Menopause and Hormone Replacement Therapy

PCOSWelcome to menopause and the next stage of your life. Menopause is an inevitable journey, one you cannot skip over or avoid. The clinical definition is the cessation of menses for at least one year before this wonderful new venture begins. All women cease menses; some do so naturally, some unnaturally, and some surgically. However we transition into menopause, it marks a significant time in our live

Now, putting all of the clichés and the labels aside, this time can be a continuation of a currently fulfilling life or the beginning of something new, a new you. Life is not over or even slowing down – far from it! Some careers are growing, some are launched; some relationships have bonded, some have severed, and some new ones are formed; children leave home or are preparing to do so, 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.

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. We want to make the most of this time, right? And that means trying to feel our best. A few of us have no symptoms whatsoever, and some may experience daily reminders. The majority fall somewhere in the middle. For those of us who do face symptoms, we need to also face the big question: “Is hormone replacement therapy right for me?”

True, studies are out there that support a concern for taking replacement hormones, but there are also studies that support the good in hormone replacement therapy. We’re not going into that issue here. We are just going to list the possible options that you can discuss with your physician. The final decision is yours.

We have entered an era where 40 million baby boomers are experiencing menopause (or will be soon), and these women are planning to accept it on their terms only…which translates to going a different route from their mothers and trying to stay as youthful as possible. In Arlene Weintraub’s recent book Selling the Fountain of Youth: How the Anti-Aging Industry Made a Disease Out of Getting Old, she describes how popular this drive to be young at all costs has become. The medical and economical possibilities for treating menopausal symptoms seem overwhelming. The reports are endless, contradictory, and confusing to the majority of 50-somethingswho might be receiving the first chronic med prescriptions of their lives. Let’s try to clear up some of that confusion.

First, what does “bio-identical” mean, and why does everyone want this type of hormone replacement? The movement began with a group of physicians who founded the American Academy of Anti-Aging Medicine (A4M) along with a book titled Ageless by Suzanne Somers. Considering how good Ms. Somers looks for her age, her book has become a popular reference in this debate and helped spawn the interest in replacing what our bodies have lost (i.e., hormonally) with what we can manufacture to resemble what was lost.

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 woman 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 some potency is compromised.

 

Oral  Estrogen Products
Composition Product Name
Conjugated Equine Estrogens Premarin Prempro
Synthetic Conjugated Estrogens Cenestin Enjuvia Congest
Estrified Estrogens Synthetic Menest
17b-estradiol Estrace Various 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 Alora Climara Fempatch Menostar Vivelle Vivelle Dot Estraderm Various generics
17B-estradiol Transdermal Gel Elestrin Divigel Estrogel
17B-estradiol Topical Emulsion Estrasorb
17B-estradiol Transdermal Spray Evamist
 
Vaginal Estrogen Therapy ProductsBoth 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 Vagifem Vagifem LD
 
Oral Combination Estrogen Therapy Products: Estrogen and Progesterone
Composition Drug Name
Conjugated Estrogens +Medroxyprogesterone Acetate Synthetic Premphase Prempro
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 Combi Patch
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 Provera Various generics
Norethindrone MicronorNor QD Various generics
Norethindrone Acetate Aygestin Various generics
Norgestrol Ovrette
Megestrol Acetate Megace Various 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.

 

READ MORE:

Speaking of Women’s Health.com

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