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What do carrot, chocolate, oyster and garlic have in common? They are aphrodisiacs which supposedly contain substances that will enhance sexual desire, increase sexual drive and boost sexual energy and performance. Thousands of years ago, the philosophers in ancient china have realized the connection between food and sex. When we eat, we use many of our senses such as taste, sight, smell and touch. These senses are similarly experienced during sexual intimacy. Throughout history, people all over the world are exploring food that can energize their sexual lives. It is therefore not surprising to find that some of the aphrodisiacs resemble the texture or shape of human sexual organs. In general, aphrodisiacs can be categorised as follows: · Foods that create warmth and moisture e.g. chili or curry. These foods are supposed to arouse "heated" passion · Foods that resemble male or female genitalia e.g. oyster and carrots. · Foods from animal’s reproductive organs e.g. animal’s eggs · Foods considered as rare and exotic: They are believed to be sexually exciting. · Foods that stimulate the desire. e.g. spices, garlic Some of these foods e.g. dark chocolate contain a brain stimulant, phenethylamine which may heighten the love senses. But according to a review by the Food and Drug Administration (FDA) in USA, there is no scientific proof that all the purported aphrodisiacs work. There are also no randomized controlled trials that can confirm or prove that these foods have an effect on sexual function or desire. Regardless of their action, it is suggested that aphrodisiacs work by psychological and emotional suggestions. If one believes taking a particular food will enhance the sex life, it can help bring about sexual desire and arousal, a placebo effect. A good night's sleep, time, privacy and good communication with the spouse may just do the same.

“You can take your baby home.” These were the magical words she was waiting anxiously to hear as the nurse from the Neonatal Intensive Care Unit (NICU) handed her the tiny baby boy which was born prematurely 6 weeks ago. D, 30, a first time mum had an emergency caesarean section because the placenta (afterbirth) had totally covered the birth passage. D first consulted me at 10 weeks of gestation when she had bloody discharge from the vagina. The bleeding subsided with rest and injections. Her pregnancy went smoothly until 20 weeks of gestation when a routine ultrasound examination showed that the placenta was covering the cervix (neck of the womb). I explained to her that she might have further episodes of bleeding in the later part of pregnancy and she should seek medical attention at the hospital immediately if the bleeding was heavy. “One night, I was woken up by what I thought was urine flowing down my legs. I was shocked to realise that I was bleeding heavily,” D related. She was rushed by the ambulance to the hospital. She was 30 weeks pregnant then. The bleeding stopped when she reached the emergency room. The baby’s heartbeat was normal and her haemoglobin level (the oxygen-carrying protein in the red blood cells) was also normal, indicating that she had not developed anaemia, which could occur with severe blood loss. She was observed in the hospital for two days and was given corticosteroids to speed up her baby's lung ​​development, lest it needed to be delivered early. She was sent home to rest when there was no further bleeding. At 34 weeks gestation, D had another bout of bleeding. This time, it was accompanied by labour pains. When she was admitted to the hospital, she was in a state of shock with a low blood pressure of 90/50mm Hg and a weak and rapid pulse rate of 100/min . The bleeding was torrential with clots. There was no sign that the bleeding would stop even when she had an emergency blood transfusion. An immediate caesarean section was done and the baby, weighing 1.7 kg, was delivered . He was put into the incubator for close monitoring. The placenta is an organ that grows along with the baby during pregnancy. It connects the baby with the mother’s blood system through the umbilical cord and provides the baby with oxygen and nutrients. In most pregnancies, it is attached to the top or side of the womb. But if the placenta is inserted at the lower part of the womb, it is called placenta previa. It can partially (marginal placenta previa) or totally (major placenta previa) covering the opening of the womb and cause severe bleeding before or during delivery. ​The hallmark sign of placenta previa is the painless vaginal bleeding which can be light or heavy in the second half of pregnancy. The bleeding usually stops without treatment, but can recur days or weeks later. It is usually diagnosed during the ultrasound examination in the second trimester. If it is marginal, expansion of the womb may bring the attachment higher and the condition may improve. But if it is a major one, it is unlikely to resolve with time, as in D’s case. Placenta previa is more common in women who · Had previous surgery in the womb such as caesarean section or fibroid removal · Are expecting more than one baby, e.g. twin, triplet pregnancies, with a large placenta · Had placenta previa in a previous pregnancy · Are 35 or older Treatment for placenta previa depends on the following factors: · The severity of the bleeding · Whether the bleeding has stopped · The gestation period of the pregnancy · Mother’s and baby’s condition "Masterly inactivity” is the key in the management. In most cases of placenta previa, bleeding usually stops after a while. A conservative approach, ensuring the mother’s haemoglobin levels and vital signs are stabilised is ​the treatment of choice. This is to allow the baby to grow to maturity where it can survive with the neonatal care and support. A planned caesarean section is usually performed after 36 weeks of gestation. However, in cases where the bleeding is severe and the maternal condition remains unstable, even with resuscitation, emergency caesarean section may have to be done to save the mother’s life even if the baby is premature.

“I think I am pregnant," she told her boyfriend anxiously and desperately. “I have tested the urine three times and they are all positive!” He was unprepared and shocked. R, who was 24 years old, came from a family where her parents divorced when she was 5. Without the support of her family and boyfriend, she decided to abort the baby. The abortion was performed about ten months ago. Three months following the procedure, her periods did not resume. She was concerned that she might be pregnant again, though the urine pregnancy test was repeatedly negative. She went back to her gynaecologist twice who gave her medications to induce menstruation. Still the menses did not come. When R saw me for a second opinion, she looked worried and confused. “Doc, what is wrong?” she kept asking. After a thorough vaginal examination, a pelvic ultrasound scan and blood hormonal tests, I told her that she was probably suffering from Asherman’s syndrome, a condition where there is extensive scarring in the womb. This was confirmed by hysteroscopy, a procedure in which a tiny telescope is introduced into the womb to visualize it. The scars were freed surgically and an intra-uterine device (IUCD) inserted to prevent the walls of the womb from sticking together and forming scars again. She was also given medications to help the womb lining heal for the next 3 months. Her periods resumed after the treatment and she was well when she came for her review recently. Asherman’s syndrome (AS) is a condition where there is injury to the lining of the womb with formation of extensive scars. It is a rare condition and occurs most often following an abortion as in R’s case. Some may result from overzealous curettage to remove the contents of a miscarriage or retained placental tissues following a delivery. Occasionally, pelvic infection, radiation treatment of womb cancers and uterine surgery for the removal of fibroids may cause AS. Very rarely it may be due to tuberculosis. Patients typically have a sudden onset of light or absent menses following the surgical procedure. Some may experience monthly menstrual cramps, repeated miscarriages and /or infertility. The diagnosis of AS is by hysteroscopy. X-ray imaging technique (Hystero-salpingogram) using radio-opaque dye to visualise the uterine cavity has also been used. Treatment involves cutting and removing the scar tissues through the hysteroscope. After the scar tissue is removed, the uterine cavity is kept open by the insertion of an IUCD to prevent scars from returning. Oestrogen tablet is prescribed to help the uterine lining heal and antibiotics given to prevent infection. Women who are infertile as a result of AS may be able to conceive after treatment. Treatment success depends on the severity of the condition and how well the lining of the womb rebuilds. Those who successfully conceive may carry the pregnancy to term. But they have to be monitored carefully, as they are at a higher risk of developing a low lying placenta (placenta previa) and/or an adherent placenta (placenta accreta) during pregnancy with serious consequences.

I am in my forties and a working woman who exercises 3 to 4 times a week .When I went for my annual medical check-up last year my results were good except for the CA125 which was 45. This was slightly higher than the normal value of up to 35. Early this year, it was 62 and I took the blood test again 2 months ago and it was 79. The number appeared to climb higher and higher. Does that indicate that I am having some problem with my uterus? My gynaecologist told me that my uterus had swollen to double the size of a normal one. He diagnosed me as having adenomyosis with some small fibroids. I had undergone a surgery 6 years ago to remove some fribriods. He suggested that I should remove my uterus which I really hesitate to do so. I have no menstrual discomfort except some bloated feeling occasionally. I am really worried about the rising levels of CA125. If I were to leave it alone, will it lead to cancer or something that will affect my health? What should I do? As I have totally no knowlegde about "Adenomysis", will be very grateful if you could give me some advice? A. CA125 is an abbreviation for cancer antigen 125. It is a protein substance in the blood which is raised in some people with cancer. Thus, it is also known as a tumour marker. Its level is generally elevated in ovarian cancer, but may also be raised in other cancers such as those involving lining of womb (endometrium), fallopian tubes, lungs, breast , stomach and intestines. It should be noted that CA125 is a non-specific test as it may also be raised in non-cancerous conditions, such as endometriotic cyst (blood cyst), adenomyosis, pelvic infection and pregnancy. It is also not a very sensitive test since not every patient with cancer will have high levels of CA-125. In ovarian cancers, only about 80% have raised CA125. In your case, the increasing trend of CA125 level is rather disturbing and may be due to adenomyosis as suggested by your gynaecologist. To understand adenomyosis, one has to know the anatomy of the womb (uterus), which is composed essentially of 2 layers of tissues: 1. The inner layer (endometrium) which sheds off regularly every month in menstruation and 2. The muscle layer (myometrium) which gives rise to contraction pain during labour. Adenomyosis is a troublesome disease where endometrium grows abnormally within the myometrium. The cause is unknown although there are many theories trying to explain it. Some women, as in your case have no symptoms while others may experience: · Excessive heavy or prolonged menstrual bleeding · Severe cramping or sharp pain during menstruation · Menstrual cramps that get worse with age · Pain during intercourse · Bleeding between periods The uterus is usually uniformly enlarged and may increase to double or triple its normal size as in your case . The disease typically regresses after menopause. Ultrasound may not differentiate adenomyosis from fibroid (a common muscle growth in the myometrium). To make matter worse, the two conditions often co-exist. MRI may be helpful in differentiating the two. Since adenomyosis has not impacted your lifestyle very much ( except having a bloated tummy), you may wish to adopt a “watch and see” option as the disease regresses with the approach of menopause. Other treatment modalities in patients with symptoms include pain killers, oral contraceptive pills, hormone-impregnated intrauterine contraceptive device (Mirena IUCD) and hormone suppression injection (GnRH agonist). However, the outcome is usually temporary and may not result in reducing the size of the womb. In such cases, removal of the womb (hysterectomy) may be the last resort, as suggested by your gynaecologist. If the CA 125 continues to rise, it may be advisable to rule out other cancerous as well as non-cancerous causes listed above.

She showed up at my clinic without an appointment and asked if she could see me for a few minute. D had been my patient for the past five years. She was 32 and a disciplined, thoughtful and caring person. It was rather unusual for her to show up at my clinic unannounced. I thought she might have some serious problem. Instead, she was beaming with joy as she placed an invitation card on my table. “Doc, I am getting married,” she said. “Can I invite you to solemnise our marriage?” I met D’s husband, an engineer on the day of their marriage. He was 36 and seemed introverted, shy and soft spoken. I expected good news from D when she came for a consultation six months later. Instead, she burst into tears when she saw me. “Our honeymoon was a disaster” she sobbed. “We could not consummate our marriage.” Apparently, her husband ejaculated before penetration every time. “Was he tense? Did it happen every time?” I asked. “Yes. He was very tense. I asked him to take it easy and encouraged him to try the next day. “But again there was no success. We tried a few more times and failed. For the past few months, our sexual desires have waned. We hardly attempt sex now and quarrel over this occasionally. We have lost confidence completely and need help.” D’s husband has a condition called premature ejaculation (PE). An occasional instance of PE might not be cause for concern, but if the problem occurs with more than 50 per cent of attempted sexual relations, a dysfunctional pattern usually exists for which treatment maybe appropriate. PE is a very distressing and common sexual problem when the man is unable to control ejaculation voluntarily. It is estimated that about 10 to 40 per cent of men have this trouble. It is less common in older men when the threshold for orgasm is raised. As in D’s case, PE is devastating for a man’s self-esteem and makes the couple unhappy and frustrated. It threatens or can even ruin a marriage, simply because it spoils their sex lives. The exact cause of PE is not well understood although the majority of cases are attributable to psychological factors. Animal studies have shown that a low level of the chemical serotonin in some areas in the brain could cause premature ejaculation. This theory is supported by the proven effectiveness of anti-anxiety medication or selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels in the brain in treating PE. Anxiety plays an important part in many cases. If the husband is nervous, he is likely to climax quickly. Some men take a small amount of alcohol to ease their nerves hoping it will make them less likely to climax prematurely. However, this does not work in most cases. I taught D’s husband some simple distraction techniques such as turning his attention to something else when he felt climax was near. These methods did not work for him. He tried to apply a local anaesthetic cream to numb his penis shortly before intercourse. But that resulted in D developing an allergic reaction to the cream. Although SSRIs have been used successfully to treat PE, D and her husband preferred not to take a drug as they were afraid of side-effects. They opted instead to try one of the behaviour modification methods widely used to treat PE which I could advise them about. D and her husband practiced diligently over a period of two months. With motivation and under careful instruction, her husband finally learnt how to delay ejaculation.

When housewife, Mrs. T, 40, first came to see me, she was wearing a diaper. “I have been suffering for a while,” she said, embarrassed. “It has become worse in the last few months. I had an occasional leak when I coughed or sneezed after the birth of my son, but it got worse after I had my second child. “My family physician taught me exercised to strengthen my pelvic muscles. It did not help. I have to wear a diaper all the time now and it’s uncomfortable. I also feel uneasy and am afraid that other people may notice the smell. Do you have any solution?” Mrs. T was slightly overweight. Her abdomen was soft. There was no abnormal swelling or lumps in the pelvis. The womb was normal in size but drooped slightly downward due to childbirth. Her bladder sagged and protruded slightly out of the vagina forming a bulge. A small amount of urine leaked out when I asked her to strain. Ultrasound scans of the abdomen and pelvis did not reveal any abnormality. I took a urine sample for culture of bacteria. The result was negative. A special X-ray of her urinary system was normal. Further investigation (an urodynamic test) indicated that she had stress urinary incontinence (SUI), a condition where urine is released involuntary with a sudden rise in the abdominal pressure. SUI is the most common type of urinary incontinence in women. The “stress” here refers to the sudden increase in abdominal pressure on the bladder brought about by movement or activity such as coughing, sneezing or heavy lifting. It has nothing to do with psychological stress. Normally, the bladder is well supported by the pelvic muscles which keep the urine in place. In older women, who are obese, smokers, near menopause or have had many vaginal births, these muscles are weakened. Any stress on the bladder will result in urinary leakage. Depending on the severity, SUI can be managed in various ways. Mrs. T was put on a weight reduction programme as obesity aggravates incontinence. She was also advised not to hold her urine as someone with a distended bladder would be more susceptible to SUI. Constipation can make urinary incontinence worse. I told her she had to have regular bowel movements. The pelvic muscle training exercises that she tried, which improve the strength and function of the erethral muscles, did not benefit Mrs. T. But they could help a patient with mild symptoms. Some women may use a device called a vaginal cone along with pelvic exercises. The cone is placed in the vagina and the woman tries to contract the pelvic muscles in an effort to hold it in place. The device may be worn for up to 15 minutes. Again, it may benefit those with mild symptoms. In severe SUI, as in Mrs. T’s case, surgical treatment is necessary and a sling operation is the procedure of choice. A sling comprises a synthetic mesh material in the shape of a narrow ribbon and is placed under the urethra. It strengthens the urethral muscles and provides a “backboard” or “hammock” of support under the urethra. A year after the operation, I received a Christmas card from Mrs. T which read “Dear Doc. I am now in Korea learning how to ski. Thank you for giving me a new lease of life. I don’t have the problem any more.

Q. Is chicken pox dangerous during pregnancy? Should I get the vaccination before getting pregnant? How long do I have to wait before conceiving after vaccination? A. Chickenpox is a very infectious illness caused by a virus called herpes zoster. It usually causes an itchy red rash with blisters but can occasionally affect the lungs (pneumonia), the liver (hepatitis) and the brain (encephalitis). Very rarely, pregnant women may die from these complications. For the unborn baby, the risk of getting chickenpox depends on the stage of the pregnancy when the mother gets infected. The highest risk is during the last 4 weeks of pregnancy. If the mother has chickenpox: · before 28 weeks of pregnancy, the baby is unlikely to be affected. However, there is a small chance (less than 1 in 100) that damage could occur to the eyes, legs, arms, brain, bladder or bowel. There is no increased risk of miscarriage. · between 28 and 36 weeks of pregnancy, the virus will stay in the baby’s body but will remain asymptomatic. The virus may become active again, causing shingles in the first few years of life. · after 36 weeks of pregnancy, the baby is at greatest risk of getting chickenpox. Chickenpox rash may appear after birth and the baby may have severe complications involving lungs, liver or brain. It is advisable that you get your blood checked first to find out whether you have the immunity against chickenpox. If you do not have the immunity, you should get vaccinated before getting pregnant. The vaccine contains a weakened form of the chickenpox virus and works by causing the body to produce antibodies (resistance) to protect against the disease. The vaccine should not be given during pregnancy and you should avoid getting pregnant for 3 months after the injection, based on guidelines by  the Royal College of Obstetricians and Gynaecologists, U.K. It is given in two doses, one to two months apart. The vaccine can have side effects but they are usually mild. They include: -  Redness, swelling, or soreness at the injection site. -   Mild fever - Mild chickenpox-like rash, usually within a month of vaccination -   Allergic reaction, usually mild.

For normal sperm production, the testes require a temperature a few degrees lower than the core body temperature. This is done by a network of veins that surrounds the testes and drains blood back to the heart – effectively cooling that area. When the valves within these veins are incompetent or defective, blood accumulates and the veins expand and become dilated, forming a venous lump in the scrotum. The collection of these abnormal dilated veins is known as varicocoele. The pooling of blood around the area raises the testes’ temperature, resulting in poor and abnormal sperm production. Metabolic waste products may also accumulate in the testes. This diminishes the amount of oxygen and nutrients required for sperm development. In addition, the abnormal blood flow interferes with testosterone (male hormone) concentration, which in turn causes a reduction in sperm production. Over time, such compromised circulation may result in a disruption of normal male hormone production. Varicocoele is more common on the left side of the scrotum. This is related to the anatomical position of the veins. Someone who has varicocoele will usually have it from early childhood but it only becomes larger and more noticeable during adolescence when there is increased blood flow to the testes. It is also more common in tall and thin men and can run in families. Occasionally, a varicocoele can develop suddenly due to a cancerous growth in the kidney which obstructs the veins. This usually happens in elderly men. Many patients do not have symptoms. It tends to be found in infertile men – accounting for about 40 per cent of men with primary infertility (never fathered a child) and about 40 to 70 per cent with secondary infertility (have fathered children in the past but are now unable to do so). As for treatment, there are two approaches: surgical repair and percutaneous embolisation. In surgical correction (varicocoelectomy), all the abnormal veins are tied off (ligation). Two different surgical techniques have been used. They are open incision on the groin or scrotum and laparoscopic (key-hole) surgery using a telescope through the abdominal wall. These can be done on a day-stay basis under general anaesthesia. Post- operative pain and complications are few. In percutaneous embolisation, which is performed by a specialist X-ray doctor (radiologist), a special tube (catheter) is inserted into a vein in the groin. Under X-ray guidance, a small metal coil is threaded through the tube into the affected vein. It is then released to block the blood flow to the affected vein and to redirect it to healthy ones.

Mrs. S, a 35-year-old woman in her second pregnancy, was diagnosed with breast cancer. She was then four months pregnant and was offered a termination of pregnancy by a gynaecologist. But she delayed her decision to abort the baby. She told her husband: “I am going to take my chance and let my baby live,” She came to see me in her sixth month of pregnancy and said that she had felt a painless lump in her right breast while bathing. She was then in her third month of pregnancy. The lump was firm to the touch and grew rapidly from the size of a small fishball to a golf ball within a month. Soon, there were lumps appearing in the right armpit. She consulted a surgeon who told her that she had advanced breast cancer and she was referred to a gynaecologist for an abortion prior to surgical removal of the cancer. Breast cancer is the most common cancer among women in Singapore. One in five cancers occurring in Singaporean women is breast cancer. Every year, about 1,100 new cases of breast cancer are diagnosed. That means three women are diagnosed with breast cancer each day. And about 270 die from the disease each year. Breast cancer occurs in about one in every 3,000 pregnancies and most often when the mother is between the ages of 32 and 38, as in the case of Mrs. S. It usually appears as an innocuous lump and may cause retraction of the nipple as it grows. Breast cancer is usually difficult to detect early in pregnant women, whose breasts are often tender and swollen. By the time the patient presents herself to the doctor, the cancer is usually at the advanced stage. This is what happened in Mrs. S, whose cancer had spread to the lymph nodes in the armpit. When I examined her, she appeared anxious, but was firm about her decision to continue with her pregnancy even though this was contrary to the surgeon’s advice. She knew very well that the cancer would grow more rapidly during pregnancy due to the increase in female hormones. This would make the management of her condition difficult. After many sessions of prolonged discussion with her and her husband, I was moved by her willingness to risk her life for the sake of her baby. A holistic approach was required in this unique case as I worked closely with my surgical colleagues. Mrs. S underwent removal of her breast with clearance of the lymph nodes in the armpit during the seventh month of her pregnancy. The cancer was found to be aggressive in nature. A baby boy was delivered in the eighth month of her pregnancy by Caesarean section. He was discharged after a week in the neo-natal intensive care unit. Soon after the delivery, Mrs. S had radiotherapy and adjuvant chemotherapy. This was more palliative than curative as the cancer was found to have spread to the brain. This information was passed on to patient’s husband. It was to prepare him for the inevitable. A difficult time Three months later, I received a phone call from her husband and was informed that she had passed away in her sleep. At that juncture, I could only be reminded of the brave decision she had made and her love for her unborn son. It was difficult time for me as I thought of the days when we journeyed together during her pregnancy. I constantly encouraged her and affirmed her determination to proceed with her pregnancy even though the odds were against her. When I attended the funeral, I met the patient’s admirable husband who was looking after the two children. I was surprised when he approached me and put a note in my hands. He said that Mrs. S wrote this note about a week before her death. It took me a while before I decided to read it. I was on verge of tears after reading the touching note which said: “Dear Doctor Chew, I appreciate your concern and care. You have certainly provided me with the opportunity of motherhood even though it may be a short one.” As an obstetrician, I have encountered numerous cases but it is these instances that render the fruits of my labour worthwhile and continue to inspire me as a health-care professional. I have kept the note till this day and it has been a source of motivation when the going gets tough.

I am a first-time mum. Is it necessary that I take vitamin and mineral supplements? How long should I take them for? Vitamins and minerals are nutrients that are essential for the healthy development of the foetus. During pregnancy, the daily intake requirements for certain nutrients, such as folic acid, calcium, and iron will increase. Although a healthy and balanced diet is the best way to get these key nutrients, sometimes it may still fall short and supplements can help fill the nutritional gaps. Supplements are also useful if you are: · unable to prepare healthy meals regularly yourself. · vegetarians or vegans · have an eating disorder · having twins or multiple pregnancy But supplements should not be taken as a substitute for a healthy diet. They should be taken under the guidance of your obstetrician as overdose of certain vitamins may be harmful to the foetus. It is best to take prenatal supplements throughout your entire pregnancy. Your obstetrician may recommend you to continue taking them if you are breast-feeding.

The idea that tofu and other soy products affect male fertility is not new. These foods contain phyto-oestrogens, isoflavones, the plant chemical that mimics the female hormone (oestrogen) and may reduce male hormone (testosterone ) levels in the body. The impact of isoflavones on male fertility has been studied and remains unclear. In 2008, researchers from the Harvard School of Public Health in Boston found that regular consumption of these foods may lower the sperm count. They studied 99 men from infertile couples.These men were asked to complete a questionnaire that included items on how often, on average, they had eaten each of 15 soy foods listed during the past three months. They were also asked to describe their usual serving sizes compared to an illustration of a medium-size serving. They found that the men who ate soy foods had, on average, 41 million fewer sperm per ml than men who didn’t eat these foods. But there were no changes seen in the shape of sperm (morphology) or in their ability to swim (motility ) or in the volume of the ejaculate, all of which are important factors in fertility. The results of this relatively small study are not consistent with the large body of U.S. government and National Institute of Health-sponsored human and research, in which controlled amounts of isoflavones from soy were fed to subjects, with no effect on quantity, quality or motility of sperm. Besides, it is observed that east Asians have regularly consumed large amounts of soy foods without fertility issues, and they have produced very healthy children for centuries. Until further large controlled studies are done, there is no harm for you to consume tofu and other soy products.

I am 56 and have had menopause since I was 51. However, I do not have any menopausal symptoms. Recently my doctor tested my saliva and told me that the levels of my female hormones were very low. He told me that I needed “natural hormones” to rejuvenate my youth. He gave me a “yam cream” which has to be specially processed by the pharmacist and is not available over the counter or by prescription. I feel uncomfortable and would like to have your opinion. Is it truly effective and safe? I presume your doctor has prescribed what is known as customised “bioidentical hormones” or “compounded hormones”. These medications are made from plants such as soy or yam and are supposed to mimic hormones the body produces. They are made individually by the pharmacist and may contain only one or more hormones. Many compounding pharmacies use the term “bioidentical hormones” to imply that these preparations are natural or the same as endogenous substances and, thus, are safe. The phrase bioidentical hormone therapy has been recognized by the Food and Drug Administration (FDA) of America and the Endocrine Society (USA)as a marketing term and not one based on scientific evidence (Committee opinion, American College of Obstetricians and Gynaecologists 2012). These medications are often advertised as being a safer, more effective, natural, and an individualized alternative to conventional hormone therapy. But these claims remain unsupported by large-scale, well designed studies. Dosage, absorption and safety information are usually not available for these medications. Because of lack of these data, variation in the absorption of the medications among individuals and the possibility of the presence of contaminants, there is no scientific evidence that these “compounded hormones” are safer and more effective than standard ones. With regards to the saliva tests to monitor hormone levels, the general consensus is that these tests are of little use because the hormone levels in the saliva does not correlate well with response to treatment in postmenopausal women.