Hormone Replacement Therapy: Women

  1. The role of hormones in our bodies
    1. Estrogens: Estradiol (E2), Estrone (E1), Estriol (E3)
      1. Responsible for: growth and function of reproductive organs, maintaining healthy bones, increasing levels of neurotransmitters in the brain, and impacting cardiovascular health
    2. Progesterone:
      1. Responsible for: normal menstrual cycle, breast development and maintaining pregnancy
    3. Testosterone
      1. Expressed in lower levels in women
      2. Responsible for: Energy, memory, muscle structure, libido
  2. What happens to hormone levels in menopause?
    1. Menopause occurs between 45 and 55 in 95% of women
    2. “Menopause is characterized by a 10- to 15-fold increase in circulating FSH concentrations compared with concentrations of FSH in the follicular phase of the cycle, a fourfold to fivefold increase in LH, and a greater than 90% decrease in circulating estradiol concentrations.5
  3. Symptoms of perimenopause hormone imbalance:
    1. Hot flashes (vasomotor symptoms)
      1. Vasomotor symptoms occur in up to 75% of women for 6 months to 2 years. 25% of women experience severe vasomotor symptoms
    2. Vulvovaginal atrophy: dryness and painful intercourse
      1. One in 4 women have sexual dysfunction
    3. Joint aches and pains
    4. Sleep disturbances
    5. Cognitive changes: mood swings, poor memory and concentration, depression
  4. Who else may need HRT?
    1. Testosterone replacement for men (separate blog?)
  5. How does HRT work?
    1. Systemic: for women with hot flashes
    2. Topical: for women with vulvovaginal atrophy only
  6. Guideline recommendations for pharmacologic management of menopausal symptoms:
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  1. The benefits of Natural HRT vs mass produced
    1. Women’s Health Initiative (WHI)
      1. Double blind placebo controlled trial.
        1. Combined estrogen and progestin arm included 16,608 women
        2. Estrogen-only arm enrolled 10,739 women
      2. Risk of VTE and stroke increases with oral MHT containing estrogen, but the absolute risk is low in women below 60 years of age. Based on observational studies, transdermal MHT and low-dose oral estrogen therapy appear to have a lower risk of VTE and stroke compared to standard-dose oral estrogen regimens.
      3. Menopausal hormone therapy is contraindicated in women with a personal history of breast cancer. The risk of MHT-related breast cancer appears to be associated with the addition of progestogen to estrogen and increases after 5 or more years of continuous combined use. However, use of estrogen alone appears to decrease rather than increase breast cancer risk.
      4. The lowest dose of hormone therapy should be used for the shortest possible duration to adequately manage menopausal symptoms.
    2. NOTE: this (below) came directly from another Pharmacy’s website- will need re-wording****

“There are many mass-produced hormone treatments on the market today. However, every woman's body, and her individual hormonal makeup, is different and each requiring a unique balance of hormones. That's why more women are turning to custom compounded HRT from Empower Pharmacy for their hormone replacement needs. We specialize in preparing a variety of custom supplements, and we can compound a customized HRT solution to suit your very specific hormone needs.”

  1. Sweetgrass products:
    1. The stability of hormones is important in maintaining a healthy and happy life. Certain hormone levels start decreasing as a person ages and can cause a wide variety of symptoms to occur. Hormones that typically decrease include estrogens, progesterone, testosterone, and DHEA. A saliva test or a blood spot test can be used to measure hormone levels in your patients. Follow-up after initiation of HRT is essential to guarantee that your patient is using the optimal dose.
    2. We provide natural, plant-derived bioidentical hormones that can be specifically tailored to your patients’ symptoms in order to optimize their well-being. Natural HRT is provided as a compounded medication the helps ensure the most appropriate formulation for your patient. Numerous dosage forms are available, such as troches, rapidly-dissolving tablets, topical or vaginal creams, sublingual drops, or sustained-released capsules.
    3. Some insurance companies may pay for compounded prescriptions but most typically do not. Our compounds typically cost $45 for a 30-day supply. We do follow-up with our patients regarding their symptom relief and will contact you with recommendations if changes should be considered. Please do not hesitate to contact us if you have any questions or concerns about our service!”

Citations:

  1. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–333.
  2. Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial. JAMA 2004;291:1701–1712.
  3. Kalantaridou SN, Borgelt LM, Dang DK, Calis KA. Hormone Therapy in Women. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017.https://accesspharmacy-mhmedical-com.ezproxyv.musc.edu/content.aspx?bookid=1861&sectionid=146067309. Accessed Jul 27, 2018.
  4. Up To Date: Treatment of menopausal symptoms with hormone replacement therapy
  5. Facts on Hormone Balance for Women. ZRT Laboratory Patient Handout.
  6. Understanding Hormone Highs & Lows. ZRT Laboratory Patient Handout.