Women's Health; Hormone Replacement Therapy
What is “Natural” (Bioidentical)
Biodentical Hormone Replacement Therapy (BHRT), and hormone replacement therapy (HRT) are prescribed for patients to alleviate symptoms of hormonal imbalance such as “hot flashes”, irregular menstrual cycles and mood swings, and more importantly to protect against osteoporosis (bone loss) and cardiovascular disease which often occurs when hormone production drops below levels that the human body requires. Historically, HRT has been composed of synthetic chemicals or animal derived hormones. BHRT refers to those hormones that have the exact molecular structure as those produced in the human body, and are indistinguishable from one another. These hormones may be plant derived from precursors in yam and soy. Bioidentical hormones are comprised of: Estrone (E1), Estradiol (E2), and Estriol (E3), which make up the estrogen component. Because there are three different estrogens, they are referred to as “Tri-est”. Progesterone, Testosterone and Dehydroepiandrosterone (DHEA), make up the remainder of the natural hormones.
E1, E2 and E3 known collectively as Tri-est, is compounded by Columbine Drug to mimic the human body’s ratio of these naturally occurring hormones; that is to say that E1 (Estrone) and E2 (Estradiol) make up 10% each and E3 (estriol) makes up the remaining 80%. The physician may dictate a patient only receive 2 or 3 hormones (Bi-est) or may prescribe a single variety, such as Estradiol or estriol. The beauty of BHRT is that it is patient specific, there is no single approach. The goal is to bring the body back to normal hormonal balance by imitating the body’s natural processes.
Progesterone replacement may be added to estrogen replacement products to protect the uterine endometrium. Estrogen alone may cause proliferation of the endometrium; progesterone counteracts this effect. However, progesterone has many other important functions that are beneficial: Acts as a precursor of other hormones such as estrogen and testosterone; Prevents acne and headache; Alleviates uterine cramping; Protects against endometrial, breast, and ovarian cancer; Acts as a natural diuretic (relieves bloating), and antidepressant; Helps thyroid function, and restores libido.
Testosterone replacement may be prescribed singly or added to estrogen and progesterone therapy. Testosterone provides cardiovascular protections by lowering cholesterol, increasing calcium retention and perhaps more importantly for the patient, enhances libido. While HRT typically evokes the image of a female patient, many male patients benefit from this therapy as well.
DHEA is a pro-hormone or “stem” hormone, meaning it is not a dedicated hormone such as the ones mentioned above. Stem hormones are metabolized in the body to form dedicated hormones such as Estrone, estriol, Estradiol, and testosterone. DHEA is often added to HRT to “boost” and enhance the effect of other hormones.Side Effect Profile
While Bioidentical HRT has the potential to cause side effects that are associated with any hormone therapy, such as breast tenderness, water retention, etc., it typically produces little to no side effects because BHRT is patient specific and concentrations are easily adjusted to levels that are both therapeutic and well tolerated.
Dosing and Prescribing
Once it is established by the physician that BHRT is indicated, the following is a useful guideline:
- Tri-est 2.5mg is approximately equivalent to 0.625mg-conjugated estrogens (premarin).
- Progesterone 100mg is approximately equivalent to 5mg medroxprogesterone (provera).
- Testosterone if desired can be added to the above at 1-2mg/gm and can be increased if needed.
- DHEA can also be added at 5-10mg/gm.
- BHRT can be compounded as a capsule, transdermal gel, vaginal cream, suppository, or troche. Transdermal gels are well absorbed due to the properties of the vehicle, a lecithin/pluronic base, which has been shown to act as a transporter or “carrier” of the hormone molecule suspended within it.
- Application is 1 gram applied one to two times daily, morning, and evening to the inner upper arms and thighs.
- All patients are given a verbal and written consult by a Registered Pharmacist when filling a new prescription for BHRT to ensure correct use of the product.
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