Womens Health

Women's Health Newsletters 8/25/02 - 11/3/02




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****** Woman's Health Newsletter *******
            August 25,  2002
Biweekly from BackupMD on the Net

1. Exercise helps fibromyalgia
2. Measuring blood pressure at home
3. Reader submitted Q&A - Surgery to lose weight
4. Eye strain and your computer screen
5. Health tip to share - Smoke-free workplaces
6. Humor is healthy

1. Exercise helps fibromyalgia
Muscle aches and pains are common complaints and 
affect as many as 1 in 7 or 8 people at any given 
time. Fibromyalgia is the extreme end of the 
spectrum in which there is constant muscle pain 
with multiple points of touch tenderness all over 
the body. It can affect as many as 1% of the 
population and is a chronic disease about which 
not much is known. Pain medicines and non 
steroidal anti-inflammatory drugs (NSAIDs) are 
commonly prescribed but like most treatments for 
this, they are ineffective. 

A person who is having constant muscle pain tends 
to be physically inactive for fear of worsening 
muscle soreness. Using this principle to design an 
aerobic cardiovascular exercise program, a group 
of investigators in London conducted a study to 
see if exercise improved or worsened the pain of 

There were 69 men and women in the active exercise 
group and they were compared to 67 in the control 
group who were just taught muscle relaxation. The 
exercise group started out with as little as 6 
minutes of exercise twice during an hour session 
on a daily basis. The sessions built up to two 25 
minute exercise periods over the 12 weeks of the 
study. The investigators then looked at how each 
group did at the end of the 12 weeks. 

At 3 months, the exercise group reported moderate 
or significant improvement in 35% of people 
compared to only 18% of the control group 
undergoing relaxation therapy. More importantly, 
the muscle point tenderness count which is used to 
diagnose fibromyalgia went down enough so that 45% 
of the study group no longer qualified to be 
labeled as having fibromyalgia. The results 
persisted out to 12 months. 

While the above improvement rates do not seem very 
high, for a medical condition that is still 
unexplained and has no successful treatments, 
these results are encouraging.  

Exercise helps fibromyalgia

2.  Measuring blood pressure at home
There can be quite a large difference between the 
blood pressure recorded at the doctor's office and 
one that you have taken yourself or had someone 
else take at home for you. The difference is not 
because the doctors or the doctor's nurses are 
more accurate reading the systolic (upper number) 
and diastolic (lower number) blood pressure. The 
difference is real and is called the "white coat 
effect" because most people's pressure goes up 
when visiting the doctor. 

This study below from Southampton England measured 
ambulatory blood pressure taken at home or 
anywhere outside the physician's medical office by 
anyone other than a doctor and compared it to 
blood pressure measurements taken by a nurse or a 
doctor at the physician's office. They found that 
on the average: 

  systolic blood pressure was almost 19 mm Hg 
different (higher) in the physicians office 

  diastolic blood pressure was 11 mm Hg different 
(higher) in the doctor's office 

  there was poor correlation between the readings 
conducted in the doctor's office versus readings 
that patients and others obtained themselves by 
ambulatory measurement. 

The existence of a "white coat hypertension" has 
been known for many years. That is why doctors are 
hesitant to newly diagnose hypertension without 
first seeing what blood pressure measurements are 
obtained outside of the physician's office on at 
least several occasions. Then if the blood 
pressure increase persists with multiple  
readings, it is time to start the appropriate 

This study confirms that there is such a poor 
correlation between the blood pressure readings 
taken at home (ambulatory) and those in the 
doctor's office that the doctor's office reading 
should not be used to make any decisions about 
therapy. Anyone with hypertension should have 
their own blood pressure cuff at home that they 
can use to monitor what the pressure is doing. 

Measuring blood pressure at home

3. Reader submitted Q&A - Surgery to lose weight
"I am interested in getting the gastric ring put 
on to help me lose weight.  What are the pro's and 
con's with this surgery, and who makes a good 
candidate?  Do you have to be a certain amount 
over weight?" 

"Weight problems run in my family.  I have always 
had a weight problem, with constant up and down 
gain and losses.  I have a thyroid condition that 
also hinders whatever dieting I do. I am 
considered hypothyroid.   I am 37 years old and 
really am tired of the way I look.  Do any of the 
insurance companies cover this?" - BWP 

There are quite a few different operative 
procedures to help people lose weight. Gastric 
ring surgery is one of them and it has its 
benefits and drawbacks just like most of the other 
procedures. They all can have some serious 
complications so should not be taken lightly. 

The criteria for how much overweight you have to 
be can vary from state to state or country to 
country. Many hospitalization insurance plans 
require a person to have a body mass index (BMI) 
of over 40 in order to pay for the surgery 
assuming the specific plan covers this type of 
surgery at all. A BMI of 40 or more would be 

5'0" - 204 lbs or more
5'3" - 225 lbs or more
5'6" - 247 lbs or more
5'9" - 270 lbs or more 

The basic principle behind any obesity surgery is 
to make the stomach much smaller in its capacity 
so that it only holds about an ounce or two of 
food. Thus the early stretching of the walls of 
the stomach sends a signal back to the brain to 
say "I'm full" and therefore presumably you will 
eat less. Also the sugars in a meal do not get 
absorbed in the stomach and they empty directly 
into the intestine. This over stimulates the 
intestine so you get very loose stools or 
diarrhea. It is a way of cautioning you to not eat 
simple sugars very much. All in all, the banding, 
stapling or bypass surgical procedures are a way 
of altering your eating behavior and making food 
less important. If you eat too much and force the 
very small stomach pouch to dilate or the rings to 
slip or staples to come out, then you can undo the 
benefits of the surgery. 

Some of the procedures are performed through an 
abdominal incision from the bottom of the breast 
bone to the navel. Sometimes the procedure is 
performed via laparoscopy but my understanding is 
that those procedures are not as successful 
although they are certainly less invasive. 
Complications vary with each different procedure 
so you need to carefully discuss with the surgeon 
the exact expectations of the surgery you two 
decide upon. Over all, some of the serious 
complications reported include: 

wound infection or rupture 3-4%
death 0-1%
hernia 7%
lung problems 1-2%
re operation 5-10%
slippage or infection of a band or ring
loosening of staples

Side effects include:

difficulty swallowing
gastric reflux

Benefits include:

90% of patients reach a weight loss of 25% of 
  their excess weight 
one third reduce excess weight by 75%
10% may reach normal weight

Do not think that this surgery is a simple 
procedure. It may be appropriate for you but it is 
very important that your expectations are in line 
with what the outcome is likely to be. 

4. Eye strain and your computer screen
Many individuals spend a considerable amount of 
time in front of a computer monitor whether it is 
for work or entertainment. After a while, the 
eyestrain and lack of bodily exercise starts 
producing fatigue and discomfort. There is no 
evidence that looking at a monitor for hours at a 
time causes long term serious health consequences 
but you can certainly feel physically bad doing 

When you start developing any of the following 
symptoms you know you need to take steps to get 
out of the rut: 

tired, burning, itchy eyes 
blurred or double vision 
distance vision blurred  
headache, sore neck 
difficulty shifting visual focus between monitor 
  and source documents 
difficulty focusing on the screen image 
color fringes or afterimages when you look away 
  from the monitor 
increased eye sensitivity to light 

To prevent problems, you should have your 
equipment set up to minimize any eye, neck or 
muscle strain. Position the monitor so that the 
middle of the monitor is exactly at your eye 
height. That way you do not need to hold your head 
and neck looking up or down. The monitor and 
keyboard should be directly in front of you so you 
do not have to hold use any rotational muscles 
tense while doing your work. 

If you use the mouse much more than the keyboard, 
you may consider getting a shortened keyboard (80 
keys) so that your hands don't constantly rest 
wider than your shoulders. Prolonged periods in 
this position will cause "mouse shoulder". 

Finally, you need to change your work habits 
otherwise you will develop chronic muscular and 
visual  disturbances. Take a visual break every 10 
minutes for 10 seconds or more to rest your eyes. 
Focus on a distant point and relax the intensity 
of your concentration. Get up from the chair and 
move around every hour and a half. This not only 
allows the muscles some rest but  helps prevent 
blood clots in the legs from sitting in one 
position too long. 

Blinking can help dry eyes. Sometimes 
concentration is so intent that people at a 
computer blink only once a minute when blinking 
every 5 seconds is the norm. If you feel your eyes 
becoming dry. make a conscious effort to blink 
frequently as well as taking "eye breaks" more 
often. Also do not forget the glare of room lights 
on the monitor. It can significantly contribute to 
eye strain and is relatively easy to change to 
produce less strain.. 

Eye strain and your computer screen

5. Health tip to share - Smoke-free workplaces
Smoke-free workplaces not only protect non-smokers 
from the dangers of passive smoking, they also 
result in more smokers quitting and a reduction in 
smoking by those who continue. If you do not work 
in a smoke-free workplace, see if there is some 
way that you can encourage the bosses to change 
the rules. 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

6. Humor is healthy
"Mid life"

Mid life is when you go to the doctor and you 
realize you are now so old, you have to pay 
someone to look at you naked. 

The good news about mid life is that the glass is 
still half-full...of course, the bad news is that 
it won't be long before your teeth are floating in 

Mid life women no longer have upper arms, we have 
wingspans...we are no longer women in sleeveless 
shirts, we are flying squirrels in drag. 

Mid life has hit you when you stand naked in front 
of a mirror and can see your rear end without 
turning around. 

You know you are getting old when you go for a 
mammogram and you realize it is the only time 
someone will ask you to appear topless in film. 

You know you've crossed the mid life threshold 
when you're in the grocery store and you hear a 
Muzak version of "Stairway to Heaven" in the 
produce department. 

Mid life is when you bounce (a lot), but you don't 
bounce back.  (It's more like Splat!) 

Mid life brings the wisdom that life throws you 
curves... and that you're now sitting on your 
biggest ones. 

It's very hard to "get jiggy with it" in 
midlife...jiggly, yes; jiggy, no. 

Mid life is when your 1970s Body-by-Jake now 
includes Legs-by-Rand McNally. (more red and blue 
lines than an accurately scaled map of the state 
of Wisconsin). 

Mid life is when you want to grab every firm young 
lovely in a tube top and scream, "Listen, honey, 
even the Roman Empire fell, and those things will 

Mid life can bring out your angry, bitter side. 
You look at your latte-swilling, beeper-wearing 
know-it-all teenager and think, "For this I have 
stretch marks?" 

Mid life is when you start to repeat 
yourself...and your chins follow suit. 

Mid life is when you realize that if you were a 
dog, you'd need a control top flea collar. 

Mid life is when your memory really starts to go. 
The only thing you still retain is water. 

You become more reflective in mid life. You start 
pondering the "big" questions-- what is life, why 
am I here...how much Healthy Choice ice cream can 
I eat before it's no longer a healthy choice? 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Health Newsletter *******
           September 8,  2002
Biweekly from BackupMD on the Net

1. Ginkgo biloba for memory enhancement
2. Night vision problems
3. Reader submitted Q&A-Exercise and lethargy
4. Endometrial biopsy
5. Health tip to share - Computer eye strain
6. Humor is healthy

1. Ginkgo biloba for memory enhancement
Ginkgo biloba is an over-the-counter herbal 
supplement that has been advocated to improve 
memory and thinking function. Since there has not 
been very good evidence one way or the other as to 
whether ginkgo works, this study from 
Massachusetts looked at a randomized trial of 203 
men and women over 60 years of age to see if 40 mg 
three times of day of either ginkgo or placebo 
enhanced performance on standardized memory and 
problem solving tests. 

The principle behind ginkgo is that it is thought 
to dilate small blood vessels in the brain which 
in turn increases the oxygen to brain cells. The 
question has always been does it do that enough to 
really affect how our brain works. People have 
used ginkgo trying to improve dementia and even 
just forgetfulness with age but there has not been 
hard evidence that it works at all. 

The investigators of this study found that after 
taking ginkgo for 6 weeks at the three times a day 
dosage that there was no difference in memory or 
cognitive function versus just taking a sugar pill 
(placebo). That is, in men and women over 60 who 
do not have any impairment of mental function 
already, taking ginkgo is not effective at all. 

Gingko for memory enhancement

2.  Night vision problems

Why is it more difficult to see distances at 
night? Of course low light levels play a role but 
many people complain that even with the low light 
levels they still have trouble seeing any distance 
that they feel they should still be able to see. 
This is most prominent with driving in which near 
distance is not a problem but far distance is. 

Nearly 40% of persons over the age of 60 have 
reduced night driving ability. Most of the time 
adults under the age of 45 are able to focus 
instantly between short and far distances. At 
night, however, even young people sometimes lose 
this ability to instantly shift focus between near 
and far. Some call this night myopia or night 
"near-sightedness". The pupil is dilated more at 
night and this leads to blurriness of vision at a 
distance. Sometimes this can simply be corrected 
by a change in glasses prescription or a new 
prescription for glasses if you do not already 
wear them. 

Halos and reflections around lights at night may 
be a different problem. Glare from lights is often 
due to a windshield that is not clean or contact 
lenses or eyeglasses that also need cleaning. 
Glare is different than blurry vision. It can also 
produce multiple images and if you see those, a 
good cleaning of windshields and any eye lenses is 
mandatory. Cataracts is one medical condition that 
can cause both glare and blurry vision. A visit to 
the doctor will quickly clear up whether cataracts 
are a problem. 

Do special glasses that you see advertised, e.g., 
amber glasses, help night driving vision? There is 
no evidence for this and any tinted glasses at 
night may reduce vision rather than enhance it.  
There are some glasses with anti-reflective 
coatings that have been shown to improve night 

in summary, be sure to keep your windows and 
eyeglasses clean and your eyes checked. If you have 
difficulty driving at night, slow down and keep 
your eye on the curb. 

Night vision problems

3. Reader submitted Q&A - Lack of exercise and lethargy
"What is the medical scenario that results in 
lethargy when a person does not exercise? I have 
been trying to list in my mind the bodily 
functions/states in poor conditions that lead to 
the sleepiness, gasping on exertion, depression, 
desire to sit all the time and general feeling of 
malaise but I cannot. 

"I am 48, no menstrual problems, no menopause 
symptoms yet, no medication. I exercise regularly.  
I have done creative dance and weights regularly 
(since age 23) up to 2 years ago. The past two 
years I have done treadmill jogging and stretching 
exercises from my dance knowledge. When I take a 
three week break I am so listless I feel just 
about to die.  The minute I start again I feel 
like a kid. The difference is so vast that it 
amazes me and I am really keen to find out what 
are the physiological changes in the body that 
cause the vast changes." -   Lawayne 

It doesn't make sense that lack of exercise can 
actually make you more tired and lethargic. You 
are asking also why exercise makes you feel so 
much better rather than being worn out. This is 
also a significant problem when a medical 
condition interferes with one's usual physical 
activity level. We frequently observe that 
postoperative fatigue and tiredness is due in 
large part to the lack of normal physical activity 
after a surgical procedure. Any illness or injury 
that forces a person to have increased bed rest or 
any reduction of their normal energy expenditure 
also causes additional fatigue that you have to 
recover from, in addition to the illness or 

Muscle fatigue receives very little attention in 
textbooks of medical physiology. In general, 
muscle movement depends upon stored sugar 
(glycogen) for energy to contract muscle fibers. 
Muscle enzymes must be present in high enough 
amounts to produce that energy from stored sugar 
almost instantly. When energy is produced from the 
muscle enzymes working on stored glycogen and 
muscle contractions take place, calcium is 
consumed, and lactic acid is produced  which 
accumulates in the muscle cells. This lowers the 
pH (makes cell fluids more acidy) and releases 
phosphorus. Any condition which lowers muscle 
glycogen, oxidative phosphorylation enzymes or 
calcium will cause fatigue and lethargy. However 
the body replenishes the calcium and clears lactic 
acid very quickly upon discontinuing the exercise. 
Muscle glycogen is only depleted and unreplenished 
with severe dieting or starvation. The energy 
producing muscle enzymes are another matter 

Lack of exercise itself significantly reduces the 
amount of muscle enzymes present and is thought to 
play a major role in producing fatigue or the 
feeling of muscle weakness. On the other side of 
the coin, exercise revs up the production of 
energy producing muscle enzymes such as citrate 
synthatase and 3-OH-acyl coenzyme A dehydrogenase. 
When these levels are high, instant energy from 
glucose can be produced whereas low levels impede 
the ability of the muscle to respond to demand. 

Thus it is an "out-of-whack" feedback loop whereby 
lack of exercise makes you feel weak and muscle 
tone and capability becomes lower and lower. If 
you put a healthy person to bed rest and do not 
allow them to get out of bed at all, they will 
become weaker and weaker until they can hardly 
walk at all when they are allowed up. Astronauts 
have the same problem when they live in a zero 
gravity environment because when muscles do not 
have to work against gravity, that is the same 
effect as bed rest. 

Exercise and physical activity stimulate muscle 
enzyme production and this provides quick muscle 
energy which makes you feel better (younger too). 
If we have been without exercise for awhile, we 
should not be amazed at how much better we feel 
after a workout. Rather, we need to remember -- 
tiredness means get active. 

Exercise also has another positive benefit. It 
releases hormones called endorphins. Endorphins 
are "feel good" hormones.  They help block pain 
and increase our mental "sense of well being". 
This may also be the reason you feel so much 
better after exercise. In any case I'm glad you 
asked this question because it reminds us to keep 
up our physical activity on a regular basis. 

4. Endometrial biopsy

Endometrial biopsy is an office diagnostic 
procedure that is quite different than a Pap 
smear. The Pap smear scrapes loose skin cells off 
of the cervix so a trained cytologist can look for 
cells that indicate cancer of the cervix (the 
mouth of the womb/uterus). It can also pick up 
precancerous cells called dysplasia. The Pap 
smear, however, is very poor at picking up cells 
from inside of the uterus that would be produced 
by a uterine (endometrial) cancer. This is one 
role for the use of the endometrial biopsy. 

An instrument is inserted through the cervix and 
up into the inside of the uterus. Skin cells 
lining the cavity of the uterus are scraped or 
suction is applied to get a tissue sample for the 
pathologist to look at. Anesthesia is not usually 
used so there is often some pain associated with 
the procedure. Uterine cramps can last for several 
minutes to several hours afterward but they can be 
lessened by taking a non steroidal anti-
inflammatory drug like ibuprofen or naproxen about 
30 minutes prior to the procedure. 

The endometrial biopsy is often used to diagnose 
abnormal uterine bleeding due to cancer or 
precancerous cells of the uterine lining. Many 
women over age 40 who have abnormal uterine 
bleeding will undergo this procedure. Sometimes it 
can also pick up benign endometrial polyps but is 
also can miss them frequently so the doctors do 
not rely on a biopsy to diagnose polyps. 

Endometrial biopsy may also be used in an 
infertility work up. In this case the biopsy is 
performed in the last week of a menstrual cycle in 
order to look at the endometrium to see if it has 
insufficient hormonal effect to optimize 
conception (luteal phase defect). Also looking at 
the tissue from biopsy confirms ovulation although 
that is now often confirmed by serum progesterone 
tests rather than biopsies. 

Endometrial biopsy

5. Health tip to share - Computer eyestrain

"Concerning eye and neck strain and computer use -  
those with bi or tri focals will tend to tip their 
head back with the screen at recommended level 
(producing neck strain). Note there are (comfort)
advantages of having a separate pair of glasses 
for using at the comptuer with the full lens 
corrected for distance to screen." -  Don White 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

6. Humor is healthy
"25 Things You Should Have Learned  By The Time 
You Have Reached Middle Age" 

1. If you're too open-minded, your brains will 
fall out. 

2. Age is a very high price to pay for maturity. 

3. Going to church doesn't make you a Christian, 
any more than standing in a garage makes you a 

4. Artificial intelligence is no match for natural 

5. If you must choose between two evils, pick the 
one you've never tried before. 

6. My idea of housework is to sweep the room with 
a glance. 

7. Not one shred of evidence supports the notion 
that life is serious. 

8. It is easier to get forgiveness than 

9. For every action, there is an equal and 
opposite government program. 

10. If you look like your passport picture, you 
probably need the trip. 

11. Bills travel through the mail at twice the 
speed of checks. 

12. A conscience is what hurts when all of your 
other parts feel so good. 

13. Eat well, stay fit, die anyway. 

14. Men are from earth. Women are from earth. Deal 
with it. 

15. No man has ever been shot while doing the 

16. A balanced diet is a cookie in each hand. 

17. Middle age is when broadness of the mind and 
narrowness of the waist change places. 

18. Opportunities always look bigger going than 

19. Junk is something you've kept for years and 
throw away three weeks before you need it. 

20. Experience is a wonderful thing. It enables 
you to recognize a mistake when you make it again. 

21. By the time you can make ends meet, they move 
the ends. 

22. Thou shalt not weigh more than thy 

23. Someone who thinks logically provides a nice 
contrast to the real world. 

24. It ain't the jeans that make your butt look 
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Health Newsletter *******
           September 22,  2002
Biweekly from BackupMD on the Net

1. Thyroid diagnosis and management
2. Indoor air pollution
3. Reader submitted Q&A - Connected gyn conditions?
4. Carpal Tunnel Syndrome Treatment
5. Health tip to share - Vinegar for dandruff and warts
6. Humor is healthy

1. Thyroid disease and management
Thyroid disease can be more complex than many 
people realize. Although the most common abnormal 
thyroid condition is primary hypothyroidism, there 
are many other possible causes. Most of the other 
causes are rare except for autoimmune thyroiditis. 
Hypothyroidism occurs much more frequently in 
women than men. Some estimates put hypothyroidism 
at an annual occurrence rate of 4.1/1000 per year 
in adult women. In other words over a 10 year 
period, 4% of women may develop hypothyroidism. 

High thyroid function called hyperthyroidism, is a 
less common problem but if it gets severe, it can 
be more life threatening than hypothyroidism. The 
heart rate becomes greatly increased and a person 
can develop fever and abnormal heart rate rhythms. 
This condition is called thyrotoxicosis with the 
most severe end of the scale being called thyroid 
"storm". These patients must be hospitalized and 
can die if not quickly treated. 

The primary screening test for thyroid disease is 
the TSH - thyroid stimulating hormone. It is 
extremely sensitive and can detect what are called 
subclinical conditions. In fact when most women 
have an  elevated TSH value (indicating low 
thyroid function), it is very likely that any 
symptoms they are having are not because of low 
thyroid function. This category is subclinical 
because the actual thyroid hormones, T3 and T4, 
are still in normal range. The thyroid gland may 
be working hard to keep T3 and T4 in normal range 
and the body's function normal, but eventually T4 
will decrease and then T3 will also decrease as 
the gland loses function. 

The three stages of hypothyroidism and their lab 
values are: 

subclinical  TSH elevated, T4 normal, T3 normal 
mild         TSH elevated, T4 decreased, T3 normal
overt        TSH elevated, T4 decreased, T3 decreased

Therefore if you have a TSH that is elevated, the 
doctor will then draw blood tests for T4 and T3 
which will tell how bad the low thyroid function 
is. Subclinical function may cause some menstrual 
abnormalities but most often there are no symptoms 
at all. Mild hypothyroidism will produce symptoms 
of fatigue and weight gain (increased fat) and 
possible dry skin. Overt hypothyroidism produces 
the above but also facial swelling, voice 
deepening, hair loss, and mental problems. 

High thyroid function is called Grave's disease. 
Most commonly it is caused by the body's immune 
response to its own cells in which thyroid 
stimulating antibodies are formed. Symptoms 
include a faster heart rate, being hot all of the 
time, swelling of the lower legs and even having 
you eyes start "bugging out". Treatment for this 
may be medical or surgical. but in either case you 
should be under the management of a physician 
promptly after diagnosis. 

2.  Indoor air pollution

Air in your house can be as polluted as outside 
air if there is not a free flow of air circulation 
from the inside to the outside. Many houses are 
built fairly air tight and do not allow harmful 
gases such as carbon monoxide, cigarette smoke  or 
radon gas from the ground to get out. Gases, toxic 
fumes, and molds can also be culprits in producing 
symptoms such as: 

irritated eyes 
runny nose 
nasal congestion 
scratchy throat 

Anyone with allergies or asthma can significantly 
be affected by indoor air pollution and figuring 
out exactly what are the toxic problems can be 
challenging. Be sure to use your nose to tell if 
there is any toxin around. Most toxins have a 
smell except for ones like carbon monoxide and 
radon.  Carbon monoxide comes from tobacco smoke, 
car exhaust, fireplaces, incinerators, gas 
appliances and furnaces. Homes should have carbon 
monoxide detectors just like a smoke detector. You 
can purchase them at a local hardware store. 

About 7% of homes have a problem with radon gas 
which comes up from the ground. Radon can break 
down into radioactive particles that become 
attached to particles in the air. Chronic exposure 
to radon is associated with an increased incidence 
of lung cancer. There are home testing kits for 
radon available at hardware stores and over the 

If your house is air tight and prevents 
ventilation, there are solutions other than just 
keeping the windows open. You may want to consider 
an air-filtration system or a heat-recovery 
ventilator. If you have a  forced-air furnace or 
air conditioner, you should investigate about 
higher-grade filters since most systems use very 
poor particle filters. The metal anti-allergy 
filters may work well for this but remember that 
even the best filter will not remove carbon 
monoxide, radon or other aerosol chemicals. 

3. Reader submitted Q&A -  Connected gyn conditions?
"I have been diagnosed with persistent, simple 
endometrial hyperplasia, endometriosis, and a 
'severely' tilted uterus. What, if any, is the 
connection among these three conditions, and how 
do they affect fertility?" 

"I am thirty eight (almost 39) YOA; onset of 
menses, 11; BCPills 22-31; Difficult periods with 
mid-cycle bleeding.  D and C, Laparoscopy, and 
hysteroscopy in Dec 2000--endometrial polyps, 
hyperplasia, adhesion of ovary to bowel, and 
endometriosis (mild). Currently undergoing third 
month of three month dosage of prometrium--400 mgs 
per night.  Repeat endometrial biopsy coming up." 
-   psmd 

There are some connections between endometriosis, 
a severely tilted or "retroverted" uterus and 
simple endometrial hyperplasia. 

Endometriosis is the presence of endometrial 
tissue outside of the uterus but inside the 
abdominal cavity. Most endometriosis comes from 
menstrual tissue that goes backwards out the tubes 
at the time of menses rather than through the 
cervix and vagina like it was meant to. Any excess 
tissue in the uterus such as that with endometrial 
hyperplasia would be reason enough to promote 
endometriosis although you do not need any 
hyperplasia to have endometriosis. 

Once endometriosis develops in the abdominal 
cavity, scarring of the pelvic organs can take 
place because of the inflammatory reaction to the 
endometriosis speckles of tissue that dot the 
abdominal cavity lining as they slough tiny 
amounts of blood and tissue at the time of the 
menses. This scarring reaction causes the bowel to 
stick to the ovary, the tubes to stick to the 
pelvic walls and the back of the uterus to get 
stuck to the bottom of the abdominal cavity so in 
effect the uterus becomes "tipped" permanently. 

Estrogen that is not opposed by much progesterone 
in the circulation can over stimulate the lining 
of the uterus so that it grows excessively 
(hyperplasia). Estrogen may come from ingested 
medications, supplements, foods or excess body 
fat. If ovulation is not regular, progesterone may 
not be produced on a regular monthly basis. Rarely 
there can be tumors of the ovaries or lungs that 
produce excess estrogen but it would be highly 

Excess body estrogen could be behind all of the 
problems but since endometriosis is not usually 
related to excess estrogen, we cannot say that 
unopposed (no or low progesterone) estrogen ties 
together the three problems you mentioned. In 
other words there could be more than one cause for 
the hyperplasia and the endometriosis and its 
related scarring. 

All of the above conditions can affect fertility. 
If the lining of the uterus is hyperplastic, 
implantation of a fertilized embryo may not take 
place. Endometriosis can also affect fertility by 
scarring which blocks the normal function of the 
tube sweeping the ovary to pick up the egg and 
transport it down the tube to meet the sperm. If 
the uterus is stuck in a backwards "tipped" 
position then scarring may be too severe to let 
the monthly egg get into the tubes. Thus all of 
these conditions can make it much more difficult 
to conceive. If you also factor in the age of 38 
or 39 with its known effect on weakening ovulation 
it may be even longer and harder to conceive 
although it is not impossible. I would guess with 
all of these conditions that the chance of 
pregnancy over the next year of trying would be 
about 20%. In vitro fertilization is a possible 

4. Carpal Tunnel Syndrome Treatment

Carpal Tunnel Syndrome (CTS) is a pinched nerve 
condition. When the median nerve that goes to the 
hand is compressed by one of the ligaments which 
it passes under at the wrist, numbness and hand 
weakness can result. Usually the thumb, index, 
middle and part of the ring fingers lose sensation 
and eventually the muscles become weak so a person 
loses her/his grip. 

Traditional treatment for this problem has been to 
wear a wrist brace (splint) so the nerve will not 
be pressured by bending the wrist. Then if that 
does not work after several months, surgery to cut 
the ligament and release pressure is often 
recommended. Surgery has been quite successful for 
this condition so the question comes up as to 
whether it should be the primary treatment. 

The following study from the Netherlands looked at 
the short term (3 months) and long term (18 
months) pros and cons of randomly assigning 
patients to either splinting or surgery as their 
primary treatment. They found that at 3 months, 
80% of the surgery group had significant 
improvement in their symptoms where as only 54% of 
the splinting group got relief. At 18 months the 
surgery group had a 90% success rate. The group 
that started out with splinting as their primary 
treatment had a 75% success rate but only because 
by that time 41% of them had switched over to 
having surgery as treatment because the splinting 
did not work for them. 

This study mainly shows that it is very reasonable 
to consider surgical treatment for Carpal Tunnel 
Syndrome as the first line of treatment rather 
than going through 3 months of splinting first. 
The strategy of splinting first and then having 
surgery if that does not work is less successful. 

Carpal Tunnel Syndrome Treatment

5. Health tip to share - Vinegar for dandruff and warts
"I use Bragg's apple cider vinegar for dandruff 
and for the removal of warts on my hands.To get 
rid of the dandruff you simply apply to the scalp 
for at least  five days and leave on about one 
hour after which you wash and continue the next 
day and so forth.To remove the warts just before 
retiring for bed apply with a piece of cotton and 
after two weeks soak the area with pot salt and 
cut with a stainless steel surgical blade if you 
have diabetes you must just apply the vinegar 
without the use of the surgical blade. Another 
helpful tip to use the vinegar for weight control 
I find it works for me I lost at least ten pounds 
together with exercising." -  Sue Mari 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

6. Humor is healthy
Words Women Use... 

FINE - This is the word we use at the end of any 
argument that we feel we are right about but need 
to shut you up. NEVER use fine to describe how a 
woman looks. This will cause you to have one of 
those arguments. 

FIVE MINUTES - This is half an hour. It is 
equivalent to the five minutes that your football 
game is going to last before you take out the 
trash, so I feel that it's an even trade. 

NOTHING - If you ask her what is wrong and she 
says NOTHING, this means something and you should 
be on your toes. NOTHING is usually used to 
describe the feeling a woman has of wanting to 
turn you inside out, upside down, and backwards. 
"Nothing" usually signifies an argument that will 
last FIVE MINUTES and end with the word FINE. 

GO AHEAD (with raised eyebrows) - This is a dare. 
One that will result in a woman getting upset over 
NOTHING and will end with the word FINE. 

GO AHEAD (normal eyebrows) - This means "I give 
up" or "do what you want because I don't care." 
You will get a raised eyebrow "Go ahead" in just a 
few minutes, followed by NOTHING and FINE and she 
will talk to you in about FIVE MINUTES when she 
cools off. 

LOUD SIGH - This is not actually a word, but is 
still often a verbal statement very misunderstood 
by men. A "Loud Sigh" means she thinks you are an 
idiot at that moment and wonders why she is 
wasting her time standing here and arguing with 
you over NOTHING. 

SOFT SIGH - Again, not a word, but a verbal 
statement. "Soft Sighs" are one of the few things 
that some men actually understand. She is content. 
Your best bet is to not move or breathe and she 
will stay content. 

THAT'S OKAY - This is one of the most dangerous 
statements that a woman can say to a man. "That's 
Okay" means that she wants to think long and hard 
before paying you retributions for whatever it is 
that you have done. "That's Okay" is often used 
with the word "Fine" and used in conjunction with 
a raised eyebrow "Go ahead." At some point in the 
near future when she has plotted and planned, you 
are going to be in some mighty big trouble. 

PLEASE DO - This is not a statement, it is an 
offer. A woman is giving you the chance to come up 
with whatever excuse or reason you have for doing 
whatever it is that you have done. You have a fair 
chance to tell the truth, so be careful and you 
shouldn't get a "That's Okay." 

THANKS - A woman is thanking you. Do not faint; 
just say "you're welcome." 

THANKS A LOT - This is much different from 
"Thanks." A woman will say, "Thanks A Lot" when 
she is really ticked off at you. It signifies that 
you have hurt her in some callous way, and will be 
followed by the "Loud Sigh." Be careful not to ask 
what is wrong after the "Loud Sigh," as she will 
only tell you "Nothing." 

See, its really very easy to understand what women 
are saying!

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Health Newsletter *******
          October 6,  2002
Biweekly from BackupMD on the Net

1. Ads for weight loss pills are often deceptive
2. Evidenced based reviews of medical treatments 
3. Reader submitted Q&A - Palpitations and supplements
4. Low salt diet - does it really make any difference?
5. Health tip to share -  Lead poisoning
6. Humor is healthy

1. Ads for weight loss pills are often deceptive
What about those ads for weight loss products.? Do 
you believe most of them or none of them? Which 
ones can you believe? 

The U.S. Food and Drug Administration (FDA) 
examined 300 weight-loss ads for dietary 
supplements, meal replacements, patches, creams, 
wraps and other weight-loss products and services. 
They found that over half of them had at least one 
claim that was either false or very unlikely to be 
true. They also compared current ads with those 
for weight loss products from 10 years ago and 
found an increased incidence of deceptive ads in 
the recent year. 

Even though the FDA has taken action against  some 
of the false and misleading weight-loss claims, 
the number and percentage of un factual claims is 
rising. Certain types of claims should raise red 
flags to signal that the ads are untrue or 

Claims for rapid weight loss such as 10 lbs in a 

Testimonials with before/after photos that make 
implausible claims 

Ads stating that no dieting or exercise is needed 

The main hazard of all the false ads is not only 
that people are spending money on products that do 
not work, but that use of these products takes 
people away from plans and services that do work. 
As of this date there still are no pills that 
significantly alter the balance between "calories 
in" versus "calories out". People who are looking 
for a "magic" pill that enhances weight loss are 
just encouraging entrepreneurs to continue false 
claims. Don't you be one of them. 

Ads for weight loss pills are often deceptive

2.  Evidenced based reviews of medical treatments 
The Cochrane Collaboration Consumer Network is a 
very helpful tool to aid in making health 
decisions. Basically this site uses scientific 
reviews of medical studies that have been 
conducted in order to answer whether there is any 
clear superiority in one treatment versus another 
for a given medical problem. The list of topics is 
fairly extensive and includes: 

Addiction & dependence 
Arthritis & autoimmune diseases 
Back, bones, joints & limbs 
Behavior & development problems & disabilities 
Blood diseases 
Chest, lungs, nose & throat 
Complementary (Alternative) therapies 
Cystic fibrosis 
Dementia, Alzheimer's & cognitive impairment 
Diabetes, endocrine system & metabolism 
Ears, balance & hearing 
Eyes & vision 
Family planning & abortion 
General medical & surgical techniques 
Gut, bowel & stomach 
Heart & blood pressure 
Improving care & communication 
Injuries & poisoning 
Kidneys, bladder & urinary system 
Leg ulcers, pressure sores & chronic wounds 
Liver & gall bladder 
Menstrual & gynecological problems 
Mental health 
Movement disorders (Parkinson's & cerebral palsy) 
Neuromuscular diseases & multiple sclerosis 
Nutrition, weight & eating disorders 
Oral health (mouth & teeth) 
Pain, fatigue problems & palliative care 
Parasites, malaria & infectious diseases 
Pregnancy & childbirth 
Premature & ill newborns 
Prostate & testicular problems 
Sexual health & sexually transmitted diseases 
Stroke & circulation problems 
Well babies & children 
For example if we look under Heart in "Heart and 
Blood Pressure", we see the subtopics of: 

Drug treatment 

Under "prevention", you can find out that reducing 
dietary fats for longer than 2 years reduces the 
number of heart attacks (cardiac events) although 
it does not significantly reduce mortality. Also, 
fish oil supplements lower triglycerides (one form 
of fat) but tended to raise bad cholesterol (LDL) 
while not changing good cholesterol (HDL). These 
studies were done in patients with adult onset 
diabetes and at least the fish oil supplementation 
did not alter blood sugar control. It is not as 
helpful for your health, however, as some product 
advertising and magazine claims would have you 

As you or your family are diagnosed with medical 
conditions, or the doctor recommends a specific 
preventative strategy, this resource can be used 
to see what has been shown to be the best 
approach. Actually you may be surprised at how few 
medical topics have been thoroughly studied. 

Cochrane Reviews Consumer Network

3. Reader submitted Q&A - Palpitations and supplements
"Can additional doses of potassium, maybe too 
much, cause heart palpitations? Each night I take 
two regular calcium with vitamin D pills along 
with one calcium magnesium potassium mix pill. I 
have been doing this for years. Recently I had 
occasional palpitations. They stopped and began 
again then stopped. I noticed that they had 
stopped when I ran out of the calcium mag 
potassium pill and so excluded that. They came 
back once I added this pill again.  I have now 
stopped taking the mix and the symptoms have 
stopped. Now I only take 2 calcium + Vitamin D 
pills each night." 

"I am 48, regular menses always To date, no major 
illnesses. Not overweight (5 ft 7 ins, 128 lbs). I 
also exercise regularly. Eat vegetarian and fish 
only. Take cod liver oil and vitamin B tabs 
regularly plus valerian root. " - Lawayne 

In general, low blood potassium levels 
(hypokalemia) are much more associated with heart 
palpitations in those people prone to them than 
are high potassium levels or potassium 
supplements. In fact potassium supplements 
normally help prevent palpitations if the blood 
levels of potassium are low. Many people who take 
water pills (diuretics) for hypertension can 
develop irregular heart rates because potassium is 
lost in the urine when diuretics are clearing 
sodium (salt) from your blood. 

The main reasons to take any potassium supplement 
at all is if you are taking a regular diuretic or 
if your diet is quite restricted in fruits and 
vegetables (yours is not I assume) which are the 
main sources of potassium. Otherwise there is 
probably not a good reason to take a pill that has 
potassium in addition to calcium and magnesium. 

Actually you have done a very good job in 
detecting that the palpitations are associated 
with the specific pill you have taken. Even though 
you may have taken that same preparation for many 
years without palpitation problems, you must 
consider that the recent "batch" of the calcium-
magnesium-potassium pills may have some sort of 
contamination in the manufacturing process and may 
have something else in it that is causing the 
palpitations. Caffeine is one contaminant that 
could produce palpitations but there may be other 
additives or contaminants that we are not aware 
of. The way to examine this would be to try a 
different brand of pill that had the same 
ingredients. Palpitations are annoying but most of 
the time they are very benign. 

Another possibility is that something in your 
health condition has changed so that you are more 
susceptible to any alterations in body salt 
levels. Conditions such as thyroid disease, 
especially hyperthyroidism, can cause this. You 
may want to have a TSH (thyroid stimulating 
hormone) test to make sure that has not changed if 
you have not had one recently. 

Also look for contaminants in other ingested 
products. Valerian root can promote sleep and have 
an anti-anxiety effect but toxicity has also been 
reported including kidney damage, headaches, chest 
tightness, visual problems, abdominal pain, and 
tremor of the hands and feet. This doesn't mean 
that your valerian root is the problem but 
whenever you are ingesting multiple commercially 
manufactured agents, there are always chances of 
interactions that are not consistently 
predictable. Just because you are ingesting 
"natural" products does not mean they are safer. 
In fact they are more likely to have contaminants 
since they are much less regulated by the FDA. Be 

4.  Low salt diet - does it really make any difference?
Low salt diets have been recommended not only for 
those who are being treated for hypertension, but 
also for the general population. Many people who 
are not hypertensive restrict their salt intake 
under the supposition that a low salt diet is 
healthier. Many studies have been performed using 
salt restricted diets and surprisingly there is no 
reduction in deaths or adverse cardiovascular 
events in people who restrict their salt. The 
average blood pressure reduction is on the order 
of of about 1 mm Hg systolic (upper number) and 
about 0.5 mm Hg diastolic (lower number). 

While salt restriction does not seem to be very 
effective in reducing blood pressure on the 
average, it does allow some people to come off of 
antihypertensive medications so there is some 
benefit. For the general population without high 
blood pressure, there is not any benefit of 
reducing salt intake. The final conclusion of this 
study in the British Medical Journal was: 

"Lower salt intake may help people on 
antihypertensive drugs to stop their medication 
while maintaining good control of blood pressure, 
but there are doubts about effects of sodium 
reduction on overall health." 

Most of the studies used to draw these conclusions 
lasted only a limited time, e.g., 5-7 years. It is 
possible that there are health benefits from 
longer term salt intake reduction but we really 
have no way of knowing. 

Low salt diet - does it really make any difference?

5. Health tip to share - Lead poisoning
Lead poisoning affects children worldwide. While 
it can affect adults also, children are more 
susceptible because they tend to put things in 
their mouth and chew on objects that may have lead 
paint more than adults do. In the United States, 
elevated blood lead levels (BLLs) (>10 microg/dL) 
result primarily from exposure to lead-based paint 
or from associated lead-contaminated dust and 
soil; however, other sources of lead exposure,  
including folk remedies, Mexican terra cotta 
pottery, Indian herbal preparations, ingestion of 
air rifle pellets and certain imported candies, 
also have been associated with elevated blood 
levels in children. Symptoms can include fatigue 
(anemia), stomach upset, joint pains, and liver 
toxicity. More serious brain and spinal cord 
effects can include: 

lower IQs 
memory problems 
reduced coordination 
learning disabilities 
increased sleeping 
decreased activity and fatigue 
hearing loss 
slow reflexes 
muscle weakness, affecting mainly the upper extremities 
seizures, coma, hypertension in high levels 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

6. Humor is healthy

Jacob age 85, and Rebecca age 79 are all excited 
about their decision to get married. They go for a 
stroll to discuss the wedding and on the way go 
past a drugstore. Jacob suggests that they go in. 
He addresses the man behind the counter: 

"Are you the owner?" 

The pharmacist answers, "Yes." 

Jacob: "Do you sell heart medication?" 

Pharmacist: "Of course we do." 

Jacob: "How about medicine for circulation?" 

Pharmacist: "All kinds." 

Jacob: "Medicine for rheumatism?" 

Pharmacist: "Definitely." 

Jacob: "How about Viagra?" 

Pharmacist: "Of course." 

Jacob: "Medicine for memory?" 

Pharmacist: "Yes, a large variety." 

Jacob: "What about vitamins and sleeping pills?" 

Pharmacist: "Absolutely."

Jacob: "Perfect!  We'd like to register here for 
our wedding gifts." 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

Back to top

****** Woman's Health Newsletter *******
         October 20,  2002
Biweekly from BackupMD on the Net

1. Screening tests for women
2. Children of divorces - how to lower problems
3. Reader submitted Q&A - Progesterone after hysterectomy?
4. Burning mouth syndrome
5. Health tip to share -  Waist size and heart risk
6. Humor is healthy

1. Screening tests for women
Occasionally we receive questions about how often 
a women should have various medical screening 
tests performed in order to stay healthy and head 
off any diseases. This recent list at 
Mayoclinic.com may be helpful to those who want to 
know this. 

Blood pressure - every two years as long as it is 
below 130/85 

Pap smear - Initially at age 18 or the start of 
sexual intercourse. After 3 normal (negative) 
smears in a row, exams can be every 3 years unless 
you have ever had an abnormal result or you have 
had a new sexual partner since your 3 negative 
smears. In the case of abnormal smear history or 
new sexual partner, the Pap smears should be 
annually or as recommended by your doctor. 

Mammogram - annually after age 40. Some recommend 
a baseline at age 35. 

Colon cancer screening - If you do NOT have 
adenomatous colon polyps or inflammatory bowel 
disease and if you do NOT have a family history of 
colorectal cancer or polyps, you should have a 
stool screen for blood (fecal occult blood) 
annually after age 50 or a colonoscopy or flexible 
sigmoidoscopy every 5 -10 years. 

Dental check-up - yearly or as often as your 
dentist recommends 

Eye exam - every 3-5 years but after age 50, more 
frequently (e.g. every 2 years) 

Bone density - at age 65 unless at high risk for 
osteoporosis. Then it should start at least by age 
60 or whenever a doctor recommends it to you. 

Blood chemistry - not routine at all unless you 
are having symptoms for which the doctor 
recommends it. 

Complete blood count (CBC) - not routine at all 
unless you are having symptoms for which the 
doctor recommends it. 

Cholesterol - Baseline in your 20s. If values are 
within desirable ranges (total cholesterol less 
than 200), every 5 years. 

Thyroid-stimulating hormone (TSH) test - Some 
doctors suggest a baseline test by age 35 and then 
every 5 years. 

Transferrin saturation test - to detect 
hemochromatosis which is hereditary and can lead 
to diabetes, arthritis, heart disease or liver 
disease.  They recommend baseline test around age 
30, with periodic repeat testing. 

Urinalysis - not routine, only as directed by your 

Sexually transmitted disease screening tests - 
gonorrhea, chlamydia, HIV, syphilis as directed by 
your doctor or as you request because of new 
sexual partners on the part of you or a spouse. 

EKG electrocardiogram - only as recommended by 
your doctor 

Chest x-ray -  only as recommended by your doctor 

2.  Children of divorces - how to lower problems
Teenagers of divorced parents have it rough in 
many aspects. They have a higher incidence of 
mental health problems such as depression, 
generalized anxiety disorder, they drop out of 
school more, use drugs more and become pregnant 
more often than teens whose parents are not 

A recent Arizona study looked at some different 
interventions with divorced mothers and their 
adolescent children. For the control group, 
mothers and children were just given reading 
materials about post divorce adjustment. There 
were two study groups: 

a mother (alone) program: in which mothers 
underwent 11 group and 2 individual counseling 
sessions and a 

mother plus child program: in which the mother 
underwent the above counseling and the children 
had 11 counseling sessions 

The outcome measures they looked at were 
externalizing (acting out) and internalizing 
(depressive reaction) problems, diagnosed mental 
disorders, drug and alcohol use, and number of 
sexual partners. 

They had the best outcomes for the mother plus 
child program in which they found: 

diagnosed mental conditions in only 11% (versus 
  23% in controls) 
decreased number of sexual partners (0.7 vs 1.6) 
decreased adolescent use of alcohol, marijuana and 
  other drug use 

The bottom line seems to be that you cannot just 
read about it. A divorced mother should take 
advantage of enrolling herself and her children in 
any locally available counseling program for post 
divorce adjustment. 

Children of divorces - how to lower problems

3. Reader submitted Q&A - Progesterone after hysterectomy?

"I had a complete hysterectomy 5 years ago with 
everything removed. I am on a estrogen pill but 
the hot flashes are worse than ever. My doctor is 
getting ready to put me on a estrogen/progestin 
pill. Even though I have no ovaries or uterus can 
I still take progestin?" 

"I am  52 yrs old. Hysterectomy in 1997. On BP 
medication, Lipitor, estrogen and vitamins." -  

You can still take natural progesterone or 
progestin even though your uterus has been 
removed. However it is usually not recommended as 
necessary. Progestin is usually only part of 
hormone replacement therapy (ERT) when a uterus is 
still present in order to protect against a small 
but real incidence of endometrial (the lining of 
the uterus) cancer. If there is no uterus, then 
there is not a risk of endometrial cancer and you 
do not "need" to take progesterone/progestin. 

Sometimes progestin is used even though there is 
no uterus. The progestin may be metabolized into 
estrogen in the body and can help augment 
prescribed estrogen to reduce hot flashes. This is 
why some women get relief from progesterone cream 
or oral progesterone (but usually not as much from 
synthetic progestins). There is no evidence at all 
that estrogen plus progestin is any better or more 
effective than just raising the estrogen dose 
alone for the treatment of only hot flashes. Since 
progestin does not really protect against breast 
cancer, there is no real reason to use it. 
Additionally, there can be some adverse effects of 

In spite of a popular media physician who 
advocates progesterone as a wonder drug that 
should be replaced in all women after menopause, 
most physicians find that women have mild to 
severe mood changes as well as physical symptoms 
when progesterone is used with ERT. Irritability 
and abdominal bloating are common complaints when 
taking added progestin. 

There is one instance I know of where the 
progesterone (not progestin) might be beneficial 
even though you have had a hysterectomy. That is 
if you are having trouble waking up at night so 
you do not get much sleep. This is different from 
insomnia where you cannot fall asleep. 
Progesterone may help the waking up at night. 

I do not think that taking the progesterone (e.g., 
Prometrium) will hurt you since it does not block 
the coronary artery dilatation benefit that 
estrogen causes, but if you are going to use it 
for hot flash control you may as well just try 
raising the estrogen dose. 

4. Burning mouth syndrome
Burning mouth syndrome is different from having 
mouth ulcers that are sore. With burning mouth 
syndrome there is a generalized burning pain that 
may include the tongue, the roof of the mouth, the 
gums, the inside of the cheeks and/or the back of 
the mouth or throat. T
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