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Hormone replacement therapy with bio-identical hormones

What are bio-identical hormones?

Bio-identical hormones have a chemical structure identical to human hormones but are chemically synthesized, such are progesterone, estriol, and estradiol. Non-bio-identically hormones are not structurally identical to human hormones and may either be chemically synthesized, such as medroxy-progesterone acetate, or derived from a non-human source, such as conjugated equine estrogens(1).

Why should one consider HRT (Hormone replacement Therapy)?

  • Relief of symptoms

  • Prevention of memory loss

  • Heart health

  • Bone production (prevention of osteoporosis)

  • Growth and repair

    • Hormones that regulate growth and repair
      • Insulin
      • Growth hormone
      • Testosterone
      • Estrogens
      • DHEA

Hormone replacement therapy with bio-identical hormones can be started after:

1. Underlying adrenal fatigue or stress have been treated.

2. A good symptomatology history to assess hormonal deficiencies/excesses (see questionnaire) has been taken.

3. Any hormonal cancers (Ca125, Ca153, CEA, breast examination, sonar, mammogram, ovarian and endometrial sonar) have been ruled out.

4. Risk for breast cancer has been established.

5. Blood tests or saliva tests to assess the hormonal status have been done.

Hormone response is as unique to each person as their own fingerprints. Hormone replacement should not be considered without a thorough understanding of how all the body’s hormones interact with each other.

What is menopause?

Menopause is defined as no menstrual cycle for 12 months. Symptoms, however, can begin as long as fifteen years prior to menopause. The normal age to go through menopause ranges from 35 to 55. Therefore, women may easily live on half of their lives without a menstrual cycle(2).

Until recently , the only hormonal therapy available has been synthetic hormone replacement. A Women’s Health Initiative (WHI) Program which was sponsored by the USA government on the study of estrogen plus progestin (synthetic progesterone) was halted in 2002. This study was halted three years early because of the increased risk of breast cancer in women taking these hormones(3). Analysis of the study also revealed that heart attack risk began increasing in the progestin group early in the study which was conducted on 16 000 women who had not had a hysterectomy. Participants in the study were either given synthetic progesterone or a placebo. The results of this study highlights the problems associated with “one-size fits all” medicine. HRT should not be a one-size fits all approach.

Natural hormone replacement – the use of hormones that are biologically identical to what one’s body makes.

THE USE OF VARIOUS OESTROGENS

Oestrogens is primarily made by the ovaries and consista of a combination of three compaunds: estrone (E1), estradiol (E2) and estriol (E3). In the suggested cycling protocol below, E2 cream can be used alone, but there are clear advantages in using Bi-Est cream which consists of two naturally occurring oestrogens: estriol and estradiol. Considerable evidance exists to show that estriol protects against breast cancer. Estradiol protects the bones, heart and brain.

For more information go to:

http://www.imcmed.co.za/articals/Fellowship%20Position%20Paper%20of%20Hormone%20Measurement%20and%20Replacement%20-%208-4-09.pdf

Hormone symptoms in peri-menopause & menopause:

SYMPTOMS ESTROGENS PROGESTERONE TESTOSTERONE
Fibrocystic breast High Low -
Weight gain High Low -
Heavy menstrual bleeding High Low -
Dry skin/hair Low Low -
Hot flushes Low - -
Anxiety High/Low High -
Depression Low - Low
Night sweats Low - -
Vaginal dryness Low - Low
Headaches High/Low High/Low Low
Irritability High High/Low -
Mood swing High Low -
Breast tenderness High High/Low -
Sleep disturbances Low Low High
Fluid retention High Low -
Breakthrough bleeding High Low -
Fatigue Low High Low
Loss of memory Low - Low
Bladder symptoms Low - Low
Harder to reach climax Low Low Low
Decreased libido High - Low
Hair loss High/Low High/Low High

The following is a suggested treatment protocol based on symptoms, blood-tests and if all contra-indications have been ruled out:

1. BIO-IDENTICAL PROGESTERONE:

See Patient Information Leaflet for directions for application of the cream and for cycling regime.

http://www.imcmed.co.za/pdf/Progesterone%2010%2002%2009.pdf

SEVERE SYMPTOMS MODERATE SYMPTOMS MILD SYMPTOMS
Fatigue Estrogen dominance Moderate hot flushes Moderate night sweats Anxiety Breast tenderness Weight gain Palpitations Irregular frequent heavy Periods Mild fatigue Hot flushes Night sweats Anxiety Unable to lose weight Periods frequent and heavy flow Night sweats Periods more frequent, not heavy Symptoms worsen last 2 weeks of cycle
PREMENOPAUSAL from age 28: Progesterone cream: Apply from day 10-25 * POSTMENOPAUSAL: Progesterone cream: Apply from day 1-25 *
Severe symptoms: Progesterone cream 3%: 1 (1ml) scoop at night Or Progesterone capsules per mouth: Take 2 capsules at night (200 mg) Severe symptoms: Progesterone cream 3%: 1 (1ml) scoop at night Or Progesterone capsules per mouth: Take 2 capsules at night (200 mg)
Moderate symptoms: Progesterone cream 3%: ½ to 1 scoop at night Or Progesterone capsules per mouth: Take 2 capsules at night (200 mg) Moderate symptoms: Progesterone cream 3%: ½ to 1 scoop at night Or Progesterone micronized per mouth: Take 2 capsules at night (200 mg)
Mild symptoms: Progesterone cream 3%: ½ (0.5ml) scoop at night Or Progesterone capsules per mouth: Take 1 capsule at night (100 mg) Mild symptoms: Progesterone cream 3%: ½ (0.5ml) scoop at night Or Progesterone micronized per mouth: Take 1 capsule night (100 mg)

* Working on a 28 day cycle

Progesterone cream 3% (transdermal) is available from doctors, selected pharmacies, Dis-Chem pharmacies, health store or from SOLAL Technologies.

Progesterone cream can be increased up to 4%, 5%, 10% - Available from The Compounding Pharmacy of South Africa.

Oral Progesterone capsules (micronized) should be the first option for adrenal stress, anxiety or Insomnia.

Oral Progesterone capsules (micronized) are available from The Compounding Pharmacy of South Africa.

2. BIO-IDENTICAL ESTROGEN : BI-EST cream:

See Patient Information Leaflet for directions for application of the cream

SEVERE SYMPTOMS MODERATE SYMPTOMS MILD SYMPTOMS
Younger and more severe hot flushes Periods ceased or less Frequent Fatigue Dry skin,mouth,vagina Mood swings Osteopenia Severe depression Lack of energy after 6pm Severe hot flushes and Night sweats Mild fatigue Periods lighter and more Infrequently Mood swings Depression Apathy Hairloss - crown of head Droopy, dry skin Some hot flushes Night sweats More periods in frequency but not heavy Irritable Depression
PRE-MENOPAUSAL: Apply from day 1-25 * MENOPAUSAL: Apply from day 1-25 * ELDERLY or ESTROGEN DOMINANCE: Apply from day 1-25 *(PMS, Cysts, Fibroids,etc.)
SEVERE SYMPTOMS: BI-EST 50:50 Or BI-EST 60:40Or BI-EST 80:201 (1ml) scoop in the morning SEVERE SYMPTOMS:BI-EST 60:401 (1ml) scoop in the morning SEVERE SYMPTOMS: BI-EST 80:201 (1ml) scoop in the morning
MODERATE SYMPTOMS:BI-EST 60:401 (1ml) scoop in the morning MODERATE SYMPTOMS:BI-EST 80:201 (1ml) scoop in the morning MODERATE SYMPTOMS: BI-EST 80:20½ (0.5ml) scoop in the morning
MILD SYMPTOMS:BI-EST 80:201 (1ml) scoop in the morning MILD SYMPTOMS:BI-EST 80:20½ (0.5ml) scoop in the morning MILD SYMPTOMS: BI-EST 80:20½ (0.5ml) scoop in the morning

* Working on a 28 day cycle

Bi-Est cream (transdermal) - Available from The Compounding Pharmacy of South Africa.

Only available on prescription.

3. BIO-IDENTICAL TESTOSTERONE cream :

TESTOSTERONE cream for women : from 0,125% - 0,25% to maximum of 0,50%

Based on symptoms and blood tests:

See Patient Information Leaflet for directions for application of the cream.

http://www.imcmed.co.za/pdf/Testosterone%20PIL%208.05.09.pdf

Testosterone cream (transdermal) - Available from The Compounding Pharmacy of South Africa.

Only available on prescription.

TESTOSTERONE cream for men: from 2.5% - 5% to a maximum of 10%

Based on symptoms and blood tests:

See Patient Information Leaflet for directions for application of the cream.

http://www.imcmed.co.za/pdf/Testosterone%20PIL%208.05.09.pdf

Testosterone cream (transdermal) - Available from The Compounding Pharmacy of South Africa.

Only available on prescription.

References:

1. K, H. (January 2009). The Bioindentical Hormone Debate: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgraduate Medicine, Volume 121, issue 1 .

2. Smith, P. HRT: The Answers. 2003.

3. Writing Group for the Women’s Health Initiative Investigators, “Risk and benefit of estrogen plus progestin in healthy post-menopausal women,” JAMA 2002; 288:321-333.

 

Contributor:

Dr Caige Golding

 
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