Ukiah Daily Journal from Ukiah, California on June 7, 1998 · Page 29
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Ukiah Daily Journal from Ukiah, California · Page 29

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Ukiah, California
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Sunday, June 7, 1998
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Page 29
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BRIEF SUMMARY OF PRESCRUINQ INFORMATION FOR THE PATIENT PREMARJN* Briral ol conKigited ettrogetit Ublttt, USP This Summary describes when and how to use estrogens and the risks ol estrogen treatment. ESTROGEN DRUGS Estrogens have several important uses but also some risks. You must decide, with your doctor, whether the risks of estrogens are acceptable in view of their benefits. II you decide to start taking estrogens, check with your doctor to make sure you are using the lowest possible effective dose. The length of treatment with estrogens will depend upon the reason for use. This should also be discussed with your doctor. USES OF ESTROGEN To reduce menopausal symptoms. Estrogens are hormones produced try the ovaries. The decrease In the amount ol estrogen that occurs In all women, usually between ages 45 and 55, causes the menopause. Sometimes the ovaries are removed by an operation, causing 'surgical menopause.' When the amount ol estrogen begins to decrease, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest or sudden intense episodes of heat and sweating ('hot (lashes'). The use of drugs containing estrogens can help the body adjust to lower estrogen levels. Most women have none or only mild menopausal symptoms and do not need estrogens. Other women may need estrogens tor a few months white their bodies adjust to lower estrogen levels. The majority of women do not need estrogen replacement for longer than six months lor these symptoms. To prevent brittle bones Alter age 40, and especially after menopause, some women develop osteoporosis. This is a thinning of the bones that makes them weaker and more likely to break, often leading to fractures ol vertebrae, hip, and wrist bones. Taking estrogens after the menopause slows down bone loss and may prevent bones from breaking. Eating foods that are high in calcium (such as milk products) or taking calcium supplements (1,000 to 1,500 milligrams per day) and certain types of exercise may also help prevent osteoporosis. Since estrogen use is associated with some risk, its use in the prevention ol osteoporosis should be confined to women who appear to be susceptible ID this condition. I he following characteristics are often present in women who are likely to develop osteoporosis: white race, thinness, and cigarette smoking. Women who had their menopause by the surgical removal of their ovaries at a relatively young age are good candidates for estrogen replacement therapy to prevent osteoporosis. To treat certain types ol abnormal uterine bleeding due to hormonal imbalance. To treat atrophic vaginitis (itching, burning, dryness in or around the vagina). To treal certain cancers. WHEN ESTROGENS SHOULD NOT BE USED Estrogens should not be used: During, pregnamy. Although the possibility is fairly small, there is a greater risk of having a child born with a birth detect if you take estrogens during pregnancy. A male child may have an increased risk of developing abnormalities of the urinary system and sex organs. A female child may have an increased risk ol developing cancer ot the vagina or cervix in her teens or twenties. Estrogen is not effective in preventing miscarriage (abortion). It you are breast feeding. Many drugs are excreted in human milk and canoe passed on to your baby. Therefore, estrogen therapy should be used only when your doctor decides it is clearly necessary. mended doses. Patients with a tendency lor abnormal blood clotting should avoid estrogen use. This includes patients who currently have clots In the leg (thrombophlebitis), or any other part ol the body (mromboembolic disorder). (See below!) It you lave ladundiagnosed vaginal bleeding. It you have ever had abnormal bleeding from the vagina estrogens should not be used unless you have talked to your physician about this problem. It you have ted oncer. Since estrogens increase the risk ol certain cancers, you should not take estrogens If you have ever had cancer ol the breast or uterus. In certain situations, your doctor may choose to use estrogen in the treatment ol breast cancer. When they are ineffective. Sometimes women experience nervous symptoms or depression during menopause. There is no evidence that estrogens are effective lor such symptoms. You may have heard that taking estrogens lor long periods (years) after menopause will keep your skin soft and supple and keep you feeling young. There is no evidence that this is so and such long-term treatment may carry serious risks. DANGERS OF ESTROGENS Cancer ol the uterus. The risk of cancer of the uterus increases the longer estrogens are used and when larger doses are taken. One study showed that when estrogens are discontinued, this increased risk of cancer seems lo fall off quickly. In another study, the persistence ol risk was demonstrated lor 10 years after stopping estrogen treatment. Because of this risk, it is important Intake the lowest effective dose ol estrogen me to tale It only as long asm need it. There is a higher risk ol cancer of the uterus if you are overweight diabetic, or have high blood pressure. If you have tad your uterus removed (total hysterectomy), there is no danger ol developing cancer ol the uterus. It you have your uterus, please refer to Cancer oline breast. The majority ol studies have shown no association with the usual doses used for estrogen replacement therapy and breast cancer. Some studies have suggested a possible increased Incidence ol breast cancer in those women taking estrogens lor prolonged periods of time and especially if higher doses are used. Regular breast examinations by a health professional and self-examination are recommended lor women receiving estrogen therapy, as they are for all women. Gallbladder disease. Women who use estrogens after menopause are more likely to develop gallbladder disease needing surgery than women who do not use estrogens. Abnormallilood clotting. Taking estrogens may increase the risk ol blood clots. These clots can cause a stroke, heart attack or pulmonary embolus, any of which may be fatal. Heart disease. Large doses of estrogen in men have been shown to increase the risk of certain heart diseases. This may not necessarily be true in women. In order to avoid the theoretical risk of high doses, the dose ol estrogen you take should not exceed the dose recommended by your doctor. Excess calcium in the blood. Taking estrogens may lead lo severe hypercalcemia in women with breast and/or bone cancer. SIDE EFFECTS In addition to the risks listed above, the following side effects have been reported with estrogen use: • Nausea, vomiting; paia cramps, swelling, or tenderness in the abdomen. • Yellowing of the stan and/or whites of the eyes. Q&A • Enlargement ol benign tumors ol the uterus. • Breakthrough bleeding or spotting. • Change in amount of cervical secretion. • vaginal yeast infections. • Refention of excess fluid. This may make some conditions worsen, such as asthma, epilepsy, migraine, heart disease, or kidney disease. • A spotty darkeningol the skin,particulailyon the face: reddeningol the skin; skin rashes. • Worsening olporphyria. • Headache, migraines, dizziness, faintness, or changes in vision (including intolerance to contact lenses). • Mental depression. « Involuntary muscle spasms. • Hair loss or abnormal hairiness. • Increase or decrease in weight. • Changes in sex drive. • Possible changes in blood sugar. REDUCING RISK OF ESTROGEN USE If you decide to lake estrogens, you can reduce your risks by carefully monitoring your treatment See your doctor regularly. While you are taking estrogens, it is important that you visit your doctor at least once a year lor a physical examination. Special attention should be given to blood pressure, breasts, abdomen, and pelvic organs. A Pap smear should be taken and tested al this visit If members ol your family have had breast cancer ot if you have ever had breast nodules or an abnormal mamrnogram (breast x-ray), yog rnay need to te^ guenlbieasl examinations. Also be sure lo let your doctor know it you have ever had liver wkia^ disease, as this rrayalfra the teion to use esuogen. . . Be alsrt lor signs ol trouble. Report these or any other unusual side effects lo your doctor immediately: • Abnormal bleeding from tne vagina. • Pains in the carves or chest, a sudden shortness of breath or coughing blood (indicating possible clots in the tegs, hean or lungs). • Severe headache, dizziness, faintness, or changes in vision, indicating possible clots in tne brain or eye. • Breastlumps. • Yellowing of the skin and/or whites ot the eyes. • Pain, swelling, or tenderness in the abdomen. OTHER INFORMATION Some physicians may choose to prescribe another hormonal drug to be used in association with estrogen treatment lor women with a uterus. These drugs, progestins, have been reported to lower the frequency ol occurrence of a possible precancetous condition ol the uterine lining. Whether this will provide protection trom uterine cancer has not been clearly established. There are possible additional risks that may be associated withlhe inclusion ol a piogestin in estrogen treatmenL The possible risks include unfavorable effects on blood fats and sugars. The choice ot progestin and its dosage may be important in minimizing these effects. Your doctor has prescribed this drug lor you and you alone. Do not give the drug to anyone else. H you will be taking calcium supplements as part of the treatment to help prevent csleopwcsis, check wth your tor atogl to Keep this and all drugs out ol the reach of children In case of overdose, call your doctor, hospital, or poison control center immediately. This Summary provides the most important information about estrogens. If you want to read more, ask your doctor or pharmacist to kit you read the professional labeling. This Bnel Summary for DirecHo-Consumer Advertising is based on the most current Premarin Tableis Direction Circular, Cl 3906-9, Devised May 21 , 1997. WAPR-0531 World Leadership in Women's Hea/tf) Care. WYETH-AYER8T LABORATORIES Philadelphia, PA 19101 7133842 Fitness By GEORGE FOREMAN AND MIA HAMM Q: How much exercise is too much? How do you find the proper balance between Improving your fitness level and avoiding injury? How do you know when the pain or soreness after a workout is a sign you need to cut back? Joel Sitrin, Alexandria, Va. Mia: Just in the past few years, I've really I begun to listen to my i body. As a profes- | sional athlete, I must be in tune with its signals. Only with experience have I learned to differentiate between the pain of an injury or potential injury and the discomfort or strain of a workout that indicates new strength. One indispensable guideline: Pain is usually the first sign that something is wrong. Yet the pain of a pulled muscle may feel similar to the discomfort of a heavy workout, if you aren't used to it. You must learn the difference, and I hope you never have to learn the hard way. Fatigue also comes into play. If you are exhausted and preparing for an activity that requires heavy concentration and technique, consider taking the day off. For example, you can do yourself more harm than good by lifting weights while physically or mentally exhausted. Instead, re- energize and come back the next day. GET IN GEAR BV TERRY BYRNE Q: I have been diagnosed with gastroesophageal reflux disease (GERD), a condition that prevents me from lying flat on my back for any extended period. I can no longer do sit-ups for my tummy. Any exercises I can substitute? Ann Gonzales, University Place, Wash. George: I've been trying something new myself, a very safe physical activity for people who have physical limitations or are frustrated by limited results. I was recently given a book called Body Rolling (HEALING ARTS PRESS, $19.95), by yoga and massage experts Yamuna Zake and Stephanie Golden. It lays out for you some powerful muscle-release exercises using a small, soft rubber ball; you roll over it with all parts of your body. I took to the idea quickly because it both energizes and relaxes the body. It also reminded me of Gill Clancy, my original trainer and a physical education teacher who in 1976 saw me exhausted from sit-ups, threw a basketball in front of me and said, "Just roll on that ball!" Surprisingly, it helped — over time, I started to feel the lines in my stomach. This is a great solution for people who have to be extra careful during their workouts. I highly recommend this book and regimen, because I believe in "Safety First." (Send inquiries to: Inner Traditions International Ltd., P.O. Box 388, Rochester, Vt. 05767. Or visit the Web site www.gotoit.com.) Q Weave and this chute weaves with you. You'll need a lot of room to run in this contraption (perhaps a desert), but the novel Power Fitness Chute is reported to help train athletes for speed - the faster the runner moves, the more "drag" it creates. Each chute comes with an adjustable resistance cord, quick-release belt and training manual ($70-$90). For info on other chutes, $57.95-$125, call Kytec at 1-800-732-4883, or visit the Web site http://kytec.spacestar.com. Send your questions about staying fit to Olympians George Foreman and Mia Hamm at "Q&A: Fitness," USA WEEKEND, 1000 Wilson Blvd., Arlington, Va. 22229-0012 (e-mail: fitness9usaweekend.com). You must include a daytime phone number. 8 USA WEEKEND • June 5-7,1998

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