You and Your Hormones

Welcome to Menopause and the next stage of your life. It is an inevitable journey that you cannot avoid or skip over. It will take place whether you experience daily reminders or you have no symptoms whatsoever. All women cease menses either naturally, unnaturally or surgically so therefore they have stepped into the next lifecycle of menses on hold or paused. The definition is the cessation of menses for at least one year before this wonderful new venture begins.

Now putting all of the clichés and the labels aside, this time can be a continuation of a current fulfilling life or a beginning of something new; a new you. Life is not over or even slowing down; new careers are launched, children have left home, relationships have bonded, relationships have severed, new friendships are formed, etc, etc. We are less fearful and reticent than we were at a younger age; less concerned for what others think and more apt to please ourselves. This could be the best stage yet; so take care of yourself, dress up, get out and mingle and be proud of what you have accomplished and what you will accomplish going forward. Today is the youngest age you will be the rest of your life.

So with that said let’s turn our attention to the confusion and controversy over what we are supposed to do when the symptoms of this wonderful journey disrupt our days and keep us up at night.

Yes, the studies are there to support the concern, but there are studies to support the good in hormone replacement therapy as well. I am just going to list the possibilities that you can discuss with your physician.

Fist what is bio-identical and why does everyone want this type of hormone replacement? Well, the movement began with a group of physicians called the A4Mers, American Academy of Anti-Aging Medicine and also with a book titled “Ageless”, by Suzanne Somers. Considering how well Ms. Somers looks for her age it has been a popular topic and helped spawn the interest in replacing what our bodies have lost with what we can manufacture to resemble it.

Without too much history or textbook references, bio-identical hormones can be loosely described as those closely resembling the molecular structure of the hormones your body made when you were younger. However, when these manufactured hormones include yams and soy products in their ingredients, this definition can be confusing. Still, that’s the basic concept.

 

Bio-identical hormone replacement is supposed to be better and more natural than traditional hormone replacement therapy, which is exactly what our mothers were prescribed. The word “natural” draws attention because people think they are improving their bodies as opposed to doing themselves harm. (I like to remind those women who automatically think “natural” is better that opium and arsenic are also “natural” compounds.) It is good to remember that bio-identical hormone therapy – if purchased as a personally compounded product at a compounding pharmacy – is a form of alternative medicine.

 

Like traditional hormone replacement therapy, bio-identicals are prescribed to relieve symptoms of menopause and possibly reduce the risk of osteoporosis. In addition, these alternative forms can be billed as a cure for many other age-related illnesses. However, there is little evidence to support many of these claims, and these compounded products share the same risks associated with their FDA approved competitors.

 

These FDA approved bio-identical drugs available are typically covered by insurance, and your physician can match an option to best fit your needs and lifestyle. A typical regimen for women presenting with menopausal symptoms for the first time is: a (very small) patch form of a bio-identical for estrogen and an oral form of a bio-identical for progesterone. If you are experiencing very uncomfortable vaginal dryness and chafing, a vaginal product used a couple of days a week might also be added until these symptoms subside.

 

Lots more options exist around and outside of this above example. As a women and a healthcare consumer who does not want to spend her precious free time reading through the plethora of books written on the subject of HRT (Hormone Replacement Therapy) or BHRT (Bio-Identical Hormone Replacement Therapy), you need a simplification. First, acknowledge that you are going to experience some degree of physical, mental, emotional, or spiritual change during this time in your life. Then, get the facts and make a personal decision. Keep in mind that what is right for your mom or your sister or your friend may not be the best therapy for you.

 

This article is intended to give you some insight so that you can make independent and knowledgeable decisions. And the chart below can help you understand the possibilities in order to determine the best therapy for you.  An equine estrogen is made from horse urine; 17-B estradiol is made from plants and is closest to what your body once made adequately.  Oral estrogen medications are also subject to drug interactions in the body as well as first pass metabolism where is some potency is compromised.

 

Oral  Estrogen Products
Composition Product Name
Conjugated Equine Estrogens PremarinPrempro
Synthetic Conjugated Estrogens CenestinEnjuviaCongest
Estrified Estrogens Synthetic Menest
17b-estradiol EstraceVarious 17b-estradiol generics
Estradiol Acetate Femtrace
Estropipate (a salt of estrone sulfate and piperazine) Ortho-Est
 
Transdermal and Topical Estrogen Therapy ProductsAll 17B-Estradiol – non-synthetic estrogen produced in the body by women during the reproductive years in the ovaries and in the adrenal cortex; estradiol is also produced in the brain and in arterial walls.
Composition Drug Name
17B-estradiol Patch AloraClimaraFempatchMenostarVivelle

Vivelle Dot

Estraderm

Various generics

17B-estradiol Transdermal Gel ElestrinDivigelEstrogel
17B-estradiol Topical Emulsion Estrasorb
17B-estradiol Transdermal Spray Evamist
 
Vaginal Estrogen Therapy Products

Both synthetic and 17B-estradiol

Composition Drug Name
Vaginal Creams
17B-estradiol Estrace Vaginal Cream
Conjugated Equine Estrogen Premarin Vaginal Cream
Vaginal Rings
17B-estradiol Estring, 90 Days
Estradiol Acetate Femring, 90 Days
Vaginal Tablets
Estradiol Hemihydrate VagifemVagifem LD
 
Oral Combination Estrogen Therapy Products: Estrogen and Progesterone
Composition Drug Name
Conjugated Estrogens +Medroxyprogesterone Acetate Synthetic PremphasePrempro
Ethinyl Estradiol + Norethindrone Acetate Femhrt
17B-estradiol + Norethindrone Acetate Activella
17B-estradiol + Drospirenone Angeliq
 
Transdermal Continuous-Combined Regimen Patch
Composition Drug Name
17B-estradiol + Norethindrone Acetate CombiPatch
17B-estradiol + Levonorgestrel Climara Pro
 
ProgesteroneA female hormone produced in the ovaries during ovulation; belongs to a class of hormones called progestins. Progesterone is a naturally produced human progestogen.  If a woman has an intact uterus during menopause and is electing hormone replacement therapy, progesterone is necessary to protect from endometrial cancers.
Oral Capsules and Tablets
Composition Drug Name
Micronized Progesterone Prometrium
Medroxyprogesterone Acetate ProveraVarious generics
Norethindrone MicronorNor QDVarious generics
Norethindrone Acetate AygestinVarious generics
Norgestrol Ovrette
Megestrol Acetate MegaceVarious generics
Intrauterine Device: Progestin
Levonorgestrel Mirena, 5-year use
Vaginal Gel: Progesterone
Progesterone Prochieve, 4 and 8%Crinone, 4 and 8%
 

 

 

There are additional products not listed, such as injections and various generic names of many of the oral and transdermal patch drugs. Also not mentioned, and I will not go into them here, are the over-the-counter products and those you can order through the mail. Many of those products are considered nutraceutical options; black cohosh and red clover are among these types of remedies for the symptoms of menopause.

 

In the end, it is your body, and you should consult with your physician before and during your course of therapy.

 

 

 

References:

  1. WebMD
  2. Wikipedia
  3. North American Menopause Society