<i>Living Jackson</i> Magazine : Is It Hot in Here or What?

Is it hot in here or is it just me?

By Kim Bost

Many women suffer silently through the symptoms of menopause, but treatment options are available.

Hormone replacement is no joking matter. For many women, the times of peri-menopause and/or menopause are miserable. They suffer silently through the symptoms of menopause such as hot flashes, night sweats, irritability, fatigue, insomnia, decreased libido and foggy headedness.

These women suffer because they know the potential risks and adverse effects that conventional hormone replacement therapy carries. Increased risks for conditions such as blood clots and cancer were well publicized after the results of the Women’s Health Initiative were released. Is there a treatment option for these women who hesitate to try conventional hormone therapy? Yes.
Many compounding pharmacies, such as Tiger Town Pharmacy in Commerce, specialize in bio-identical hormone replacement therapy (BHRT). This therapy option allows the pharmacist to prepare medications that are bio-identical to the hormones the human body produces.

Bio-identical means that when examined under a microscope, the chemical structure of the hormones contained in these compounds are identical to the chemical structure of the human hormones. This allows a more natural therapy and, if monitored correctly, one without the many risks that accompany traditional hormone therapy.

Symptoms
Do any of these sound familiar to you? Estrogen deficiency: hot flashes/night sweats, sleep disturbances, vaginal dryness, painful intercourse, low libido, foggy thinking, depression and bone loss.
Progesterone deficiency (estrogen dominance): swollen and tender breasts, headaches, irritability, irregular menses, cramping, mood swings, depression, fuzzy thinking, joint pain, anxiety, weight gain and low libido.
Testosterone deficiency: fatigue, decreased libido, decreased mental alertness and decreased sense of well-being.
Where do you turn if you can relate to these symptoms? Since traditional hormone replacement comes with risks of adverse effects, many women are turning to bio-identical hormone replacement therapy. BHRT provides a simple and safe alternative for peri-menopausal and menopausal women.

Why does it work?
To start, we should discuss basic physiology. Once physically mature, a woman’s body engages in a hormonal cycle that lasts for, on average, 28 days, and then repeats. The single purpose for this cycle is to prepare for procreation. The hormone cycle prepares a woman’s body for a possible pregnancy. The normal menstrual cycle is driven mainly by two hormones: estrogen and progesterone.

Estrogen is dominant during the first half of a woman’s cycle, when it works to release an egg and prepares the uterine lining for possible implantation of a fertilized egg. Once the egg is released, estrogen levels begin to drop and progesterone becomes the dominant hormone for the second half of the menstrual cycle. Progesterone opposes the continued growth message sent by estrogen and sends the message of development to the same cells in the ovary and uterus. If no egg is implanted into the uterine lining, levels of both progesterone and estrogen drop, stimulating the beginning of the next menstrual period.

Progesterone balances estrogen, so the balance of the levels of these two hormones is critical for optimal health and well-being.

As a woman ages, hormone levels drop and a women enters a phase known as peri-menopause. During this time, symptoms such as increased PMS symptoms with shortened cycles and heavy menses (bleeding) may be present. As time progresses, the menstrual periods become irregular, sometimes skipping a month. Menopause is diagnosed once 12 consecutive periods have been missed.

By measuring estrogen and progesterone levels, the proper therapy dose can be administered to achieve a balance. The goal of BHRT is simple: symptom relief using a prescription medication that most closely mimics the natural menstrual cycle. The medication is dosed to provide symptom relief while avoiding adverse effects.

Many other factors influence the regularity of the menstrual cycle, some of which are testosterone levels (yes, women have “normal” levels of testosterone), thyroid function and stress. These must also be considered when evaluating hormone replacement therapy.

How does it work?
At Tiger Town Pharmacy, the comprehensive BHRT program involves collaboration between the patient and doctor. The program begins with the collection of objective data in the form of salivary hormone levels. From the results of the salivary testing and patient evaluation/interview, an individual prescription is formulated, made specifically for each patient.

Since many adverse effects occur as a result of high estrogen levels, frequent monitoring may be utilized to adjust doses, thereby avoiding a lot of adverse effects. Further individualization of each prescription comes in the choice of dosage form. BHRT medications can be compounded in many different dosage forms to meet each patient’s needs and/or desires. These dosage forms include topical creams, lozenges, capsules, vaginal creams or suppositories. (See Compounding a Solution!, Living Jackson, November/December 2006.)

Helpful for men
BHRT is also used to treat the male equivalent of menopause, which is called andropause. The word andropause first appeared in 1952 and is defined as the “natural cessation of the sexual function in older men.”

The symptoms and conditions of andropause and menopause are very similar, such as lack of adequate levels of androgens (male sex hormones) or estrogens and bone loss.

Likewise, the diagnosis and treatment is very similar to the women’s program, beginning with salivary testing of several hormones, including testosterone. A patient evaluation follows with, again, collaboration between the patient, pharmacist and physician. If testosterone is found to be deficient it can be replaced via a variety of dosage forms.

On-going support
With each BHRT prescription dispensed, the professionals at Tiger Town Pharmacy perform an initial patient consultation. A follow-up consultation checks symptom relief to determine the effectiveness of the current formula.

The goal is re-establishment of the patient’s ultimate feeling of well-being with little or no hormonal related side-effects. A look into BHRT today could begin a walk on the road to the destination of ultimate health.

Kim Bost, pharmacist, is the owner of Tiger Town Pharmacy in Commerce and Homer Drug in Homer. Bost received her BS and Doctorate in Pharmacy from the University of Georgia. She resides in Jefferson with her husband, Zeb, and their children, Zach, Taylor and Emma Grace.