Transcript Female Hormone Replacement Therapy

Natural Therapy for
Menopause
By
Lisa Beth Freedman, M.D.
Definition
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Menopause, as the name suggests, signals the
time in a woman’s life when she no longer has a
menstrual cycle
It is the time that the female ovaries cease to
produce certain sex hormones, most notably
estrogens
When menopause occurs the only source of
estrogen is that which is produced by the
adrenal glands
“The Change”
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The onset of menopause signals the end
of a woman’s reproductive cycle
Some of the most common symptoms of
menopause are: Vasomotor Symptoms,
vaginal atrophy, vaginal dryness, memory
loss, loss of libido
Ages
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The average age of the onset of
menopause is 51 although it can occur
earlier or much later
Menopause that starts before the age of
45 is termed early menopause and
menopause that occurs before the age of
40 is termed premature menopause
Perimenopause
Hormone Decline
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When ovarian function ceases, circulating
levels of the estrogens, progesterone, and
testosterone decrease dramatically
These sex hormones play vital roles in
countless bodily functions
Hormones
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The word hormone is derived from the Greek word
“horman” which means to set in motion
Hormones serve to send messages from one cell to
another
There are 4 types of hormones in the human body :
1. Amine Hormones – i.e thyroxine
2. Peptide hormones – i.e. insulin
3. Lipid and Phospholipid Hormones – i.e. prostaglandins
4. Steroid Hormones – testosterone and cortisol
Estrogen
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The role of estrogen is to prepare the lining of
the uterus for pregnancy, promoting the growth
of the fetus, preventing bone destruction,
preventing hypertension and lowering insulin
levels
Estrogens also increase body fat, and increase
water and sodium retention
Many physicians also believe that circulating
estrogens provide cardiac protection and
protection from Alzheimers Disease
Progesterone & Testosterone
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The role of progesterone is to promote bone
growth, prepare the endometrium for the
implantation of the fertilized ovum, prevent
water retention, serve as a natural
antidepressant and as a precursor to other sex
hormones
The role of testosterone is to increase libido,
increase strength, and improve and protect
cardiac function
Symptoms
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The delicate balance of the these
hormones is critical in the physical,
emotional and mental health of all women
During the onset of menopause the
decreased level of these circulating sex
hormones manifests themselves in a
variety of ways
Symptoms (continue)
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Many women complain of weight gain,
depression, migraine headaches, breast
tenderness, acne, sleep disorders, hot flashes
and hair loss
In an effort to alleviate these symptoms many
physicians will institute hormone replacement
therapy
Some other symptoms of the menopause are
insomnia, osteoporosis, increased cholesterol
and Alzheimers
Therapy
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For years, hormone replacement therapy used a cookie
cutter approach to treatment. Most women were placed
on conjugated estrogen (Premarin) and
medroxyprogesterone (Provera)
There was little choice of doses and drugs available and
women were presented with a”take it or leave it”
approach to therapy
Hormone replacement therapy involves the introduction
of exogenous hormones to the body
The goal of therapy is to elevate circulating levels of sex
hormones and the removal of all menopausal symptoms
Synthetic
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Conjugated estrogens are a combination of many
different types of estrogens, some of which are not even
present in humans
These estrogens were obtained primarily from the urine
of pregnant mare, hence the blockbuster drug we now
know as Premarin was launched
This was coupled with the progestational agent
medroxyprogesterone and doctors now had the tools to
treat menopausal symptoms
For many women these therapies proved to be very
helpful. They were able to sleep well at night,
concentrate on the tasks at hand, and get relief from
their annoying hot flashes
Synthetic (continue)
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But for many other women the side effects produced by
these drugs were sometimes worse than the symptoms
they were meant to treat
Medroxyprogesterone was found to cause depression
and breast tenderness and conjugated estrogens were
linked to breast cancer
While these drugs were similar to the hormones
produced by the female body there were not exact
It is believed that these slight structural differences in
the molecules are what causes the unwanted side effects
of therapy
Synthetic (continue)
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Estrone
Equilin
Estradiol
Estriol
Natural
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When we use the term “natural” or “bioidentical” hormone therapy we are referring to
the chemical structure of the hormones
They are chemically identical to the hormones
your body produces
They are, however, still estrogen and
progesterone, etc. They have all the positive
and negative effects of these chemicals
The hormones that I prescribe are derived from
both the soy and yam plants
Natural (continue)
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The basic sterol molecule, the building block of all
hormones is extracted from the soy and yam plants, and
then in a laboratory they are converted to the various
hormones we are discussing (estriol,testosterone, DHEA,
etc.)
It is my thought that when a physician is going to initiate
any hormone replacement therapy, whether it is insulin
therapy, thyroid replacement therapy, or sex hormone
replacement therapy, it makes the most sense to use
drugs that are identical to the hormones in which you
are deficient.
DHEA
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DHEA – DHEA is a natural steroid produced by
the adrenal gland
It is the most abundant steroid in the body
It is a precursor to testosterone, and estrogen.
DHEA is also produced in adipose tissue, the
gonads, and the brain
When determining levels of DHEA it is best to
measure DHEA Sulfate as it is more stable
Estrogen
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Estrogen – Estrogen is the primary sex
hormone for females
The 3 main estrogens are estriol,
estradiol, and estrone
Estradiol is produced from testosterone
and estrone is produced from
androstendione
Progesterone
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Progesterone is a steroid hormone that is involved in the
female menstrual cycle, pregnancy and embryogenesis
Progesterone is formed from the precursor hormone
pregnenolone
Progesterone is produced by the adrenals, the gonads,
the brain and the placenta during pregnancy
In women progesterone levels are low during the preovulatory phase of the menstrual cycle, they rise after
ovulation, and are elevated during the luteal phase
Testosterone
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Testosterone is produced by the testis in males
and in smaller quantities by the ovaries in
women
It plays a key role in health and well being in
both males and female
It is believed to increase libido, energy, and
immune function and protect women from
osteoporosis
Testosterone is produced from progesterone and
is a precursor to estradiol
BHRT
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BHRT can be implemented utilizing several
different dosage forms based on physician
and patient preferences
The primary modes of administration are
oral, sublingual vaginal and topical
Each method has its pro and cons, we will
discuss these now
Capsules
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Oral- Capsules can be compounded by
your pharmacist and used orally
This is a convenient mode of
administration
The downside of oral administration is that
this method places more stress on the
liver and would be contraindicated in
patients with hepatic dysfunction
Troches
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Oral Troches – these are small flavored lozenges which
are dissolved in the buccal cavity of your mouth
This mode of administration bypasses first-pass
metabolism and places little or no stress on the liver
These troches can be flavored based on pt preferences.
The downside of troche administration is taste or
palatability
Depending on the ingredients and the doses taste can
sometimes become an issue with compliance
Vaginal
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Vaginal – Not the best method for HRT, however
it is the best method for treating vaginal dryness
and recurring UTI’s associated with menopause
Usually estriol only is used to treat these
symptoms
It’s use in vaginal atrophy is well documented.
It also has been used as a prophylactic
treatment for recurring UTI
Topical
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Topical – Many physicians prefer this method
because it puts no stress on the liver and is
generally well received by patients
Combinations of estrogen, progesterone DHEA,
testosterone, etc are compounded in a hypoallergenic cream base and patients apply a
measured amount to their forearms, wrists,
abdomen or thighs
Physician/Pharmacist
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Not all physicians are experienced in BHRT, you must
find physicians in your area that utilize this method of
hormone replacement
Not all pharmacies compound BHRT products
You must locate a compounding pharmacy and have
prescriptions prepared by a trained compounding
pharmacist
It is critical to find a pharmacist that works closely with
your physician to customize your therapy
Every woman is different and one size HRT does not fit
all
Follow Up
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Initially, it is not uncommon for your doses of
ingredients to change over several months
depending on how you feel
That is the advantage of customized BHRT,
working with your physician and pharmacist to
individualize your therapy
Costs of therapy – The cost of therapy for BHRT
is roughly $30 per month.