Transcript: Gynecology | May 31, 2001

(music plays)

An animated slate shows the title inside the shape of a house: "More to health." The opening sequence shows a wooden table with a small lit candle.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: "More to life."

Then, Maureen Taylor appears in a studio with textured yellow walls and the logo of the show in the background, which reads "More to life."

Maureen is in her late thirties, with wavy brown hair in a bob. She's wearing a black blazer over an orange shirt.

She says Hello, I'm Maureen Taylor, and WELCOME TO "MORE TO LIFE." WOMEN ACCOUNT FOR 67 percent OF HEALTH CARE SPENDING, WE HAVE MORE HOSPITAL PROCEDURES, MORE VISITS TO THE DOCTOR, AND WE'RE PRESCRIBED MORE DRUGS THAN MEN ARE. THIS MAY NOT BE ALL BAD NEWS, IT MAY MEAN THAT WOMEN ARE JUST MORE LIKELY TO TAKE CHARGE OF THEIR HEALTH AND SEEK TREATMENT WHEN THEY'RE ILL. TODAY WE'RE GOING TO FOCUS ON WOMEN'S HEALTH WITH DR. NANCY DURAND. SHE'S AN OBGYN AT SUNNY BROOK HEALTH SCIENCES CENTRE IN TORONTO.

Nancy is in her late thirties, with short blond hair. She's wearing a blue blazer and blouse.

Maureen continues WHETHER YOU'RE PREGNANT OR TRYING TO BE. MENOPAUSAL OR TRYING TO FORGET YOU ARE, GIVE US A CALL WITH YOUR QUESTIONS. IN TORONTO 416-484-2727. LONG DISTANCE, YOU CAN REACH US TOLL-FREE AT 1-888-411-1234. AND YOU CAN E-MAIL US AT MORETOLIFE AT TVO.ORG.

A caption reads "416-484-2727. 1-888-411-1234."
Then, it changes to "moretolife@tvo.org"

Maureen continues WELCOME BACK DOCTOR DURAND,

Nancy says HI.

Maureen says LET'S START WITH MENOPAUSE. ARE YOU FINDING HRT STILL POPULAR with YOUR PATIENTS?

The caption changes to "Doctor Nancy Durand. Obstetrician, Gynecologist."

Nancy says WOMEN ARE BECOMING MORE INFORMED ABOUT IT, FROM THEIR HEALTH CARE PROVIDER, BUT ACTUALLY GOING OUT AND DOING MORE WORK ON THEIR OWN SO WHEN THEY GET TO ONE OF US, THEY'VE ACTUALLY DONE A LOT OF BACKGROUND READING IN MANY WAYS. AND I THINK THAT THAT IS ACTUALLY A GOOD THING PAUSE WE KNOW THAT HORMONE REPLACEMENT THERAPY ALTHOUGH THE STATISTICS SHOW IT IS BENEFICIAL FOR BONES AND HEART AND MEMORY, THAT THE VAST MAJORITY OF WOMEN WHO COULD BENEFIT FROM IT ARE NOT ON IT AND IT'S SURPRISING TO PHYSICIANS THAT THAT'S THE CASE. PROBABLY 10 OR 20 percent OF WOMEN THAT ARE ACTUALLY TAKING IT OF THE ONESS THAT DO, MANY DISCONTINUE TAKING BECAUSE OF EITHER SIDE EFFECTS, OR FEARS OF THINGS LIKE CANCER. AND SO, WE REALLY NEED TO DO MORE WORK IN ADDRESSING SOME OF THOSE ISSUES, IF THEY FEEL WE'RE NOT RESPONSIVE TO THOSE CONCERNS, THEY MAY STOP IT WITHOUT TELLING US. AND JUST NOT COME BACK. AND THEN WE REALLY WOULDN'T KNOW. SO I THINK THE CHANGES THAT ARE HAPPENING NOW WITH HRT, FIRST OF ALL THEY HAVE MORE KNOWLEDGE WHEN THEY START IT, WHICH IS A GOOD THING, AND TO TRY AND LOOK AT THE CONCERNS AND SEE ARE THEY VALID CONCERNS, BECAUSE SOME ARE, AND TRY TO FIND WHAT REGIMENS MIGHT BE ACCEPTABLE TO THAT PATIENT. LET'S SAY THEY DON'T WANT TO GO THE TRADITIONAL ROUTE WE'VE DONE FOR YEARS YOU TAKE PILLS OF ESTROGEN AND PROGESTERONE AND THEY'RE NERVOUS ABOUT THAT FOR VARIOUS REASONS. THERE ARE MANY ALTERNATIVES TO THE TRADITIONAL METHODS THAT WE CAN NOW OFFER PEOPLE. THEY MAY NOT BE QUITE AS GOOD AS THE TRADITIONAL HRT, BUT IT MAY BE SOMETHING YOU'RE MORE COMFORTABLE WITH, AND THEREFORE YOU'LL STAY ON IT MORE AND ACTUALLY IT WILL DO YOU MORE GOOD BECAUSE YOU CONTINUE.

Maureen says NOW WHAT ARE THOSE ALTERNATIVES.

Nancy says WELL, FULL RANGE OF PHARMACEUTICAL PREPARATIONS THAT JUST COME IN DIFFERENT WAYS THAN THE TRADITIONAL PILL. NOW A LOT OF TOPICAL HRT THAT. WOULD BE SOMETHING PUT ON YOUR SKIN EITHER IN A PATCH FORM OR CREAM OR GEL FORM, ABSORBED TO YOUR BLOOD STREAM AND THAT BYPASS THE BOWEL AND LIVER WHICH IS THE WAY PILLS ARE ABSORBED AND THE LIVER HAS TO EXTRACT A LOT OF HORMONES BEFORE IT GETS TO THE TISSUES THAT NEED TO SEE THEM. WITH PILLS WE NEED THE DOSE TO BE HIGHER WITH. WITH TOPICAL WE CAN START OUT WITH THE LOWER DOSE WHICH HELPS IN PEOPLE WHO ARE HAVING SOME SIDE EFFECTS, LET'S SAY BREAST TENDERNESS OR BLOATING. SOME FIND TOPICAL IS BETTER. ABSORPTION FOR THEM WITH WITH LESS SIDE EFFECTS. THAT'S PHARMACEUTICAL. YOU CAN CONTINUE DOWN THE LINE TO HERBAL REMEDIES, HAVE BEEN USED FOR MANY YEARS FOR HERBAL, A RELIEF OF SYMPTOMS ESPECIALLY. SOY IS ONE, IT'S VERY POPULAR RIGHT NOW. AND SOY IS IN THE GROUP OF PLANTS ESTROGEN-LIKE COMPOUNDS. AND THERE ARE OTHER PREPARATIONS BEYOND SOY NOW THAT ARE USING MORE SIOFLAVINS NOW. IN HEALTH FOOD STORES AND IN MANY FARM SIS WITHOUT A PRESCRIPTION AND IT'S JUST ONE PILL A DAY. COMES IN A PILL FORM. TWO FORMS OF THAT ARE AVAILABLE. ONE MEANT MORE FOR WOMEN IN TRANSITION HAVING TROUBLE WITH SYMPTOMS, THAT ONE IS CALLED PROMENSAL. ONCE YOU'RE THROUGH YOUR MENOPAUSAL SYMPTOMS LET'S SAY FIVE YEARS LATER BUT YOU WANT TO BENEFIT BONES AND HEART THAT COMPANY CAME OUT WITH ANOTHER ONE WHICH IS AGAIN JUST ONE PILL A DAY OF RED CLOVER WHICH IS BENEFICIAL TO BONES AND HEART. SO THESE ARE NONPHARMACEUTICAL PREPARATIONS WHICH EVEN THE COMPANY WOULD AGREE ARE LESS EFFECT, LESS BENEFIT, ARE MORE PALATABLE TO MANY WOMEN.

Maureen says THIS IS WHAT CONFUSES ME, IF I WERE ON HRT BECAUSE OF MENOPAUSAL SYMPTOMS THAT I FOUND TO BE BOTHERSOME, HOW WILL I KNOW WHEN THE SYMPTOMS ARE GONE?

Nancy says YOU CAN'T KNOW UNLESS YOU STOP. SO PEOPLE WILL SAY THE QUESTION AND USUALLY AFTER A FEW YEARS WILL SAY TRY GOING OFF. YOU DON'T HAVE TO GO OFF FOR VERY LONG, LIKE A MONTH WOULD BE ADEQUATE, IN FACT A WEEK OR TWO SOMETIMES IS. IF YOU'RE GOING TO DO THAT, PROBABLY DON'T JUST STOP COLD TURKEY LIKE YOU'VE BEEN TAKING SO MUCH AND STOP DEAD TODAY. BUT TAPER YOURSELF DOWN. BECAUSE YOU'RE GOING TO FEEL WITHDRAWAL SYMPTOMS PROBABLY IF YOU JUST STOP TODAY. WHEREAS IF YOU COULD BRING YOURSELF DOWN TO HALF DOSE, SOME OF THE PREPARATIONS YOU CAN CUT THEM. PATCHES YOU CAN CUT IN HALF AND PUT ON HALF DOSE OR YOU CAN TAKE ONE EVERY OTHER DAY OR CHANGE YOUR PATCH ONCE A WEEK INSTEAD OF TWICE A WEEK TO BRING YOUR DOSE DOWN.

Maureen says FINAL QUESTION, ANY A WOMEN TO STAY ON HRT LONGER THAN FIVE YEARS.

Nancy says SOME WOMEN, WILL DEFINITELY NEED TO BE ON IT LONGER THAN THAT, WHERE THE BENEFIT TO BEING ON IT WILL OUTWEIGH THE RISK. ACTUALLY IN MY CASE I PROBABLY WILL BE ONE THAT WILL BE ON IT LONGER THAN THAT. IN MY FAMILY THERE'S A HISTORY OF OSTEOPOROSIS. SO IN THAT CASE, IN MY BONE DENSITY AT 40 IS ALREADY COMPROMISED AND I'M NOT MENOPAUSAL. SO WE KNOW THAT I'M STARTING WITHOUT THIS VERY STRONG GENETIC COMPONENT TO THAT WHICH WILL LIKELY OUTWEIGH THE RISK TO BREAST BECAUSE THERE ISN'T MANY OTHER RISKS TO BEING ON HRT AS LONG AS YOU FEEL WELL WHILE YOU'RE ON IT. IT'S THE RISK OF BREAST CANCER. YOU HAVE TO MAKE THIS JUDGMENT CALL. AM I CONFIDENTABLE BEING ON IT FOR BENEFIT BONES AND HEART. MANY WITH WITH FAMILY HISTORY OF ALZHEIMER'S HAVE THIS INTEREST TO BE ON IT BECAUSE IT IMPROVES MEMORY. MANY WOMEN OF A STRONG FAMILY HISTORY OF BREAST DO NOT WANT TO GO THE ROUTE OF TRADITIONAL HRT.

Maureen says WE'RE TALKING WITH DR. NANCY DURAND ABOUT WOMEN'S HEALTH. IF OFF QUESTION ABOUT YOURS GIVE US A CALL. IN TORONTO 416-484-2727. LONG DISTANCE 1-888-411-1234. OR VIA E-MAIL, MORETOLIFE AT TVO.ORG.

The phone numbers and email reappear briefly.

Maureen says MEASUREIAL IN OTTAWA, HI.

The Caller says YES. IN RELATION TO SOMEBODY WHO HAS A FIBROID, WOULD HRT BE ADVISABLE? AND THE OTHER THING IS INCONTINENCE RELATED TO POST MENOPAUSE.

Nancy says FIBROIDS MANY OF US DO HAVE, BY THE TIME WE'RE 40, IT'S ESTIMATED 40 PEST OF US WILL HAVE FIBROIDS, IT'S ALMOST HALF OF US. PRETTY AVERAGE TO HAVE FIBROIDS. AND THEREFORE WE KNOW THAT HRT CONTAINS ESTROGEN AND THE CONCERN HAS BEEN THAT WE TAKE ESTROGEN WILL THE FIBROIDS GROW? ACTUALLY THE ANSWER IS NO, AND THE REASON IS THE DOSE OF ESTROGEN USED IN HORMONE REPLACEMENT THERAPY AT THE MENOPAUSAL AGE GROUP IS EXTREMELY LOW COMPARED TO WHAT WE MADE DURING OUR REPRODUCTIVE YEARS. WOMEN OFTEN THINK, I DON'T KNOW WHY, BUT THEY JUST THINK WHEN YOU BECOME MENOPAUSAL AND YOU GO ON IT, SUDDENLY BOOSTING UP YOUR ESTROGEN DOSE. IF YOU WANT TO EQUATE HRT DOSE TO A BIRTH CONTROL PILL, MANY WOMEN THINK THE BIRTH CONTROL PILL IS VERY LOW DOSE AND THE HRT IS HIGH. ACTUALLY IT'S THE REVERSE. THE HRT IS 1 fifth THE DOSE OF BIRTH CONTROL PILLS. YOU CAN ALWAYS WATCH WITH ULTRASOUND THE DIE AMATEUR OF THE FIBROID BUT NOT SOMETHING THAT'S NECESSARY TO DO. AND THE SECOND ABOUT INCONTINENCE AND THAT'S URINARY PROBLEMS ESPECIALLY AS WE AGE AND IN WOMEN THAT HAVE HAD VAGINAL BIRTHS AND SEVERAL PREGNANCIES WILL DEVELOP INCONTINENCE WITH TIME. WE KNOW THERE ARE ESTROGEN RECEPTORS IN THE BLADDER. AND WE KNOW THAT AS WE LACK ESTROGEN IN THE MENOPAUSAL YEARS, THAT THE INCONTINENCE WILL BECOME WORSE. URGENCY INCONTINENCE MAY RESPOND SOMEWHAT TO HRT BUT OFTEN NOT ENOUGH. WHEN YOU COUGH, OR WHEN YOU'RE EXERCISING OR WHEN YOU SNEEZE. THAT YOU LOSE BLADDER CONTROL. URGENCY IS A DIFFERENT MECHANISM WHERE IT'S MORE LIKE YOU JUST DON'T HAVE ANY CONTROL AND YOU CAN'T REACH THE BATHROOM IN TIME. SO STRESS INCONTINENCE WE SEEM TO HAVE BETTER RESPONSE WITH ESTROGEN, BUT ALWAYS WORTH A TRY IF YOU'RE TRYING TO AVOID A SURGICAL APPROACH.

Maureen says SO THE SPECIALIST FOR THAT WOULD BE A UROLOGIST.

Nancy says AND FOR WOMEN, THERE'S NOW A SUBSPECIALTY OF GYNE UROLOGY. AND THEN AN EXTRA FELLOWSHIP IN UROLOGY AND THEY'RE REALLY GOOD AT ASSESSING THIS PROBLEM BECAUSE THEY WILL LOOK AT THE WHOLE REPRODUCTIVE HISTORY MEAN FIGURE YOU HAVE A LARGE UTERUS AND INCONTINENCE YOU MAY DO A PROCEDURE TO COMBINE TREATMENT FOR BOTH.

Maureen says ALL RIGHT. THANKS VERY MUCH. EDUARDA. HELLO.

The Caller says HI, I'VE BEEN TRYING TO GET PREGNANT FOR THE LAST SIX MONTHS AND I'VE BEEN HAVING A HARD TIME. AID HARD TIME WITH MY SECOND AND I WAS WONDERING THE SAME PROBLEM.

Nancy says YES.

The Caller says I HAD TOO MUCH MALE HORMONES IN.

Nancy says PROBABLY YOU HAD TROUBLE OF LATING, WE CALL THAT PCO. AND IT'S EXTREMELY COMMON. WE THINK IT'S ON THE RISE FOR UNKNOWN REASONS. AND YEAH, IF YOU'RE HAVING TROUBLE, SIX MONTHS ISN'T THAT LONG BUT YOU KNOW YOUR PROBLEM NOW. AND IT MAY BE THAT YOU WOULD HAVE TO GO BACK TO THE ROUTE THAT HELPED YOU THE SECOND TIME AROUND TO HELP YOU GET PREGNANT WHICH OFTEN IS AN ISSUE OF TIMING AND SOMEWHERE WHERE YOU NEED MEDICATION TO HELP YOU OF LATE. SO WE USUALLY SAY IF YOU KNOW THERE'S A PROBLEM AND YOU THINK YOU KNOW THAT, SEEK ADVICE EARLIER THAN YOU MIGHT IF YOU THINK IT'S YOUR FIRST PREGNANCY, AND YOU JUST HAVEN'T WAITED LONG ENOUGH. BECAUSE THE FIRST TIME TO GET PREGNANT OFTEN WILL TAKE A YEAR OR EVEN TWO YEARS.

Maureen says POLYCYSTIC VERY SYNDROME. SHE'S HAD TWO CHILDREN, I THOUGHT THAT WOULD HAVE BEEN HARD TO ACHIEVE.

Nancy says DON'T OF LATE REGULARLY WHO DON'T OVULATE EVER AND THERE'S THE WHOLE OTHER SPECTRUM OF WOMEN WHO HAVE SLIGHTLY LONGER CYCLES AND DON'T OVULATE EVERY FOUR WEEKS. AND SO THOSE CAN OFTEN GET PREGNANT BY THEMSELVES. IT'S JUST A MATTER OF TIMING. THEY NEVER KNOW WHEN THEY'RE OVULATING. MEANS THEIR INTERCOURSE FREQUENCY HAS TO BE MORE THAN THE PERSON WHO KNOWS EXACTLY THE DAY 14 SHE'S OVULATING.

Maureen says WE'RE ON THE TOPIC OF INFERTILITY. ENDOMETRIOSIS, WHAT IS THAT.

Nancy says HAS BEEN AROUND FOR A LONG TIME, AND IT'S STILL A MYSTERY AS TO WHY AND HOW DOES IT CAUSE INFERTILITY. THE WORLD COMES FROM THE WHICH IS THE NAME OF THE CELLS IN THE LINING OF THE UTERUS, THE PART WHERE WE HAVE A PERIOD FROM EVERY MONTH. AND THE WITH WE HAVE THOSE CELLS WHERE IT SHOULD NOT BE, OUTSIDE THE UTERUS, THAT'S ENDOMETRIOSIS. THE COMMON PLACE WOULD BE ON THE OVARIES. UNDERNEATH THE OVARIES. ON THE BOWEL. ON THE BLADDER. BEHIND THE UTERUS AND IT CAN CAUSE PAIN IN SOME WOMEN, PAINFUL PERIODS, PAINFUL OVULATION, PAINFUL INTERCOURSE. AND CAN CAUSE INFERTILITY IN OTHER WOMEN OR MAY CAUSE BOTH SO. JUST BECAUSE YOU HAVE THIS DOES IT MEAN YOU'RE INFERTILE? NO, IT'S JUST ASSOCIATED WITH MORE INFERTILITY. AND WE DON'T REALLY KNOW WHY THESE WOMEN OVULATE FINE. THEIR TUBES ARE HOPE, THEY'RE NOT BLOCKED. THE SPERM FROM THEIR PARTNER IS FINE. SO THEY'RE DOING EVERYTHING THEY'RE SUPPOSED TO DO. THE SPERM IS REACHING THE EGG AT THE RIGHT TIME. AND SOMETHING IS NOT HAPPENING, AND WE WONDER WHETHER THE IMPLANT, A LITTLE SPOTS ARE RELEASING SOMETHING, A SUBSTANCE INHIBITING ACTUAL FERTILIZATION TO OCCUR. AND SO THAT'S WHERE RESEARCH IS BEING DONE NOW, SPECIFICALLY FOR INFERTILITY. THE PAIN IS WHOLE OTHER PROBLEM, AND AGAIN, THE WAYS THAT WE TRY TO TREAT PAIN ARE EITHER MEDICATIONS TO TREAT THE PAIN OR TO DEDEGREES GROWTH OF THE TYPE OF CELL. OR SURGERY TO ACTUALLY BURN IT OR THAT'S WHERE LASER COMES IN.

Maureen says DOES IT COME BACK?

Nancy says IT MAY AND OFTEN WILL IN A BAD CASE. USUALLY WHEN WE TREAT SOMEBODY ONCE DO WE THINK THAT'S A CURE, NO, WE THINK IT'S A TREATMENT. AND THAT IT MAY VERY WELL BE A RECURRING PROBLEM.

Maureen says WHAT ABOUT LONG-TERM FOR THESE WOMEN, A SFRID THE FERTILITY PART, WHAT ABOUT AFTER THEY'RE DONE HAVING CHILDREN. IS THERE A DIFFERENCE IN MENOPAUSE FOR THESE WOMEN?

Nancy says USUALLY NOT IN TERMS OF MENOPAUSE. IT'S JUST SURGICALLY THEY END UP WITH MANY MORE INTERVENTION SO THERE'S A HIGHER CHANCE IF THEY HAVE A BAD CASE THAT THEY MAY END UP WITH PERMANENT SURGERY LIKE REMOVING OVARIES, IN THAT SENSE THEY WOULD BE GOING THROUGH A MENOPAUSE EARLIER. WE DO NOW KNOW THAT WE HAVE TO WATCH THESE WOMEN CHOSELY ON RECALL THE SOUND IN THEIR OFRIES. WE USED TO RECOMMEND A LOT MORE SURGERY THAN IS CURRENTLY RECOMMENDED. AND WE THOUGHT RECENTLY AS WE DO LESS INVASIVE SURGERY AND REMOVE LESS, THIS WAS A GOOD THING FOR WOMEN. IT WAS PRESERVING, AND INTERESTINGLY ENOUGH WE'RE FINDING MORE TYPES OF OVARIAN CANCER THAT SEEM RELATED TO, SO MAY BE WE'RE NOT DOING A FAVOUR, IF WE NEGLECT DOING RECALL THE SOUNDS AND MONITORING THE OVARIES OF THESE WOMEN. BECAUSE THESE ARE THINGS YOU CAN'T FEEL ON PHYSICAL EXAMINATIONS. THE WOMAN WOULDN'T FEEL A PROBLEM WITH THIS TYPE OF OVARY SO IT'S AN RECALL THE SOUND, SUSPICION AND THERE ARE BLOOD TESTS FOR OVARIAN CANCER WE CAN NOW DO, AND I THINK THAT AREA IS AN AREA LOOKED AT CLOSELY BY THE ONCOLOGISTS AS TO ARE WE DOING THE RIGHT THING BY TRYING TO PRESERVE THE UTERUS AND OVARIES IN THESE WOMEN FOR AS LONG AS POSSIBLE. IT'S AN AREA OF THE FUTURE, I THINK.

Maureen says ALL RIGHT, LET'S DO AN E-MAIL HERE.

Maureen reads from a laptop computer and says MY MOTHER JUST RECENTLY HAD A MAMMOGRAM FOR EXTREME NEIGHBOR ONE OF HER BREASTS. WE'VE NOT YET GOT THE RESULTS BUT IS THIS A SYMPTOM OF MENOPAUSE OR CANCER? THERE'S NO LUMP. IT'S JUST PAINFUL.

Nancy says USUALLY WHEN WE TALK ABOUT BREAST CANCER, WE TALK ABOUT PAINLESS LUMPS THAT ARE HARD FIXED MEANING NOT MOVABLE. AND THEY MAY EXTEND UP INTO THE ARMS WHERE THE GLANDS ARE. SO THAT'S THE USUAL THING WE TELL YOU TO WATCH OUT FOR. AND USUALLY WE SAY PAIN, ISN'T A BAD THING. BUT THERE ARE SOME TYPES OF BREAST CANCERS THAT DO CAUSE PAIN. I DON'T THINK IT'S A SYMPTOM YOU SHOULD IGNORE BECAUSE YOU'RE MENOPAUSAL. PAIN IS QUITE COMMON, PREPERIOD WHEN BREASTS ARE DEVELOPING, BUT I THINK YOU HAVE TO TAKE HEED OF THE PAIN. IS IT A SYMPTOM OF MENOPAUSE IN DIRECTLY IT KIB A SYMPTOM OF TRANSITION WHEN YOU'RE IN YOUR 40s AS THINGS ARE SLOWING DOWN , YOU MAY SAY EVERYTHING IS MORE EXAGGERATED. THE PREMENSTRUAL BREAST PAIN, THE PREMENSTRUAL CHANGES OF MOOD CHANGES AND SUCH. IF YOU'RE ON MEDICATION FOR MENOPAUSE THAT CAN GIVE A SIDE EFFECT OF BREAST PAIN SO, WE DO HAVE TO LOOK AT WHAT MEDICATIONS THE PERSON IS ON.

Maureen says I SEE. REBECCA IS IN HAMILTON. HI, WELCOME.

The Caller says HI. I'M A 22-YEAR-OLD WOMAN, I'M IN A MONOGAMOUS RELATIONSHIP FOR SIX YEARS. I HAVE A HISTORY OF BREAST CANCER, MOTHER HAS PREMENOPAUSAL BREAST CANCER. I WAS ON THE PILL FOR THREE YEARSEN AND MY PARTNER HAS GONE AWAY FOR SIX MONTHS SO I WENT OFF THE PILL. AND NOW WHEN HE GETS BACK I'M WONDERING ABOUT ALTERNATIVE FORMS OF BIRTH CONTROL, I'M ALLERGIC TO LATEX SO CONDOMS AREN'T AN OPTION. I WAS THINKING ABOUT DEPO-PROVERA.

Nancy says IT'S A TOUGH ONE BECAUSE PEOPLE WHO COME AND ASK ABOUT BIRTH CONTROL, WHAT SHOULD I DO AND I ALWAYS SAY, IF THERE WAS A GOOD METHOD OF BIRTH CONTROL WE WOULD ALL BE USING IT AND NO ONE KNOWS WHAT TO DO AND ACTUALLY YOU HAVE A MORE DIFFICULT SITUATION BECAUSE IT SOUNDS LIKE YOU'RE GETTING TO THE POINT WHERE YOU'RE NOT AS COMFORTABLE USING THE BIRTH CONTROL PILL, THAT'S UNDERSTANDABLE, WITH THE FAMILY HISTORY. PROBABLY NOT A BAD IDEA. IF YOU CAN COME UP WITH SOMETHING ELSE THAT WORKFORCE YOU. DEPO-PROVERA IS AN INJECTION, IT'S REALLY EASY BECAUSE IT'S A SHOT GIVEN ONCE EVERY THREE MONTHS. IT'S BEEN AROUND FOR MANY YEARS, IT'S EXTREMELY INEXPENSIVE ALSO FOR PEOPLE WHO HAVE TO PAY FOR THEIR MEDICATIONS. CERTAINLY EXTREMELY AFFORDABLE. IT IS A PREPARATION OF SYNTHETIC PROGESTERONE-LIKE SUBSTANCE, AND SYNTHETIC MEANS THE STRUCTURE IS NOT THE SAME AS THE PROGESTERONE THAT WE MAKE. IT SIMULATES IT. MANY WOMEN DO VERY WELL WITH DEPO-PROVERA. THE SIDE EFFECTS OF IT, REMEMBER THAT WHEN YOU TAKE DEPO-PROVERA IT SUPPRESSES YOUR PERIODS SO YOU NO LONGER HAVE A NATURAL CYCLE AND I THINK SOME WOMEN GET SHOT WITHOUT REALIZING THAT. AND THEN THEY GET VERY CONFUSED BY WHERE DID MY PERIODS GO. ACTUALLY THEY ARE MEANT TO GO AWAY.

Maureen says YOU DON'T GET THEM AT ALL LIKE ON THE PILL.

Nancy says YOU DON'T GET YOUR PERIOD. THE NEGATIVE TO IT IS BECAUSE OF THAT, A SIDE EFFECT IS BREAK THROUGH BLEEDING AND SOME WOMEN WILL GET IRREGULAR AND UNPREDICTABLE BLEEDING OR SPOTTING. YOU HAVE TO SORT OF IT SOUNDS EASY BEFORE YOU'VE DONE IT BUT I THINK YOU HAVE TO THINK THROUGH OR LIVE THROUGH CAN I COPE WITH THIS. AND THAT'S QUITE A PROBLEM FOR SOME PEOPLE. OTHER SIDE EFFECTS THAT IT CAN CAUSE ARE SIMILAR TO BIRTH CONTROL PILLS, SIDE EFFECTS SUCH AS BREAST TENDERNESS, FLUID RETENTION AND MOOD CHANGES. IT ALSO AFTER YOU STOP YOUR DEPO-PROVERA, IF YOU'RE STOPPING BECAUSE YOU WANT TO GET PREGNANT IT MAY TAKE YOU A WHILE THE RESUME YOUR CYCLE. SO IT WOULD DEPEND ON YOUR SITUATION LIKE IF YOU SAID WELL I ONLY WANT TO TAKE THE DEPO-PROVERA FOR ONE YEAR AN THEN I WANT TO GET PREGNANT. YOU MIGHT WANT TO USE A TEMPORARY METHOD INSTEAD. BECAUSE ONE YEAR ISN'T ADVANTAGE TO WAIT FOR THE TIME THAT YOU WANT TO GET PREGNANT. WHAT ELSE IS AROUND. IUDs ARE AROUND, BUT YOU CAN ONLY USE IF YOU'RE IN A MONOGAMOUS RELATIONSHIP. WHERE YOU'RE SURE OF YOUR PARTNER ALSO. WHERE YOU KNOW NOTHING ELSE IS COMING INTO THIS RELATIONSHIP. NO CHLAMYDIA, NO GONORRHEA NOTHING, ASSOCIATED WITH INFECTION, ESPECIALLY WITH STDs LIKE CHLAMYDIA WHERE KIT CAUSE PERMANENT INFERTILITY. BUT FOR WOMEN WHO ARE IN A MONOGAMOUS RELATIONSHIP FOR PEOPLE WHO HAVE HAD PREGNANCIES AND SURE OF THEIR FAMILY SITUATION, SO WHO CAN BE, IS THAT KIND QUITE A GOOD ALTERNATIVE BECAUSE YOU PUT THE IUD IN IN A DOCTOR'S OFFICE AND LEAVE IT IN FOR 2, 2 and a half YEARS AND NOT WORRY ABOUT IT. YOUR PERIODS ARE THE SAME. STILL COMING.

Maureen says HOW EFFECTIVE IS THE DEPO-PROVERA COMPARED TO THE BIRTH CONTROL PILL?

Nancy says IT'S SLIGHTLY LESS EFFECTIVE BUT IN THAT SAME REALM OF MORE THAN 90 percent. EXTREMELY HIGH. BUT REMEMBER YOU HAVE TO IF YOU'RE CHANGING PARTNERS WITH DEPO-PROVERA, YOU HAVE TO USE THE BARRIER FORM TO PROTECT... PREVENT INFECTION. SO, IT REALLY IS TOUGH. I SURE WOULDN'T WANT TO BE A YOUNG PERSON TODAY.

Maureen says PLAYING SCIENTIST FOR A MOMENT THINKING ABOUT THE BREAST CANCER RISK. IF A RISK OF BREAST CANCER RISES WITH WITH FEWER NUMBER OF PREGNANCIES WE HAVE AND WE TALKED ABOUT THAT EARLIER THIS WEEK WITH THE BREAST CANCER SPECIALIST, WILL IT MAKE A DIFFERENCE WHAT TYPE OF BIRTH CONTROL SHE'S USING IF SHE'S NOT GETTING PREGNANT.

Nancy says IT'S THE ACTUAL STATISTICAL ANSWER TO THE QUESTION, NO. THE AMOUNT OF INCREASE PEOPLE ARE TALKING ABOUT WITH THE BIRTH CONTROL PILL MAY BE EXTREMELY LOW AND A LOT OF THOSE STUDIES WERE DONE ON HIGH DOSES OF BIRTH CONTROL PILLS NOT ON THE ONES CURRENTLY AVAILABLE.

Maureen says GOOD LUCK REBECCA, LET'S GO NEXT TO LISA IN EGANVILLE. HI, LISA.

The Caller says HI.

Maureen says HOW ARE YOU.

The Caller says GOOD, MY CONCERN AND MY QUESTION IS DEALING WITH HRT, WHEN YOU SPOKE ABOUT IT EARLIER, I KNOW THAT THERE ARE BENEFITS TO TAKING HRT. BUT TO ME THE RISK OF CANCER BOTH CERVICAL AND BREAST CANCER WOULD FAR OUTWEIGH ANY BENEFITS REGARDING OSTEOPOROSIS, AND THE TIME FRAME THAT YOU NEED TO BE ON HRT BEFORE YOU RECEIVE THE BENEFITS FOR OSTEOPOROSIS, WOULD CONCERN ME. AND IT'S NOT AS DISCUSSED AS OFTEN AS THE BENEFITS SEEM TO BE DISCUSSED MORE THAN RISKS. AND TO ME THE RISKS WOULD BE MUCH SCARIER THAN THE BENEFITS. IS THERE ANYTHING ELSE THAT CAN BE DONE OR IS THERE, AM I JUST TOO CONCERNED ABOUT YOU KNOW, RISKS?

Nancy says WELL, I THINK WHAT YOU HAVE TO DO IS SIT DOWN AND KWANTY TATE THE RISKS? BECAUSE TO JUST STAY RISK, YES, IT SOUNDS MUCH WORSE AND THE YOU ACTUALLY LOOK AT THE QUANTITY DAYTIVE NUMBERS, IT'S NOT WHAT YOU WOULD THINK, THE BENEFIT YOU FEEL DOES NOT OUTWEIGH THE RISK AND IN FACT THE NUMBERS DID NOT SHOW THAT. YOU HAVE TO SIT WITH THE PERSON AND TALK IT THROUGH, AND I'M NOT SAYING THAT YOU SHOULD GO ON IT. I'M SAYING YOU SHOULD KNOW THE NUMBERS THAT EXIST, AND THEN IF YOU'RE STILL NOT COMFORTABLE. THAT'S A WHOLE OTHER QUESTION. IT'S OKAY TO NOT BE COMFORTABLE AND TO GOT ON IT. THE RISK FOR BREAST CANCER. WHAT IS THE RISE IN BREAST CANCER IN USERS WITH HRT. IT'S ABOUT 2 TO 10 percent INCREASED RISK OF BREAST CANCER. OVER THEIR LIFETIME. WHAT IS THE BENEFIT TO BONES AND HEART, IT REDUCES FRACTURES FROM OSTEOPOROSIS AND REDUCES CARDIOVASCULAR DISEASE FROM 50 TO 60 percent. IT'S ACTUALLY A HUGE DIFFERENCE IN THE NUMBER OF THE AMOUNT OF BENEFIT TO THE AMOUNT OF RISK. BUT THAT DOESN'T HE WILL THE PERSON WHO HAS BREAST CANCER. AND THAT IS MY POINT, WHEN YOU'RE MAKING THIS DECISION, IS IF YOU REALLY FEEL STRONGLY ABOUT IT, TRUST YOUR FEELING. AND ALLOW YOUR FEELING TO BE THERE. AND ALLOW YOURSELF TO SAY, THIS IS HOW I FEEL. BECAUSE IF YOU'RE TAKING SOMETHING AND YOU REALLY FEEL EXTREMELY ANXIOUS ABOUT IT AND YOU DON'T THINK IT'S A GOOD IDEA IT PROBABLY ISN'T GOING TO DO YOU NEARLY AS MANY GOOD AS THE PERSON WHO BELIEVES IT IN. WE KNEW THAT PLACEBO EFFECT IS SO STRONG, WHAT ELSE CAN YOU DO IS WHAT I WAS TALKING ABOUT THE NONPHARMACEUTICAL APPROACHES CAN BE USED AND IF HAVE NOT BEEN SHOWN TO INCREASE BREAST CANCER. THAT PERSON MAY FEEL MORE COMFORTABLE WITH HERBAL REMEDIES. REMEMBERING THAT THE VOLUME OF STUDIES ARE NOT BEHIND THE HERBAL STUFF AS MUCH AS THE PHARMACEUTICALS, WHICH I THINK IS UNDERSTANDABLE. THE INDUSTRY HASN'T BEEN AS BIG. I THINK THAT WILL COME WITH TIME AND WHAT WE NEED IS RANDOMIZED TRIALS TO LOOK AT ADVERSE EFFECTS OF PLACEBO VERSUS HERBAL REMEDIES AS WELL.

Maureen says ARE YOU STILL IMPRESSED WITH THE HEART PROTECTION OF HRT DESPITE LAST STUDY.

Nancy says YEAH. YOU HAVE TO READ LITERATURE VERY CAREFULLY THAT YOU ARE USING AT WOMEN USING TO IT PREVENT HEART DISEASE. NOT USING IT IN WOMEN WHO HAVE HEART DISEASE, BECAUSE THAT IS WHERE THE CONCERN HAS RISEN. THAT IF YOU HAVE HAD SIGNIFICANT HEART DISEASE AND HEART ATTACKS YOU SHOULDN'T START HRT NOW. THAT'S TRUE.

Maureen says OKAY.

Nancy says AND IF YOU'RE IN THE AGE GROUP NO, WHERE YOU HAVEN'T DEVELOPED HEART DISEASE, THEN THAT'S WHERE THE BENEFIT SEEMS TO LIE.

Maureen says I SEE. AND THERE WAS ANOTHER QUESTION I WANTED TO ASK, BUT I CAN'T REMEMBER WHAT IT IS. SO HERE'S ONE ABOUT HRT AS WELL.

Maureen reads from the laptop and says I'M 64 YEARS OLD AND I'VE BEEN TAKING ESTROGEN AND PROGESTERONE SINCE '88 FOR THE TREATMENT OF MENOPAUSAL SYMPTOMS. BECAUSE OF THE LENGTH OF TIME ON THESE DRUGS I'VE TRIED SEVERAL TIMES WITH THE HELP OF MY DOCTOR TO DISCONTINUE, I TRIED AND THIS DID NOT HELP AT ALL. I STILL SUFFER WITH SEVERE SYMPTOMS WHEN I'M OFF THE MEDICATION. MY DOSAGE HAS BEEN CUT FROM .625 TO .3, SHOULD I BE CONCERNED THAT I'VE BEEN ON ANY FORM OF ESTROGEN FOR SO MANY YEARS. MY MOTHER DIED OF BREAST CANCER.

Nancy says IT'S A PROBLEM AND WE DO SEE THIS IN MANY WOMEN THAT NO MATTER HOW MANY YEARS GO BY, THEIR SYMPTOMS ARE THAT BAD, YES.

Maureen says LET'S SAY IT WAS 1904 AND THIS WOMAN.

Nancy says THEY WOULD JUST BE SUFFICIENTING A LOT OF THEM. AND, THE DROP IN DOSE, IS PROBABLY A SMART IDEA IF YOU CAN LIVE WITH 0.3 MILLIGRAMS FOR SYMPTOMS. YEAH, I THINK THAT'S QUITE A REASONABLE THING TO DO. IT DOESN'T COME ANY LOWER THAN THAT. THEN YOU'RE SORT OF BOUNDED TO CUTTING YOUR ONE IN HALF AND THEY'RE NOT THAT ZI CUT, BUT THAT'S ANOTHER OPTION. OR YOU CAN USE TOPICAL GEL, CAN BE CUT, JUST AN AMOUNT YOU PUT IN YOUR HAND. THERE'S AN ESTROGEN GEL. I THINK IF WE COULD GET PEOPLE OFF IT AFTER TEN YEARS THAT WOULD BE GREAT AND THERE ARE PEOPLE THAT CANNOT SEEM TOO GET OFF IT. THERE ARE LITTLE 08-YEAR-OLD WOMEN WALKING AROUND ON THEIR ESTROGEN BECAUSE THEY CAN'T SEEM TO GET OFF IT. EVISTA SHE MENTIONED IS AN ALTERNATIVE TO TRADITIONAL ESTROGEN AND PROGESTERONE WHICH WAS GREETED WITH MUCH EXCITEMENT WHEN IT FIRST CAME OUT AND I THINK WE HAVE LEARNED A LOT ABOUT IT OVER THE PAST FEW YEARS. IT IS CALLED AN SERN SELECTIVE ESTROGEN RECEPTOR MODULATOR AND WORKS LIKE ESTROGEN ON CERTAIN AREAS OF THE BODY. AND ANTIESTROGEN IN OTHER. IT'S ANTIESTROGEN AT THE BREAST AND UTERUS SO IT'S IN FACT MAY PROTECT AGAINST BREAST CANCER, AND IT HAS A POSITIVE EFFECT LIKE ESTROGEN ON THE BONES AND HEART. AND IT SOUNDS GREAT. THAT'S WHAT EVERYBODY SAYS. WHAT'S THE CATCH BECAUSE THERE HAS TO BE AND THERE IS.
THE CATCH IS THAT ESPECIALLY IN WOMEN WHO ARE ARE NEWLY MENOPAUSAL AND VERY SYMPTOMATIC, IT MAY WORSEN YOUR HOT FLASHES. IT DOESN'T SEEM TO WORK ON THAT PART OF SYMPTOMS AND SO, TO PUT SOMEONE ON IT YOU'LL ACTUALLY MAKE THEM FEEL WORSE. AND SO NOW WE'VE LEARNED THAT EVISTA'S VOLLEY LIKELY AFTER FIVE TO TEN YEARS OF MENOPAUSE, THEN YOU COULD TRY IT AND SHE DID TRY THAT AND COULDN'T, AND I'M NOT THAT SURPRISED IN A PERSON WHO HAS SUCH BAD SYMPTOMS STILL. IT WILL ONLY BE RIGHT FOR CERTAIN WOMEN WHO CAN TAKE IT WITHOUT FEELING MORE HOT FLASHES.

Maureen says I SEE. OKAY, SHARON IS IN OTTAWA, HELLO.

The Caller says HI THERE.

Maureen says HI.

The Caller says HOW ARE YOU GUYS.

Maureen says GOOD.

The Caller says I HAVE A QUESTION REGARDING VERY HEAVY MENSTRUAL PERIODS. I'M 39, I'VE HAD TWO CHILDREN. MY YOUNGEST IS FOUR. NOW I'VE NEVER SUFFERED FROM REALLY HEAVY MENSTRUAL PERIODS BEFORE, AT LEAST NOT WITH THE MAJOR CLOTTING THAT I HAVE. AND MY GYNECOLOGIST DOESN'T SEEM TO THINK IT'S MUCH OF A PROBLEM, BUT SHE SAID THAT'S THE WAY IT IS NOW, AND YOU CAN COPE WITH IT, THEN BASICALLY STAY WITH IT THAT WAY. I STILL THINK THAT THERE IS SOME KIND OF A PROBLEM OR WHETHER IT'S PREMENOPAUSAL, OR WHETHER IT'S HORMONE LEVELS ARE NOW GOING OUT OF WHACK OR SOMETHING IS JUST DEFINITELY NOT NORMAL FOR ME. BUT I'M NOT SURE IF IT IS A NORMAL PHASE OF PRE34E7B PAUDS OR AM I WAY TOO EARLY TO BE GOING THROUGH THIS.

Nancy says SHE SHOULD BE A DOCTOR, YOU'RE RIGHT. IT CAN BE THAT THINGS ARE STARTING TO CHANGE. IT'S PRETTY COMMON. I HEAR IT ALL THE TIME. AND THERE ARE WAYS THAT YOU CAN INVESTIGATE IT BECAUSE YOU MAY HAVE THIS FOR A REASON. OR YOU MAY HAVE THIS AND WE CAN'T FIND WHAT THE REASON IS. AND THERE ARE DIFFERENT APPROACHES TO EACH. SO THE INVESTIGATIONS WOULD ACTUALLY INCLUDE DOING RECALL THE SOUND TO RULE OUT THINGS THAT ARE BLEEDING IN THE UTERUS LIKE A BIG FIBROID IN THE CAVITY OF THE UTERUS CAN GIVE THIS INCREASINGLY HEAVY PERS WHERE YOU DON'T FEEL ANY DIFFERENT, YOU DON'T FEEL BIGGER BECAUSE WHEN I SAY FIBROID IN THE UTERUS, I MEAN TWO OR THREE SENT METERS AND THAT CAN BE REMOVED VAGINALLY, AND YOU CAN DO VERY WELL. THE RECALL THE SOUND MAY BE COMPLETELY NORMAL. WE OFTEN IN A WOMAN NEAR THE AGE OF 40 WHICH YOU ARE, USUALLY AT 40 THE TIME WHERE WE SAY WE START TO INVESTIGATE THINGS. WE TO A BIOPSY OF THE LINING OF THE UTERUS BECAUSE THICKENING OF THE LINING CAN BE NORMAL OR STARTING TO BECOME ATYPICAL LEADING TOWARDS CANCER OF THE UTERUS LATER IN LIFE. AND THAT CAN ACTUALLY BE TREATED AS WELL. SOMETIMES WE FIND NOTHING IS WRONG ON THOSE INVESTIGATIONS, BUT YOU CAN STILL DO THINGS TO HELP THE PERSON WITH THEIR BLEED FIGURE THEY WANT HELP WITH IT. SOME WOMEN JUST WANT TO KNOW NOTHING IS WRONG AND I WILL LIVE WITH MY BLEEDING, AND OTHERS CAN'T STAND IT AND REALLY WANT SOMETHING DONE. WHEN YOU LOOK AT APPROACHES YOU CAN ALWAYS CHOOSE A MEDICATION TYPE APPROACH, WE CALL THAT MEDICAL THERAPY. A SURGICAL APPROACH. AND THERE'S A NEW GROUP OF SORT OF IN BETWEEN, WHERE WE WOULD GO TO THE X-RAY DEPARTMENT, THE RADIOLOGY DEPARTMENT AND WE CAN INJECT NOW THE ARTERY IN THE X-RAY DEPARTMENT AND BLOCK THE ARTERIES TO RELIEVE HEAVY BLEEDING AND ESPECIALLY PEOPLE WITH FIBROIDS TO TRY ACHIEVE SHRINKAGE OF THE FIBROID. IT'S RATHER NEW, IT'S BEEN AROUND FOR A FEW YEARS, AND THE RADIOLOGISTS ARE GETTING MORE EXPERIENCE IN IT. PEOPLE THINK IT'S NOT WITHOUT RISK AND I DON'T THINK THAT'S TRUE. I DON'T THINK ANYTHING IS WITHOUT RISK. WAITING AND DOING NOTHING IS NOT WITHOUT RISK. TAKING MEDICATIONS IS NOT WITHOUT RISK, AND SURGE HAVE CERTAINLY NOT. THESE RADIOLOGY PROCEDURES AS WELL, YOU SHOULD SIT DOWN AND SAY, WHAT ARE THE POTENTIAL COMPLICATIONS OF THIS PROCEDURE RIGHT AWAY? AND DOWN THE ROAD. RIGHT AWAY WOULD INCLUDE IN ANYTHING LIKE THIS IS INFECTION, CAUSING BLOCKAGE TO OTHER VESSELS LIKE TO THE BLADDER, BECAUSE THAT'S SAME AREA. DOWN THE ROAD, ARE WE BY DOING THESE PROCEDURES, ARE WE MASKING SYMPTOMS OF MALIGNANCY LATER, FOR INSTANCE IF WE GIVE YOU NO MORE PERIODS WITH A SURGICAL PROCEDURE WHICH WE CAN DO, DO WE NOT THEN GIVE YOU THE CHANCE TO HAVE BLEEDING FROM YOUR LATER UTERINE CANCER AS A PRESENTING SYMPTOM THAT BRINGS YOU IN. SO WE HAVE TO REMEMBER THESE THINGS ARE TRUE IN THE BACK OF OUR MINDS AND SURVEILLANCE OF PEOPLE IS IMPORTANT. PHYSICAL EXAMINE IS PRETTY LIMITED IN WHAT KIT FIND, THAT'S WHERE WE USE RECALL THE SOUND A LOT AS A METHOD OF SEEING INSIDE WITHOUT DOING SURGERY.

Maureen says IF YOU KNOW YOU HAVE A FIBROID OR FIBROIDS, HOW OFTEN SHOULD THEY BE LOOKED AT AND MONITORED.

Nancy says WHEN YOU FIRST FIND OUT IT MAY BE INADVERTENT. WE I HAD THE AN RECALL THE SOUND FOR SOME REASON OR WE DID A PHYSICAL EXAM AND DISCOVERED THESE FIBROIDS, SO AT THE BEGINNING DEPENDING ON YOUR AGE, USUALLY SAY REPEAT YOUR RECALL THE SOUND IN THREE TO SIX MONTHS, TO SEE IS THERE ANY CHANGE IN SIZE, ARE WE RIGHT ABOUT THE DIAGNOSIS. FIBROID IS JUST A FIBROID IF THEY GROW, WHERE IF WE'RE MISSING SOMETHING AND IT ISN'T A FIBROID, IT WILL TEND TO GROW QUICKLY. ONCE YOU'VE GOT A THREE TO SIX MONTH RECALL THE SOUND THAT'S THE SAME, START DOUBLING THE INTERVAL SO THEN I'LL SAY NOW WE CAN GO TO A YEAR IF YOU FEEL OKAY, AND YOU DON'T THINK ANYTHING HAS CHANGED BECAUSE OFTEN YOU WOULD COME IN AND SAY I THINK THEY'RE BIGGER AND YOU'RE OFTEN RIGHT. SO, YOU THINK NOTHING HAS CHANGED, YOUR BLEEDING PATTERN HASN'T CHANGED AND YOU DON'T FEEL THEY'RE ANY BIGGER. YOU CAN GO TO A YEAR. AFTER A YEAR I WOULD DO ANOTHER ONE IN A YEAR AND IF WE'RE SEEING THE SAME THING YOU CAN RELY ON PHYSICAL EXAM TO SOME EXTENT AND YOU CAN PROBABLY DO IT THEN IN A MORE INFREQUENT BASIS.

Maureen says ALL RIGHT, WE'RE TAKING WITH DR. NANCY DURAND THIS AFTERNOON. OBGYN. IF YOU HAVE A QUESTION ABOUT WOMEN'S HEALTH GIVE US A CALL. IN TORONTO 416-484-2727. LONG DISTANCE 1-888-411-1234. AND THE E-MAIL ADDRESS THE MORETOLIFE AT TVO.ORG.

The phone numbers and email reappear briefly.

Maureen says TWO QUESTIONS...

Maureen reads from the laptop and says I HAD MY DAUGHTER 11 MONTHS AGO. SINCE I HAD HER MY PERIODS HAVE CHANGED DRASTICALLY. I'M ON THE PILL AND I WAS ON IT BEFORE I HAD HER. BEFORE I HAD HER MY PERS WERE REGULAR AND SHORT AND NOW THEY'RE QUITE IRREGULAR AND LAST OVER TWICE AS LONG. SHE SAID THEY WOULD GO BACK TO THE WAY THEY WERE BEFORE, IS SHE RIGHT? MY SECOND QUESTION IS I'VE HAD TWO ABNORMAL PAP TESTS IN THE LAST SEVEN MONTHS AND I HAVE TO GO FOR MORE TESTS. WHAT DOES ABNORMAL MEAN? I MY DOCTOR NEVER TOLL ME WHAT ABNORMAL MEANS, THAT'S FROM GENERAL.

Nancy says THAT'S A PROBLEM. I GET THE REFERRAL FOR THE ABNORMAL PAPS AND TURF SAY IT DOES OFTEN TAKE SITTING DOWN AND GOING BACK TO SQUARE ONE ABOUT WHAT A PAP CELL MEANS. I'LL DO THAT PAT OF QUESTION FIRST, BLEBL HAS HAPPENED IS THE PAP TEST HAD COME BACK WITH ABNORMAL CELLS WHICH WE CAN SAY ARE PRECANCERS NOW NATURE. I LIKE TO DRAW A LINE WITH A SPECTRUM OF WHERE CAN YOUR PAP BE ON THE LINE. THE BEST YOU CAN BE IS NORMAL. THE WORST YOU CAN HAVE ON YOUR PAP TEST IS CANCER OF THER IS VIC. AND ABNORMAL USUALLY IS THE TRANSITION FROM ONE TO THE OTHER. THE WORLD WE WILL USUALLY USE IS DYSPLASIA WHICH MEANS ABNORMAL GROWTH AND WE HAVE A GRADING SYSTEM FOR DYSPLASIA, SO THEY WILL USUALLY BE ABLE TO TELL YOU IT'S LOW GRADE OR MILD. AND NOW WE ONLY HAVE TWO GROUPS IT WILL BE HIGH GRADE OR SEVERE. USED TO BE THREE. MILD MODERATE SEVERE. SO YOU'LL NOW BE LOW OR HIGH GRADE. GIVES YOU A SENSE OF THE WEIRDNESS OF THE CELL, THE SIZE AND SHAPE IS WHAT THEY'RE LOOKING AT. AND HOW ARE THEY CHANGES. REMEMBER THAT ALTHOUGH I'VE SAID THESE ARE PRECANCEROUS CHANGES, IF WE DIDN'T TREAT YOU, DOES THAT MEAN YOU WOULD GULS ON TO CANCER OF THE CERVIX, ACTUALLY THE ANSWER IS NO. THE VAST MAJORITY WOULD NOT GO ON TO REACH CANCER OF THE CERVIX. THEY WOULD STAY AT DYSPLASIA, THE PROBLEM IS WE DON'T KNOW WHO WILL GO ON AND GET WORSE AND WHO WON'T SO. WE HAVE TO TREAT PEOPLE BEFORE THEY GET THERE, AND A METHOD OF TREATMENT AT THE CURRENT TIME IS REMOVING A LITTLE PATCH OF CELLS FROM THE CERVIX BY VARIOUS METHODS, AND CURRENTLY THE WAY WE USUALLY DO IT IS CALLED LEAP WHERE WE USE A LOOP ATTACHED AND IT REMOVES A SMALL CIRCLE OF THE CERVIX. IN BETWEEN IS A GROUP BETWEEN NORMAL AND DYSPLASIA AND YOU COULD FIT INTO THAT WHICH IS LESS WORRISOME BECAUSE YOU'RE NOT EVEN IN DYSPLASIA. IT'S CALLED ATYPICAL AND THAT SOUNDS LIKE IT MAY BE WHERE YOU LIE, ATYPICAL IS INVESTIGATED BECAUSE TIMES IT'S ON ITS WAY TO BECOMING DYSPLASIA, AND OTHER TIMES PATH IS SAYING ATYPICAL WHEN IT IS WORSE AND THE PAP ISN'T QUITE PICK UP THE DEGREE TO WHICH IT SHOULD. I THINK THAT THE MURDER TEST IS A GOOD IDEA. THE FURTHER TESTS ARE QUITE EASY TO DO. IF YOU CAN DO A PAP, YOU CAN DO THE NEXT STOP. IF WE WOULD EXPLAIN THAT IT'S REALLY JUST LIKE A PAP IT WOULDN'T SCARE PEOPLE SO MUCH.

Maureen says I DON'T UNDERSTAND HOW THAT TREATS FOR PRECANCEROUS GEL CELLS. HOW DOES REMOVING THAT A LITTLE BIT OF THE CERVIX SORT OF TAKE AWAY THE RISK OF CANCER.

Nancy says THE AREA OF RISK FOR DYSPLASIA IS ALMOST ALWAYS THE AREA RIGHT AROUND THE CANAL IN THE CERVIX THAT GOES UP TO THE UTERUS. SO IT DOESN'T SEEM TO BE OUT HERE OR HERE OR HERE, IT TENDS TO BE THIS ONE LITTLE AREA AND THAT'S WHERE THEY'RE DONE, WHEN I SAY LITTLE, ABOUT 1 TO 2 CENTIMETRES IN DIE AMATEUR. SO ITEM NOT THAT SMALL THE AREA WE REMOVE. AND THAT SEEMS TO THE REPAIR THAT GOES ON YOU REPAIR WITH NORMAL CELLS NOT ABNORMAL CELLS. IT'S TREATMENT AGAIN, NOT A CURE, KIT RECUR. JUST LIKE DONE ME TRI SIS THIS CAN COME BACK. SURVEILLANCE BECOMES VERY IMPORTANT. WE ALL NEED OUR PAPS EVERY YEAR BUT THESE PEOPLE NEED TO KNOW WHEN THEIR PAPS SHOULD BE. AT THE BEGINNING USUALLY TWICE A YEAR AND WILL GET TO ONE YEAR EVENTUALLY BUT SHOUMD NOT MISS THEIR PAP CHECK UP.

Maureen says AND TO HER HEAVIER PERIODS.

Nancy says THE QUESTION IS TIME. WITH BREAST-FEEDING IN THERE IN MANY PEOPLE THAT ALSO WILL USUALLY CHANGE YOUR CYCLE TO SOME EXTENT BECAUSE YOU TEND WHILE YOU'RE BREAST-FEEDING NOT TO BE OF LATING AND YOU GET A STRANGER PERIOD OR CYCLE WHEN YOU'RE NOT OVULATING. IF YOU'RE NOT BREAST-FEEDING NOW, YOU PROBABLY WANT TO WAIT ANOTHER SIX MONTHS BUT I CAN'T SAY YOU WILL DEFINITELY GO BACK TO THE PERIODS YOU HAD BEFORE THE PREGNANCY. BECAUSE THERE ARE CERTAINLY LOTS OF WOMEN AND WE'VE HEARD FROM SOME WHO SAY, NO I THAT, DIDN'T.

Maureen says ALICE IN PETERBOROUGH, HI.

The Caller says GOOD AFTERNOON. I WANTED TO TALK ABOUT PROLAPSE TODAY, AND RIGHT NOW I AM WEARING AN ESTROGEN RING. AND I WOULD LIKE TO KNOW WHERE I COULD FIND... YOU'RE A GYNECOLOGIST, BUT DO SURGERY LAPAROSCOPIC SURGERY ON THIS.

Nancy says WHAT YOU'RE TALKING ABOUT PROLAPSE IS DESCENT OF THE PELVIC ORGAN SO USUALLY PROLAPSE WILL INVOLVE SWHOUN HAS MAD PREGNANCIES ESPECIALLY VAJ NAM BIRTHS AND THE OUTVOWS COMING LOWER. THE LIGAMENTS THAT HOLD THE UTERUS UP, BECOME WEAKENED WITH AGE AND ESPECIALLY WITH CHILD BIRTH. YOU RARELY WILL SEE THIS IN SOMEONE WHO HAS NEVER HAD A PREGNANCY. AS THE LIGAMENTS RELAX THE UTERUS FALLS DOWN LOWER AND THERE ARE VARYING DEGREES TO WHICH THAT CAN HAPPEN. THE BLADDER MAY BE INVOLVED AS WELL. IF ESTROGEN RING SHE'S USING IS A FORM OF HORMONE THERAPY. IT'S A SMALL RING THAT'S HAS A SLOW RELEASING ESTROGEN IN IT. AND CAN BE USED FOR PEOPLE WHO DON'T WANT TO BE ON HORMONE THERAPY LIKE SYSTEMIC SO THE PILLS OR THE PATCH, IT'S USED LOCALLY TO HELP WITH VAGINAL DRYNESS AND URINARY SYMPTOMS. BUT WITH PROLAPSE, BECOMING YOU KNOW MORE THAN THIS CAN HANDLE, YES, YOU CAN GO TO A SURGEON WHO CAN DO USUALLY A HYSTERECTOMY WITH A BLADDER REPAIR AS A LAPAROSCOPIC PROCEDURE. YOU YOU BELIEVELY NEED GO TO A LARGE CENTRE. IN CANADA YOU PRETTY MUCH HAVE TO GO TO THE MAJOR CITIES WHERE UNIVERSITIES ARE TO FIND SOMEBODY WHO IS COMFORTABLE DOING THIS TYPE OF SURGERY. HERE IN TORONTO THERE'S ACTUALLY I CAN THINK OF SOMEONE AT SUNNYBROOK HERE IN TORONTO. A FEW PEOPLE DOWN AT WOMEN'S COLLEGE, ONE AT MOUNT SINAI. AS YOU CAN SEE THERE ARE MORE THAN ONE PERSON AND YOU CAN GO THROUGH A ONTARIO COLLEGE OF PHYSICIANS AND SUR JOHNS. THEY HAVE A VERY GOOD WEB SITE CPSO.ORG I THINK, AND THEY CAN HELP YOU FIND A GYNO UROLOGIST. SO THESE PEOPLE ARE NOT UROLOGISTS FIRST. IT'S VERY SUBSPECIALIZED. WITH LAPAROSCOPIC SURGERY IT'S FAIR TO POINT OUT THE TRADITIONAL OPERATION WAS DONE AS AN OPEN PROCEDURE WITH AN OPEN INCISION. MOST OF US WOULD TELL YOU HONESTLY THE COMPLICATION RATE IS HIGHER THAN THE OLD FASHIONED TRADITIONAL METHOD. BECAUSE IT'S MORE DIFFICULT. SO BE AWARE, ALTHOUGH THERE'S BENEFITS TO LAPAROSCOPY. YOU GET OUT OF THE HOSPITAL QUICKER. YOUR TIME BACK TO YOUR ACTIVITIES IS QUICKER. YOURRIES SOUTH CAROLINA SOMEWHAT HIGH SNEER YOU NOW YOU SAID I'M INTERESTED IN THIS. BECAUSE I THINK I KNOW WHAT'S GOING ON HERE. IF THE SBLAERD INVOLVED, THIS IS A WOMAN WHO MIGHT SHARE A PROBLEM THAT MANY OF US HAVE WHERE WE SNEEZE OR COUGH. YOU MEAN SOMEBODY CAN FIX THAT SURGICALLY RIGHT.

Maureen says DO YOU HAVE TO LOOSE YOUR UTERUS IN THE PROCESS.

Nancy says NO. THE PROLAPSE COMPONENT HERE IS THE THAT ONE MAY LEAD TO HYSTERECTOMY WITH IT. BECAUSE IT WILL IMPROVE THE RESULT. YOU DON'T WANT THE UTERUS COMING DOWN. WHERE AS THE PERSON WHO FEELS THE OUTVOWS FINE AND HAS STRESS INCONTINENCE YES, CAN DO PROCEDURES. A FEW DIFFERENT MINOR SURGERIES THAT CAN BE DONE, WHICH USED TO BE QUITE MAJOR. YOU NEED TO HAVE GOOD TESTING DONE FIRST. THAT'S CALL TO RULE OUT IS IT PURE STRESS INCONTINENCE. SURGICAL PROCEDURE ARE NOT AS GOOD. WHEN IT'S MIXED OR ONLY URGENCY SO, YOU AT LEAST NEED TO KNOW WHAT CAN YOU IF I CAN AND WHAT MAY YOU STILL BE LEFT WITH.

Maureen says I JUST LIKE A WHOLE NEW BLADDER. DO THEY EVER DO THAT?

Nancy says NO.

Maureen says SOMEDAY. OKAY, GOOD LUCK ALICE. THANKS VERY MUCH. JACQUELINE, HI.

The Caller says HI. I HAVE A QUESTION TO ASK, SINCE LATE DECEMBER I'VE BEEN HAVING EXCESSIVE BLEEDING AND SO I HAVE GONE FOR THE PAP TEST, I HAVE GONE FOR A AND IN-OFFICE.

Nancy says THE BIOPSY.

The Caller says YES, AND WHAT THEY HAVE DETERMINED, IS THAT THEY BELIEVE... ALSO I HAD AN ULTRASOUND. WHAT THEY BELIEVE IT COULD BE POSSIBLY HORMONAL, HAVE I DONE EVERYTHING THAT'S NECESSARY TO BE PROACTIVE ABOUT THIS?

Nancy says YES, IF YOUR RECALL THE SOUND IS GOOD, AS LONG AS YOU KNOW IT'S A GOOD RECALL THE SOUND, IT REQUIRES THE PHYSICIAN KNOWING THE LAB IS GOOD. AND THAT WE TRUST THEM. SO I FOR INSTANCE ONLY USE TWO PLACES SO I KNOW THEM WELL. DONE THE BUY ON CIRCUMSTANCE AND THE BIOPSY IS NORMAL AND IT'S GOOD THAT YOU MENTIONED THE PAP BECAUSE WE FORGET ABOUT THE PAP AS A SOURCE OF ABNORMAL BLEEDING, IT CAN BE THAT. SO YES, IF YOU'RE OKAY WITH THE RESULTS BEING NORMAL, AND YOU DON'T WANT TO INTERVENE WITH YOUR BLEEDING, THEN YES, YOU'VE DONE WHAT YOU NEED TO DO.

Maureen says IS THERE A PROBLEM OF BAD LABS IN ONTARIO?

Nancy says WELL, I JUST THINK THAT SOMETIMES WHEN I GET AN ULTRASOUND, IF YOU COME FROM SOME OUTLYING SUBURB AND I JUST DON'T NOTICE YOUR PLACE, WHEN I READ REPORTS, SOMETIMES ESPECIALLY WITH PELVIC RECALL THE SOUND, BECAUSE THAT'S PRETTY MUCH ALL I WOULD DO, THE REPORTS ARE SO BRIEF THEY DO NOT GIVE ME THE INFORMATION I'M LOOKING FOR. FOR INSTANCE, IF YOU'RE MENOPAUSAL AND YOU HAVE BLEEDING OF ANY SORT, THAT'S ABNORMAL. AND I NEED AN RECALL THE SOUND TO MAKE SURE THAT THAT WOMAN'S LINING OF THE UTERUS IS OKAY. IF I GET AN RECALL THE SOUND THAT JUST SAYS, NORMAL UTERUS, IT'S NOT GOOD ENOUGH. I NEED TO KNOW THE THICKNESS OF THE MEASUREMENT OF HER LINING. HOW MANY MILLIMETERS THICK IS IT. TO DETERMINE DO I NEED TO GO ON TO A BIOPSY. SOMETIMES I FIND REPORTS CAN BE SO BRIEF, THAT THEY'RE NOT HELPFUL AND I END UP NEEDING TO REPEAT IT. A WAY AROUND THAT FOR A PHYSICIAN IF I COULD BE MORE SPECIFIC, IF I WAS ORDERING IT, SAYING PLEASE MEASURE THE LINING, THE PROBLEM IS WHEN I AS A SPECIALIST AS A REFERRAL GET IT IT'S ALREADY BEEN DONE AND ORDERED BY SOMEONE THAT WASN'T ME,.

Maureen says I WANT TO MOVE ON TO AN STD WE TALKED ABOUT ABOUT AND THAT'S GENTLE WARTS. I WANTED TO ASK YOU ABOUT ALDARA CREAM.

Nancy says AND ALDARA IS A NEW CREAM. BEEN AROUND FOR A YEAR NOW. MADE BY THE SCOTCH TAPE PEOPLE, 3M. IT'S NOT BECAUSE IT'S A STICKY THING. NO. IT'S A CREAM THAT'S NOW BEING OFFERED TO WOMEN BY PRESCRIPTION, BY YOUR PHYSICIAN, COULD BE BY YOUR FAMILY DOCTOR. DOESN'T NEED TO BE A SPECIALIST. FOR WOMEN WHO HAVE EXTERNAL GENTLE WARTS SO THEY HAVE THE TYPE OF WARTS ONLY ON GENTLE SKIN, IT COULD BE USED ON MEN AS WELL BECAUSE MEN SUFFER FROM THE SAME PROBLEM. GENITAL WARTS CAUSED BY A VIRUS CALLED HPV. THE VIRUS IS PASSED FROM PERSON TO PERSON BY GENITAL SKIN CONTACT. IT DOESN'T NEED TO BE SBESH COURSE, IF YOU SAY YOU'RE NOT SEXUALLY ACTIVE BECAUSE YOU BELIEVE THAT ONLY MEANS HAVING INTERCOURSE, YOU COULD STILL GET GENITAL WARTS BY CONTACT. THIS CREAM IS INTERESTING IN THAT PREVIOUS TREATMENTS FOR GENITAL WARTS HAVE INVOLVED DES TRICK ISTIVE TREATMENT. BURNING IT OFF. SOMETHING LIKE ONE WE CALL TCA BECAUSE WE DON'T WANT TO SAY WHAT IT REALLY. IS ONE VERY SIMILAR TO THAT, THERE'S COLTRY OR JUST BURNING OFF OR CUTTING OFF. ALL OF WHICH YOU CAN IMAGINE ARE PAINFUL. ALDARA WORKS BY YOU YOURSELF AT HOME PUTTING IT ON THREE TIMES A WEEK FOR ANYWHERE FROM FOUR WEEKS A MONTH OR 16 WEEKS. FOUR MONTHS THE VARYING TIME PERIODS. YOU WILL PITT PUT IT ON THE WORT OVERNIGHT. LEAVE IT ON, WATCH IT OFF IN THE MORNING THREE TIMES A WEEK AND WORKS BY BOOSTING YOUR IMMUNE SYSTEM TO FIGHT THE WORT VIRUS ITSELF. SORT OF A MORE NATURAL WAY OF OUR OWN BODY FIGHTING THIS VIRUS TO HAVE IT DISAPPEAR. WITH WITH TIME. THE NEGATIVE, OBVIOUSLY SLOWER THAN ME JUST BURNING IT OFF TODAY. SO YOU NEED TO HAVE SOME DEGREE OF COMMITMENT TO DO THAT. WHAT'S INTERESTING ABOUT THE CREAM THOUGH IS THAT THIS CREAM CREATES MEMORY IN YOUR IMMUNE CELLS. TO DECREASE RECURRENCES, WHICH IS VERY IMPORTANT BECAUSE THIS IS THE PROBLEM THAT TENDS TO COME BACKCH SO THE RECURRENCE RATE FOR THIS IS 13 percent. MUCH, MUCH LOWER THAN FOR PEOPLE WHO EITHER DIDN'T DO ANY DREAM AT ALL, GENITAL WORTS CAN GO AWAY BY THEMSELVES, OR FOR WOMEN WHO HAVE HAD DESTRUCTIVE METHODS TO USE.

Maureen says WHAT'S THE OCCURRENCE RATE FOR PEOPLE.

Nancy says CAN BE AS HIGH AS 50 percent FOR THOSE PEOPLE.

Maureen says ARE YOU CONTAGIOUS WHETHER THEY'RE VISIBLE OR NOT.

Nancy says YES, YOU'RE PROBABLY MORE CONTAGIOUS WHEN THEY'RE VISIBLE BUT JUST BECAUSE YOU SAY THERE'S NOTHING THERE, DOESN'T MEAN YOU DON'T CARRY THE VIRUS ON NORMAL LOOKING SKIN. THAT'S PROBABLY HOW PEOPLE GET IT IN THE FIRST PLACE, BECAUSE A LOT OF PEOPLE WILL SAY I DON'T KNOW HOW I COULD HAVE GOTTEN THIS, THIS WAS MY FIRST PARTNER AND THEY DON'T SHOW WORTS. THEY'RE CARRYING IT ON NORMAL LOOKING SKIN IS WHY. IT'S QUITE EXPENSIVE WHICH IS IMPORTANT TO POINT OUT BUT WILL BE COVERED BY MOST DRUG PLANS. IT'S GOING TO BE IN THE NEIGHBOURHOOD OF 108 TO 200 DOLLARS PER MONTH THAT YOU USE IT. SO COST, I ALWAYS FORGET, BECAUSE I DON'T GUY STUFF MYSELF TO TELL PEOPLE AND WARN THEM, APPROXIMATELY HOW MUCH IS EACH THING GOING TO COST. BUT YOU HAVE A DRUG PLAN IT WOULD BE COVERED.

Maureen says HOW LONG WOULD YOU HAVE TO APPLY THAT.

Nancy says BETWEEN FOUR WEEKS AND 16 WEEKS. ONE TO FOUR MONTHS. IT CAN BE COSTLY IF YOUR PAYING BY YOURSELF.

Maureen says AT LEAST IT'S NOT THE REST OF YOUR LIFE LIKE SOME DRUGS. ANN IN TORONTO IS NEXT. HELLO.

The Caller says HI. I WOULD LIKE TO ASK THE DOCTOR ABOUT MY HUSBAND. THERE'S A CUT THAT BREAKS OUT ON HIS PENIS, EVERY TIME WE HAVE SEX. NEVER BREAK OUT ANY OTHER TIME. AND IT'S BEEN LIKE THAT FOR THE LAST SIX TO EIGHT MONTHS. I'VE BEEN TO TWO DIFFERENT DOCTORS AND HAD DIFFERENT PAP TESTS. HE'S BEEN TO A DOCTOR WHO HASN'T REALLY SAID ANYTHING ABOUT IT. JUST MORE OR LESS WHEN HE MENTIONED IT TO HIM, NEVADA CAME UP WITH AN ANSWER. JUST BRUSHED IT OFF BECAUSE HE WAS THERE FOR OTHER REASONS. BUT I WAS WONDERING IS THERE ANY GYNECOLOGY REASON WHY THIS WOULD BREAK OUT. THERE'S NO SORE. JUST LIKE A SLICE, LIKE A LITTLE SCRATCH. AND IT KIND OF BLEEDS BUT THERE'S NO SORES ON THEM OR ANYTHING ELSE, AND IT'S NEVER THERE, UNLESS WE HAVE SEX AND IT COMES UP.

Nancy says THAT WOULD BE EVERY SINGLE TIME.

The Caller says YES. WE DON'T HAVE SEX A LOT, BUT WE'VE BEEN TOGETHER 20 YEARS AND YOU NOTICE. NOT EVERY DAY.

Nancy says HER PIECE YOU'LL HAVE LOTS OF TIMES WHEN YOU'RE FINE, IT PROBABLY ISN'T. BHAU YOU NEED TO DO IS CONTINUE AND PURSUE THIS, AND SOMETIMES THE FIRST PERSON YOU SAW, DOESN'T KNOW, ISN'T CONTRACTABLE. THE TWO PEOPLE THAT WOULD BE GOOD IN A SITUATION HIKE THIS A UROLOGIST OR BELIEVE IT OR NOT DERMATOLOGIST IS OFTEN VERY GOOD WITH SKIN PROBLEMS OF THE GENITAL AREA. AND THEY SUBSPECIALIZE A BIT. I HAVE A WOMAN THAT I USE FOR FEMALE WE CALL VUL VERY OF THAT AREA OF DERMATOLOGIST, SHE'S SWLENT IN GYNECOLOGIST TURF SAY WE DON'T GET A LOT OF TRAINING IN SKIN STUFF AND I IMAGINE YOURING SO PROBABLY VERY SIMILAR. AND DERMATOLOGIST MAY BE AN AREA THAT CAN GIVE YOU MUCH MORE ADVICE. REMEMBER ANYTHING THAT DOESN'T HEAL, SOMETIMES DESERVES THE BIOPSY AND THAT MAY BE SOMETHING THAT YOU NEED TO KVM THESE THINGS ARE RARE, BUT YOU DON'T WANT TO MISS THEM.

Maureen says WHO NEEDS ALL THIS, HER OR HER US...

Nancy says THE HUSBAND, ACTUALLY. I GUESS THEY'RE THINKING IT MIGHT BE SOMETHING INSIDE HER.
IF IF YOU HAD YOUR CHECK UP DONE, YOUR PAP, YOU'VE COVERED YOUR BASES FROM THE FEMALE POINT OF VIEW.

Maureen says INTERESTING. THANK YOU VERY MUCH. E-MAIL QUESTION HERE...

Maureen reads from the laptop and says I'M 36 AND ON HRTVJTS I WAS DIAGNOSED WITH WITH PREMATURE OVARIAN FAILURE WHEN I WAS 246789 WE SUCCESSFULLY WITH THE HELP OF AN ORGAN DONOR HAVE TWO BEAUTIFUL BOYS. I'M BREATH FEEDING BY FOUR-MONTH-OLD AND ON A VERY LOW DOSE OF ESTRACE. I'M STARTING TO FEEL TIRED. MOODY ALMOST LIKE PMS. I KNOW WHEN I'M ON MY REGULAR DOSE, 6 MILLIGRAM, THE TIREDNESS AREN'T THERE. CAN I INCREASE THE ESTROGEN AND CONTINUE BREAST FEEDING. ALSO I'M GOING TO BE ON HRT FOR A VERY LONG TIME. PROBABLY 40 YEARS, YOUR THOUGHTS WOULD BE APPRECIATED, THAT'S FROM WENDY.

Nancy says THAT'S AN INTERESTING QUESTION BECAUSE THE NUMBERS YOU'RE TALKING ABOUT THE DOSE OF ESTROGEN AS A YOUNGER WOMAN IS VERY DIFFERENT THAN THE DOSE YOU WOULD BE GIVING A 60-YEAR-OLD THAT'S BECAUSE SHE'S YOUNG. TO PROTECT AGAINST DISEASE LATER, YOU'RE TRYING TO SIMULATE WHAT WE MAKE AT OUR AGE VERSUS 20 YEARS FROM NOW. SO GOING BACK UP ON DOSE OF THE ESTROGEN ITEM ACTUALLY PROBABLY OKAY. BECAUSE YOU'RE JUST PRESCRIPTIONING YOURSELF BACK UP TO A WOMAN WHOSE NOT GOT PREMATURE OVARIAN FAILURE. PROBABLY THE SMARTEST WAY TO TALK ABOUT THAT QUESTION IS TO TALK TO SKIK CHILDREN'S HOSPITAL BECAUSE THEY TEAL WITH DRUG USE AND PREGNANCY AND THEY CAN DO A LITERATURE SEARCH ON ANYONE ON ANY TOPIC AND THAT WOULD BE AN EXCELLENT TOING AND I'M SURE THEY'LL TELL YOU YES, IT'S OKAY TO ACTUAL FLI UP. WE KNOW ANY DRUG IS EXCRETED IN THE BREAST MILL TO BE SOME EXTENT. BUT FOR EXAMPLE, WE WILL SAY YOU CAN BE ON THE BIRTH CONTROL PILL WHILE YOU'RE BREAST-FEED FIGURE IT'S NECESSARY. AND THE BIRTH CONTROL PILL IS ACTUAL LAY SIMILAR AMOUNT OF ESTROGEN TO 6 MANAGES OF SO IT'S LIKELY THEY'LL TELL YOU YES, IT'S OKAY.

Maureen says DO WE HAVE 40 YEARS HISTORY OF HRT TO BE ABLE TO TELL WENDY WHETHER.

Nancy says WE DO, BUT WE HAVE 40 YEARS OF USE OF HRT PROBABLY IN OLDER WOMEN. NOT IN YOUNGER WOMEN. I THINK IT'S HARD TO ADVISE HER WHAT WILL HAPPEN FOR SURE. WE DO KNOW IF YOU DON'T TAKE IT, THAT PROBABLY WE'RE PUTTING YOU AT RISK CONSIDERABLY WITH BONE AND YOU CAN MEASURE THAT WITH THE BONE DENSITY IN WOMEN WHO CAN'T OR DON'T WANT TO BE ON IT AT QUITE A YOUNG AGE, SAY SURGICALLY WHEN WE'VE TAKEN OUT OVARIES. AFTER A COUPLE YEARS FROM THE SURGERY AND THE REMOVAL, YOU CAN MEASURE QUITE EARLY ON OSTEOPOROSIS HAPPENING. SO, I THINK ITEM ONE OF THOSE CASES WHERE YOUR OBLIGED TO BE ON IT TO PREVENT DISEASE AT LEAST UNTIL AROUND THE AGE OF 50, WHEN YOU CAN THEN MAKE A DECISION AS TO ARE YOU GOING TO STOP IT LIKE SOME WOMEN USED TO, AND NOW, WANTING TO. AND THEN YOU HAVE TO REASSESS. I THINK EVERY DIVE FIVE TO TEN YEARS, EVERYTHING.

Maureen says OKAY, WE'LL GET SANDRA IN, SHE'S IN ST. CATHARINES. HI, SANDRA.

The Caller says HELLO, I HAVE A QUESTION THAT YOU SOMEWHAT ANED ON YOUR PREVIOUS CALL, BUT I'M GOING IN FOR SURGERY, I HAD ONE OVARYREMOVED TWO YEARS AGO. AND THEN THERE WAS A CHANCE A 10 percent CHANCE THAT I COULD GET THE SAME CYST ON THE LEFT SIDE. SO NOW I HAVE A DECISION TO MAKE. I WAS JUST WONDER IS IT WORTH TRYING TO SAVE A PORTION OF MY OVARY, IF THEY'RE ABLE TO DO IT. OR JUST GO ON HORMONE REPLACEMENT THERAPY.

Nancy says HOW OLD ARE YOU.

The Caller says I'M 38.

Nancy says AND IS IT A CYST YOU'RE TALKING ABOUT.

The Caller says YEP.

Nancy says THAT'S 10 percent. WE CALL IT BILATERALITY. NOT A USUAL, A DIFFERENT CYST ON THE OVARY, 10 percent OF THE TIME YOU'LL HAVE IT ON THE OTHER SIDE TOO. YEAH, I WOULD. SEE IF YOU CAN SAVE, BECAUSE OFTEN WHEN WE DO THE SURGERY FOR A CYST IT'S EASY TO SEPARATE THE DETERMINE ID FROM THE REGULAR TISSUE. IF POSSIBLE. DEEP OTHER OVARY. THE EXCEPTION IS GOING TO BE IF THE CYST IS VERY LARGE, IT COMPRESS OR PRESSES ON THE NORMAL TISSUE AND WITH TIME, YOU OFTEN HAVE NO NORMAL TISSUE LEFT SO. SOMETIMES ALTHOUGH WE WANT TO DO THAT WE CAN'T. AND WHEN WE REMOVE IT THERE'S NOTHING LEFT THAT IS IF YOU THINKING AND THEN YOU'RE LEFT WITH THE THE NECESSARY FOR MAKING A DECISION ABOUT HORMONE THERAPY. AND AT THIS AGE YOU'RE YOUNG ENOUGH, I KNOW IF IT WERE ME I PROBABLY WOULD GO ON IT. IF I DIDN'T HAVE A REASON NOT TO.

Maureen says OKAY, IN LESS THAN A MINUTE, CAN YOU GIVE US TOP THREE TIPS FOR WOMEN, THINGS CAN THEY DO STARTING TODAY TO IMPROVE THEIR HEALTH.

Nancy says MY MISSION THIS YEAR and I JUST STARTED DOING IT ABOUT SIX MONTHS AGO ASKING EVERYBODY WHEN WAS YOUR LAST BREAST. PEOPLE YOU JUST WOULDN'T BELIEVE THE ANSWERS, OH, I DON'T DO THOSE, AND I MEAN BOTH WITH YOURSELF AND WITH YOUR PHYSICIAN. WHEN WAS YOUR LAST CHECK UP IS WHAT I REALLY MEAN. WHEN WAS YOUR LAST PAP TEST, IF YOU CAN'T REMEMBER, IT'S TOO LONG AGO. BECAUSE YOU WOULD REMEMBER IF IT WAS WITHIN THE LAST YEAR.

Maureen says AND LAST THING.

Nancy says KEEP A NOTE ON YOUR BODY. KEEP IN TUNE WITH YOURSELF, AND DON'T BE SCARED OF THINGS THAT ARE HAPPENING TO YOU. COME IN WITH COMPLAINTS, DON'T just run away.

Maureen says AND WE DO. 57 percent. ALL RIGHT, THANKS NANCY. NANCY DURAND IS AN OB/GYN. FOR MORE INFORMATION check OUT THE BOOK Menopause BY DOCTOR Miriam STOPPARD...

A picture of the book appears briefly on screen. The cover is white, with pictures of active women.

Maureen continues AND THOSE ON-LINE CAN VISIT HEALTH CANADA'S WEB SITE FOR WOMEN'S HEALTH INFORMATION...

A slate reads "Health Canada, www.hc-sc.gc.ca."

Maureen says And that's all the time for this edition of More to Life. I'm Maureen Taylor. Thanks for joining us and I hope you'll tune in again Monday through Friday from 1 to 2 o'clock.

A slate reads "The advice given in the preceding program is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances."

Watch: Gynecology