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.
Doctors usually prescribe hormone therapy (HT) as a combination of
estrogen and another synthetic female hormone, progesterone. Synthetic
progesterone compounds are referred to as progestins. Long term estrogen without
progesterone increases the risk of uterine cancer
(endometrial cancer), whereas addition of
progesterone counteracts this risk. Therefore estrogen without progestin is
usually only recommended for women who have had their uterus removed
(hysterectomy). Estrogen is available as pills, tablets, patches, creams, or
vaginal preparations (vaginal rings, vaginal tablets, or vaginal cream). The choice of estrogen preparation recommended by
the doctor depends on the women's symptoms. For instance, vaginal creams,
vaginal tablets, and vaginal rings are used for vaginal dryness, while pills or
patches are used to ease hot flashes. Estrogen pills are also useful for vaginal
dryness and are sometimes used along with vaginal creams, tablets, or rings.
Although progestin is usually taken in pill form, it is also available, together
with estrogen, in patch form.
Doctors may prescribe different schedules for
taking hormone therapy (HT). Every woman's hormone therapy (HT) treatment and schedule should be individualized
based on her particular situation. Below are some standard forms of hormone
therapy (HT) that are
used:
Pills (Oral Therapy)
In order to avoid monthly vaginal bleeding, some women choose to take small
doses of estrogen and progesterone together every day. This is called daily
continuous therapy. Sometimes, daily continuous therapy can cause some
irregular, unexpected vaginal bleeding for the first several months of
treatment, especially in younger women entering menopause. For these women, and
for some other women, planned cyclic bleeding is more acceptable. In these
women, progesterone is usually added to estrogen for the first 12 calendar days
of the month.
Patches (Transdermal Therapy)
Hormone therapy (HT) skin patches are to be worn on a continuous basis. Newer patches need to
be changed once or twice per week. Combination estrogen/progesterone patches are
available for women who have not undergone hysterectomy to prevent cancer of the
uterus. Patches are as effective as oral hormone therapy (HT) for controlling hot flashes.
Vaginal
Tablets rings, and Creams
Estrogen vaginal tablets and creams are generally prescribed nightly for 2
weeks, and then reduced to twice per week as a long-term "maintenance therapy."
There is a low level of absorption of estrogen into the body with the use of
vaginal preparations as directed. Circulating blood levels of estrogen are
slightly increased from vaginal estrogen use, and the long-term safety of
vaginal estrogen rings, creams and tablets has not been clearly established (for
example risk of uterine cancer, heart disease, or breast cancer). For this
reason, occurrence of vaginal bleeding during any type of vaginal estrogen use
should be promptly evaluated.
Vaginal estrogen rings are approved to treat genital and
urinary dryness and irritation that can occur due to the lack of estrogen in
women after menopause. A higher dose vaginal ring is available to treat hot
flashes, so this higher dose ring clearly reaches high enough levels to affect
other parts of the body besides the genital area. They vaginal ring remains in
place for 12 weeks, after which they can be changed by either the woman herself
or her physician. The long-term safety of estrogen rings is not
yet clear, but there is a low level of absorption of the hormone into the
bloodstream with use of the vaginal estrogen ring.
Bioidentical hormone therapy
There has been increasing interest in recent years in the use of so-called "bioidentical" hormone therapy for perimenopausal women. Bioidentical hormone preparations are medications that contain hormones that have the same chemical formula as those made naturally in the body. The hormones are created in a laboratory by altering compounds derived from naturally-occurring plant products. Some of these so-called bioidentical hormone preparations are U.S. FDA-approved and manufactured by drug companies, while others are made at special pharmacies called compounding pharmacies, which make the preparations on a case-by-case basis for each patient. These individual preparations are not regulated by the FDA, because compounded products are not standardized.
Advocates of bioidentical hormone therapy argue that the products, applied as creams or gels, are absorbed into the body in their active form without the need for "first pass" metabolism in the liver, and that their use may avoid potentially dangerous side effects of synthetic hormones used in conventional hormone therapy. However, studies to establish the long-term safety and effectiveness of these products have not been carried out.
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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