Dr. Zorba Paster: New information emerges on treating menopause, arthritis

Keeping up to date – that is the goal of every health care provider. We do it on the web, by reading books and journals, going to lectures, etc. Everyone has their own method.

Family doctors need 50 hours, minimum, of education each year to keep up our certification. Mayo Clinic has great meetings. They start super early, 7 a.m., and end at 11:30 p.m.

Now what would motivate you to go to something that early? Well, their meetings aren’t in Rochester, Minnesota, where Mayo is based. They’re in Hawaii – in Maui this year, to be exact.

What a shame, I know, but someone has to go. And this year it was me – and fortunately it was before the coronavirus pandemic kept us home.

So with that introduction, let me share some of the updates I learned in no particular order.

Menopause

The Heart and Estrogen/Progestin Replacement Study research from more than a decade ago seemed to show that women who take estrogen have more heart attacks. That basically was the death knell for the company that made Prempro, which was the most common estrogen preparation on the market with something like 85% of the share.

Well, guess what: Looking at the data now, and looking at what we know about heart disease, we may have been wrong.

Yes, there might be a small increase in heart attacks among women who take estrogen, but it might just be a subgroup of women. And a woman who suffers from menopausal symptoms might not exercise as much and might not sleep as well. She might not, well, she just might not be as healthy because she has menopausal symptoms.

For some lucky women, the symptoms never happen or go away in a few months. But for others, they can last seven to 10 years – or even forever.

The most effective treatment, by far, is estrogen. The safest way is to take an estrogen patch, one designed for menopause, not for contraception. That one is much stronger, accompanied by micronized natural progesterone of 100 milligrams daily.

Now who should get estrogen? That’s a question I won’t answer. It’s one that every woman who still has symptoms should discuss with her health care provider.

It’s important that they know the data has changed. So if you talk to them, ask if they have read the latest data. The estrogen used in the study, Prempro, is not the estrogen recommended today, and it was oral estrogen and not the estrogen patch. Those two facts may have played a major role into the outcome of the study.

Believe me if you go into that office armed with information – you could print it out for them – that will be an eye -opener. And, believe it or not, if they know you’re looking over their shoulder with good, reliable scientific evidence, you’ll get better medical care.

I kid you not. Whether you like it or not, health literacy – the ability to discuss your health issues scientifically with your provider – pays off. Try it.

Diclofenac gel for arthritis

This was a very expensive gel back in the day, but it’s off patent now. This is an anti-inflammatory in a topical form. You can get a large tube for about $25.

You’ll need a prescription for this. Studies have shown, shockingly in my eyes, this gel works as well as oral anti-inflammatories for many patients with arthritis.

The gel is as good as the pill but without the side effects of the pill – no worries about stomach pain, bleeding ulcers, elevated blood pressure and kidney problems. It can cause your kidneys distress, that is if you’re prone to it, older or on certain medications.

And it’s cheap, cheaper than CBD oil and much more effective, with efficacy proven by scientifically well-controlled studies.

My spin: It might not be as sexy as CBD, but it’s cheaper and it works. If you have joint pain, call your doctor and get it. I’m using it for my hand arthritis, and my hands feel more like 55 than 72.

More updates next in the next column. Stay well.