Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Women can experience side effects during hormone
therapy; these can be divided into more minor side effects, and more serious side effects. The more
minor side effects are more common than the serious side effects, and are
generally perceived by women as "annoying." These symptoms include:
It is still controversial which of these side effects
are due to the estrogen component as compared to the progesterone component.
Therefore, if side effects persist for a few months, the doctor will often alter
either the progesterone or the estrogen part of the hormone therapy (HT).
Contrary to common belief, recent research has confirmed
that women who take commonly prescribed doses of hormone therapy (HT) are no more likely to gain
weight than women not taking hormone therapy (HT). This is probably because menopause or aging
itself is associated with
weight gain, regardless of hormone therapy.
The more serious health concerns for
women undergoing hormone therapy (HT) include:
Hormone therapy (HT) increases the risk of vein
clots in the legs (deep vein
thrombosis
) and blood clots in the lungs
(pulmonary embolus) by about
2 or 3 fold. However, it is important to
remember that these conditions are extremely rare in healthy women. Thus, the
true increase in risk for healthy women is minimal. Women with a personal or
family history of these clots should
review this issue when considering hormone therapy (HT).
Uterine Cancer (endometrial
cancer): Research shows that women who have their uterus and use estrogen
alone are at risk for endometrial cancer. Today, however, most doctors
prescribe the combination of estrogen and progestin. Progestin protects
against endometrial cancer. If there is a particular reason why a woman with a
uterus cannot take some form of progesterone, her doctor will take sample
tissue from her uterus
(endometrial biopsy) to check for cancer annually while she is taking estrogen.
Women without a uterus (including women who have had a hysterectomy) have no
risk of endometrial cancer.
Breast cancer:
Recent research indicates that hormone therapy (HT), and especially EPT, increases the risk of
breast cancer, although the increase in risk is very small. For example, the
Women's Health Initiative, a reliable large study of hormone therapy (HT) in menopausal women,
predicted that there were approximately 8 extra cases per 10,000 women who
took hormone therapy (HT) for 1 year, compared to women taking a placebo pill. The increase in
risk of breast cancer associated with hormone therapy (HT) likely
increases with duration of use and is especially increased with 5 or more years
of use.
Heart disease: Even
though hormone therapy (HT) lowers the bad LDL cholesterol and
raises the good HDL cholesterol,
hormone therapy (HT) increases the risk of heart attacks in women who already
have heart disease, as well as in women who do not have known heart disease.
Hormone therapy (HT) does not prevent heart attack based on recent research from the
Women's Health Initiative.
Abnormal vaginal bleeding: Women on
hormone therapy (HT) are more
likely than other postmenopausal women
to experience abnormal vaginal bleeding.
What is called "abnormal bleeding" depends on the type of hormone therapy (HT). With cyclic
therapy, in which 5monthly bleeding is expected, bleeding is abnormal if it
occurs when it is not expected or is excessively heavy or long in duration. With
daily continuous therapy, irregular bleeding can last for 6 months to a year,
therefore, irregular bleeding that lasts for more than a year is considered
abnormal. When abnormal bleeding occurs, a doctor usually takes a sample of the
lining of the uterus to rule out an abnormality or cancer in the uterus. This
procedure is usually done in the office. After the evaluation is done, if
nothing is found to be wrong, hormone therapy (HT) doses will often be adjusted to minimize
further abnormal bleeding.
Stroke: Hormone
therapy (HT)
slightly increased the risk of stroke in women studied in the Women's Health
Initiative. The WHI predicted that there were 8 extra strokes per 10,000 women
taking hormone therapy (HT) for one year, compared to women taking a placebo (sugar pill).
Because of the possibility of increased breast cancer, stroke, and heart
disease risks, women who have no major menopause
symptoms may choose to avoid hormone therapy (HT). The effects of other types of
hormone therapy (HT) (aside from
the Women's Health Initiative types) on breast cancer risk are still unclear.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Canker sore is a small ulcer crater in the lining of the mouth. Canker sores are one of the most
common problems that occur in the mouth. Canker sores typically last for
10-14 days and they heal without leaving a scar.
Hot flashes (or flushing) is the most common symptom experienced by a woman prior to and during the early stages of menopause. Hot flashes can be caused by other conditions. Diagnosis is made by taking a patient history and at times, blood tests. Treatment options include hormone therapy, bioidentical hormone therapy, and medications. There are non-FDA approved natural remedies.
Hot flashes are experienced by many women, however, not all women undergoing menopause experience hot flashes. A hot flash is a feeling of warmth that spreads over the body. Treatment for hot flashes include hormone replacement therapy and alternative prescription medications such as SSRIs (Effexor, Paxil, Prozac), clonidine (Catapres), megestrol (Megace), and gabapentin (Neurontin). Few alternative treatments for hot flashes (for example phytoestrogens - isoflavones, black cohosh, and vitamin E have been scientifically studied.
Turner syndrome is an inherited chromosomal condition affecting women. Women with Turner syndrome do not have ovarian function, and features of the syndrome include webbed neck, lymphedema of the hands and feet, heart defects, kidney problems, and skeletal abnormalities. The X chromosome is related to Turner syndrome. Treatment focuses on the symptoms of the syndrome.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Osteopenia is a bone condition characterized by bone loss that is not as severe as in osteoporosis. Bone fracture is the typical symptom of osteopenia, though the condition may be present without symptoms. Treatment involves lifestyle modifications (quitting smoking, not drinking in excess) and ensuring an adequate intake of vitamin D and calcium.
Amenorrhea is a condition in which there is an absense of menstrual periods in a woman. There are two types of amenorrhea, 1) primary and 2) secondary. Treatment of amenorrhea depends on the type (primary or secondary). In prmiray, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options.
Melasma is a patchy brown discoloration of the skin on the face. When it occurs in pregnancy, it's called chloasma. Melasma is commonly treated with hydroquinone creams.
Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Premature ovarian failure (POS) is the cessation of normal functioning of the ovaries in women under the age of 40. Premature ovarian failure may be caused by follicle depletion or dysfunction. The most common symptom of premature ovarian failure are irregular periods. There is no "treatment" that will restore the ovarian function, but there are treatments that my relieve symptoms.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
Cholesterol occurs naturally in the body. High blood cholesterol levels increase a person's risk of developing heart disease, heart attacks, strokes, TIAs, and more. In addition to medication (fibrates, statins, bile acid sequestrants, and niacin), lifestyle changes can be made to lower blood cholesterol levels
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
Endometrial cancer, or uterine cancer, affects the endometrium of the uterus. It's the most common invasive cancer of the female reproductive system. Risk factors include smoking, obesity, lack of exercise, taking estrogen-only hormone therapy, early menstruation, late menopause, and never being pregnant.
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