Compounding: Hormone Replacement

nat·u·ral (nāch'ər-əl, nāch'rəl) adj.  1. Present in or produced by nature: a natural pearl.  4.c. Biology  Not produced or changed artificially; not conditioned: natural immunity; a natural reflex.

bi·o-i·den·ti·cal (bī'ō-ī-děn'tĭ-kəl) adj.  3. Having such a close similarity or resemblance as to be essentially equal or interchangeable.  4. Having properties with uniform values along all axes.  PP. The bio-identical hormone is taken from the naturally-occuring hormone in the plant source and altered to resemble and therefore, act, identically to the hormone produced by the human body.

Compiled from various definitions on Dictionary.com 

In medicine, there are very few treatment areas which can compare to hormone replacement therapy (HRT) for its ability to generate controversy and confusion.  For decades, hormone replacement therapy with estrogen and progestins had been the treatment of choice for alleviating menopausal symptoms. However, that all changed in 2002 with the publication of the Women's Health Initiative (WHI) study.  The study was designed to determine whether HRT could prevent diseases such as dementia and heart disease.  What the trial found was that HRT did not prevent these diseases and actually increased the risk of breast cancer, blood clots, strokes and heart attacks.  This discovery halted the study after five years, two years earlier than scheduled.

So what were women to do?  Many women sail through menopause with no problems, but for some women, the symptoms are debilitating. Following the WHI trial, many women stopped taking their HRT entirely only to find the symptoms of night sweats, hot flashes, vaginal dryness, and mood changes came back in full force.  Some women suffered so much that they had to go back on HRT, albeit with a sense of worry that they may be increasing their risk of other diseases.  Others refused to expose themselves to these risks and went without treatment.

Key recommendations in the Menopause Report include:

• Health and Wellness: Health care providers should discuss and encourage menopausal women to make healthy lifestyle choices, especially with respect to nutrition and exercise.
• Symptomatic Treatment: ACOG recommends health care providers offer hormone therapy as the most effective option for the medical management of menopausal symptoms (e.g. hot flashes, night sweats, changes in mood).  The primary indication for systemic hormone therapy is for the management of moderate to severe menopausal symptoms.  The Report recommends hormone therapy is prescribed at the lowest effective dose.
• Urogenital/Sexual Health: Local estrogen therapy (applied directly in a specific area) is recommended if hormone therapy is prescribed for vulvovaginal symptoms alone, such as vaginal dryness; vulvar soreness, discharge, urinary urgency and frequency; and/or recurrent lower urinary tract infection.
• Cancer: Breast cancer risk continues to be a key consideration for physicians and their patients.  The increased risk for breast cancer after five years of combined estrogen/progestin hormone therapy (systemic hormone therapy) is similar in magnitude to other lifestyle variables such as fewer pregnancies after 30 years old, reduced breast-feeding, postmenopausal obesity, excessive alcohol or cigarette use and lack of regular exercise.
• Osteoporosis: Evaluation of osteoporosis in postmenopausal women should include the assessment of clinical risk factors for low bone mineral density (BMD) and BMD testing.  Hormone therapy should be prescribed to symptomatic postmenopausal women as the most effective therapy for symptom relief and a reasonable choice for the prevention of bone loss and fracture.  The risks should be weighted against the benefits if estrogen therapy is being used solely for fracture prevention.
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Regarding the recommendation for symptomatic treatment, the ACOG is basically saying to only use HRT if you really need to, with the lowest effective dose, and for the least amount of time.  This is what most physicians have been doing since 2002 anyway.  It's just that now the ACOG Report is backing them up.  Gone are the days when HRT was touted as the magic bullet for anti-aging.  We now have a 'New Normal' for HRT in 2006.

And yet ... many women are still uncomfortable with this recommendation. They worry about relying on synthetic or unnatural versions of the hormones estrogen and progesterone that are completely foreign to a woman's body.  The sad part is that women are made to believe that these hormones are their only option; take them or suffer with the symptoms of menopause.

However, the good news is that an effective alternative does exist.  At Peoples Pharmacy, we offer the alternative of bio-identical plant-derived natural hormones.  A bio-identical hormone is a hormone that is identical to one produced by the healthy human body.  For women, these include estrone, estradiol, estriol, progesterone and testosterone.  Bio-identical Hormone Replacement therapy offers all the benefits of conventional hormone replacement therapy such as reduced hot flashes, vaginal dryness, and night sweats, not to mention an improvement in mood.  More importantly, there is less worry by the patient that they are using synthetic hormones.

Despite the benefits of Bio-identical Hormone Replacement Therapy, pharmaceutical companies choose not to market it because it cannot be patented like synthetic products.  This lack of patentability equals little profit and therefore little incentive to pursue this fascinating area.

This is where the specialty compounding service at Peoples Pharmacy comes in.  We can compound Bio-identical Hormone Replacement Therapy in a variety of dosage forms and in any strength required.  Our ability to compound low dose hormones is of particular interest considering the current recommendation by the ACOG to prescribe the lowest effective dose of hormone therapy (as compared to conventional products which are only available in a small number of fixed dosage units).  If you feel that you or someone you know could benefit from our Natural Hormone Replacement compounding services, or would just like to find out more about this growing field, please contact one of our knowledgeable pharmacists.  We will be happy to discuss your questions and concerns.

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