Posts Tagged ‘condition’

TINNITUS
6 Test drive a hearing aid/masking device    ***
•    Take melatonin at bedtime    **
•    Ask your doctor about misoprostol (Cytotec)
Can you imagine anything more annoying than hearing a mosquito buzzing around your head and not being able to catch it? A dentist’s drill might be a close match. Now imagine what it would be like to have crickets chirping in your ear 24 hours a day, 7 days a week.
Experts estimate that more than 30 million Americans hear a constant noise in their ears.807′Roughly one in eight men between the ages of 65 and 74 experiences some form of tinnitus (pronounced TIN-a-tus or tin-EYE-tus).808 Women and children are not spared the unwanted sound effects, which some describe as hissing, humming, chirping, whooshing, whistling, squeaking, or roaring.
Many tinnitus sufferers hear a high-pitched ringing, while others say it sounds more like steam escaping. Others complain of radio static or an electronic whine inside their head. One person described it this way: “I have aff ocean between my ears every day, 24-7.” Whatever the sound, it never lets up—but nobody else can hear it, either.
My husband has a constant buzz in his ears andalso hears a sound he likens to a dishwasher running. This particular sound bothers him most when he goes to bed or wakes up at night, and it wakes him frequently. The doctor says lots of people have tinnitus and the problem isn’t serious, but it has my husband on the ropes.
According to the medical establishment, “Many patients with tinnitus believe that they have a serious medical prob- lem. This is rarely the case.” 8(3) We beg to differ. People with tinnitus look normal, but the affliction can be as crippling as arthritis. Some individuals are so distressed by the sounds they hear that they become severely depressed and contemplate suicide. A study has found that even moderate tinnitus can interfere with cognitive ability, making it harder to focus and achieve peak performance while working on demanding tasks-810
Tinnitus can be caused by many things, including very loud noises. More than 15 years ago, Joe was preparing to cohost a radio show when a student engineer made an error and created a feedback loop through Joe’s headphones (the kind of screech you sometimes hear through speakers in an auditorium). The sound was so loud and so close to his ears that from that day to this, Joe has heard a ringing and hissing sound. Some days the noise is so overpowering that it is hard for him to concentrate. For people who cannot imagine what you are going through, it is difficult to describe how disconcerting it is to have a fieldful of crickets inside your head all the time.
We fear that millions of teenagers and young adults may be setting themselves up for tinnitus and other forms of hearing loss by exposing themselves to high volume levels while listening to iPods and other music devices. There are so many loud noises in our environment that the cumulative effect can damage our ears and increase our risk of tinnitus. We’re talking about everyday things in our lives like blenders, vacuum cleaners, motorcycles, leaf blowers, and lawn mowers. All of them are loud and can contribute to hearing problems.
G. I have just developed a hissing sound in my ears. The onset was very rapid!
The doctor diagnosed it as tinnitus but would give me no reason for the problem. He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others, but some nights it awakens me because it has become so loud.
I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?
A. Stop the tonic water! Quinine gives tonic its distinctive bitter flavor, but it can cause tinnitus, especially at high doses. Hopefully the hissing sound will gradually go away once the quinine is out of your system.
Drugs are another common cause of tinnitus. An amazing number of prescription and over-the-counter medications can cause ringing in the ears. Aspirin is one of the most common culprits, but many other arthritis drugs can also contribute to the problem. If you suspect that a medicine is causing ringing, hissing, or whooshing, please discuss this with your physician promptly.
Drug-Induced Tinnitus
A. 1 am desperate to find some way to alleviate my arthritis pain without experiencing unbearable tinnitus. I have taken aspirin for some time, and it has been quite effective. If a joint flares up, l increase the dose for a few days. Then I heard your radio show where you mentioned that aspirin can contribute to tinnitus.
The noises in my head had been getting worse. I was resigned to this, but after listening to your program I stopped the aspirin. The result for my ears was dramatic! But then the joint pain came back. I feel I am walking a very thin line between arthritis and tinnitus.
A. Sadly, you are caught between a rock and a hard place. Aspirin and other arthritis drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs, like naproxen and ibuprofen) can cause ringing in the ears. Some people are susceptible to even low doses. You may need to investigate other options for arthritis pain. (See page 102 for some nondrug approaches.)
In addition to sound-induced injury (like Joe experienced) and drugs, many other things can cause tinnitus. Impacted earwax is probably the most benign and easiest to correct. Some other contributors include head injury, multiple sclerosis, hypertension, infections (otitis media, Lyme disease), and tumors (acoustic neuroma). That’s why it is important-to be seen by a specialist (an otorhinolaryngologist, or ear, nose, and throat doctor) to rule out any treatable condition. Sometimes there is no obvious reason for the ringing or whooshing.
A few months ago I suddenly developed a case of tinnitus in my left ear It sounds like the high-pitched noise the computer makes when logging onto the Internet I am 36 years old and in extremely good health. I have not experienced any head trauma and am not exposed to loud noises.
I had an MRI to rule out a brain tumor Neither my family physician nor an ear, nose, and throat doctor could find anything wrong
DRUGS THAT CAN CAUSE TINNITUS*
GENERIC    BRAND NAME
Aspirin    Alka Seltzer, Ascriptin, Bayer
Bleomycin    Blenoxane
Bumetanide    Bumex
Bupropion    Wellbutrin SR and XL
Cetirizine    Zyrtec
Chloroquine    Aralen
Cisplatin    Platinol
Diclofenac    Cataflam, Voltdren
Erythromycin    E-Mycin, Ery-Tab, Eryc
Furosemide    Lasix
Ibuprofen    Advil, Motrin
Meloxicam    Mobic
Methotrexate    Rheumatrex
Nabumetone    Relafen
Naproxen    Aleve, Anaprox, Naprosyn
Quinine    Quinamm, Quinerva, QM-260
Risedronate    Actonel
Tetracycline    Sumycin
Valproic acid    DepakeRe,
Vancomycin    Vancocin
Vincristine    Oncovir
*This is just a partial list. Hundreds of drugs can contribute to tinnitus.
with me and they have not suggested any remedies. I currentlyiust barely manage it with white noise (a fan) at night
Treatments for Tinnitus
When everything else has been ruled out and you are left with ringing in the ears, what can be done? First and foremost, do not expose yourself to noise pollution. Chances are good you already have some hearing loss. Be cautious around all appliances (blenders and vacuum cleaners, for example) and power tools. When flying, take along hearing protectors (you can buy earplugs that fit in your ears unobtrusively) to block out some of the jet engine sounds at airports or on loud commuter airplanes. Do the same when attending concerts or sports events. Protect your ears from any further damage.
The official word from the medical establishment is that “most treatments [for tinnitus] are unsuccessful.”811 A review of 69 randomized clinical trials published in 1999 concluded that there was no proof that any therapy provides long-term improvement.812 Investigators have experimented with powerful medications that control irregular heart rhythms (intravenous lidocaine, and oral flecainide and tocainide), but the results were disappointing and the side effects scary. Anti-anxiety agents (benzodiazepines) such as alprazolam (Xanax) may help ease the psychological impact of tinnitus, but when the drug is discontinued, the problem can return with a vengeance. The antidepressant nortriptyline has shown more promise than many other approaches, but the benefits still are not overwhelming.813 Acupuncture, biofeedback, hypnosis, and “tinnitus retraining therapy” have all been disappointing and do not make the ringing go away.
Most physicians will say that the primary goal of treatment for tinnitus is “management.” Usually this means things like masking devices. In its crudest and cheapest form, a masking device is an FM radio tuned so that you do not get a signal, just static. The theory is that this “white noise” will mask the sound of the tinnitus. Some people find this helpful, whereas others report that it just intensifies the annoying sounds.
There are also white noise generators or masking devices that can be “tuned” to an individual’s general noise frequency. There are also sophisticated new hearing aids that both amplify sound in the hearing range that is impaired and  Hearing Aid/Masking Device
High-tech hearing aids that combine frequency-specific amplification and masking in one device may be worth consideration. Some folks report both improved hearing and reduced tinnitus with such equipment. Sometimes the tinnitus relief lasts for some time after the device is turned off or removed .814
Downside: These special hearing aids are pricey, costing several thousand dollars. Insurance is not likely to cover the cost. They require professional fitting. Do not expect them to solve the problem, but they may make it more tolerable.
Cost: Approximately $1,000 to $3,000 per ear. Try to work out a “test drive” to make sure they work well and adequately relieve your tinnitus discomfort. Another option: Lease with an option to buy. If they do not solve your problem, you can at least give them back when the lease is up.
use a masking signal that is adjusted to the specific range of the patient.
My husband has suffered for years from tinnitus and hearing loss (due to his time in Vietnam). He recently found great relief with the new technology in hearing aids. Since getting his hearing aids, the ringing, buzzing, etc., has completely gone away and his hearing is now very acute.
Many folks have tried hearing aids in the past without success. know my husband did. He said they just made the ringing louder! He is thrilled with this new technology. I believe this might help many who haven’t tried the devices.
No one should buy these pricey instruments unless they ac-
tually work. That means you should be able to either test the device for a short while or lease it for somewhat longer before shelling out thousands of dollars to purchase it.
Ginkgo Biloba
There has been some interesting research on this ancient Chinese herbal medicine. From the more than 100 clinical
trials that have been published, there seems to be a reasonable amount of data suggesting that standardized ginkgo extracts (Ginkgold, Ginkoba, and Ginkai) improve circulation throughout the body, in general, and may modestly improve symptoms of dementia.’”‘ A 1999 review of clinical studies of ginkgo concluded that “overall, the results of these trials are favorable to ginkgo biloba as a treatment for tinnitus, but a firm conclusion about efficacy is not possible … the body of evidence is small.„816
Since then, there have been two studies that have not found ginkgo to be an better than placebo for relieving symptoms of tinnitus.”11,81′ At this time it would be fair to say that the evidence is mixed at best and probably not very promising. On the other hand, ginkgo does seem to improve circulation and may be worth a try. Do not expect any miracles, though.
Adding a little zinc to the mix (50 milligrams) might be worth consideration since a small study suggested that this mineral produced some modest clinical improvement.”’ If after several weeks there is no improvement, we would give up on this approach.
Melatonin
One of the least studied but most promising new approaches for the treatment of tinnitus may be melatonin. This natural compound is inexpensive and safe. Melatonin is a hormone that is made primarily by the pineal gland in the brain in response to darkness. During the daytime, the blood level is low, but at night melatonin climbs until it reaches its peak between
** Melatonin
Melatonin is natural, safe, and not very expensive. Although there is some controversy about its effectiveness for insornni8, two preliminary studies suggest that it may help people with tinnitus and sleeping problems associated with ear ringing. The dose that has been tested is 3 milligrams.
Downside: The data are not yet strong enough to elicit a ringing endorsement.
Cost: Approximately $2 to $4 per month when purchased in bulk
2:00 and 4:00 a.m. It is crucial for regulating sleep and wake
cycles.
Some extraordinary claims have been made for melatonin. Some proponents say that it can reverse aging, improve immune function, reduce the risk of cancer, control blood pressure, and lower cholesterol. The best-known use of melatonin is as a sleep aid. An extensive review of the existing studies published in the Cochrane Database concluded, “Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended to adult travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys
Despite this good news, two reviews of melatonin’s use for easing insomnia were less glowing. They concluded that melatonin does not work for sleep disorders’ 1,822 Nevertheless, a small preliminary study carried out by the Ear Research Foundation in Sarasota, Florida, in 1998 revealed that a dose of 3 milligrams of melatonin was helpful for patients with tinnitus that interfered with their sleep. 823 Following up on this research, investigators at Washington University in St. Louis also found that a dose of 3 milligrams was beneficial for people with tinnitus: “In summary, our study demonstrates that melatonin use is associated with improvement of tinnitus and Sleep.”824 Although the research to date is preliminary, melatonin seems to be worth a try because of its safety and affordability.
Misoprostol (Cytotec)
Sometimes doctors teach old drugs new tricks.’Tbat might be the case with misoprostol (Cytotec), a medication approved more than a decade ago to help prevent stomach ulcers. It was hoped that Cytotec would be especially beneficial for people taking aspirin or other NSAVDs like ibuprofen or naproxen. This medication has become controversial in recent years because some obstetricians have used it to induce labor. Others have combined misoprostol with mifepristone to induce abortion.
An entirely different use for misoprostol is treating tinnitus. We first stumbled across a pilot study that was published in 1993 in the Archives of Otolaryngology—Head & Neck Surgery.wL’ One of the most prestigious ear clinics in the world (House Ear Institute in Los Angeles) enrolled 24 subjects. These volunteers were given either misoprostol or placebo. Not surprisingly, the placebo did not work. Misoprostol, on the other hand, provided improvement for eight (33 percent) of the subjects. According to the investigators, “Responders reported improvement in tinnitus severity, sleep, and concentration:
More than a decade later, Turkish investigators noted that 13 of 28 patients (46 percent) who were given misoprostol reported a decline in the volume of their tinnitus, compared to only 2 of 14 subjects (14 percent) in the control group. 827 A
Misoprostol (Cytotec)
This prescription medication has FDA approval for the prevention of stomach ulcers. An “off-label” use may ultimately turn out to be for tinnitus. Preliminary studies have found that misoprostol may help roughly one-third to two-thirds ofrr tinnitus sufferers, with those who experienced a sudden onset of tinnitus or who had a history of acoustic trauma getting the most benefit. The dose used by the researchers was “200 micrograms per day for the first week, increased by 200 micrograms every 5 days” to reach a maintenance dose of 800 micrograms per day. This latter amount is also the dosage commonly used in gastroenterology.”828
Downside: Very expensive! Misoprostol must never be taken by a woman who is pregnant or might become pregnant. It can induce premature labor and cause other serious complications. Patients with heart or inflammatory bowel problems should also avoid misoprostol.
Side effects: Common adverse reactions include abdominal pain, indigestion, diarrhea, nausea, vomiting, flatulence, constipation, headache, and menstrual changes. Rare but potentially serious side effects include allergic reaction, irregular heart rhythm, heart attack, high blood pressure, low blood pressure, breathing difficulty, and blood clots.
Cost: Approximately $160 to $300 for a 2-month supply (depending on whether you purchase from a Canadian or US pharmacy)
follow-up study found that 18 of 28 patients “showed improvement in tinnitus loudness, representing an improvement rate of 64 percent. These are all small studies, and larger, more comprehensive, and longer follow-up research is required to prove that misoprostol represents a true advance in the treatment of tinnitus.
Conclusions
Compared to heart disease, diabetes, and cancer, tinnitus seems like a trivial complaint. But ask anyone who suffers from it and you will discover that it can have devastating consequences on the person’s quality of life. The constant ringing or hissing not only affects concentration, it also can interfere with sleep. Many people with tinnitus are depressed, and some even contemplate suicide. There is no cure and no perfect treatment. Nevertheless, there are some options worth considering.
•    Avoid loud noise, including common household appliances like blenders, hair dryers, vacuum cleaners, and power tools. Concerts, sporting events, and airports call for ear protection. Noise can make tinnitus worse.
•    Beware of prescription medicines and over-the-counter remedies that can trigger tinnitus or make it worsee. Even the quinine in tonic water can be a problem for some people.
•    Some people benefit from antianxiety agents like alprazolam (Xanax) or antidepressants such as nortriptyline. These drugs are not without side effects, however.
•    Seek professional advice about new technology that combines a hearing aid with a masking device. This equipment may help improve hearing and reduce the ringing. Try to negotiate for a trial period to test the hearing aid so you can make sure you are satisfied before shelling out thousands of dollars to purchase it.
•    Give ginkgo biloba a try. Although the research is not very supportive, ginkgo may help and it is relatively inexpensive. Make sure that it won’t interact with any other medicine you are taking.
•    Consider melatonin. This natural compound appears to be quite safe and may help tinnitus sufferers get some much-needed sleep.
•    If all else fails, your physician might prescribe misoprostol. A few small studies have found it useful for about one-third to two-thirds of tinnitus patients. Its price and side effects are daunting, however.

NAIL FUNGUS
Over the last several years, nail fungus has garnered public attention completely out of proportion with its seriousness. The medical term, onychomycosis (oh-nick-o-my-CO-sis), is long and scary, but it just means fungal infection of the nail. Perhaps so many people are curious about this topic because nail fungus is very common. In addition, the development of
•    Soak your nails in a solution of one-third vinegar to two-thirds water
•    Prepare a cornmeal suspension and soak nails for an hour a week
•    Apply Listerine to infected nails daily
•    Coat the nails with Vicks VapoRub
•    Soak the nails in tea tree or vitamin E oil
•    Try Pau d’Arco tea soaks
•    Ask your MD about a prescription for urea paste 40 percent to remove the infected nail
•    Apply prescription Penlac (ciclopirox)
•    Consider the pros and cons of Lamisil (terbinafine) and Sporanox (itraconazole)
new antifungal drugs that can treat (dare we say cure?) nail fungus has encouraged the pharmaceutical industry to advertise in magazines, in newspapers, and on television.fbe popularity of sexy sandals as footwear may also have contributed to the interest in treating nail fungus.
For diabetics, nail fungus is a medical issue.fbey need to be extremely vigilant about foot care and attend promptly even to things that may seem minor. For the rest of us, though, thick, yellow toenails that are crumbly or hard to cut are more of a nuisance than a serious health concern. They look ugly, and if they get very thick, they may be uncomfortable as well. Sometimes they split, which can be quite painful.
In our opinion, though, it would be a mistake to put your life on the line to clear up your funny-looking nails. Mat’s why we have collected so many home remedies for this problem. They probably won’t work for everyone, but they shouldn’t be very risky, either.
Q. My husband took Lamisil to treat toenail fungus, The drug worked but was ultimately responsible for his death.
The fine print for this prescription drug noted that it might cause neutropenia. For my husband, it did. This led to MDS (myelodysplastic syndrome), which was followed thereafter by AML (acute myeloid leukemia) and his subsequent death.
He had suffered with periodic flare-ups of toenail fungus and athlete’s foot for most of his life. Neither condition was life threatening. The Lamisil was!
Even though serious side effects mentioned in prescription drug labels may affect only 1 percent of users, anyone could be in that I percent. People should ask themselves if it is worth taking that chancel
A. We are so sorry to hear of your husband’s tragic death. In rare cases, Lamisil may trigger serious blood disorders such as neutropenia, a lack of white blood cells. This drug can also damage the liver; there have been deaths associated with this problem. This is a high price to pay to cure toenail fungus.
Patients must always take into account not only common side effects but also the possibility of rare but deadly adverse reactions.
Home Remedies
It’s hard to say just where nail fungus comes from and why some people appear to be more susceptible than other-, Occasionally readers report that they first noticed nail fungus after going for a manicure or a pedicure. Presumably, it is possible to pass the organism that causes nail fungus from one person to another, and surely from one nail to another.To minimize that likelihood, we suggest that any tools such as scissors or clippers that have been used on a nail that might be infected be soaked in rubbing alcohol for 15 minutes before being used on an uninfected nail.
We think home remedies are the place to start for treating nail fungus, whether it affects the toenails or fingernails. (”This does not apply to people with diabetes, who should seek medical care for this problem.) Needless to say, some doctors are not fond of the idea of using home remedies for nail fungus.
Some time ago, we heard from a podiatrist who was very unhappy with our recommendations. “Home remedies hardly ever work,” he wrote. “The unproven treatments you mentioned are little more than urban legends. In 23 years of practice, I have never seen even one patient who responded favorably to Vicks VapoRub, dilute vinegar soaks, or vitamin E oil. Don’t make me waste time dispelling these myths.” He recommended that people take FDA-approved prescription drugs like Lamisil, Penlac, or Sporanox instead.
We certainly heard from readers who disagreed with him. One person who had success treating nail fungus with vinegar soaks expressed this opinion: “If a treatment is relatively harmless, as this is, and there’s even a chance it can work, I believe doctors should encourage alternative methods instead of high-priced medicines laden with potential side effects.”
A pharmacist also weighed in with some information on the effectiveness of the prescription medications:
I would like to point out some facts about the FDA-approved drugs the podiatrist prefers (Lamisil, Penlac, Sporanox). Does this doctor know that Penlac’s success rate for a complete cure, accord-ing to the manufacturer’s prescribing information, is only 5.5 to 8.5 percent after 48 weeks? When using Sporanox, the percentage of overall success rises to a dizzying 35 percent.
Also, does he know the costs of these medications? A bottle of Penlac costs $72.99. To reach 48 weeks of treatment once a day to a single affected nail, I conservatively estimate that the patient will need six bottles of the lacquer (one bottle approximately every other month), So Penlac will cost the patient, without insurance, 5437.94 to reach an outstanding 8.5 percent cure rate.
For Sporanox, one pulse-pak costs ME99. This is a 14-day supply. The manufacturer recommends 12 weeks of treatment, bringing the patient cost, without insurance, to $1,535.94! No wonder people are looking for alternatives to these medications.
Oral medicines such as Sporanox can occasionally trigger serious reactions as well. No wonder some people are willing to spend time and effort—but not much nioney—trying a low-risk home remedy.
I assumed toenail fungus was a fact of life forme. khad spread to five or six toenails when I finally saw a dermatologist The prescribed treatment was costly, and after it began, the dermatologist told me the odds of reinfection after treatment were about 50 percent
I had a nightmare reaction to the pills a week later I was in remote Finland, of all unlikely places, when I developed hives and severe itching. After 24 hours of nonstop, nonsleep itching, I got through to my doctor and was told to stop taking the pills.
When I got home, / decided to try the vinegar treatment I applied a drop of distilled white vinegar to my toenails with a cotton swab each time I got out of the shower As the nails grew out the fungus was completely gone, along with slight traces of athlete’s foot
Cost: under $ZOO over 9 months.
Side effects: none.
Effectiveness: 1019 percent (or 200 percent it you include the athlete’s foot).
Vinegar
One of our favorite home remedies is a vinegar soak. It is surely, one of the cheapest remedies for nail fungus. People who sit still to read, use the computer, or watch television could soak the foot with the affected toenails or hand with the affected  Vinegar
Use two parts of water to one part vinegar for a soaking solution. It does not seem to matter whether you use white vinegar or apple cider vinegar, so we suggest the cheaper
white vinegar.
Downside: Your toes may smell of vinegar.
Cost: $1.60 to $2 for 64 fluid ounces—enough for at least four treatments, and possibly eight
fingernails in a solution of one part white vinegar to two parts water. Vinegar is acidic, and acid makes the environment inhospitable to nail fungus. Because it is a home remedy, there is no “prescribed” method. Some people have had success soaking for an hour each week, all at one go; others soak once a day; and still others use the technique of daubing undiluted vinegar on the affected nail with a cotton swab every day. Persistence is needed with any home remedy. Nails grow slowly, especially toenails, and you need to give them time to grow out healthy and fungus free.
Cornmeal
Another natural fungus fighter may be cornmeal. We first learned of this approach from a public radio listener: “Put about an inch of cornmeal in a plastic dishpan. Pour in hot water, stir it so the cornmeal gets dissolved, and when it is cool enough not to hurt, soak your feet for an hour. If you do this regularly, it will get rid of the fungus.”
When examining me my doctor noticed that I had nail fungus affecting toes on each foot He recommended that) make a batter by mixing cornmeal and water in a shallow pan, let it sit for an hour, and then soak my feet for an hour He told me to do this once a week for a month. I did the cornmeal therapy for 3 weeks and the fungus was gone. I don’t know why it works, but it’s cheap, harmless, and it worked for me.
We haven’t found any scientific support for cornmeal as a nail fungus treatment, and fewer people have written us regard-Cornmeal
A footbath of cornmeal mush is neither expensive nor dangerous, and it takes just 1 hour a week. Put about an inch of cornmeal in a shallow pan and add enough hot water to dissolve it. Let it cool to a comfortable temperature and soak your tootsies for an hour.
Downside: This treatment could be somewhat messy. Don’t spill it on the carped
Cost: $2 to $4 for 5 pounds of cornmeal—enough for at least five treatments, and probably more
ing their success with cornmeal than with vinegar, but some have used it to eliminate their nail fungus.
Cornmeal does seem to be a popular home remedy in the garden, though. Gardeners claim that working some cornmeal into the soil around a rose bush will discourage black spot disease, a fungus that affects roses.
Vitamin E
We are always impressed by our readers’ ingenuity. We would never have thought of putting vitamin E oil on fungus-infected toenails, for example. We can’t think of a good reason why vitamin E in particular would be useful against fungus, and yet a number of people have tried this approach with some success.
I keep reading about treatments for toenail fungus so I thought I would pass on my solution. When I had this problem several years ago, I used a simple approach. I kept my toenail soaked with vitamin E oil and the fungus disappeared completely. I can’t recall exactly how long it took but it wasn’t too long.
As we understand the vitamin E tactic, a capsule that you would take as a vitamin—any dose will do—is pierced with a needle or a pin.’Iben the contents are squirted out all around the edge of the nail and particularly under the nail, between it and the skin. The key here, as with most nail fungus treatments, is patience and persistence.
Listerine
The old-fashioned mouthwash Listerine is one of America’s favorite all-purpose home remedies. (The other is Vicks VapoRub; more about it in just a bit.) Amber-colored original flavor Listerine contains a mixture of herbal extracts that can fight fungal pasties from dandruff to jock itch. Some people have also reported having good success with soaking infected nails in Listerine.
0. 1 cured my toenail fungus using a fifty-fifty mixture of vinegar and Listerine. I kept the mixture in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. I wore socks to protect the bedsheets at night.
The fungus took about 3 months to clear up. It is slow growing but is also slow to cure. I hope this helps someone else.
A. You combined a couple of favorite remedies. Many people have reported success with soaking infected - nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.
*** Listerine
This amber-colored mouthwash contains a fair amount of alcohol along with a mix of herbal oils including thymol, eucalyptol, methyl salicylate, and menthol. The thymol and the eucalyptol, at least, seem to have antifungal activity, and the other two may fight fungus as well. Soaking the nail in Listerine (original flavor) or daubing on a bit of Listerine after the daily bath has worked for some people.
Side effects: None known
Downside: Your nails may smell like Listerine. Cost: Approximately $5 for a liter  Vicks VapoRub
This ointment contains herbal oils such as camphor, menthol, thymol, eucalyptol, cedarleaf, nutmeg, and turpentine. Some of these have antifungal activity, and they may work synergistically. Apply Vicks VapoRub all around and under the affected nail or nails once or twice a day. Putting it on right after a shower or bath seems to help. If you apply it at night, wear socks to bed to protect the sheets. It may take 6 months to see results.
Side effects: Allergic rash is possible. In addition, we heard from a few people whose fungus-infected nails came off with this treatment. This might increase the effectiveness of the remedy, but it could be painful.
Downside: Inconvenience
Cost: Approximately $12 for 6 ounces. You could probably treat several toenails twice daily for 6 months with this much Vicks.
People have conjectured why Vicks seems to be beneficial against nail fungus. There is a compound in Vicks—thymol—that is now listed as an inactive ingredient.
When I was a premed student at UCLA in 1951, 1 met a mycologist (an expert on fungus). During World War It he devised a preparation to treat fungal infections that were common among the troops in the North African campaign. ft was an ointment that relied heavily on thymol as the most effective antifungal agent and reeked of thyme.
Vicks contains three active ingredients and 22 considered inactive. One or more of these might help thymol penetrate the tissues. I suspect that a pure preparation of diluted thymol, without other ingredients except a solvent, would be a good antifungal nail treatment
Vicks VapoRub certainly does not work for everyone. But we have heard from a great many people who have tried it and gotten a positive response. Some could see the results within a few weeks; others needed to keep applying it for month-s. Even prescription drugs take quite a while to clear toenail fungus, however, because the toenails grow so slowly. The infected nail must grow out completely and be replaced by uninvolved nail.
I had nail fungus fora long time. Medicines recommended by my doctor didn’t work. Then I read about using Vicks VapoRub. I applied it to the nail every day for about 5 months and now the fungus has disappeared. I’ve been cured.
Tea Tree Oil
Tea tree oil comes from an Australian tree, melaleuca. It has long been used to treat skin problems, particularly fungal infections. You don’t need to go to Australia to get it, though. It is marketed widely in stores and on the Internet in the United States. Applying tea tree oil to the infected nails daily can overcome some cases of nail fungus. Some people do develop allergic rashes in response to tea tree oil, however, so be alert for any itching or redness.
Q. Some years ago I was diagnosed with a fungal infection on one toenail. The intense throbbing pain made it difficult to wear a shoe.
My podiatrist said the only way to treat the toenail was to remove it. I had several more months of pain while the toe healed.
After the surgery I was alarmed when another toe showed signs of fungus. I asked about a natural treatment at the health-food store and was told to try tea tree oil.
I applied it liberally several times that day. Within 10 hours, the pain had diminished. I continued using tea tree oil on the nail daily for a few months. The base of the nail grew in pink and healthy.
I am angry that my podiatrist chose to operate on my toenail rather tha” recommend a natural, pain-free tMMYnent.
A. Tea tree oil (derived from the Australian melaleuca tree) has antifungal activity. It has long been used to combat skin and nail problems. Your podiatrist may not know about this herbal product, however.
Pau d’Arco Tea
The lure of the exotic can be seen not only in tea tree oil but also in Pau d’Arco, also called taheebo. This product is the inner bark of a South American tree that has been used medicinally by the natives of Brazil. Argentina, and Paraguay. It contains at least one compound with antifungal activity. Some readers report that using an infusion of Pau d’Arco to soak toenails, much as one would use vinegar or Listerine, can help clear the infection.
Oregano Oil
Oregano oil doesn’t come from a tropical rain forest, but it is hardly a common household staple. Nonetheless, some people have used it topically for fighting athlete’s foot, and others have reported success in using it against nail fungus. Like Listerine and Vicks VapoRub, oregano oil contains thymol. It also contains carvacrol. These two herbal oils together seem to have some antifungal action. Some people are allergic to oregano oil. Anyone who has experienced a reaction to basil, sage, lavender, marjoram, or mint probably should steer clear of oregano oil.
Can you stand another toenail fungus cure? I have found one that works for me, and I have tried them all, including prescription Lamisil pills.
I read somewhere that oil of oregano will kill anything, so tried putting a drop down between the nail and the skin every day. Slowly but surely the toenail is growing out normally! I hope someone else can benefit from this as well.
Lemon
Some years ago, we heard from a reader who maintained that sleeping with a lemon attached to the toe for 3 nights running would clear up toenail fungus. Only a few others have tried this -and reported back to us. It did not work for at least one person, though it seemed to help another.
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0. Many people write to you about toenail fungus, but you have never mentioned a remedy I learned from an elderly lady in South Carolina. This remedy requires three fresh lemons. At night cut a hole in the top of one and scoop out a hollow just large enough for the toe.
My mother had a great toenail so thick and hard that she could hardly wear a shoe on that foot. I used duct tape to hold the lemon on Mother’s foot, and put a sandwich bag over it to protect the bed. Do this for 3 nights in a row. The toenail becomes so soft that it can be peeled right off, and the new nail that grows in is normal. It worked for my mother!
A. We have been collecting nail fungus remedies for years, but this is the most unusual. Fungus doesn’t thrive in an acidic environment, which may be why dilute vinegar soaks are so effective. The citric acid in the lemon may work in a similar manner.
Prolonged exposure to pure lemon might be irritating for some people, so we suggest that anyone who wants to try such an approach test it first. Removing a
toenail should be done only with medical supervision,
because there is a risk of infection.
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Prescription Treatments
Unlike home remedies, prescription medications for nail fungus have been scientifically tested and have performed better than placebo. That is the criterion applied by the FDA before approving any prescription product. Don’t expect too much from these medicines, though: They don’t work for everyone, even though they might be more effective than home remedies. Before beginning a prescription medicine for nail fungus, make sure you understand the risks.
Urea Passe
One treatment for toenail fungus is to remove the nail surgically and then treat the underlying skin with an antifungal cream while the nail grows back without fungus. Many people are understandably reluctant to undergo surgery for nail fungus. Infection is always a risk. We hate it when the cure is worse than the condition it’s intended for.
Dermatologists have studied a different approach that is Urea Paste
The high-strength 40 percent urea paste that dissolves infected nails is available only by prescription. Its use should be supervised by a physician who is familiar with the treatment.
Side effects: Irritation, itching, or burning
Downside: Many doctors are not familiar with this approach. Cost: Approximately $75 for an 85-gram tube
far less traumatic. Urea paste at a 40 percent concentration will dissolve infected nail and leave healthy nail alone. It is essential to work together with the prescribing physician, however, as removing a nail is not a trivial issue. Please do not do this at home by yourself.
0. 1 have ugly, thick, yellow toenails that are hard to clip. My doctor says they are infected with fungus but he doesn’t want to prescribe Sporanox because it could interact with other medicine.
I have tried home remedies, including Vicks VapoRub, and none has worked. The podiatrist wants to remove the nails surgically. I know you have written about urea paste to dissolve away the infected nail. Where do I get it and how do I use it?
A. Surgical removal of nails can be painful and there is a risk of infection. Stanford dermatologist Eugene Farber, MD, discovered the urea treatment many years ago while traveling in Russia. 761 Urea (40 percent) is available only by prescription (Ureacin-40, Carmol 40, Gordon’s Urea 40). Your doctor should supervise the treatment.
Penlac
A lot of people are reluctant to take an oral antifungal drug. Some worry about side effects, others are concerned about potential interactions with other drugs they take. Both are valid concerns.
One manufacturer came up with a topical prescription antifungal medicine that is applied like nail polish. Penlac (ciclopirox) was approved by the FDA for the treatment of mild to moderate nail fungus. Like most of the home remedies we’ve already discussed, Penlac requires a lot of persistence. It needs to be applied to the affected nail, including between the nail and the skin, every day. It can cause redness or irritation, and it may take up to 6 months to produce results.
When people use Penlac, they need to see a health-care professional on a regular basis to have any unattached, infected nail removed so it won’t continue to spread the infection. We have no way of comparing Penlac’s effectiveness to that of other treatments. Presumably it is as good as most of the untested home remedies, but it is not really too astonishing. About 12 percent of the patients treated with Penlac in clinical trials were able to clear their toenails of fungus. One of the biggest differences between Penlac and a home remedy is the cost. A little bottle (6.6 milliliters) costs $130 or more.
Sporanox or Lamisil
The heavy artillery for treating nail fungus is an oral antifungal medication. If it is crucial to eliminate the infection, the physician will prescribe a drug such as itraconazole (Sporanox) or terbinafine (Lamisi)). (You may have seen magazine or television ads for Lamisil that feature a cartoon character, Digger the Dermatophyte.)
In a long-term head-to-head study, patients with toenail fungus were given either terbinafine or itraconazole according to the recommended dosing procedure for 3 to 4 months. 762 At the end of that time, 46 percent of the people who had taken Lamisil and 13 percent of those who had taken Sporanox had no detectable fungus in their nails. The follow-up extended for another 4 years or so. The investigators (some of whom worked for the maker of Lamisfl) found that relapse rates were significantly higher among those who had taken Sporanox.
An analysis of cost-effectiveness found that terbinafine is the most cost-effective treatment a doctor can prescribe. 761 Penlac was judged to be at least three times more expensive than the others, considering cost per cure. This analysis did not take any of the home remedies into account. If there were scientific data on them, they might well demonstrate low effec-tiveness, but because they are cheap, their cost-effectiveness might compare well to some of the standard treatments.
Another advantage of home remedies is the low likelihood of serious side effects. Lamisil is considered fairly safe, even for children and the elderly.764 Nonetheless some people taking Lamisil have developed liver failure.’W~ People who already have liver problems should not be given this drug. Other people taking Lamisil have come down with a very serious skin reaction, so anyone who develops a rash should get in touch with the doctor promptly. People who have lupus could get worse while taking Lamisil, so it’s generally not recommended for them.
As we mentioned at the beginning of this discussion, Lamisil occasionally can lower white blood cell counts to dangerous levels. Usually, the count comes back up once the person stops the drug. This drug may interact with other prescription medicines, including antidepressants. beta-blockers, and certain other medications that regulate the heart’s rhythm. By now, we hope we have convinced you to stay in very close touch with the doctor who prescribes Lamisil for your toenail fungus. It’ll probably run you more than $800 for the 12 weeks of treatment, but because it works so well, it is quite cost-effective.
Conclusions
Nail fungus, particularly toenail fungus, is usually more of a nuisance than a serious medical problem. (For diabetics, however, nail fungus or any other foot problem qualifies as serious and requires medical care.) As a result, we feel comfortable in recommending that most people try home remedies first. We don’t have any data on how well they work, but the testimonials we have received indicate that they do work for some people. In addition, they are inexpensive and don’t cause dangerous interactions or reactions.
A palm) who needs a higher likelihood of cure may need a prescription for Lamisil. It is the most cost-effective of the prescription nail fungus drugs. Even so, it does not work for everyone, and it is not always appropriate. Some people may be taking other medicines that could interact with Lamisil. Others may be at risk of liver problems or complications such as lupus. Most of the time, nail fungus is a problem you can live with; some of the rare side effects could be deadly.
•Toenails grow slowly. It takes a year to a year and a half for them to grow out completely, so be very patient and persistent.
•    After cutting fungus-infected nails, soak the clippers or scissors you used in alcohol for 15 to 20 minutes so you don’t spread the infection.
•    Soak your feet in a footbath of one part vinegar to two parts water for 20 minutes a day.
•    Mix cornmeal with hot water, allow it to cool to a comfortable temperature, and soak the affected nails for 1 hour once a week for at least a month.
•    Squeeze vitamin E oil or tea tree oil around the cuticle and under the nail once or twice a day.
•    Soak the feet in original Listerine or apply it daily to the affected nails.
•    Smear Vicks VapoRub around and under the nail every day.
•    Brew an infusion of Pau d’Arco for soaking the affected nails every day.
•    Stick your toe in a lemon overnight to soften the infected nail for removal.
•    If the nail needs to come off, ask your doctor about prescribing urea paste (40 percent).
•    Lamisil is the most effective prescription pill for fighting nail fungus.

MENOPAUSE
*Turn the thermostat down to reduce hot flashes
•    Use the lowest-dose estrogen and progesterone therapy for the shortest time possible
•    Try Remifemin for hot flashes    ***
•    Eat tofu or tempeh or drink soy shakes    **
•    Ask your doctor about Paxil (paroxetine) or Effexor (venlafaxine) for hot flashes
•    Inquire about Neurontin (gabapentin) for hot flashes
•    Apply olive oil topically for vaginal dryness
•    Squeeze vitamin E out of a capsule as a sexual lubricant
•    Experience slippery sex with Sylk
•    Experiment with aloe vera gel
•    Get a prescription for Estring (estradiol)    ***
Decades ago, menopause used to be referred to in whispers as The Change. The mystery surrounding the event gave it a sinister aura. Now, though, more than 5 000 women enter menopause every day in the United States. ~21 That’s because the baby-boom generation is aging. We are not a bashful bunch, and female boomers have brought menopause out in the open. Women refer to hot flashes, somewhat jokingly, as power surges. But few women relish them. Most would like some way W ease this symptom, even it it is the consequence of a perfectly natural biological process.
We ought to begin with some explanation of menopause. Most people know this refers to the time when a woman’s ovaries stop making the hormones that support the ripening and release of eggs. It is a gradual process that may be spread out over years, perhaps even a decade, and is properly referred to as perimenopause. Menopause itself is technically just one point in time: the day when an entire year has passed since the end of a woman’s last menstrual cycle.722 The average age on this day is 51 years, but women may be as young as 40 or as old as 58 and still be within the normal range for menopause.
Just as the timing of this change in ovarian function differs from one woman to another, so do the timing and intensity of menopausal symptoms (yes, we should be calling them perimenopausal symptoms). Some women barely notice a hot flash or two. We’ve even spoken with women who had “cold flashes” rather than hot flashes. Others are distressed by intense heat waves that may plague them daily for years. Most fall between those extremes but would still welcome some respite from the sweating, the flushing, and the distracting feeling that they might spontaneously combust. (Not to worry—that has never happened!)
I hope you can recommend something for my wife, who feels like she is about to burst into flames. Her doctor suggested Premarin, but she refuses to take it because she is worried about the increased risk of breast cancer What other options are there?
If it is any comfort, this period of discomfort lasts about 4 years, on average. That means, though, that some women zip through it much more quickly, whereas others take longer, sometimes much longer, to get through to relief.
The Hormone Controversy
For years, women suffering from hot flashes and other menopausal discomforts were told that their doctors had the magic solution: Just take hormones to replace the ones their ovaries were no longer making. Hormone replacement therapy, or HRT, has had its ups and downs over the decades, beginning with Premarin’s approval in 1942. Since then, more than 30 billion doses of this h101MIOnt di Wled from pregnant mares’ urine have been dispensed.
When doctors discovered that women taking Premarin were at greater risk of developing cancer of the uterine lining, this prescription went out of vogue for a while. But then researchers found that adding progestin, a synthetic form of progesterone (usually prescribed under the brand name Provers), could reduce this risk. In the 1990s, Premarin became the most prescribed pill in history. Besides easing hot flashes,night sweats, and other menopausal problems, HRT was supposed to save women’s lives by reducing their risk of heart disease, colon cancer, osteoporosis, and other serious health
threats.
These days, though, the story has changed, and a lot of menopausal women are feeling confused and betrayed. For years, they were told that they were suffering from an estrogen deficiency syndrome. Replacing the hormones their bodies no longer made was supposed to ease menopausal symptoms. Women who resisted a prescription for HRT were sometimes treated as difficult cases. Some were told that though HRT might raise the risk of breast cancer, it was a much less significant concern than heart disease, which HRT might protect against.
After I was operated on for breast cancer, I was told that I could no longer take estrogen, because my tumor was ‘estrogen-dependent’ My primary physician actually had the gall to tell me: The benefits of estrogen far outweigh the threat of breast cancer, and besides, we can cure breast cancer’
Women have a right to be furious. The hormone hype that lasted for several decades represents one of the biggest scams in modern medicine. Millions of women were guinea pigs in an uncontrolled experiment. Physicians who pride therpselves on practicing “evidence-based medicine” prescribed drugs that were unsupported by data. Many women who expressed their fears to their physicians were told in no uncertain terms that the benefits of HRT outweighed the risks.
When the National Institutes of Health announced a huge, long-term study of hormone replacement therapy, advocates of HRT were thrilled. They anticipated that the best available science would support their convictions that HRT had many health benefits, far beyond simply easing hot flashes. Thousands of women were recruited to the study and randomly assigned to take either Prempro or a look-alike placebo pill.
When the results of this study—called the Women’s Health Initiative (WHI)—were announced in 2002, many physicians were surprised and women were shocked to learn that instead of protecting women from heart disease and cardiovascular complications, HRT actually increased their risk. A few doctors had anticipated that the study might show an increased risk of breast cancer. As early as 1995, the Nurses’ Health Study, which followed more than 100,000 women, had confirmed that estrogen replacement therapy significantly increased the risk of breast cancer in postmenopausal women and demonstrated that progestin did not diminish that risk 723 If anything, the data suggested that adding progestin could increase the risk .721
Although there had been hints from previous research that estrogen, with or without progesterone, might increase a woman’s risk of breast cancer, such concerns were mostly downplayed. Opinion leaders reminded physicians that the leading cause of death in postmenopausal women is heart disease. (Breast cancer  comes in second.) Some eminent gy- necologists opined that if breast cancer was a risk, it was a minimal one, associated only with long-term HRT use. Such cancers were thought to be “good” cancers in that they were “early” cancers, easily detected and treated and not associated with increased mortality.
Further results from the WHI gave the lie to that claim. The investigators found that women taking combined HRT (Prempro) were more likely to be diagnosed with breast cancer than those on placebo and were more likely to have invasive, more advanced cancers. They concluded, “These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.”115
As a result of these new findings, doctors may also be feeling betrayed. They too were sold a bill of goods that did not turn out to be as advertised. It is now clear to all that HRT is not a panacea for the miseries of menopause. But what remains unclear is exactly how women should cope with hot flashes, night sweats, sleep disruption, and vaginal dryness. Finding out that estrogen doesn’t really prevent heart disease still leaves women with plenty of options for reducing their risk of heart trouble. And there are other possible treatments for osteoporosis, another condition for which women were given long-term estrogen treatment. But what can be done for those annoying, sometimes debilitating hot flashes?
Alleviating Hot Flashes
Certain simple lifestyle adjustments might be all that some women need to make hot flashes tolerable. First, turn down the thermostat. This seems too simple to work, but many menopausal women are less uncomfortable when the temperature is cooler.726 Second, dress in layers that can be easily removed. ‘Ibis is simple common sense.Third, follow the Southern belles’ example and keep a fan and a nice coot (nonalcoholic) drink handy. Fourth, keep exercising. Or if you are not already walking, swimming, or dancing, start. It’s not a miracle, but women who exercise regularly seem to have fewer hot flashes or find them less bothersome. Besides, exercise eases depression and anxiety and is beneficial for the heart and the bones as well.
Hormone Replacement Therapy
When it comes to taming hot flashes, estrogen is undeniably the gold standard. Estrogen, either alone or in combination with progestin, clearly reduces the frequency and severity of hot flashes by about 75 percent.727 This is significantly better than placebo, although women with hot flashes are susceptible to the placebo benefit.
In most studies of HRT or herbal alternatives, women taking the placebo had nearly 60 percent fewer hot flashes per week at the end of the studies, on average, than at the beginning. 721 Women on HRT, either estrogen alone or estrogen together with progesterone, also seem to have less trouble with night sweats that awaken them and disturb their sleep. There’s little evidence that herbal treatments have much effect on menopausal sleep problems, which many women find extremely disdirbing.
If it weren’t for the WHI, doctors would still be prescribing Prempro (a combination of Premarin and Provers) to virtually every menopausal woman who would take it. And they would still be encouraging women to keep taking it long after menopausal symptoms faded away, as a general-purpose “health and beauty aid.”
The characteristics of the women who were willing to use HRT before the WHI results were available probably accounted for many of the benefits seen with HRT in earlier, observational studies. Women were told that HRT was good for their health, so those who chose to take it were more likely to be the health-conscious, careful eaters, regular exercisers, nonsmokers, and occasional drinkers. Their healthy behaviors, rather than the HRT per se, are now believed to be responsible for their lower rates of heart attack, stroke, and many other problems.
The WH I put the issue of HRT and heart attack prevention to  Estrogen and Progesterone
Hormone replacement therapy reduces hot flashes significantly for most women. Women who still have a uterus need to take progesterone along with estrogen to protect themselves from endometrial cancer.
The risks of this therapy rise significantly at 5 years of use. For most women, intense hot flashes last less than 5 years. Ask for the lowest possible dose, and increase the dose only if that does not adequately relieve the hot flashes and night sweats. Hot flashes may return if HRT is stopped abruptly, so gradually tapering off it may be more successful. Transdermal estrogen (Climara, Estraderm) may be less likely to trigger nausea, but there haven’t been good headto-head comparisons.
Side effects: Breast tenderness, nausea, gallbladder problems, migraine headaches, intolerance to contact lenses, elevated blood sugar. If progesterone is given only 1 week a month, vaginal bleeding resembling a menstrual period is common.
Downside: HRT increases the risks of breast cancer and blood clots that could trigger heart attacks and strokes. These risks increase over time. HRT should be used only as long as it is needed for perimenopausal symptoms.
Cost: Approximately $40 to $75 per month for brand-name HRT; generic is available for $12 to $20 per month
the test with more than 16,000 postmenopausal women. Unfortunately, HRT did not pass. Women who had never undergone hysterectomy were randomized to Prempro or placebo, but the study was stopped early when it appeared that the women taking HRT were at greater risk than those on placebo .129 Although Prempro had been expected to protect women from heart attacks and strokes, the results showed that women taking this HRT were nearly 30 percent more likely to develop coronary heart disease and twice as likely to come down with a pulmonary embolism, a dangerous blood clot in the lung.730
None of this has much bearing, though, on the use of hormones to treat hot flashes. The risks are primarily for women who take Prempro or other forms of estrogen and progester-one for extended periods of time.The most recent recommendations, based on subanalyses of the WHI data, suggest that women just entering menopause (ages 50 to 54 in particular) may be more resistant to the dangers of estrogen and might even get some protection from heart attacks by taking it. 31 Short-term use (for a few months up to a couple of years) to get through the worst of the hot flashes doesn’t seem to pose an excessive risk for most women. Those who have previously had dangerous blood clots or breast cancer or who have a strong family history of breast cancer should probably avoid estrogen even in the short term, however.
O. 1 took hormones for 4 years and then discontinued them for a year. Now I have started again, at the urging of my doctor. While I was not taking hormones, I had hot flashes, night sweats, and vaginal dryness.
I stopped taking hormones because the progesterone component made me irritable and depressed. (I was taking Premarin and Provera.) My doctor put me on Estrace and Prometrium this time, but I still feel prickly and sad.
I’m convinced progesterone is the problem, so I wonder if I can take the estrogen alone. I recently read that estrogen has heart benefits.
A. The hormone controversy has heated up again. A study showed that women between the ages of 50 and 59 taking estrogen alone were not at increased risk of heart attacks (Archives of Internal Medicine, February 13, 2006►. These women had previously undergone hysterectomies, so they did not need progesterone.
Estrogen alone is not safe for a woman who still has her uterus since it increases the risk of endometrial cancer. Progestins like Provera protect against this kind of cancer. When added to estrogen, however, they may increase the risk of heart attacks and strokes and possibly breast cancer as well. For some women, progesterone lowers libido and leads to depression.
Doctors have followed the practice of prescribing progestin along with postmenopausal estrogen for many years, since research determined that estrogen alone increased the risk of cancer of the lining of the uterus (the endometrium). Endometrial cancer is not an issue for women with no uterus, and in the WHI study, these women were randomized to Premarin (estrogen alone) or placebo. This works just fine for hot flashes. Don’t count on it to provide any cardiac benefits, though. Overall, women in the WHI study were not protected from heart attack or stroke by HRT whether they took Prempro or Premarin alone.32
Some critics of the WHI have objected to the use of Premarin or Prempro, and suggested that other forms of postmenopausal estrogen replacement therapy would be preferable. There aren’t studies to prove or disprove that idea. Epidemiologists at Group Health Cooperative, a big health maintenance organization in Washington, compared rates of heart attack and stroke among women taking Premarin and those taking another form of estrogen such as Estratab or Menest. They found a hint that the other forms of estrogen might be somewhat less likely to trigger a heart attack or stroke, but these data need to be confirmed.733
Bioidentical Hormones
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Q. I am a family physician. Back when we were prescribing HRT regularly, I used to offer women the option of plant-based estrogens instead of synthetic hormones. Since we learned the results of the Women’s Health Initiative (WHI), though, I’ve viewed all estrogens as carrying similar risk until proven otherwise.
There are practitioners who are saying that bioidentical hormones are safer. They encourage women to use them as an alternative for treating menopausal symptoms. Is there any research that shows that the risks are lower for plant-based HRT than for synthetic?
A. There is no comparable study of plant-based estrogens, and there is not likely to be one. The WHI was a very large and expensive study funded by the National Institutes of Health. Women were randomly assigned to receive Prempro or placebo. The results showed that postmenopausal hormones increased the risk of breast
cancer, heart attack, and stroke.
Women’s health expert Susan Love, MD, responded
to a question like yours: “I think that it is very unlikely that bioidentical hormones, as they’re called, will be any safer than Prempro.”
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The American College of Obstetricians and Gynecologists (ACOG) came out with a very strong caution about bioidentical hormones in 2005. Michele Curtis, MD, is associate professor of obstetrics and gynecology at Houston’s University of Texas Medical School. On behalf of ACOG she said. “There are a growing number of women who are seeking therapy with bioidentical hormones, but there is a lot of misinformation about the assertion that these are plant-derived and therefore more closely mimic the estrogen that is in a woman’s body….. These are hormones. They act just like estrogens that are 34    commer-
cially produced.,,7
The obstetricians and gynecologists of ACOG are concerned that plant-based hormones are unregulated and, as a result, women may not be informed about risks. In addition, lack of oversight may mean that it is hard to guarantee quality. Many of these products are made in small compounding pharmacies that act like micro–drug companies but escape the kind of regular FDA inspections one might expect a bigger manufacturer to undergo. When the FDA did check on samples from 12 compounding pharmacies, ACOG reports that “34 percent of them failed one or more standard quality teStS.!,131
Progesterone
Kau Nwmnwe intrigued by the possibility that a progesterone cream derived from plant sources can be applied to the skin to relieve hot flashes naturally. Although wild yam can be used as a raw material for the manufacture of progesterone-like compounds, the human body can’t convert wild yam to progesterone. A controlled study suggests that a cream containing wild yam extract is not much better at reducing hot flashes than a placebo.736 Other creams formulated to contain progesterone can provide a dose comparable to taking progesterone by mouth.”‘ Progesterone pills or long-lasting injections such. as Depo-Provera can ease hot flashes, but questions remain about the long-term safety of this hormone for postmenopausal women. 738
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0. A nasty divorce has left me feeling slightly depressed, despite the relief of being out of a bad marriage. At times my heart races and then I break out in a sweat. I don’t know if these episodes are just anxiety or if they are hot flashes, since I am menopausal.
I am reluctant to take estrogen because I’ve heard about negative effects. IV rather use a more natural approach. Would a progesterone cream be safe?
A. Many women experience hot flashes much as you have described them, with an accelerated heart rate, a vaguely anxious feeling, sweating, and feeling too warm. Progesterone cream may help reduce hot flashes. Women’s health expert Susan Love, MD, points out, however, that high levels of progesterone are not natural after menopause. She worries that potential side effects might arise with long-term progesterone use. In addition, progesterone has been linked to depression.