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Menopause and Bioidentical Hormone TherapyWomen want a smooth and easy menopause transition. Unfortunately some women are bothered by very severe symptoms such as hot flashes, night sweats, mood swings and fragmented sleep which can persist for many years. A friend, colleague or even a health professional might suggest a trial of bioidentical hormone therapy (BHT) to ease these symptoms. Before proceeding however, women want to be fully informed about this topic. Gone are the days where a women would pick up a pamphlet or discuss this topic with a trusted friend or health care professional. Today it is much more common for women to turn to their computers or their smart phones- enter the words BHT into their favorite search engine and off they go! A wealth of information is at their fingertips- but just how reliable and credible are these websites?

A menopause clinician and researcher in Edmonton, Dr. Nese Yuksel, wanted to evaluate the quality of information and claims made on websites specifically offering BHT products or services. She joined with her colleagues Laetitia Treseng, Bushra Malik and Ubaka Ogbogu, to examine the

content on 100 websites promoting or selling BHT products and services in the fall of 2013. Websites were from Canada (59%), United States (38%), and other countries (3%). Almost half the websites originated from medical clinics (47%). Websites overall claimed that BHT had less risk compared with traditional hormone therapy (62%). Unfortunately many of these claims are misleading and

Women’s Wellness ProgramRoom 3006 Grey Nuns Community Hospital1100 Youville Drive West NWEdmonton, AB T6L 5X8

WOMEN’S WELLNESS PROGRAM

Women’s Wellness Program Newsletter Fall 2017

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Continued on page 2

Dr. Nese Yuksel, BScPharm, PharmD, FCSHP, NCMP

Professor, Faculty of Pharmacy and Pharmaceutical Sciences

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Where do I find BHT?“Bioidentical hormones are actually in many commercial hormone therapy products that have been approved by Health Canada, as well as formulations that are compounded by pharmacies that specialize in compounding (formulations not available in conventional hormone therapy).

“Bioidentical hormones found in commercial HT products include 17 β-estradiol (pills, patches, gels, vaginal products), estrone (vagina) and micronized progesterone.”

What are compounded BHT?“Compounded BHT are hormone-therapy formulations prepared by a pharmacy specializing in compounding. Any of the bioidentical hormones can be compounded to provide a variety of doses and administration routes such as oral, transdermal creams and vaginal products.

“Bioidentical hormones used in compounded BHT include estrogen such as estradiol, estrone, estriol, and progesterone. In some settings testosterone and DHEA may also be added to the regimen.

“There is a very important role for compounding as it can provide delivery formulations or doses that may not be commercially available. However, the issue is the way compounded BHT is sometimes promoted online as being better tolerated or safer than commercial hormone therapy. Unfortunately, it is difficult to support these claims without further evidence.”

Is BHT natural?“There are no bioidentical hormones that can be considered completely natural.

“One common misnomer is that BHT is ‘natural’ as this is often the way it is promoted. Even though many of the initial compounds are often extracted from plant-based sources such as soy and Mexican yam, they are then chemically converted or synthesized to the same molecular structure as human hormones.

“Furthermore, the use of the word ‘natural’ often gives the connotation that a product is in some way better for the human body, however being natural does not always mean it is safe.”

Is BHT safer than conventional hormone therapy?“There is preliminary evidence that shows some benefits may exist with certain bioidentical hormones found in conventional HT products. For example, micronized progesterone may have better sleep, mood and possibly breast cancer outcomes as compared to synthetic progestins.

not consistent with guidelines/recommendations supported by other professional organizations such as the Canadian Menopause Society, North American Menopause Society or the Society of Obstetricians and Gynaecologists of Canada.

Now for the good news: Dr. Yuksel’s research article attracted a fair amount of attention and was profiled on the University of Alberta website in June 2017. This article is reprinted below. Read on to discover more about Dr.Yuksel’s research and her responses to common questions about the use and safety of compounded BHT products.

What you need to know about bioidentical hormone therapyUniversity of Alberta pharmacy researcher addresses the big questions around BHT.

Recent University of Alberta research shows that women who take or who are thinking of taking bioidentical hormone therapy—hormones that mimic human hormones—may encounter health information online that is misleading and not consistent with recommendations from professional organizations.

Menopausal bioidentical hormone therapy shadowed by misleading claims“This may leave women who are considering taking BHT or currently taking it to help with symptoms of menopause even more confused about the risks,” said Nese Yuksel, a professor in the Faculty of Pharmacy and Pharmaceutical Sciences, who led the study.

She said many health organizations, such as the North American Menopause Society recommend against using compounded BHT unless it’s in situations where there is an allergy to commercial hormone therapy or a need for a tailor-made formulation or doses.

“Women may not always know where to go for helpful and accurate information,” she added.

We asked Yuksel to address some of the big unknowns arising out of using BHT.

What is BHT anyway?“The term ‘bioidentical hormones’ rose as a marketing term and there is no real scientific definition for BHT. It refers to the use of any hormone that is ‘identical in molecular structure to human hormones.’ The hormones are often extracted from plant sources and synthesized into molecules that are the same structure as hormones produced in the body.

“Bioidentical hormones include estrogen such as estradiol, estrone, estriol and progesterone.”

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Women’s Wellness ProgramOur program offers specialized health information for women over age 35. Areas of focus include perimenopause, menopause and treatment options, osteoporosis, and other midlife aging concerns. We believe in women making well informed health decisions at midlife and beyond. In addition to offering menopause and osteoporosis clinics, we also host an annual conference called Prime Time for Women, and publish a Women’s Wellness Newsletter.

Program TeamShelly Hagen - BSHEc, RD, NCMP- Health EducatorLori Reich Smith - BScN, RN, NCMP- Health EducatorChristine Maslanko - BSP, NCMP- Pharmacist (On Leave)Lisa Forester - BSP - PharmacistAndrea Hardy - Program Assistant Leslie Tyler - RN - Unit Manager

Outpatient Clinic StaffDr. Marian Tami-Lee Shandro - NCMP - Specialist in Family Medicine, Women’s Health and Sleep Medicine Clinics, Assistant Professor – University of AlbertaDr. Nan Schuurmans, Medical Director Menopause Clinic, Facility Medical Director - Glenrose Rehabilitation Hospital, Clinical Professor, Obstetrics & Gynecology – University of AlbertaDr. Brian Wirzba - Medical Director - Osteoporosis ClinicDr. Andrea Opgenorth - Endocrinologist

We operate on a part-time basis. Staff are usually in the office on Tuesdays, Wednesdays and Thursdays.

Location: Grey Nuns Community HospitalTo ask questions call 780-735-7604 or 780-735-7216

“Additionally, transdermal formulations (transferred through the skin) containing estradiol, bypass the first pass effect in the liver and may have less blood clot risk at low to standard doses compared to oral estrogens.

“But the lack of evidence from direct head-to-head studies makes the answer to this important question difficult. At this time, the risks and benefits should apply equally among the hormone therapies.”

Is BHT safer when it comes to breast cancer?“Breast cancer is one of the greatest safety concerns expressed by women with the use of hormone therapy. This fear can drive women to use BHT if they feel it is safer in regards to breast cancer risk. Claims of less breast cancer risk with compounded BHT are especially misleading.

“Estriol is often used in compounded BHT formulations as it is promoted as being safer for breast cancer, however there are no published peer reviewed data to support these claims. At this time we just don’t know.”

Will BHT help me look and feel younger?“Compounded BHT is sometimes promoted as an antiageing agent with the belief that it will restore hormone balance to a younger woman and prevent long term health risks.

“However, there is no evidence that it will prevent the normal ageing process.”

For more information, check out these links: The North American Menopause SocietyThe Society of Obstetricians and Gynaecologists of Canada (SOGC)SIGMA Canadian Menopause Society

Reference article: Yuskel N, Treseng L, Malik B, Ogbogu U. Promotion and marketing of bioidentical hormone therapy on the internet: a content analysis of websites. Menopause: The Journal of The North American Menopause Society 2017; 24: 1-7.

Questions? Concerns: Talk to a Menopause Health Educator at 780-735- 7604 or 780-735-7216

Written by Lesley Young, Journalist and Communications Associate- University of Alberta Story courtesy of University of Alberta

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Voices of Everyday WomenFlee to NatureSleepy stillness beyond any I know in my usual place. May I trade all I have for this?

Warmth from the sun caresses me, cradles me and assures me. On the grass carpeted path, leaves rustle, providing a slow melody of peacefulness. Trees knot together like a web, with cascading rays of heavenly light, gently casting shadows swaying slowly to and fro, to and fro. All cares are unburdened and released into the sweet, summer wind.

Bumbling flies are here and there, without a care they zip! Birds release their wings, float and flare in open spaces between white floating wisps of clouds in an open sky. Geese and ducks and lines of offspring float and bobble along ripples of a lazy pond, in the full, hot, sticky sun. The buildings beyond are as much out of place as if someone had tricked nature into growing the hideous structures. Intruding on this gentle, innocent place of refuge and I turn my eyes away.

Wood, water and foliage mingle together to scent the landscape with a wet clean fragrance that the fairies of the air carry along. Colors fry and sizzle, a mirage to behold, a watercolor scene of boldness and pastels, blotches of pines, orange flecks and lavender lilies.

Life is everywhere, some searching for the coolness of the shade while some thriving in full sun. This is a day that God hath made, no doubt of His existence on a day such as this.

Befriended by nature, I am humbled and settled and peaceful within myself.

Voices of Everyday WomenPlease share your stories with us!

Send us your “post card” writings – 250 - 350 words or less – on any topic, so that we might include in a future newsletter. Women like to tell stories. It’s how we share our thoughts, our feelings, our lessons and our wisdom. It’s how we transform our experiences into memories that ground us in history and deepen our commitment to life. We all have stories to tell about everyday life experiences, such as…a dating disaster, a perfect peony, the smell of a puppy’s breath, the feel of a baby’s skin, a secret bared, a sunset shared, a poignant farewell, a joyous beginning, an impish tot, a bathing suit bought, your mom, your friend…there is no end… to our stories.

Please share your stories with us!Send us your “post card” writings – 250 - 350 words or less – on any topic, so that we might include in a future newsletter.

Send your submissions:Email: [email protected] Mail to: Women’s Wellness Program Grey Nuns Community Hospital 1100 Youville Drive West Edmonton, AB T6L 5X8If you have any questions, call 780.735.7604

Written by Lynn RamshawAbout the author……….

Hello, my name is Lynn. I reside in the beautiful south (south Edmonton that is)! I sincerely hope you have enjoyed my poem, as it was a pleasure to have the opportunity to share it with all of you. Writing, regrettably receives a very small piece of my life’s pie.However, I have written several poems and am currently working on a children’s book about Enzo, our 6 month old miniature Schnauzer puppy! I am also hoping to revive a novel I started several years ago which follows the life of a women, who finds herself very much unprepared for raising 3 young boys on her own.

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PROTEIN: What is the big fuss?Enter the word protein into any common search engine and you will see a massive amount of hype and enthusiasm surrounding this important nutrient. The food industry has also tapped into this latest marketing buzzword. Food labels now prominently highlight the protein content of everything from cereal to yogurt to granola bars. High protein, low carbohydrate diets are touted as the new elixir for weight loss. It is time to sift through the mountain of research on protein and present the facts: Why is protein important and what are common food sources? How much protein is necessary for health? Do high protein diets have a role in weight loss?

Protein is essential for life. It is needed by the body to help build muscle, connective tissue, bone matrix, hormones, enzymes and other life giving compounds. Protein is also required to heal tissue, maintain muscle mass and keep our immune system strong. All protein is made of building blocks called amino acids. There are twenty different amino acids - all of which are needed for good health. The body can make eleven of these amino acids. The remaining nine amino acids must come from food sources as the human body is unable to make them, or in sufficient quantities to meet its needs. For this reason they are called essential amino acids.

Eggs, meat, fish, seafood, poultry, soy beans, quinoa, milk and milk products are considered complete protein foods as they contain all nine essential amino acids. Most vegetarian based protein foods such as beans, peas, lentils, nuts and seeds tend to be limited in one or more essential amino acids. However, combinations of vegetarian proteins such rice and beans, peanut butter and whole-grain bread, or tofu with vegetables and rice offer a full range of essential and nonessential amino acids. When eating a vegetarian or vegan diet it takes more planning and attention to detail to ensure you are fully meeting your protein needs.

Food

Protein Content

Meat and Alternatives Grams of protein

Meat, fish or poultry 100g (2 ½oz) 17 - 22

Tofu 175mL (3/4 cup) 14

Beans, peas or lentils 175mL (3/4 cup) 9 – 11

Egg (1) 6

Nuts or seeds 30g (1oz) 3 - 8

Milk and AlternativesCottage cheese 250mL (1 cup) 28

Icelandic yogurt 175g (3/4 cup) 18

Cheese 45g (1 ½oz) 10 - 12

Greek yogurt 175g (3/4 cup) 11

Kefir 250mL (1 cup) 9

Milk 250mL (1 cup) 8

Soy beverage 250mL (1 cup) 8

Yogurt 175g (3/4 cup) 6

Protein and the Food Industry To capitalize on the sudden interest in protein, food manufactures are fortifying, or adding additional protein, to a wide variety of foods. Have a look in your local grocery store and not just in the “health food” section. More likely you will find a variety of granola/nut bars or cereals packed extra protein lining the regular store aisles. Food manufacturers add soy, pea, hemp, casein, or whey protein to boost the protein content of these foods. Each type of protein has unique nutritional benefits. For example, hemp protein is a source of heart healthy, anti-inflammatory omega-3 fatty acids. There is some preliminary evidence to suggest that whey protein can slow down muscle loss in people over the age of 65 in turn, improving long term health and quality of life. Soy protein is in lower in cholesterol and saturated fat. Depending on your nutritional goals you may choose or prefer a certain protein source.

Protein powders are also becoming increasing popular. The powders are usually sold in bulk in large canisters. Protein is measured out and can be added to a variety of different foods or beverages. Check out your neighborhood juice bar and you are bound to see lots of fancy expensive drinks touting the addition of protein. Unfortunately, the ingredient list on these products can be very confusing and complicated. Listed below is an

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explanation of some of the terminology you may see on these labels and what it all means.

Isolate: The protein is in its purest form and only contains protein such as whey or another source. All fat and carbohydrate have been removed. This is handy option for people that are lactose intolerant but want a protein supplement that doesn’t contain lactose.

Concentrate: The protein powder is a mixture of protein, fat and carbohydrates.

Hydrolysed protein: The protein has been broken down into smaller units or groups of two to five amino acids. This may make the protein easier to absorb but the extra processing significantly increases the cost of the products. It may also affect the flavour making the protein powder taste slightly bitter.

Some protein powders and bars also have added fibre. A common added fibre is inulin which is made from chicory root. People with sensitive digestive systems may find it causes gas and bloating. Other ingredients, such as sugar alcohols (mannitol, sorbitol and isomalt) are also found in some protein powders. Stomach upset has also been reported if these sweeteners are consumed in large quantities. Also note that sugar, in one of its many forms, may be added to protein powder for added taste and appeal. Be aware that this can greatly add to the overall calorie content. Try to choose products that contain 10 grams or less of added sugar per serving.

The addition of vitamins and minerals is also common practice in protein powders. If a person is also taking vitamin or mineral supplements in other forms such as pills or “gummies” exercise caution as more is often not better. Refer to https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables.html to find out the Upper Tolerable Limit (UL) of nutrients. The UL is the highest average daily nutrient intake level likely to pose no risk of adverse health effects to almost all individuals in a given life-stage and gender group.

Finally, additives such as creatinine and leucine are commonly found in protein powders. Check out the following website, https://naturalmedicines.therapeuticresearch.com to learn more about these ingredients and if they offer any specific health benefits or just hype.

The following chart lists some common foods and their protein content.

Novel Protein SourcesThe food world is always changing and expanding. Food researchers are actively working to develop alternative protein sources. One interesting example is Quorn™ - a vegetarian protein or mycoprotein. It is made from a fungus and is sold as a meat substitute. Often Quorn™ protein is mixed with egg whites and may not be vegan-friendly. Quorn™ has a texture like meat but is lower in fat and higher in fibre. One half cup of Quorn™ provides 13 grams of protein. Quorn™ contains all of the essential amino acids, but it does not fully measure up to the other nutrient standards defined by Health Canada for simulated meat and poultry products. Quorn™ has been available in Europe for the past several years and has recently been approved for sale in the United States.

Another new technology involves actually growing meat from specific tissue cells in a rich nutrient bath. Meat originating this way has a variety of names including cultured meat, synthetic meat, clean meat, vat meat, in-vitro meat or even “Franken” meat. A company from California called Hampton Creek™ will be releasing its first chicken product produced using this technology in 2018. The potential benefits of being able to produce meat this way are very broad. These include, fewer greenhouse gas emissions, decreased energy needs and less arable land use, less animal cruelty, etc. Also cultured meat is less likely be exposed to pesticides, fungicides and/or bacteria. Nutritional profile of cultured meat can also be enhanced by adding essential omega 3 fatty acids- an important nutrient that is low in our current diets. Debates about the ethics, economics and religious considerations of this novel food source are raging on.

How much protein is needed? The Recommended Daily Intake of protein for an adult (age 18 to 64) is 0.8 grams per kilogram of body weight. For an average Canadian woman who weighs 69 kilograms (152 pounds), the recommended amount of protein is 55 grams per day (see page 8 for a sample menu designed to meet daily protein requirements). About 15 percent of a woman’s total daily calories should come from protein sources.

As we age we need more protein. The latest research supports increasing protein intake to 1.0 grams per kg body weight after age 65. Practically speaking, older women should try to eat about 70 grams protein per day from a variety of sources. This is an increase of about 20 percent compared to younger

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women. Conditions that may increase one’s protein needs include being ill or having a medical condition such as cancer, or recovering from surgery or healing a broken bone. In terms of weight loss, a study from the British Journal of Nutrition found that at least 1.2 grams protein per kilogram body weight is beneficial. Protein intakes higher than 2 grams per kilogram body weight are thought to be excessive. At this

point, the body starts converting the protein into glucose, which is an energy source and may actually contribute to weight gain.

High protein, very low carbohydrate diets such as the Atkins Diet, suggest 30-50 percent of the total calorie intake each day come from protein sources. This diet is extreme as it initially recommends very low amounts of carbohydrate i.e. only 20 to 40 grams per day. Carbohydrates are the main fuel source for the body. If we consume less than 50 grams of carbohydrate per day, the body is forced to break down its own fat stores for energy. This process is called ketosis and the diet is called a ketogenic diet. Over the short term, up to six months, there appears to be little risk for healthy individuals following a ketogenic diet. Some studies do show that high protein, lower carbohydrate diets are more effective for weight loss than lower fat diets containing the same amount of calories. However, the rate of weight loss slows after the first six months. This could be due to the difficulty following such an extreme diet. Think about how difficult it may be to eat a diet containing very limited amounts of grain products, fruit, starchy vegetables, nuts or dairy products, – only meat, fish and chicken day after day.

Ketogenic diets have been shown to cause positive metabolic changes such as improvements in diastolic blood pressure, triglycerides and HDL cholesterol levels. Unfortunately it is difficult to tell if these changes are due to the diet or the accompanying weight loss. The American Heart Association, the American College of Cardiology, and the Obesity Society have concluded that there is not enough evidence to suggest that low carbohydrate, high protein diets provide any additional health benefits to the heart than traditional weight loss approaches.

The key for weight loss is finding a plan that includes changes you can live with for the long term. This helps prevent the weight loss/gain cycle many people fall into.

You also need to maintain optimal overall health and work to prevent chronic diseases even when trying to lose weight. Over the long term, following a high protein diet that may also be high saturated and/or hydrogenated fat, low in fibre and unsaturated fat is not beneficial or desirable as it may increase your risk for heart disease, some types of cancer and digestive disorders. It is difficult to ignore the vast amount of research about the benefits of fibre, nutrients and antioxidants that are found in many carbohydrates. A diet containing a balance of nutrients, adequate fibre, and healthy sources of fat is a more reasonable approach and easier to maintain well into the future. A dietitian can help assess eating patterns, suggest the best food choices to improve health and if appropriate promote gradual weight loss.

High Protein Diets…Be Cautious Higher protein diets are not recommended for people with diabetes especially if they are using insulin, people with kidney impairment or liver disease, people undergoing cancer treatments or women that are pregnant or breastfeeding. There is also very limited information and research available to help us know if people that have underlying medical conditions such as osteoporosis need more or less protein. A higher protein diet can cause an increased excretion of calcium that could lead to further bone breakdown or the formation of kidney stones. The role of the kidneys is to filter the by-products of protein breakdown. If they are not working well, eating additional protein may cause further stress on these organs. For some medical conditions such as liver disease, irritable bowel disease and people undergoing hemodialysis a high protein diet is recommended as part of their treatment plan.

Do athletes need more protein? Athletes have higher protein needs. The International Society of Sports Nutrition gives a range of 1.4 – 2.0 grams per kilogram body weight per day. Dietitians of Canada suggest that some of the increased protein should be consumed after exercise. Studies have shown that consuming 20 to 30 grams of protein (providing 10 grams of essential amino acids) within zero to two hours after exercise, results in optimum muscle repair and rebuilding, and may help refuel energy stores. If the exercise session if very intense i.e. lasting more than an hour, or you exercise twice in one day or on two consecutive days, your recovery nutrition plan should also include a carbohydrate source along with the protein. This helps to replace energy or glycogen stores in muscles. Recovery meals or snacks should include carbohydrate rich foods like grain products, milk, yogurt, starchy vegetables, beans,

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peas or lentils along with a protein rich food. Tasty food combinations could include: Greek style fruit yogurt with granola, a whole grain pita with tuna or a handful of nuts, small piece of cheese and some fruit.

Canada’s Food Guide to Healthy Eating provides a framework to help you obtain a healthy balance of protein, carbohydrate and fat from a wide variety of foods. It is currently undergoing revision and new tools will be released in 2018. The food guide suggests having 15-20 percent of your total daily calories come from protein. Fortunately, most Canadians are close to this as food surveys show the average adult eats 16.5 percent of daily calories in the form of protein. However, there are a few populations who fall short of this goal. These include older adults that live alone and are reliant on others to obtain and prepare their food. People of lower economic status may have difficulty affording foods high in protein. People with illnesses such as cancer or alcohol/drug addiction can have poor appetites causing an inadequate intake of protein. Another high risk group are people with poor diets driven by fads, a lack of education or social pressure to be thin.

Getting Enough Protein: A Food Based Approach Generally it is easy to get enough protein from everyday foods. It just take a little planning. Research suggests it is best to spread your protein intake out over the course of the day. Aim to include 20 to 30 grams of protein per meal. Not only is this more effective in slowing muscle loss as we age, but it can also help us feel fuller and more satiated thereby eliminating the tendency to overeat.; (30 g is more realistic for women). A sample food plan is outlined below which provides 55g of protein- typical amount of protein needed per day by women age 18 to 65.

In conclusion, try to enjoy protein in its natural form whether it be from animal or plant based sources. An abundance of choices exist including nuts, eggs, beans, legumes, peas, nut butters, milk products or meat, fish and poultry. Get creative and aim to fill one quarter of your plate with protein rich foods at each major meal. Your body will thank you!

References available on request.

Meeting Your Daily Protein Needs with Food: Sample Menu Plan

Breakfast

Large bran muffin (3 grams protein)

1 tsp. non-hydrogenated margarine

125mL apple juice (0.5 grams protein)

175 g 0% MF Greek vanilla yogurt

(11 grams protein)

250mL coffee + 1% milk/1 tsp. sugar

Snack

1 banana (1.3 grams protein)

30g almonds (5 grams protein)

250mL herbal tea

Lunch

375mL homemade noodle vegetable soup

(2 g protein)

250mL 1% milk (8 grams protein)

1 medium orange (1.2 grams protein)

2 rye crisp crackers (1.8 grams protein)

Snack 2 arrowroot cookies (0.6 grams protein)

Dinner

2.5oz grilled salmon (20 grams protein)

125mL steamed carrots (1 grams protein)

125mL brown rice (2.6 grams protein)

125mL canned pears in juice

5mL of non-hydrogenated margarine

Note: Older women need about 70 grams of

protein per day. Adapt the food plan listed above

by adding one hardboiled egg (6 grams protein) at

breakfast and a 250mL of warm milk 1% (8 grams

protein) with cinnamon and a ½ tsp of honey in the

evening.

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Written by: Klara Lorinczi, RD Outpatient, Surgery and Community Dietitian at the Grey Nuns Community Hospital.Email questions or comments to: [email protected]

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Menopause is a unique and personal experience for every woman. A few lucky women make the transition with nary a concern. Others are bothered by an array of symptoms such as hot flashes, muscle aches and joint pain, lack of energy, mood changes, sleep

disturbances, vaginal dryness and/or changes in sex drive. Symptoms will settle over time but for some women they may persist for 7 to 10 years or longer. Fortunately there is a wide range of options to choose from to provide relief from menopause symptoms. Even more exciting is the fact a new agent has been approved by Health Canada to treat menopause symptoms. The medication is called Duavive® - single pill taken once a day that helps relieve hot flashes, night sweats and other symptoms of menopause. Read on for more information about this novel medication.

More than eighty percent of women have mild symptoms of menopause requiring no treatment. Other women may experience severe hot flashes occurring many times per day and at night, and persisting for many years. Hormone therapy has been shown to be a very effective option for treating these symptoms if necessary. Women with a uterus have traditionally been prescribed a combination of estrogen and progesterone to help with these symptoms. The estrogen component is what helps to settle the symptoms. In addition to helping with symptom relief, estrogen can slowly cause the lining of the uterus (endometrium) to grow or thicken. Over time, the lining may begin to grow abnormally and could lead to uterine or endometrial cancer. To minimize this risk and protect the lining of the uterus, progesterone is taken along with the estrogen. Unfortunately, a small percentage of women do not tolerate progesterone well and develop side effects such as day time drowsiness, mood changes, and/or bleeding.

Enter a new alternative into the Canadian marketplace to address this very concern: Duavive®. Duavive® is a unique alternative for women who may not be able to tolerate progesterone. Duavive® contains 0.45 mg of conjugated estrogens and 20 mg of bazedoxifene. Similar to hormone therapy, the conjugated estrogens in Duavive® relieve the symptoms of perimenopause and menopause. The other component in the medicine, bazedoxifene is classified as a Selective Estrogen Receptor Modulator (SERM). It works as an alternative to progesterone to protect the lining of the uterus. The combination of an estrogen and SERM together in one pill is called a Tissue Selective Estrogen Complex (TSEC).

Duavive® is available by prescription and is taken once per day, at the same time each day (morning or evening), and with or without food. Tablets should be swallowed whole.

The most common side effects of Duavive® include: nausea, upset stomach, heartburn, abdominal pain, diarrhea, muscle

spasms, and dizziness. Estrogen may cause a very small increase in the risk of blood clots. It is important to contact a doctor if one experiences symptoms that may indicate a blood clot. Signs and symptoms of a blood clot may include: pain or swelling in the legs; sudden or severe headache, dizziness or fainting; loss or changes in vision or problems with speech; sudden shortness of breath or coughing up blood; weakness or numbness in an arm or leg; pain or heaviness in the chest.

Duavive® must be stored at room temperature (15-30°C) in the original blister packaging as the tablets are sensitive to moisture. The medication must be kept out of the reach of children, and unused medications should be returned to the pharmacy for safe disposal.

For more information on Duavive® and other menopause treatment options please call 780-735-7604 or 780-735-7216. Or sign up for a menopause workshop - see below for dates, times and registration information.

References available upon request.

Exciting New Treatment Approach for Troublesome Menopause Symptoms

Written by: Christine Maslanko, BSc Pharm, ACPR, NCMP – Pharmacist- Menopause Clinic- Grey Nuns Community Hospital

Going Through Menopause…….. We can Help!Attend one of our popular evening workshops. Gain new insights to be in charge of your change.

Straight Facts on Menopause and BeyondStaff from the Menopause Clinic at the Grey Nuns Community Hospital will help you steer through the mountain of conflicting and often confusing information about menopause and hormone therapy.

Topics of discussion include:• Perimenopause and menopause signs and symptoms • Options for managing symptoms • The benefits and risks of hormone therapy • Bioidentical hormone therapy • Options to manage symptoms for women who

cannot – or prefer not to – use hormone therapy

Fall Dates 2017• Monday October 30th, 2017 • Monday November 20th, 2017

Sessions are held from 7:00 – 9:30 p.m.Location: Grey Nuns Community HospitalPre-registration is required. No charge.

To register call 780.735.9919or email [email protected]

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Osteoporosis Workshops - Fall 2017Take steps to protect your skeleton. Sign up for a workshop today!Did you know that broken bones due to osteoporosis are more common than heart attack, stroke or breast cancer combined?

Join us and learn more about osteoporosis. Topics of discussion will include:

• what is osteoporosis • how to read bone density reports • bone health nutrition update • exercise and safe movements for people with

osteoporosis• medication options

A great way to increase your confidence in building and maintaining strong bones!

Sign up today for one of the sessions listed below.

Friday September 15, 2017 Friday November 3 , 2017 Friday October 6, 2017 Friday December 8 , 2017

Sessions are held from 1:00 to 4:30 P.M. Location: Grey Nuns Community Hospital Pre registration is required. To register call 780.735.9919 or email [email protected]: Workshops are also open to men.

At least one in three women and one in five men will suffer an osteoporotic fracture during their lifetime

Roll Up Your Sleeves at the Annual Prime Time for Women conference

Do you like to learn to do by doing? If so, join Christine and Jen on Saturday, October 21 to create a beautiful framed décor piece for your home. Or give it away to someone special in your life. Each completed project will be your own

unique creation, and a true reflection of your personal style and taste! The completed shadow box can stand freely on a shelf, or can be proudly displayed on a wall.

During the workshop, you will create a decorative paper layout to fit in a 9” x 9” black frame. The project will feature several layers of paper arranged in very attractive patterns within the frame- see accompanying photo. The instructors will also show you how to use “Dimensional’s” to create a special 3D or raised look. Pre-cut letters spelling the word “FAMILY” can be embellished with butterflies, ribbon and jewels- let your imagination guide you. You can choose from several different paper colors to compliment your home and your personal taste.

A black frame, acid and lignin free paper, Dimensional’s and embellishments are included in the cost of the project ($15 per person). Note: glue sticks will be available to help you complete your project. If you prefer, please feel free to bring your own acid-free double sided adhesives to help you finish your shadow box.

No experience required to complete this fun project. Cost $15 per person- payable to instructors. See Prime Time for Women conference brochure for registration information.

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AnnouncementIt was with great sadness we announce The Massage Therapy Clinic and Footcare Clinic at the Grey Nuns Community Hospital will be closed as of August 31, 2017. New Clinics are being established with existing staff. Please visit www.mymassageclinic.ca for more details.

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PHYSIOTHERAPY SERVICESQuality physiotherapy is available on an individual basis to help you recover from:

• Musculoskeletal injuries – strain, sprains, fractures • Orthopedic surgery – total joint replacements, shoulder

surgery, etc.• Hand surgery

Note: referral from physician is required to access these services

Educational and Exercise ClassesSenior’s Balance and Conditioning Class(Doctor’s referral required)This one – on – one exercise and condition program is designed for seniors at risk of falling or for seniors who feel they are starting to have more difficulty moving about.The program emphasizes lower body strengthening, posture, balance and fall prevention. Each client will receive one – on – one education and instructions for exercising at home. Program is taught by a physical therapist. No cost – program is funded by Alberta Health Services.

Osteoporosis Exercise ProgramThis class is designed specifically for people with osteoporosis or low bone density. Class is taught by a physical therapist.

Topics include the role of exercise in managing osteoporosis, posture, back care and positioning, tips to protect your spine during daily activities, upper and lower body strengthening, balance and fall prevention, and how to start a walking program. Two hour workshops are held weekly for five weeks. No cost – program is funded by Alberta Health Services.Please Note: Participants must attend the osteoporosis workshop prior to attending the osteoporosis exercise program.

Get Up and GoIs it getting harder to get through your everyday activities? This exercise class is designed for those who would like to improve or maintain their current level of activity or mobility.

The focus of the class is to improve and maintain strength, endurance, posture, flexibility, balance and walking to help participants stay safe and independent with everyday activities.

Small group classes are led by a trained Physical Therapy Assistant. Referral by a health care professional (physical therapist, doctor, nurse) is required to attend this class.

For more information about these programs, or to book an appointment please call Rehab Medicine at 780.735.7161.

Grey Nuns Rehab Department Physiotherapy Programs

We Can Help.Specialized health educators at the Menopause Clinic, Grey Nuns Community Hospital can answer your questions on perimenopause and menopause, symptom management, hormone therapy, lifestyle choices, osteoporosis and more.Call 780.735.7216 or 780.735.7604Information packages available upon request

STRUGGLING TO CONQUER MENOPAUSE?


We invite you to join our Circle of Friends

Membership formYes, I am delighted to become a friend of the Women’s Wellness Program at the Grey Nuns Community Hospital. Please enclose $10.00 cheque, made payable to Women’s Wellness Program, Grey Nuns Community Hospital, or provide your credit card number & expiration date.

Name: _________________________________ Email Address: ____________________________________________

Address: ________________________________ Phone: ___________________________________________________

City & Province __________________________ Postal Code: ______________________________________________

Amount Enclosed: [ ] $10.00 [ ] $20.00 [ ] Other [ ] New Membership [ ] Renewal Membership

CHEQUE** VISA MASTERCARD

Credit Card#: ______________________________ Expiry Date: ___________ *Card Security Code: ____________

Name on Card: _____________________________________________________________________________________

Signature: _________________________________________________________________________________________

Please mail to the address below:

Women’s Wellness ProgramRoom 3006

Grey Nuns Community Hospital1100 Youville Drive West NW

Edmonton, AB T6L 5X8

An annual contribution of $10.00 or more to the Women’s Wellness Circle of Friends supports our newsletter, information workshops, the Prime Time for Women Conference and our telephone information and referral service on women’s health issues. Please return the form below along with your donation.

Health Questions? We’re up for the task – give us a call! Phone 780.735.7604 or 780.735.7216

Please check inside

for conference details.

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