to rent them for showing/discussion to community and school groups. Time has gone on, but the images in the ads have tended to get worse, not better. You need to be aware of how the images affect you. We need consumer activism to help solve these issues.
CHAPTER 2: HORMONES: A GUIDE TO YOUR BODY CYCLES
1. Woman’s Body: A Manual For Life. Dr. Miriam Stoppard, Dorling Kindersley, London and New York, 1994. Compiled by a team of health experts from many fields, this book covers physical and emotional concerns of women throughout the life span and is illustrated with hundreds of color charts, graphs, and photos. It is one of the most comprehensive and practical women’s health books I have found.
2. The Good News About Women’s Hormones. Geoffrey Redmond, M.D., Warner Books, New York, 1995. This book was not available at the time I first wrote Screaming to Be Heard in 1994 or I would have included it in the references for my first edition since his book is an excellent resource. There are many parallels in the work Dr. Redmond has done to identify and treat women’s hormone problems and the hormone connections I have been addressing in my own work. Dr. Redmond has been President of the Foundation for Developmental Endocrinology and has also edited medical texts on hormone disorders. This book is written for consumers, is easily understandable, and has excellent sections on androgenic disorders (excess hair growth, acne, and other problems) and alopecia (hair loss) as well as the many other hormone problems he discusses. He gives a balanced view of benefits and risks of hormone treatments, and a logical approach to helping women decide about hormone use and how to get reliable lab tests.
3. Listening to Your Hormones. Gillian Ford, Prima Publishing Co., Rocklin, CA, 1997. Gill is a health educator, not a physician, but she has spent many years reviewing medical articles on hormone issues as a result of her own hormonal problems that she describes in her book. Gill worked with me for about a year in our Texas center, and I valued the contributions she made to educate women about these problems even though I don’t agree with all of her approaches and opinions. In addition, some of the physicians she cites have questionable theories not supported by the current medical literature, so you need to be cautious about accepting without question all of the opinions presented. One of the strengths of this book is the bibliography of over 200 references for those who would like to be able to locate original medical articles.
CHAPTER 3: HORMONES AND THE BRAIN
1. “New Perspectives on the Relationship of Hormone Changes to Affective Disorders in the Perimenopause.” Elizabeth Lee Vliet, M.D., and Virginia Lee Hutcheson Davis, M.S., Clinical Issues in Mid-Life Women’s Health (NAACOG), vol. 2, no. 4, October/December 1991, pp. 453–471. An eighteen-page detailed review of over thirty years of world-wide neuroendocrine research on hormone effects on brain and mood. Includes list of references of classic papers in the field of neuroendocrine research. Available from medical libraries, or you may order a copy by sending a check for $10.00 to HER Place, P.O. Box 64507, Tucson, AZ 85728.
2. The Thyroid Solution. Ridha Arem, M.D., The Ballantine Publishing Group, a division of Random House, Inc., New York, 1999. An excellent reference book on thyroid disorders, written by an endocrinologist with solid credentials and clinical experience. Dr. Arem validates what I have seen in my practice for my entire career: Many women in particular have subclinical forms of thyroid disorders that affect mood, fertility, weight and a host of other problems. In addition, Dr. Arem goes into more depth on the value of adding T3 to a thyroid medication regimen, as I have espoused and used for many years as well. I do not think Dr. Arem’s information on estrogen therapy is either comprehensive or up-to-date, and I am very concerned about his emphasis on the use of Premarin and Provera based on the issues I have described in Screaming to Be Heard. I do, however, think his information on thyroid is outstanding.
3. Living Well with Hypothyroidism. Mary Shomon, Wholecare/Avon Books, New York, New York, 2000. An excellent, practical guide to improving the quality of your life and health if you suffer from hypothyroidism. Mary is a lay person who has suffered from a thyroid disorder, and she has done extensive research on the subject to bring the latest information to her readers. She also has a thyroid newsletter (Sticking Out Our Necks), and Web site (www.thyroid-info.com) that you will also find full of useful tips and the latest scientific studies.
CHAPTER 4: HORMONES OF PREGNANCY AND STRESS: PROGESTERONE AND CORTISOL
1. Why Zebras Don’t Get Ulcers. Robert M. Sapolsky, W.H. Freeman & Co., New York, NY, 1998. Excellent and humorous review of the adverse effects over time due to high cortisol levels from stress. If you ever wondered just how “stress” affects your entire body, this is a terrific and well-written book.
2. There is not space to provide all of the medical references for the progesterone material, but some readers might want to locate this classic paper for further reading: “Progesterone suppression of the Plasma Growth Hormone Response,” Bhatia SK, Moore D, and Kalkhoff RK, J. Clin Endocrinol Metab 35: 364-369; 1972.
3. I have not included any of the current consumer books on progesterone as a resource since these all contain serious errors and incorrect medical information about the roles of estrogen and progesterone, with most of them emphasizing incorrectly negatives about estrogen and failing to give balanced view of the drawbacks of progesterone. Most of the authors are promoting or selling progesterone creams as the answer to all of women’s hormone problems. If you are interested in more detailed material on the roles of progesterone, I refer you to the medical studies described in my book.
CHAPTER 5: THE BIG QUESTION: HAS ANYBODY SEEN MY ESTROGEN?
1. Menopause and Midlife Health. Morris Notelovitz, M.D., and Diana Tonnessen, St. Martin’s Press, New York, 1994. Written by a pioneer in osteoporosis and menopause, this book presents accurate and up-to-date information about managing your health, including the role of healthy lifestyle habits. Discusses hormone therapies, pros and cons of gynecological procedures, issues about breast cancer and other concerns of importance to women.
2. Menopause. Miriam Stoppard, M.D., Dorling Kindslerly Publishing, London and New York, 1994. A beautifully illustrated book that addresses the total woman during this important transition and the years beyond. Color charts and graphs make it easier to understand difficult medical concepts and help women manage their menopause in optimal ways.
3. The Silent Passage: Menopause. Gail Sheehy, Pocket Books (paperback), New York, 1998. The best-selling book that brought the M word out of the closet and into mainstream. Although it originally came out in hardcover in 1991, it is still a good one to provide an overview of what to expect and to read other women’s experiences.
CHAPTER 6: TESTOSTERONE AND DHEA: THE FORGOTTEN WOMEN’S HORMONES
1. The Magic of Sex. The Book That Really Tells Men About Women and Women About Men. Miriam Stoppard, M.D., Dorling Kindersley, Inc., New York, 1992. Men and women approach love and sex with different expectations; they respond to physical love in different ways; and even when their responses are similar, they often happen at different times and are brought about by different stimuli. With beautiful photographs, The Magic of Sex covers this subject from both the man’s and the woman’s point of view. I think this is THE best, most comprehensive and beautifully written book on sex I have found, and I highly recommend it.
2. The Art of Sexual Ecstacy: The Path of Sacred Sexuality for Western Lovers. Margo Anand, Jeremy P. Tarcher, Inc., Los Angeles, CA, 1991. A comprehensive and clearly written work on contemporary Tantric and Taoist practices adapted and made understandable to Western readers. Helpful for those who wish to explore ways to intensify their sexual experiences.
3. Becoming Orgasmic; A Sexual and Personal Growth Program for Women. Julia Heiman, Ph.D., and J. Lopiccolo. Ph.D., Simon and Schuster, New York, 1988. If you have any inhibitions about sex or want to enhance the pleasure you get from sex, the program presented will help you feel comfortable with yourself and your ideas about sex.
4. Dancing With Myself: Sensuous Exercises for Body, Mind and Spirit. K. dePeyer, Nucleus Publications, Willow Springs, MO, 1991. Intuitive approach to physical fitness that embraces mind, body, and spirit; suggest exercises that enhance body/sensual awareness.
CHAPTER 7: THE PERSNICKETY P’S: PMS, PCOS, PREMATURE MENOPAUSE, PERIMENOPAUSE, AND POSTPARTUM DEPRESSION
1. Menopause. Miriam Stoppard, M.D., Dorling Kindersley Publishing, London and New York, 1994. A beautifully illustrated book that addresses the total woman during this important transition and the years beyond. Color charts and graphs make it easier to understand difficult medical concepts and help women manage their menopause in optimal ways.
2. PCOS: The Hidden Epidemic. Samuel S. Thatcher, M.D., Ph.D. Perspectives Press, Indianapolis, IN, 2000. Dr. Thatcher is a renown expert in reproductive endocrinology and brings to this book many years of clinical experience as one of the early advocates for increased understanding of this complex and serious metabolic disorder. The book gives an overview of what PCOS is, our current understanding of causes, and information on helpful treatments based on research findings. This is an excellent resource, recommended by the Polycystic Ovarian Syndrome Association. The order line for Perspective Press is 317-872-3055, 8:00 A.M. to 4:00 P.M. Indiana time, Monday through Thursday, or through their Web site at www.perspectivespress.com.
3. PolyCystic Ovarian Syndrome Association, Inc. An excellent resource for educational materials, support groups, web discussions of PCOS. The organization also hosts an outstanding annual conference on PCOS, with presentations from many of the leading experts in the field. Check out their Web site at www.pcosupport.com. or call 630-585-3690. Mail address is P.O. Box 7007, Rosemont, IL 60018
4. The Premature Menopause Book. Kathryn Petras, Avon Books, Inc., New York, 1999. This is a good book written by a lay person sharing her own story about struggling with premature menopause. This book provides an abundance of resources and other helpful consumer information including Web sites and support groups for women finding themselves in menopause at an early age.
5. Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health. Deborah Sichel, M.D., William Morrow and Co., New York, 1999. This book extends what I have written in 1991 and 1994, as well as in Screaming to Be Heard, about the crucial hormone effects on mood syndromes in women. Dr. Sichel has included additional material on postpartum mood syndromes that many readers will find helpful. Although her emphasis is more on the serotonin connections than on the ovarian hormones, the book does provide validation for women experiencing these bewildering mood shifts.
CHAPTER 8: IS IT CHRONIC FATIGUE, “YEAST,” OR PERIMENOPAUSE?
1. From Fatigued to Fantastic! Jacob Teitelbaum, M.D., Avery Publishing Group, Garden City, New York, 1996. A good overview of chronic fatigue causes and suggestions for evaluation and treatment options for CFS to pursue with your physicians. The hormonal recommendations for women are a weakness of this book, and I don’t recommend following the ovarian hormone protocols he suggests, since this is not reflective of the current international research information in the menopause field. He puts more emphasis on use of androgens prior to appropriate restoration of estrogen balance for women, which commonly leads to more side effects of androgen-excess. He is also recommending use of “tri-est” that contains too little estradiol to provide the protective effects on bone, brain, and heart and other vital estrogen target tissues. I do think this book provides very helpful suggestions for chronic fatigue treatment approaches, as well as crucial validation for the sufferers of this disorder.
2. Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Other Neural Network Disorders. Jay A. Goldstein, Haworth Press, Binghamton, NY, 1996. An in-depth discussion of neurological connections in these syndromes, with some attention to hormone systems such as the adrenal and pituitary. This book, however, has very little material on women’s hormones and their role in these disorders as I have described in my book.
3. Chronic Fatigue and Tiredness: A Self-Help Program. Susan M. Lark, M.D., Westchester Publishing Co., Los Altos, CA, 1993. A more in-depth exploration of the role of nutrition, vitamins, minerals, and herbs in the treatment of chronic fatigue. This book has many helpful and practical suggestions for enhancing energy level and well-being but doesn’t address any of the ovarian hormone issues in fatigue syndromes.
4. Doctor, Why Am I So Tired? Richard N. Podell, M.D., FACP, Pharos Books, New York, 1987. Although this book may now be difficult to find, it addresses unrecognized medical causes of fatigue as well as suggestions for nutritional and other mind-body approaches to help improve your energy and well-being. Dr. Podell also includes helpful approaches to discuss symptoms and problems with your physician.
5. The Yeast Connection. W. Crook, M.D., Professional Books, Jackson, TN, 1986. Written by a leading proponent of the candida theory, this book gives an overview of the ideas developed by Orian Truss and W. Crook. It has not been well accepted by most allergists because of the lack of adequate studies to verify the “yeast connection.” Dr. Crook has also written another book, The Yeast Connection and the Woman, but I do not recommend this one since his medical information on women’s hormones is not accurate, complete or up-to-date, and he is often incorrect on which hormones have what functions in a woman’s body. I include my comments on these books here because so many women have been told they have this syndrome without ever having the proper reliable tests of their ovarian hormones. I recommend a careful evaluation of your ovarian and thyroid hormones (and other medical conditions) as outlined in my book before you accept the diagnosis of “chronic candidiasis” and spend a great deal of money on unproven treatments. In spite of its limitations, Dr. Crook does have helpful dietary and lifestyle suggestions.
6. “Position Paper on the Candida Yeast Theory.” American Academy of Allergy and Immunology, 611 E. Wells St., Milwaukee, WI 53202. Provides a detailed evaluation (from an objective, albeit somewhat skeptical, point of view) on the scientific evidence pertaining to the yeast theory. A good balance for the above books that attribute every symptom a woman experiences to “yeast overgrowth.”
7. National CEBV Syndrome Association. P.O. Box 230108, Portland, OR 97223. Support group organization for people diagnosed with Epstein-Barr syndrome. Write to them for information and suggested reading list.
CHAPTER 9: ESTROGEN AND MEMORY: THE WORDS ESCAPE ME
In the first edition of Screaming to Be Heard. I wrote that I had not seen consumer books that focused on the hormonal connections in memory function. Since that time, a consumer book was published that brings together the scientific literature on menopause and memory and other issues affecting the mind: Menopause and the Mind, by Claire Warga, Ph.D., Simon & Schuster, New York, 1999. Although not the first (as she claims) to identify these “cognitive” connections with hormone change at menopause, the author has summarized over thirty years of research in the field of hormone effects on the brain and mental functioning. This book is based on the extensive research over the last 25 years by such pioneers as Dr. Barbara Sherwin of Canada and other experts world wide. It extends material I wrote about in 1991 and 1994 on these subjects and the author has provided references to the extensive medical literature about hormone effects on the brain.
CHAPTER 10: MIGRAINES AND HORMONAL HEADACHES
Organizations: The following organizations provide educational materials and referral lists of headache specialists and you may find them helpful: National Headache Foundation, 1-888-NHF-5552, www.headaches.org; American Council for Headache Education, 800-255-ACHE.
The following books do not address much information on the hormone connections that trigger migraines as I have described in Screaming to Be Heard, but the authors provide other helpful background information on causes and treatments of a variety of headache syndromes.
1. Help for Headaches. Joel Saper, M.D., Warner Books, New York, 1987.
2. Headache Relief for Women. Alan Rapoport, M.D., and Fred Sheftell, M.D., Little Brown and Co., New York, 1996.
3. The Headache Book. Seymour Solomon, M.D., and Steven Fraccaro, Consumers Union, Mount Vernon, NY, 1991.
4. Overcoming Migraine: A Comprehensive Guide to Treatment and Prevention by a Survivor. Betsy Wyckoff, Station Hill Press, Tarrytown, NY, 1998. May be ordered through Amazon.com. A very helpful book, and more useful than many since the author has herself struggled with the migraine problem for many years.
Headache Centers. I have listed the following programs because the physician directors have more experience in addressing the hormonal issues many programs overlook. There are also many medical centers with pain clinics that treat headache problems, as well as pain programs affiliated with university medical centers that have headache specialists. Either of the national organizations above can provide additional referral resources in your area, but make sure they pay attention to the hormone connections and will evaluate those as part of a comprehensive treatment program.
Stephen D. Silberstein, M.D., Chief of Neurology and Co-Director, The Comprehensive Headache Center at The Germantown Hospital and Medical Center, Philadelphia, PA
Joel Saper, M.D., The Michigan Neurological Institute, Ann Arbor, Michigan
Elizabeth Lee Vliet, M.D. HER Place Tucson, Arizona, and Dallas area, Texas.
These two programs designed by Dr. Vliet are tailored to women and include complete hormonal measurement to check this overlooked trigger of migraines. Both provide comprehensive hormonal evaluations and multidisciplinary recommendations including alternative therapies (such as acupuncture, myofascial release, neuromuscular therapy, massage therapy, dietary changes, biofeedback, hypnotherapy, water therapies, chiropractic, osteopathic manipulation, and others) along with traditional medical options. Women’s previous medical test results are reviewed to be certain that disorders more common in women have not been overlooked.
You may download information forms from the HER Place Web site at www.herplace.com. or contact the staff in either office for guidance on the process to arrange consultation:
1. HER Place: Health, Enhancement and Renewal for Women, Inc. For information package, mail request to P.O. Box 64507, Tucson, AZ 85728, or call 520-797-9131, fax 520-797-2948.
2. HER Place: Health, Enhancement and Renewal for Women, Inc., 2700 Tibbets Drive, Suite #100, Bedford (Dallas area, near DFW airport), TX 76022, 817-355-8008, Fax 817-355-8010
CHAPTER 11: FIBROMYALGIA, ACHES AND PAIN: THE ESTROGEN FACTOR
Unfortunately, very few programs in the country at this time are addressing women’s hormone levels as part of a comprehensive pain evaluation and treatment program even though there are many excellent, accredited, pain treatment centers across the country. The national organization of pain specialists, The American Academy of Pain Management, reviews credentials of specialists in pain management from many different professional backgrounds (physicians, nurse practitioners, psychologists, acupuncturists, physical therapists, etc.), provides a referral resource to help identify pain programs and specialists around the country, and also provides information on upcoming conferences, books, and other resources. You may contact them at 209-533-9744, 13947 Mono Way, Suite A, Sonora, CA 95370, or their Web site at www.aapainmanage.org. Another resource is the Fibromyalgia Network. 1-800-853-2929, P.O. Box 31750, Tucson AZ 85751. This organization publishes a very good newsletter that gives an overview of current research on fibromyalgia, helpful pointers for people with this problem, and news of upcoming conferences. Web site: www.fmnetnews.com.
Centers that include detailed assessment of women’s hormones as contributing factors in chronic pain syndromes:
HER Place, Tucson, Arizona and Dallas-Ft. Worth, Texas, designed by Elizabeth Lee Vliet, M.D. These two programs are tailored to women and include complete hormonal measurement to check this overlooked cause of fibromyalgia and other chronic pain conditions. Both provide comprehensive medical/hormonal evaluation, with recommendations for multidisciplinary therapy approaches including alternative therapies (such as acupuncture, myofascial release, neuromuscular therapy, massage therapy, dietary changes, biofeedback, hypnotherapy, water therapies, chiropractic, osteopathic/craniosacral manipulation, sound therapy, and others) along with traditional medical options. Women’s previous medical test results are reviewed to avoid duplication of testing, and to be certain that disorders more common in women have not been overlooked. You may download information forms from the Web site at www.herplace.com.
1. HER Place: Health, Enhancement and Renewal for Women, Inc., for information package, mail inquiries to P.O. Box 64507, Tucson, AZ 85728, or call 520-797-9131, Fax: 520-797-2948.
2. HER Place: Health, Enhancement and Renewal for Women, Inc., 2700 Tibbets Drive, Suite #100, Bedford (Dallas area, near DFW airport), TX 76022, 817-355-8008, Fax 817-355-8010.
CHAPTER 12: INTERSTITIAL CYSTITIS, VULVODYNIA, AND LEAKY BLADDERS
1. Alliance for Aging Research. 2021 K Street, N.W., Suite 305, Washington, D.C. 20006, 202-293-2856
2. Interstitial Cystitis Association. (Vicki Ratner, M.D., Founder), P.O. Box 1553, Madison Square Station, New York, NY 10159
3. The Bladder Health Council, American Foundation for Urologic Disease. 1120 N. Charles Street, Baltimore, MD 21201, 1-800-242-2383.
4. National Association for Continence. PO Box 8310, Spartenburg, SC 29305, 1-800-252-3337 or 864-579-7900, Web site: www.nafc.org
5. HIP, Help for Incontinent People. P.O. Box 544, Union, SC 29379, 1-800-BLADDER
6. The Simon Foundation for Continence. P.O. Box 835, Wilmette, IL 60091, 1-800-23-SIMON (patients) 708-864-3913 (health professionals)
7. Women Leaders in Urology:
Tamara G. Bavendam, M.D., Center for Pelvic Floor Disorders, Medical College of Pennsylvania, 3300 Henry Avenue, Philadelphia, PA 19129, 215-842-7007
Kristene E. Whitmore, M.D., Director, The Incontinence Center Clinical Associate Professor of Urology, University of Pennsylvania, Philadelphia, PA
8. The Urinary Incontinence Sourcebook. Diane Kaschak Newman, R.N.C., M.S.N., C.R.N.P., F.A.A.N., Lowell House, Chicago, IL, 1997.
CHAPTER 13: ESTROGEN AND YOUR HEART: NOT JUST A MENOPAUSE PROBLEM
1. The Female Heart: The Truth About Women and Coronary Artery Disease. Marianne Legato, M.D., and Carol Colman, Harper Collins Publishers, New York, 1996.
2. Nutrition, Hypertension & Cardiovascular Disease. Smith R., Lyncean Press, Beavertown, Oregon, 1989. Although this was published in 1989, it is clearly written, and provides understandable explanations of hypertension and cardiovascular disease, emphasizing risk factors you can control and ways to prevent development of disease.
3. No Ifs, Ands or Butts: A Smoker’s Guide to Kicking the Habit. Julie Waltz, Northwest Learning Associates, Tucson, AZ, 1989. Quite simply, one of the best and most practical guides for helping “kick the tobacco habit.” Full of helpful tips and very human stories of dealing with change at all levels.
4. Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance. Jack Challen, Dr. Burton Berkson, and Melissa Diane Smith. John Wiley and Sons, New York, NY, 2000. An excellent resource for understanding the role that elevated insulin plays in causing heart disease, hypertension, elevated triglycerides, abnormal cholesterol patterns, and diabetes. Gives helpful information on nutritional approaches to correct these problems and reduce later risk of diabetes and cardiovascular disorders.
5. American Medical Women’s Association (AMWA) Continuing Education Workshop: Coronary Heart Disease in Women (CME credit for physicians, educational materials for consumers). Contact AMWA at 703-838-0500.
CHAPTER 14: BREAST CANCER: CONTROVERSIES
AND RISKS YOU AREN’T TOLD, OPTIONS TO EXPLORE
1. Breast Cancer: If It Runs in Your Family, How to Reduce Your Risk. Mary Dan Eades, M.D., Bantam Books, New York, NY, 1991. An excellent review of the known risk factors for breast cancer (even if it doesn’t run in your family), and more in-depth discussions than I had space for in my book. It is thorough, very readable, and gives sound practical approaches for changes in your lifestyle. I highly recommend it for all women.
2. Dr. Susan Love’s Breast Book. Susan Love, M.D., with Karen Lindsey, Perseus Press, Cambridge, MA, 1995. A comprehensive book on total breast health for women of all ages. Very detailed and well researched. I highly recommend this book. Sadly, I cannot recommend Dr. Love’s Hormone Book because I have found it to be seriously flawed in its medical content, and not accurate in presenting many women’s health risk beyond breast cancer (osteoporosis and heart disease in particular). Dr. Love also does not address the crucial differences between types of estrogen and progestins or progesterone as I have done in Screaming to Be Heard. In my opinion, these are serious deficiencies in her book. In addition, Dr. Love has an anti-hormone message that is not warranted by our current science or in keeping with many women’s needs as well as positive experiences with HRT.
3. Breast and Cervical Cancer Education Project. A program offered by the American Medical Women’s Association (AMWA) as a continuing education workshop for physicians and other health professionals. For information about obtaining a speaker or for a list of consumer educational materials, contact AMWA at 703-838-0500.
4. T. L. Bush, and M.K. Whiteman, “Hormone replacement therapy and risk of breast cancer” (editorial). JAMA 1999, 281, pp.2140-2142.
CHAPTER 15: HORMONE THERAPY: FACTS AND FALLACIES
1. North American Menopause Society. Check their Web site at www.nams.org for information on hormone therapy, a list of health professionals specializing in menopause around the country, consumer educational materials and other helpful resources.
2. Menopause and Midlife Health. Morris Notelovitz, M.D., and Diana Tonnessen, St. Martin’s Press, New York, 1994. Written by a pioneer in osteoporosis and menopause, this book presents accurate and up-to-date information about managing your health, including the role of healthy lifestyle habits. Discusses hormone therapies, pros and cons of gynecological procedures, issues about breast cancer and other concerns of importance to women.
CHAPTER 16: COMPLEMENTARY MEDICINE: MAKING “HOLISTIC” MEDICINE WHOLE
1. Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. J. M. Jellin, F. Batz, and K. Hitchens, Therapeutic Research Faculty, Stockton, CA, 1999. This group publishes a newsletter and a comprehensive reference book of detailed information on vitamins, herbs, and natural medicine supplements. Their reference book has been prepared by pharmacists who have reviewed the medical studies from around the world and then compiled summaries of uses, side effects, and symptoms of overdose for thousands of supplements. It is one of the most comprehensive, reliable, scientifically-based compilations of information on natural medicines that I have found anywhere. It is not supported by advertising, is objective and medically sound. For more information on how to subscribe to their newsletter or purchase a copy of the reference book, call 209-472-2244 or visit their Web site: www.naturaldatabase.com.
2. Mind/Body Medicine: How To Use Your Mind For Better Health. Consumer Reports Books, Consumers Union of the U.S., Inc., New York, 1993. A well-researched book written by the leading authorities from the nation’s top medical centers. Full of practical suggestions and descriptions of what works and how to find resources in your area.
3. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. Herbert Benson, M.D., and Eileen M. Stuart, R.N., M.S., Birch Lane Press, New York, 1993. Competent overall look at wellness with practical how-to information.
CHAPTER 17: FAT TO FIT: HEALTHY LIFESTYLE CHANGES FOR ALL AGES
1. Cooking Low Carb. Brenda Laughlin and Kelly Nason, Two N’s Publishing, P.O. Box 35, Littleton, MA 01460, 1999. Order from www.cestbon.com. A practical and easy-to-follow cookbook written especially for sufferers of PCOS, but useful for anyone with problems managing waistline weight gain.
2. CPSI/Nutrition Action Health Letter. 1875 Connecticut Avenue, N.W., Suite 300, Washington, D.C. 20009. Web site www.cspinet.org/nah. A hard-hitting, scientifically-based newsletter that exposes frauds and fads in all the nutrition-supplement hype abounding today. An excellent resource to get reliable information since it is NOT supported by advertising.
3. 40-30-30 Fat Burning Nutrition. Joyce and Gene Daoust, Wharton Publishing, Del Mar, CA, 1996. An excellent, easy-to-read, practical and easy-to-follow meal plan that helps you reduce the fat-storing insulin excesses caused by our current high-carbohydrate, low-fat diets. The Daosts have done a terrific job of providing healthy meal plans for both vegetarians and non-vegetarians, and they have also provided a list of prepared foods that fit well into the 40-30-30 balance. Our patients have really found this book helpful, and they have lots of lost pounds to back them up!
4. Mastering The Zone. Barry Sears and Mary Goodbody, Harper Collins, New York, 1996. I think this is an excellent meal plan, and addresses important points about the role of excess insulin in causing a number of serious health problems that become more common in women during the years of transition to menopause and beyond. I have recommended it to our patients since 1996, but the feedback from patients has been that it is difficult to read, comprehend, and follow as a meal plan. For that reason, I have turned to the simpler, more “user-friendly” book by the Daousts. Dr. Sears has recently published a new book, The Soy Zone, which I have also reviewed and do not recommend as positively as his original “Zone” meal plan. In his new emphasis on soy, he does not take into account the latest science showing competitive inhibition of ovarian hormone production in premenopausal women by high dietary intake of soy protein or soy supplements. Nor does he address the potential for a high soy diet to markedly interfere with thyroid function, particularly a common problem in women. For these reasons, if you have any symptoms suggestive of either ovarian hormone imbalance or thyroid disorders, I suggest if you want to follow the “Zone” meal plan, stay with the original book and recipes rather than the “soy zone.”
5. Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance. Jack Challen, Dr. Burton Berkson, and Melissa Diane Smith. John Wiley and Sons, New York, NY, 2000. An excellent resource for understanding the role that elevated insulin plays in causing heart disease, hypertension, elevated triglycerides, abnormal cholesterol patterns and diabetes. Gives helpful information on nutritional approaches to correct these problems and reduce later risk of diabetes and cardiovascular disorders.
6. The Callaway Diet: Successful Permanent Weight Control for Starvers, Stuffers, and Skippers. Wayne Callaway, M.D., Bantum Books, New York, 1990. An older book (and possibly hard to find), but still an excellent resource to explain the effects on the body from chronic diets, how to reduce the problem of insulin resistance and how to break out of the trap of “skipping and stuffing.” Dr. Callaway has extensive experience in obesity treatment and provides medically sound overall information.
7. The Bodywise Woman: Reliable Information About Physical Activity and Health. Written by the staff and researchers of the Melpomene Institute for Women’s Health Research, Prentice Hall Press, New York, 1990. Well-researched and specific to the needs of women of all ages. Write to this organization for updates of their consumer materials.
8. The Protein Power Plan. Michael R. and Mary Dan Eades, M.D., Bantam Books, New York, NY, 1996. Similar to the above meal plans in providing background understanding of the ways to reduce excess insulin through your meal plan schedule and food choices. Although it is a bit expensive, their complete package of materials (sold as a set with videotape, audiotapes, workbook guide, professional references, et cetera) provides a wealth of practical tips for success as well as medical references for you to discuss with your own physician before starting this meal plan.
9. “Long-term effects of oral estradiol and dydrogesterone on carbohydrate metabolism in postmenopausal women.” U.J. Gaspard, O.J. Wery, A.J. Scheen, et al, Climacteric: The Journal of the International Menopause Society, vol. 2, no 2, June 1999, pp. 93-100.
CHAPTER 18: OSTEOPOROSIS—A CASE FOR PREVENTIVE MEDICINE
1. National Osteoporosis Foundation (NOF), 2100 M Street N.W., Suite 602, Washington, D.C. 20037, 1-800-223-2226, Web site: www.nof.org. An excellent source of cutting edge information about osteoporosis prevention and treatment. Join NOF and become an advocate in your community. I highly recommend their educational materials.
2. Strong Women Stay Young. Miriam E. Nelson, Ph.D., Bantam-Doubleday-Dell, New York, NY, (paperback) 1998. An excellent book outlining the benefits of both aerobic and strength-training for women to preserve and build healthy bone and muscle. I highly recommend it.
CHAPTER 19: PATIENT AND PHYSICIAN: IMPERATIVE AGENDAS IN WOMEN’S HEALTH FOR THE TWENTY-FIRST CENTURY
1. The Complete Guide to Women’s Health: Revised Edition. Bruce D. Shephard, M.D., F.A.C.O.G., and Carroll A. Shephard, R.N., Ph.D., Plume, 1997, paperback. This is an excellent reference book to have in your library. Available from Amazon.com.
2. Take Charge of Your Hospital Stay. Karen Keating McCann, Perseus Books, Cambridge, MA, 1994. A must-read before you go in for tests, out-patient surgeries or other procedures or you find that you have to be hospitalized for anything. It may be difficult to find in bookstores, but is available on Amazon.com.
CHAPTER 20: WEAVING YOUR TAPESTRY OF HEALTH AND WHOLENESS
The following books are ones I have used often in my women’s growth groups and seminars because I feel they offer a great deal of clarity about our lives as women, how we have reached the place we are now and the opportunities to discover the fullest dimensions of ourselves as women for the times ahead. In my opinion, these remain classics and I have kept this list for the revised edition to encourage you to explore them.
1. Women Who Run with the Wolves. Clarissa Pinkola Estes, Ph.D., Ballantine Books Div. of Random House, Inc. 1997. A powerful and moving book about recovering the creative, spontaneous, passionate soul force within each individual woman that is too often masked by societal roles and expectations. I found this a moving and inspiring book and still turn to it often. I agree with the description by Jean Shinoda Bolen, M.D., “Full of wonderful, passionate, poetic, and psychologically potent words and images that will inspire, instruct and empower women to be true to their own nature and thus in touch with sources of creativity, humor and strength.”
3. The Crone: Woman of Age. Wisdom and Power. Barbara G. Walker, Harper, San Francisco, 1988. Many women have a negative image of a “crone.” Barbara Walker’s book clarifies the derivation of crone as being from “crown,” representing “wise woman” after menopause. This book chronicles the historical roots of devaluation, repression, and denial of the wisdom of older women, and offers a wealth of insights into ways women may develop the kind of constructive healing power that will benefit themselves as well as present and future generations. I highly recommend it.
4. The Heroine’s Journey: Woman’s Quest for Wholeness. Maureen Murdoch, Shambhala Publications, Inc., Boston and London, 1990. A meaningful exploration of feminine psyche and female psychological development, and a guide to help women find the spiritually alive feminine self who will be actively engaged in personal and cultural empowerment. If you are just beginning your inner quest, this book has many suggestions for helping you explore your feelings and gain appreciation of your full self.
5. The Road Less Traveled. M. Scott Peck, M.D. Simon and Schuster, New York, 1977, and Buccaneer Books, 1995. The power and enduring quality of this book is indicated by it being on the N.Y Times best-seller list for over ten years. It is one of the most meaningful books I have read; I continue to find new levels of thought-provoking ideas each time I go back to it. It is truly a classic, and I highly recommend that you read it.
6. Healing Words. The Power of Prayer and the Practice of Medicine. Larry Dossey, MD, Harper, San Francisco, 1993. A meaningful book about the ways that modern medicine has overlooked the crucial role of prayer in healing, and how to help you re-connect with your spiritual needs as you face life’s challenges. I have read most of Dr. Dossey’s books and have found they are inspiring and encouraging of the steps we need to take to make medicine and healing more focused on the whole person.
7. Sacred Journey. An inspirational journal of readings, prayers and reflections on life written by contributors of all faiths and published by the interfaith organization, A Fellowship in Prayer, Inc. 291 Witherspoon St., Princeton, NJ 08542. This little journal is a wealth of short, inspiring readings that will help facilitate your daily meditation and spiritual awareness.
Nutrition Action published by the Center for Science in the Public Interest, Washington, D.C. Web site: www.cspinet.org/nah. An excellent, progressive newletter which is NOT supported by advertising. It is hard-hitting and unbiased by commercial influences. Contains practical advice on reading food labels, selecting healthy options and avoiding hidden sources of fat, salt, and sugar and other useful pointers.
The Harvard Women’s Health Watch Newsletter. In my opinion, of all the many women’s health newsletters that have brought out since the first edition of my book, this is by far the best in terms of quality and depth of information. It is published monthly by Harvard Health Publications, 10 Shattuck Street, Suite 612, Boston, MA 02115. The authors provide timely, well-researched information on many topics of interest to women of all ages, and the content is provided in enough depth to make it useful to guide your discussions with your own health professionals. I subscribed to a number of other women’s health newsletters for at least a year or so with each one so that I could evaluate their material over time. After this detailed review, I am not recommending any other women’s health newsletters because in my professional opinion, they are either (1) pushing supplements and other products, (2) have unreliable medical information, (3) have too much “fluff” without enough depth to their content to be overly useful, or (4) they push a narrow point-of-view without sufficient balance to be objective.