If you’re taking prescription medicines regularly, say for hormone balancing, or blood pressure, you’ve probably compared prices offered by the big chains like Costco or Walmart with your local pharmacy. But did you also research the cost of meds from Canadian pharmacies online? Perhaps you were concerned about their legitimacy or integrity of products. I certainly was. However, I’ve learned how to order with confidence, thanks to some tips from an industry insider that I’ll share with you here.

When searching online for Canadian pharmacies, you’ll have a lot of choices. However, the only ones you should consider are those that display a seal from PharmacyChecker.com. This is a U.S. Based company, founded by Dr. Tod Cooperman who also founded ConsumerLab.com, an independent evaluator of dietary supplements and nutrition products. (see my earlier article about this company).  They continually evaluate and monitor pharmacies operating online and through mail-order to determine that they are safe to buy from.  Their website offers a robust price comparison feature to help consumers find the lowest priced products. The participating pharmacies pay a fee to apply and have membership status as a verified, trust-worthy business, just as Good Housekeeping runs their well-known “seal of approval” program.

“Americans do need to be warned about going online,” said Gabriel Levitt, vice president of PharmacyChecker.  “It’s important that pharmacies meet important safety criteria and that they’ve been properly verified.”

Gabriel explained that pharmacies must meet the following criteria in order to get the thumbs up from Pharmacy Checker:

1. They must be a licensed pharmacy and/or only work with licensed pharmacies in other countries (i.e. Australia, U.K. Turkey, India) that fill orders. “We do that by checking their relevant boards of pharmacy and and governmental regulatory pharmacies to make sure they are duly licensed.”
2. The online pharmacy must require a valid prescription. “There are many websites that claim to be legitimate, but if they don’t require script, run the other way.”  Gabriel added that they use mystery shoppers to verify this.
3. The pharmacy’s website must show an address and phone number. PharmacyChecker verifies this information for accuracy. (The World Health Organization reports that drugs from websites that conceal their physical address are counterfeit in more than 50 percent of the cases!)
4. Online pharmacies must encrypt those pages on which financial and personal information are shared, to protect customers from ID theft.
5. Privacy requirements are also investigated.  “A lot of websites share information with third parties, but the online pharmacies in our program have to agree NOT to share information, and use personal information only for the execution of the order,” Gabriel explained.

Now, you should know that there are several rogue sites out there that publish a fake PharmacyChecker seal.  Pharmacy Checker describes rogue sites as those that are unethical or unsafe.  For example, they don’t require a prescription, might use counterfeit drugs, or engage in identity theft. So, before ordering from any site, it’s wise to first check PharmacyChecker’s list of Rogue Pharmacy Websites.

But as a first step, make sure that the PharmacyChecker seal is genuine. It may look legit at first glance, but take a closer look. It might say “Pharma Checker” or something similar.  If you click on the seal, a profile of the pharmacy should appear in a new window. If you look at the URL, verify that it is hosted by PharmacyChecker and NOT by the pharmacy itself. Here’s an example of an online pharmacy site that put up a fake PharmacyChecker seal that you can’t click on.  Here’s another example of a fake seal. A new window pops up when you click on it but notice that it is not hosted by PharmacyChecker.  This Canadian online pharmacy doesn’t show any seal, nor do they show an address – only a phone number for ordering.

If you’re concerned about receiving medicines that are counterfeit, Gabriel told me that in all their investigations since their launch in 2002, they have never found a single instance of this. He pointed me to an independent study, published last year, by an economist at the American Enterprise Institute who looked at internet-sourced drugs from pharmacies vetted by PharmacyChecker and the National Association of Boards of Pharmacy (NABP) and found that all products tested proved to be genuine.

And if you’re afraid of breaking U.S. Laws by ordering medicine from Canada, I was told by Gabriel that while technically illegal, “the FDA has stated very clearly they do not take enforcement actions against individuals when they purchase non-controlled prescription medicine for their own use. Enforcement is focused on companies or individuals who try to import at wholesale prices for resale in the U.S.”

Finally, PharmacyChecker is not limited to Canadian pharmacies. When comparing prices you’ll find U.S. based online pharmacies as well.  However, you just might find that the price for a generic drug at your local pharmacy is just as good, or even better than you would find online. And you wouldn’t have to wait for an international delivery that can take up to three weeks or even longer, if there are weather or other delays.

If you’ve had consistently good, reliable service from an online pharmacy offering good pricing, please share your recommendations below.

“Urinary incontinence can occur at any age… but symptoms do seem to show up more often during the menopause transition.”

One third of all women in the U.S. suffer from some type of “pelvic floor” disorder,  a term that covers a number of conditions ranging from a leaky bladder, frequent urinary tract infections to a more serious “dropping” or prolapse of a pelvic organ. Many women experience early symptoms (they leak urine when they sneeze, for example) but choose not to discuss them with their doctor because they find the subject too embarrassing to talk about or they mistakenly attribute them to normal aging. But it’s not just an old woman’s problem, explained Dr. Sandy Culbertson, an expert in the diagnosis and treatment of urogynecologic conditions at the University of Chicago Medical Center.

“Urinary incontinence can occur at any age, since childbirth and even heavy lifting can trigger urinary incontinence and prolapse issues,” she explained in a YouTube video. But she added in an email to me that that symptoms do seem to show up more often in women during the menopause transition and sometimes they can be helped by hormone therapy.

“There does seem to be an increased onset in symptoms in mid-life.  This is likely due to loss of estrogen, and further weakening of the pelvic floor musculature.  It’s really unclear if hormonal therapy helps all pelvic floor disorders.   It does seem to help issues with urgency and frequency of urination.”

If the fear of having to wear adult diapers is keeping you from getting medical treatment for what you consider “a small problem that I can live with,” know that symptoms such as urinary frequency and stress incontinence worsen with time, according to Dr. Culbertson, and there are a wide range of treatments available to bring these symptoms under control. These range from nutritional therapies and Kegel exercises to strengthen the pelvic floor muscles, to medications and surgery depending on the cause and severity of the condition.

Due to the prevalence of PFD disorders, there are now more urogynecologists and hospital centers with Pelvic Disorder Centers where you can talk about your incontinence issues without embarrassment and get the help you need. Dr. Culbertson, for example, is part of an interdisciplinary care team in the Center for Pelvic Health and the University of Chicago Medical Center.

In the San Francisco Bay area, three major hospitals, The John Muir Health Center (Walnut Creek), California Pacific Medical Center (San Francisco) and the UCSF Medical Center all offer Pelvic Medicine Centers.  Chances are there are similar facilities or a PFD specialist where you live as well.

The “Find a Provider” section of the “Voices for PFD” website makes it easy for you to search for a specialist by zip code.  I found 10 physicians within a 10 mile radius of where I live.

This Voices for PFD website also offers discussion forums where women with PFD conditions can connect with others who are going through the same thing.

• what we now know about the safety of hormone therapy and bio-identicals in particular
• new therapies for post-menopause osteoporosis
• solutions for hot flashes
• the connection between menopause, depression and hormones
• and the latest thinking on the what the mind-body connection means for women during the menopause transition.

The days will be packed but I will share what I learn on Twitter as often as possible until I’m back at my desk and can summarize everything I learned for you.  So stay tuned!

Her website covers just about everything you need to know about sex after menopause.   And she’s not bashful about details or offering advice to help us “keep our bodies in shape for continued sexuality,” as she puts it.  She even offers a “recipe” for enjoying sex more. There are five ingredients, she says:  knowledge, vaginal comfort, genital sensation, pelvic tone and emotional intimacy.  Her website is organized around these five elements making it easy to find answers.

However, if your question or condition is not explained adequately on her website, Dr. Barb makes it easy to contact her. At the top of the website is a pink button that says Ask Dr. Barb*Free Advice. (Free!) Just click on it and write your question in the pop-up window.  I did. I asked for her opinion about the use of vaginal estrogen. Is it safe and/or more effective than using a lubricant as needed?  Here’s her very detailed response – I’m including it here in case you were wondering the same thing:

The most effective treatment for vaginal atrophy and its symptoms (dryness, itching, irritation, pain with intercourse, etc) is vaginal estrogen.  There are three low dose, localized (without systemic absorption) estrogen options: The vaginal ring (estring), vaginal tablets (vagifem) and vaginal creams (premarin and estrace).

I prefer the estring and vagifem. The absorption of the creams is somewhat more variable and the cream is more messy to use.  The studies confirm that there is no significant or noted changes in circulating blood estradiol levels with the ring and tablet (again, the creams are more variable and therefore more likely to have transient elevations in the estradiol levels).  I have many breast cancer patients who use these methods.

Then there are OTC lubricants and moisturizers.  The lubes are effective to make sex comfortable at the time of the event, but provide no additional improvement or prevention of progression of the atrophy.  Vaginal moisturizers are necessary to give more lasting comfort and are used independently of sex on a continuous basis (usually 2X/week), they can help restore moisture to the tissues.  The moisturizers can help restore a more healthy pH, promote elimination of dead cells and help increase moisture in the tissues.

What’s been your experience in talking with your doctor about sexual health problems? Have you even tried? I’d love to hear your stories.

I often receive emails from these women. They tell me about their health problems and severe menopause symptoms that have converged to make them miserable and they’re desperate for answers. They found this blog in an online search while trying to self-diagnose and self-prescribe with over-the-counter medicines, supplements or herbal remedies that they really don’t know anything about.  Some of their stories are truly heart-breaking because I know that a caring doctor or nurse practitioner could help them feel better.  If only they could find one.

If this sounds like your situation, here’s a tip. The solution just might be found at your local hospital, especially if you live near a major medical center, as I do here in San Francisco.

I just received the Fall newsletter from the Women’s Health Resource Center of  California Pacific Medical Center. and it reminded me about the many resources a community hospital can offer women.  In addition to a wide range of classes, special programs and even therapeutic massages, private consultations with a nurse practitioner about Osteopororis (including screening), managing Menopause, eating disorders, nutrition and mental health are available.  Meeting one-on-one with the center’s founder, Barb Silver, a nurse practitioner, cost $30 for each half hour (considerably less than a physician’s bill for a 10 minute appointment).  And from time to time she offers a women’s health “roundtable” where women can get their questions answered.  It costs only $5 and it’s a great way to get an overview of a health topic you’re interested in as well as meet other women who share the same interests or concerns.

“I love the intimacy of getting women together and having their individual concerns addressed,” said Barb. “Most likely, many women share the same questions, fears and anxieties about their health issues. It gives me an opportunity to really hear their voice, whether it is during a one-to-one consult or a roundtable.”

If you do live in the Bay area, be sure to sign up for their annual Mini Medical School on Women’s Health on Saturday, Oct. 22.  Distinguished local physicians will be speaking on a wide range of topics that you’ll find relevant and helpful. This one-day program is open to the public but pre-registration is required.  You’ll find more details on their website.

California Pacific Medical Center has other departments that serve the needs of Bay area women of all ages including the Comprehensive Pelvic Medicine and Continence Center,  and the Breast Health Center. Chances are the medical center near you has similar capabilities that you can take advantage of.

If there’s a Women’s Health Center or Menopause Clinic at a medical center near where you live,  I invite you to share their information with other women in the comment box below.

If you want to know which products you should try, or avoid, be sure to read the latest report on Menopause supplements from Consumer Lab, a member-supported organization that independently evaluates multivitamins, minerals and herbal products for consumers.  Their latest report provides quality ratings for more than 20 branded products that you see on the shelves every day. They reveal which ones provide the amounts of compounds shown to be effective in clinical studies and which products failed to meet their label claims or posed other problems. In one case, a menopause supplement contained only a third of its listed isoflavones; and a black cohosh supplement was contaminated with a small amount of lead.

You can purchase this single report for $15. But I suggest signing up for an annual subscription ($33 or $2.75/month for 12 months) to give you access to all of their reports. There are currently 50 major reports covering more than 900 products including multi-vitamins, Calcium, Vitamin D and Fish Oil (only 17 of 24 passed quality testing).  Each product review provides thorough information about the supplement; what it does, how it works, what the latest research shows and what Consumer Lab tested for.  You’ll want to have it handy next time you stock up on supplements.

In the course of my research, I’ve discovered some online resources that can really save you money on lab tests and prescription drugs. In this post, I’ll focus just on the medicines and I’ll tackle the lab work in a separate blogpost soon. Here are two ways that you can save on many of your prescription drugs, including hormone therapy.

1) Visit the website of Prescriptiondrugs.com and enter the name of your medicine.  I entered Prometrium and found a 75 percent discount coupon. I checked with my local pharmacy chain to see if they would accept this coupon. They told me it can be used when applied to a cash price. I figured out that it was still cheaper than the negotiated insurance price I’m entitled to.  But remember, it’s a coupon for one-time use, so the savings won’t be consistent month to month.

2) Alternatively, you could sign up for a subscription at RX-Savings-Solutions.com. This is a new service created by a pharmacist who told me that he hates to see people overpay for their medicine.  He doesn’t sell any products. He just offers advice on how (or where) to pay less for your prescriptions.  It’s simple to use. You enter your list of medications, dosing instructions and how much they cost you.  A pharmacist on their team creates a report that you can review with your own doctor or local pharmacist.  I tested it by listing several commonly prescribed medicines and found significant savings over what my local pharmacy chain store was charging. In some cases, the pharmacists at RX-Savings-Solutions suggested using an alternative class of drugs that they explained accomplished the same thing but cost far less. In another case, they told me about the availability of a generic drug that I suspect some physicians aren’t aware of.  They also told me which retailers offer better pricing.  I like the concept of having my own pharmacist advisor whose mission is simply to save me money.  As drug costs continue to spiral upward, this kind of service will become even more valuable.

When it comes to health and wellness information, there is no shortage of good online resources to choose from. I often start my research at websites like WebMD, Organized Wisdom and Women To Women when I want a good overview or general information about a particular topic.  But I’ve recently discovered three websites that are written by women who share my interest in women’s health in mid-life and aging well. Their selection of topics always seem to coincide with what’s happening to me health-wise, or what I want to know more about. Their commitment to solid research and reporting also inspires me to continue the work I do on this blog and to make it as informative as theirs. So, here are my recommendations for three serious minded blogs by and for our crowd:

Deb at The No-Nonsense Beauty Blog is a former lab assistant to a research dermatologist who was studying aging. So naturally, her blog about aging products and her personal quest to find the ideal beauty regimen is infused with her scientific sensibilities. There’s no fluff here. For example, her recent blogposts have focused on why some anti-aging products cause acne (and what ingredients you should avoid if you’re intending to use them);  the link between carbs and wrinkles (are vegetarians more wrinkled than others?);  and a look at the benefits of vitamin A to our complexion.

MarshaNunleyMD – If you’re confused about the role that certain hormones play in your health, read the very informative blog of Dr. Marsha Nunley, a San Francisco internist who specializes in internal and functional medicine, and women’s health.   This month she wrote about the three hormone protagonists; Testosterone (“The Hormone of Love”), Progesterone (“The Great Mediator”) and Estrogen (“A Hormone Much Maligned’).  You’ll appreciate her simple explanations (“progesterone is like the grandmother who comes in and calms everything down”) and balanced writing.  Her subscriber newsletters are equally informative. The current issue explains micro-nutrient testing and how this can help identify nutritional deficiencies.

The medical librarian who writes at Happy Health Long Life likes to “test-drive” everything new in the health and fitness field that seems sensible to her. Fortunately, she chronicles her journey and shares her new-found wisdom with her readers. I’ve already learned so much from her; from why sit-ups  are bad for your back (try the bird-dog exercise instead);  why exercise is good for us; and why olive oil isn’t; and how Bill Clinton’s diet can prevent and reverse heart disease.

If you have discovered other, equally informative blogs that you feel are a must read, please share your recommendations in the comment box below.

Pharmaca is also hosting a series of Menopause Events in their stores in early April. They’ll be holding free help sessions on hot flashes, sleep and stress issues, and hormones. They’ll also be offering bHRT consultations. I’ve always found their staff to be extremely knowledgable and helpful. So if you’re not getting the answers you need from your own doctor, this might be a good resource for you if you live nearby one of their stores in California, Colorado, New Mexico, Oregon and Washington.

• Workouts for Women Nutritional Calculator – Shows you your caloric requirement based on how active you are
• Healthy Body Calculator – More detailed than a BMI score, this calculator gives you feedback on your overall health.
• What Does 200 Calories Look Like? Not exactly a calculator but it’s a great visual tool to show you what a serving-size of a particular food looks like.
• Free Weight Loss Calculators and Tools:  This website aggregates many free calculators and tools to help you plan and maintain your diet.  Examples include a weight loss calculator (how long will it take you to lose the weight?)  and a Macro-nutrient calculator (how many grams of carbos, protein and fat should you be eating at each meal?)

Have you found a calculator, tracker or other online resource that’s made a difference in your life?  Let me know in the comment box below.