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Update in Menopause Therapies



Sooner or later, every woman goes through menopause. Menopause usually begins in the later 40s and can last around 4 years or so. Menopause begins when our estrogen levels begin to fall. As our ovaries stops producing estradiol and progesterone, ovulation ceases.  A decrease in estrogen and progesterone can mean troubling symptoms for some; hot flashes, night sweats, vaginal symptoms and trouble sleeping. Not all women react the same to menopause. As such, not all women will need hormone therapy to treat menopause symptoms. Hormone therapy is indicated for women who experience moderate to more severe symptoms.(1)

What are my choices for hormone therapy?

As discussed in our other article, ‘Bioidentical Hormones; An Alternative to Premarin', there are perhaps 3 types of medicinal treatments available for menopause symptoms. The first being traditional, prescription conjugated estrogens or ‘synthetic' hormones. These hormone products are typically made from the urine of pregnant mares or from plant sources. Examples of these products include Premarin and Enjuvia.

The second type of product is referred to as ‘bioidentical hormones'. These are hormones that are 'identical' to human estrogen on a molecular basis. Bioidentical hormones are typically isolated from natural sources such as soy beans and yams, but are modified so that they are just like the human hormone. Examples of bioidentical hormones include the products Biest and Triest. These products are specially prepared for you by a pharmacist according to a doctor’s order that is specific to your hormone-balancing needs. Biest and Triest require a prescription from the doctor. The Wiley Protocol, made famous by Suzanne Somers, utilizes bioidentical hormone compounds like these . The Wiley Protocol calls for dosing bioidentical hormones to mimic the ups and downs of a woman's cycle. There are also a couple of commercially available bioidentical products available by prescription including Ogen, Estrace and Estraderm.

The third type of therapy is referred to as ‘natural' hormone products. The term ‘natural' is very misleading and is not a scientific term. Typically, natural is used to describe products that are derived from plants, also called ‘phytoestrogens'. Phytoestrogens are similar to but not the same as human hormones.

There are two new estrogen products. Elestrin (estradiol gel) and Angeliq (drospirenone and estradiol tablets). Elestrin is a new, commercially available, bioidentical estradiol gel. Angeliq is a synthetic, commercially available tablet. It has an advantage in that not only can it be used to treat symptoms like hot flashes and night sweats, it is also indicated to treat vulvar and vaginal problems as well.

The Controversy

Which therapy does one choose? There are advantages and disadvantages to all of these. Bioidentical hormones offer flexible dosing and have the option of having a dose tailored to you. However, the FDA has not regulated the compounding of bioidentical hormones. This has caused a bit of controversy in the medical community regarding the potency and consistency of dosing for these products. This may change though. Currently, there is talk about the FDA beginning to regulate the compounding of these hormones. The concern among pharmacies is that this push for legislation seems to be heavily backed by pharmaceutical companies that make synthetic hormones such as Premarin who may see bioidentical hormones as a threat to their financial livelihood. These manufacturers are even calling for the FDA to award the use the term ‘bioidentical' solely to those products that are manufactured by a drug company and recognized as an FDA approved hormone product.

What the experts do agree on

Although there is no clear-cut evidence that states one treatment (synthetic, bioidentical or natural) is superior, the experts do agree on a couple of things.(2-5) First, that women with moderate to severe symptoms should use oral or transdermal (cream, patch) hormone therapy. They also agree that one should start the dose low and increase slowly until the symptoms are relieved. Finally, for women who suffer from vulvar and vaginal symptoms but no other symptoms, topical remedies that are applied just to that area are recommended first.

Author: Christi Larson, Pharm. D.

Dr. Larson is a Clinical Infusion Pharmacist and author of Empowered Medicine; A Guide for Consumers . Get your copy of this one-of-a-kind medication reference NOW and find out if YOUR doctor is following the guidelines.




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