Bio-Identical HormoneReplacement

Julie Gorman, PharmD

D’Lisa Haas, PharmD

Kristen Riddle, PharmD

Becca Mitchell, PharmD

Pamela Sampson, Pharmacy Technician

“The Triad”

PH

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ICIA

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PATIENT

What is “Natural”?Bio-identical hormones that are

derived from plants

• Bio-Identical: – Hormones that are identical to those made in the

human body– Same exact chemical structure as hormones

produced by our bodies• Plant-Derived:

– Chemically processed from precursors found in yam or soy plants

What is “Synthetic”?“Patented,” “Conventional,” or “Artificial”

• Usually not found in nature, at least not in humans

• Chemically altered from human hormone

• Not identical in structure or activity to the natural hormones they emulate

Progesterone vs Progestin

•Bio-Identical, Human

•Increases fertility

•Synthetic analog

•Contraceptive

Medroxyprogesterone acetate (Provera)

Life StagesPRE-MENOPAUSE• Begins with first menstrual period• Monthly fluctuations of LH, FSH, estrogens &

progesterone• Most common problem is PMS

– Neurotransmitter profile affected by fluctuating hormones (endorphin, serotonin)

– Often successfully treated with stress reduction, diet, exercise

– Treated with progesterone, SSRI’s

Life StagesPERI-MENOPAUSE• Time between onset of changes in hormonal secretions and

onset of menopause• Fluctuating hormone secretions due to intermixed normal &

abnormal cycles• Sometimes referred to as period of “Estrogen Dominance”

MENOPAUSE• Termination of menstrual periods

– Defined as missing 12 consecutive periods– Surgical hysterectomy

Signs & Symptoms of Hormone Imbalance

• Depression• Fatigue• Poor concentration• Hot flashes• Breast tenderness• Insomnia• Anxiety• Painful menses• Irregular bleeding

• Irritability• Hair loss• Fibroids• Water retention• Cholestasis• Weight gain• Decreased libido• Breast & uterine cancer

Estrogen Benefits & RisksBenefits of Adequate Estrogen

• Increase metabolism• Increase insulin sensitivity• Maintain muscle mass• Improve sleep quality• Prevent Alzheimer’s• Reduce cataracts• Reduces overall risk of heart disease by

40-50%• Numerous cardiovascular benefits• Maintain collagen in skin• Decrease blood pressure• Maintain memory• Improves concentration• Maintain bone density• Increases energy & sexual interest• Decreases wrinkles

Risks of Excess Estrogen• Depression• Fluid retention• Headaches• Poor sleep• Irritability/mood swings• Fatigue• Increased risk of auto-immune diseases• Weight gain• Increased risk of breast & uterine cancer

Promoting Healthy Estrogen Levels

• Conservative, customized dosing• Diet high in grains & fiber• Moderate exercise• Stress reduction• Vitamins B2, B6, B12, Folic Acid• Omega-3 fatty acids (fish oil)• Healthy body mass index (BMI)

Progesterone & TestosteroneProgesterone•Helps balance estrogen•Improves sleep•Natural calming effect•Lowers high blood pressure•Helps the body use & eliminate fats•Lowers cholesterol•Increases metabolism•Natural diuretic•Natural antidepressant•Antiinflammatory•Stimulates new bone production•Enhances action of thyroid hormones•Improves libido

Testosterone Increases sexual interest Increases sense of emotional well-

being Increases muscle mass & strength Helps maintain memory Helps skin from sagging Decreases excess body fat Helps maintain bone strength

Natural Ways to Improve Libido• Decrease calorie & increase protein

intake• Exercise• Get enough sleep• Lose weight• Reduce stress

Cortisol• Only hormone that increases with age• Made by the adrenal glands (on top of the kidneys)• Supposed to briefly increase during times of stress• Adrenaline is the “run from a bear” stress hormone while cortisol is our

“stuck in traffic” stress hormone• Should start highest in the morning and gradually fall throughout the

day

Functions:• Balances blood sugar• Weight control• Immune system response• Stress reaction • Sleep

Cortisol ImbalanceHigh Cortisol

• Fatigue• Irritability• Insomnia• Sugar cravings & binge eating• Increased osteoporosis risk• Decreased immune system• Low energy• Night sweats• Increased cholesterol• Insulin resistance• Thin skin• Muscle weakness• Easy bruising• Weight gain around the middle• Impaired thyroid function

Low Cortisol (Adrenal Fatigue)

• Fatigue• Low blood pressure• Insomnia• Decreased sexual interest• Decreased immunity• Emotional paralysis• Allergies• Unresponsive hypothyroidism (does

not respond to treatment)• Feeling of being overwhelmed• Emotional imbalances• Lack of motivation• Digestive problems

Balance is Key!

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SEX HORMONES

Our Goals• Symptom improvement within 2 months• Improved overall health & quality of life• Hormone balance through:

– Conservative dosing– Adequate, appropriate nutrition– Regular exercise– Stress management