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Note to Tom Cruise:
It's My Hormones, Stupid!

Of course, it's hormones, Mr. Cruise. As Brooke Shields so aptly stated in her New York Times article July 1, "War of Words," it is the sudden, extreme drop in hormones, estradiol and progesterone, that triggers postpartum depression, plus a myriad of other medical conditions in women.

Thyroid hormones often get out of balance in the postpartum time as well, further contributing to the risk of depression and anxiety.

But, then again, how would Mr. Cruise know this? First of all, he is male. Secondly, as he marries younger and younger women, he isn't around long enough with one wife to witness the hormonal fluctuations that stress women's bodies on a daily basis as they get older.

As internationally-recognized expert on hormonal issues in women Elizabeth Lee Vliet, M.D., writes in her ground-breaking book, It's My Ovaries, Stupid, "Although many physicians are not interested in these hormone changes, women who experience postpartum depression are quick to connect the rapidly falling hormones to their profound depressed-anxious mood and fragmented sleep."

In England, postpartum depression is often successfully treated with estradiol patches to restore the low hormone levels to an optimal range, rather than antidepressants.

Dr. John Studd, an ob/gyn at Chelsea and Westminster Hospital in London and a leading researcher in the area of hormones and depression, has found that estradiol treatment can be as effective as anti-depressants in treating postpartum depression, and can help women who are resistant to standard anti-depressant therapy.

Margaret Bennett was at high risk for PPD due to a previous history of depression and thyroid disease, but here is her story for her second child: "Well, I slapped two Climara patches on my hip a couple of hours after delivery, felt great and recovered quickly from delivering a 10 lb., 10 oz. baby. My episiotomy healed more quickly and with much less pain than my with my first child, and thanks to the fact that I was taking only a physiologic dose, I could breast-feed, unlike with anti-depressants.

I had to take antidepressants for the last month of my pregnancy, but didn't need them at all with the patches after delivery. I wouldn't mind looking like Ms. Shields, but I'm sure glad I missed out on the PPD, thanks to Dr. Vliet and Dr. Studd."

For Ms. Shields, Paxil provided real relief. Good for her. But women concerned about possible side effects of such a powerful antidepressant medication, there is an alternative. Rather than treat the depression alone, women should ask their doctors to help them get at the root cause of the depression as well as other symptoms by restoring hormones to optimal levels.

If you're concerned that hormone therapy has its own side effects, don't be frightened by the news reports. Studies showing that certain hormone treatments could increase the risk of cancer or heart disease focused only on one type of hormone product (conjugated equine estrogens and the synthetic progestin medroxyprogesterone acetate, or PremPro) and there are safe and effective options that use FDA-approved bioidentical hormones.

And now, even the headlines have begun to reflect growing recognition that not everyone reacts the same way to the same treatment. As noted in CBS News Correspondent Elizabeth Kaledin's piece on Vitamin E and aspirin findings from the Women's Health Study, "One size does not fit all [women]." Dr. Vliet has been saying that for over 20 years.

If your physician can't or won't work with you to reach a deeper understanding of the reasons you're not feeling good, there is a goldmine of useful information at . Find out why the Wall Street Journal, Business Week and others are starting to recognize Dr. Vliet's fresh perspective on a topic too often oversimplified or exploited.

Elizabeth Lee Vliet, M.D. is the author of Screaming to Be Heard; Its My Ovaries, Stupid; Women, Weight and Hormones, and The Savvy Woman's Guide to Testosterone.

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