Stafford Pharmacy & Home Healthcare

1475 St. Edward Blvd. N.  Lethbridge, Alberta T1H 2P9

(403) 320-6500    Fax (403) 320-6676  Toll Free: 1-800-320-1260

Website:  http://www.staffordpharmacy.com

 

 

Introduction

 

What is menopause?

Before we can understand the rationale for hormone replacement, we need to first understand the hormonal changes that occur during menopause.  Menopause is a natural stage in life that occurs when a woman stops having menstrual cycles.  However, menopausal symptoms and irregular menstrual cycles can begin to occur 5-10 years before menopause as the ovaries gradually stop producing eggs and there is a progressive decline in hormone production.  This time period of gradual change is called peri-menopause. 

 

What does hormone replacement do?

Hormone replacement therapy (natural and synthetic) restores declining hormonal levels associated with menopause.  This helps alleviate many discomforts associated with menopause and allows the body to continue to receive the beneficial effects hormones have against cardiovascular disease and osteoporosis.   

 

 

 

Natural Hormone Replacement Therapy – What is it all about?

 

What is natural hormone replacement therapy?

Natural hormone replacement therapy uses hormones that are identical in chemical structure to the hormones produced by the human body.  These “bio-identical” hormones are given in the same proportions that occur naturally in a woman’s body. 

 

What is the difference between natural hormones and conventional hormonal replacement medications?

Conventional hormonal therapies use hormones that are not identical in chemical structure to the body’s natural hormones.  Synthetic hormones are not given in the same proportions as the naturally occurring levels in the body. 

 

What is the source of natural hormones?

Natural hormones are obtained from precursor molecules found primarily in plants such as wild yams and soybean.  These estrogen and progesterone-like compounds are then transformed in the laboratory to the bio-identical hormones found naturally in humans. 

 

Do natural hormones require a prescription?

Yes – They must be prescribed by a licensed physician.  

 

Frequently Asked Questions About Estrogen

 

 

What is estrogen?

Estrogen is not one hormone, but a group of similar hormones of varying degrees of activities, all produced in the ovaries.  The three most important hormones and the proportions they occur in are estrone (10-20%), estradiol (10-20%) and estriol (60-80%).

 

What does estrogen do?

Estrogen is secreted by the ovaries throughout a woman’s reproductive years and is the female hormone responsible for ovulation.  Estrogen receptors are located throughout the body, in the breasts, lining of the uterus, cervix, brain and in bones. 

 

Estrogen plays an important role in a woman’s life from the time she enters puberty until the end of her last menstrual period.  Not only does estrogen have beneficial effects on cholesterol and lipid levels but it also contributes to the strengthening of bones and the mental well-being of women.     

 

What does estrogen replacement do?

Decreased production of estrogen by the ovaries can lead to symptoms such as hot flashes, night sweats, vaginal dryness, urinary tract infections, depression and irritability.  Estrogen replacement can help relieve these symptoms, provide protection against cardiovascular diseases and strengthen bones, which decreases the risk for osteoporosis.  Although estrogen offers many benefits, it is not indicated for everyone and women should evaluate their individual risks versus benefits.   

 

What is triple estrogen (Tri-est?)

Tri-estrogen contains 10% estrone, 10% estradiol and 80% estriol.  These proportions are similar to normal physiological levels.  Tri-est is not available commercially but specialty pharmacies can compound these hormones into oral capsule or topical gel and cream formulations.

 

What are the benefits of using Tri-est over conventional hormonal therapies?

Because Tri-est uses bio-identical hormones in similar proportions to naturally occurring levels, many women experience less side effects such as breast tenderness, nausea, vomiting and fluid retention with Tri-est, compared to synthetic estrogens.  Tri-est is compounded in the pharmacy, therefore, doses and preparations can be individualized for each patient. 

 

How long will I need to use Tri-est?

Tri-est can be given to treat menopausal symptoms and its usage can be discontinued when these symptoms subside.  However, because of the other health benefits associated with estrogen replacement, Tri-est may be continued for life for many women.

  

 

 

Frequently Asked Questions About Progesterone

 

 

What is progesterone?

Progesterone is a female hormone produced by the ovaries each month during the second half of the cycle.    

 

What does progesterone do?

Progesterone prepares the lining of the uterus (endometrium) for pregnancy but in the absence of pregnancy, progesterone helps facilitate the monthly shedding of the endometrial layer.  Progesterone and estrogen work together in a delicate balance to regulate the menstrual cycle. 

 

What is the purpose of progesterone therapy? 

Progesterone replacement can help restore the natural hormonal balance in woman entering menopause, which can further aid in alleviating unwanted menopausal symptoms such as irregular bleeding and depression.  It is also recommended that women taking estrogen who still have a uterus also take progesterone because it opposes the stimulatory action of estrogen on the endometrial lining and protects against endometrial cancer.   

 

Progesterone has also been shown to have beneficial effects on bones and may help protect against osteoporosis and fractures. 

 

Progesterone therapy can also help relieve PMS symptoms when given from day 14 to 28 of a woman’s cycle. 

 

What are the side effects associated with natural progesterone therapy?

When given appropriately, side effects are generally minimal but temporary spotting, acne, dizziness and sleepiness can occur.  Notify your doctor or pharmacist if these side effects become persistent or bothersome because you may not be receiving an appropriate dose. 

 

What is the difference between natural progesterone and other progestins?

Progestins are synthetic hormones that have actions that are similar but not identical to progesterone. 

 

Natural progesterone replacement uses the bio-identical progesterone hormone produced by the ovaries.  Natural progesterone is usually micronized (made into very small particles) to increase its absorption.  Natural progesterone is available in both oral capsules and topical cream and gel formulations, vaginal suppositories, oral liquids and sublingual drops or lozenges.  With the exception of the oral capsules, these dosage forms must be compounded by a pharmacist.  All forms can be obtained by prescription only.

 

  

 

Frequently Asked Questions About Testosterone

 

 

What is testosterone?

Testosterone is a hormone found in both men and women, although men have higher levels.  In men, testosterone is produced mainly by the testes, while women produce testosterone in the ovaries and adrenal glands.

 

What does testosterone do?

Testosterone plays an important role in the overall health and well-being of both men and women.  In males, besides being responsible for the changes that occur during puberty, testosterone enhances sex drive, elevates mood, builds muscle, strengthens bones and increases energy levels.  In women, testosterone enhances sex drive, improves mood, strengthens bone and restores energy.

 

What are the benefits and risks of taking testosterone?       

In addition to improving libido, energy and bone strength in both men and women, when used properly, testosterone is reported be protect against atherosclerosis, heart disease and other vascular disorders.  Contrary to synthetic or anabolic steroids, natural testosterone has beneficial effects on cholesterol levels. 

 

Testosterone supplementation in men and women can increase the risk of liver toxicity, especially if high doses are taken orally because testosterone is taken directly to the liver following oral administration.  For this reason, it is better to give testosterone in appropriate physiological doses through non-oral routes such as patches, gels or injection for men and gels or vaginal ointments for women.  In women, side effects such as oily skin, acne, increased facial hair and irritability can occur, however they are very unlikely when testosterone is dosed correctly.  

 

What is the difference between natural testosterone and synthetic testosterones?

Natural testosterone is bio-identical to the hormone produced in the body and therefore works in exactly the same way.  Synthetic testosterones work like testosterone in some, but not all ways.  The anabolic steroids are testosterone derivatives which have the muscle building effects of testosterone, but contrary to the natural hormone, they increase the risk for heart attack and stroke and are associated with increased side effects.

 

Is there a commercial source of testosterone for women?   

Natural testosterone can be prescribed by your doctor and compounded by special pharmacies into topical formulations. 

 

 

 

Interpretation of lab values

 

Normal blood pressure ~120/80

 

Cholesterol levels	Normal (mmol/L)  30 yr. old female	Normal (mmol/L) 50 yr. old female	Normal (mmol/L) 65 yr. old female
Total Cholesterol	0 – 5.2	0 – 5.2	0 – 6.2
LDL	2.0 – 3.4	2.2 – 3.4	2.4 – 4.1
HDL	0.9 – 2.2	0.9 – 2.4	0.9 – 2.4
TG	0 – 2.30	0 – 2.3	0 – 2.3

 

Bone Mineral Density
Normal	> 0 to -1
Osteopenia	-1 to -2.5
Osteoporosis	< -2.5

 

In women over the age of 65, a finding of osteopenia indicates a 2-fold risk increase for fractures and a woman with osteoporosis will have a 4-5 fold higher risk for future fractures. 

 

 

Risk factors for osteoporosis and fractures

o Women are at higher risk than men

o Age – risk increases with age

o Small frame size

o Early menopause (normal or surgical)

o Low calcium and vitamin D intake

o Smoking

o High caffeine intake

o Excessive alcohol consumption

o Sedentary lifestyle

o Heredity and race – Caucasians and Asians are at greater risk

o Maternal history of hip fracture

o Certain medications (e.g. corticosteroids, heparin, excess thyroid hormone)

o Previous falls or fractures of any type after age 50

o Predisposing medical conditions (e.g. malabsorption, renal failure, hyperparathyroidism)

 

The recommended daily intake of calcium for both men and women between the ages of 19 and 49 is 1000mg.  Individuals over 50 should receive 1000 – 1500 mg of calcium daily.