Transcript Bio-Identical Hormone Replacement Therapy

Bio-Identical Hormone
Replacement Therapy
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7/17/2015
Raylene Mote Pharm D
Inland Compounding Pharmacy
24747 Redlands Blvd., Suite F
Loma Linda, CA 92399
(909) 478-3842
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Introduction
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As a member of the Baby-Boomer
Generation, I am looking at the
Perimenopausal and Menopausal Era
with increased interest. I would like to
share with you some of the information I
have learned, which can be of benefit to
you as well.
My name is Raylene Mote, Over the
past 15 years, I have been compounding
medications, starting with Progesterone
suppositories, my interest in
compounding has escalated to the point
of starting my own Compounding
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Pharmacy
Topics of Discussion
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I would like to talk about
Perimenopause and Menopause,
and their symptoms, effects on the
body and alleviation using Natural
Bio-Identical Hormones
First, we will discuss the various
Life Stages
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Life Stages
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Premenopause
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Begins with the first menstrual period
Monthly fluctuations of LH, FSH,
Estrogens, Progesterone
Most common problem is PMS
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Neurotransmitter profile affected by
fluctuating hormones
Often successfully treated with stress
reduction, diet, exercise
Treated with Progesterone, St John’s
Wort, 5-Hydroxytryptophan, SSRI’s
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Life Stages
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Peri-menopause
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Period between onset of changes in
hormonal secretions and onset of
menopause
Usually begins around age 45 to 49
Fluctuating hormone secretions due to
intermixed normal and abnormal cycles
Still menstruating but experience
menopausal symptoms
Sometimes referred to as a period of
“Estrogen Dominance”
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Life Stages
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Menopause
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Post-menopause
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Termination of menstrual periods
Onset defined as missing 12 consecutive
Not all women experience problems
The years following the cessation of
menstruation (with or without HRT)
HRT to maintain vital functions such as
heart protection, lipid profile, bone mass
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Functions of Estrogens
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Responsible for normal growth and
development of female sex organs
Responsible for maintenance of
secondary sex characteristics
Promote proliferation and growth of
specific cells in the body
Protect against bone loss, heart disease
and other aging dilemmas
Provide maintenance of anti-aging
mechanisms
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Any Questions?
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Menopausal Symptoms
of Estrogen Deficiency
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Hot Flashes
Hair Loss
Dry Skin
Sleep disruption
Night Sweats
Anxiety
Vaginal dryness
Vaginal atrophy
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Iritability
Memory Loss
Nervousness
Diminished Sex
Drive
Painful
intercourse
Urinary
incontinence
Heart Palpitations
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Goals of Bio-identical
HRT
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Alleviate the symptoms caused by the
natural decrease in production of
hormones by the body
Replace the hormones to the extent to
provide the positive benefits of hormone
therapy
Bring the body back to hormonal balance
Imitate the body’s natural processes as
much as is possible
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Synthetic Vs. Natural Vs.
Bio-identical
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“Patented” or “Conventional” or
“Artificial”
Usually not found in nature or at
least not in humans
Chemically altered from structure
of human hormone
Not identical in structure or
function to the bio-identical
hormones they emulate
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Synthetic Vs. Natural Vs.
Bio-identical
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“Natural” HRT
Should refer to what’s natural to the
human body in physiological amounts
and ratios
To layperson, natural means not manmade
May refer to plant or animal source
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Precursors found in yam or soy plants
Premarin from pregnant horses’ urine
May refer to phytoestrogens or
alternative therapies
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Synthetic vs. Natural vs.
Bio-identical
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Hormones that have the exact
molecular structure as those made
in the human body
Produce the same physiological
responses as endogenous
hormones
Should be administered in a
manner that imitates the body’s
natural ratios and mechanisms
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Bio-identical Hormones
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Estrone (E1)
Estradiol (E2)
Estriol (E3)
Progesterone
Testosterone
Dehydroepiandosterone (DHEA)
Pregnenolone
Androstenedione
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Benefits of Bio-identical
Estrogen Therapy
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Reduced risk of cancer
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Less potential undesirable side effects
than with conventional synthetics
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Estriol indicated to be the “safest”
estrogen
Metabolites of Premarin, Estrone and
Estradiol thought to be carcinogenic
Only approximately 20% of women who
start conventional HRT remain on it 2
years later
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Conventional
“Estrogen” Therapy
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Possible UNWANTED Side Effects
Breast tenderness, high blood pressure,
gallstones, vaginal bleeding, fluid
retention, blood clots, nausea and
vomiting, headaches, leg cramps,
impaired glucose tolerance, worsened
uterine fibrosis and endometriosis,
jaundice, and
Increased risk of endometrial cancer and
breast cancer
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Estrogen Dominance
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Relative excess of estrogen
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Symptoms include:
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High fluctuations of peri-menopause
Overdosing of estrogen
Lack of progesterone to balance
Fatigue, breast tenderness, fluid
retention, headaches, craving of sweets,
decreased libido, heavy or irregular
menstruation, weight gain, fibrocystic
breasts, uterine fibroids, mood swings,
loss of scalp hair
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Progestins vs.
Progesterone
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Progestins are synthetic, man
made molecules developed to
mimic the actions of natural
progesterone. Progestins do not
have the full range of activity of
natural progesterone
Natural progesterone is a molecule
that is plant derived and is bioidentical to the hormone produced
in our bodies
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Side Effect Profile
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Progesterone
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Slight to
moderate
drowsiness
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Synthetic
Progestins
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Breast
tenderness
Acne
Bloating
Depression
Vision changes
Thrombosis
Migraine
And more……
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Progesterone
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Oldest know sex hormone
Present in every human regardless of
age (or sex)
Produced by the ovaries and adrenal
glands
Secreted by the corpus luteum
Has receptors in almost every cell in the
body
Acts on uterus, breasts, brain, smooth
muscle, kidneys, bones and cellular
membranes
Metabolized to other active hormones
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Functions of
Progesterone
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Promote secretory changes in uterine
endometrium
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Necessary for maintenance of pregnancy
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Counteracts prolific action of estrogens
Prepares and maintains uterine lining for
implantation of fertilized egg
Decreases uterine contractions
Prepare breasts for lactation
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Effects of Progesterone
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Acts as a natural diuretic
Normalizes blood clotting
Stimulates osteoblast-mediated
new bone formation (increases
bone mass and density)
Precursor for other sex hormones
Maintenance of anti-aging
mechanisms
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Effects of Progesterone
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Anti-estrogen:
Suppresses nuclear estradiol
receptors
 Induces estradiol dehydrogenase
 Suppresses DNA synthesis
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Anti-mineralocorticoid effect
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Blocks binding of aldosterone to
renal receptors therefore causing
sodium excretion
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Benefits of
Progesterone Therapy
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Balances the effects of estrogens
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Counteracts the symptoms of estrogen
dominance, especially breast tenderness,
fluid retention, headaches, break through
bleeding, sleep disturbances, irritability,
loss of libido, loss of scalp hair
Decrease uterine fibroids
Protects against fibrocystic breasts
Decreases cramping
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Benefits of
Progesterone
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Natural antidepressant
Helps normalize thyroid
Uses fat for energy
Restores libido
Has a positive effect on cholesterol
Builds bones and protects against
osteoporosis
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Combination Hormonal
Therapy
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In most cases, it is beneficial to
use a combination of estrogen and
progesterone to obtain hormonal
balance
One without the other can lead to a
dominance of one hormone
Estrogen and Progesterone have
reciprocal actions at the cellular
level
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Effects of Testosterone
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Enhances Libido
Provides cardiovascular protection
(lowers cholesterol)
Enhances bone building (increases
calcium retention)
Improves energy level, mental alertness,
and a sense of well-being
Maintains muscular tone
Maintains skin and hair health
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Application of Bioidentical Hormone
Replacement
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It depends on the individual!!!
Determine needs/goals of the patient
Health evaluation
Individual factors for each patient
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Hysterectomy
Thyroid function
History of hormonal cancer
Family history of heart disease, etc.
Weight
Diet, exercise, and stress influences
Previous pharmaceutical agents and
response
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I Want a Second
Opinion!
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Adjunctive Therapies
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Healthy diet
Regular Exercise
Lifestyle Modification
Nutritional Supplementation
Pharmaceutical Agents
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Questions???
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Thank you for this opportunity to
share with you today!!
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