E N D
1. Hormone Balance & Health
Riverpoint Pharmacy
Catherine Hudek, RPh
Edie Ward, RPh
Vickie Landkammer, PharmD
2. BALANCE Hormones in balance are the key to health
As hormones decline, health declines and aging accelerates
Hormone imbalance can occur at any age
Diet and lifestyle are extremely important to hormone balance
Every person is a unique individual
3. Conventional HRTWomen's Health Initiative Trial Prempro, Premphase, Provera, (Premarin)
41% increase in strokes
29% increase in heart attacks
26% increase in breast cancer
Twice the rate of blood clots
Possible contributor to Alzheimer's
vs.
Estrogen alone arm
4. Synthetic Progestins Increase the risk of breast cancer
Increase the risk of heart disease (coronary vasoconstrictor)
Not protective against osteoporosis
Fluid retention and edema
Cause weight gain
Increase incidence of blood clots (DVT/PE)
5. Synthetic Progestins (cont.) Cause DEPRESSION
Increase anxiety and nervousness
Increase the risk of dementia
Can cause headaches
Hair loss and skin discoloration
Decrease thyroid action
Patentable…profitable
6. Provera
is not
Progesterone
7. Bioidentical Hormones Are chemically converted from yams or soy and are identical in composition to human hormones
Are not patentable
Have been used in Europe over 40 years
Have been extensively researched
Estradiol, progesterone, and testosterone are FDA approved
9. Estrogens Estrone (E1)……SHBG metabolites
Estradiol (E2)…..SHBG metabolites
Estriol (E3)
Found in balance in the human body
10. Functions of Estrogen Estrogens have over 400 functions in the body
Stimulates the production of choline acetyltransferase, an enzyme which prevents Alzheimer’s disease
Improves insulin sensitivity
Helps prevent muscle damage
Improves sleep
Regulates body temperature
Glucose transport in the brain
11. Functions of Estrogen Cont. Reduces the risk of cataracts and macular degeneration
Decreases blood pressure
Helps maintain memory
Maintains the amount of collagen in skin
Reduces the overall risk of heart disease by 40-50%
Maintains bone density
Decreases the risk of colon cancer
12. Estrone (E1) Stronger Estrogen
Made in the ovaries and adrenal glands
Converted from androgens in fat cells (aromatized)
Major source of post-menopausal estrogen
High levels may increase the risk of breast and endometrial cancer
Weight gain in the hips and thighs
Premarin is 60% estrone
13. Estradiol (E2) Stronger Estrogen
High, unopposed levels may increase the risk of breast, uterine, and prostate cancer
High levels are found in premenopausal females but the majority is bound to SHBG
Important for health in both women and men
Vital for heart, brain, bones, joints, and immune system health
14. Estriol (E3) Weaker estrogen balancing E1 & E2
Breast protective estrogen
Does not stimulate the uterine lining
Does not increase the risk of blood clots
High levels are found during pregnancy
Significant improvement of symptoms in women with Multiple Sclerosis
Mother Natures Designer Estrogen
15. Progesterone Balances other hormones in the body
Protects the breast, uterus, and prostate
Natural antidepressant, anxiolytic-binds GABA receptor
Helpful in PMS
Osteoblast mediated new bone formation
Coronary vasodilator
Restores libido
16. Progesterone cont. Improves sleep
Helps the body use and eliminate fats
Lowers cholesterol
Increase metabolic rate by decreasing TBG-thermogenic
Improves estrogen receptor sensitivity
Progestational
17. Progesterone cont. Myelenation of nerves
Neuro-regeneration properties
Increases cognitive function
Decreases brain edema in stroke and brain injury
Natural diuretic-blocks aldosterone receptors
Precursor hormone to cortisol, aldosterone, and androstendione
18. Testosterone Anabolic hormone that improves muscle mass and bone density
Improves mental sharpness, memory, and concentration
Increases energy level
Improves flexibility, mobility, and coordination
Prevents aches, pains, and arthritis
Restores sex drive and libido
19. Testosterone (cont.) Protects against Alzheimer’s dementia, Parkinson’s disease, AODM, complications of diabetes, abdominal obesity, depression, inflammatory-related syndromes, and cardiovascular disease
Levels decline with age, by age 70, 40-50% of men are testosterone deficient
Does not cause prostate cancer
Does not cause liver failure
20. DHEA ( dehydroepiandrosterone) Precursor hormone for both testosterone and the estrogens
Low levels have been associated with cancers, depression, autoimmune diseases, heart disease and other chronic diseases
Low levels and high levels have been associated with increased risk of breast cancer
Chronic stress, illness ie. RA, Lupus, MS predispose to low levels
Can help decrease visceral and subcutaneous fat, increase insulin sensitivity and increase IGF-1
21. Functions of DHEA Decreases cholesterol
Decreases formation of fatty deposits
Prevents blood clots
Increases bone growth
Promotes weight loss
Increases brain function
Helps the body repair itself and maintain tissues
22. Replacement of DHEA can: Increase muscle strength and lean body mass
Activate immune function
Increase quality of life
Improve sleep
Increase feeling of wellness
Decrease joint soreness
Increase sensitivity of insulin
Decrease triglycerides
Stop the damaging effects of stress
23. Thyroid Main hormone responsible for metabolism and energy
Every cell depends on adequate thyroid hormone levels to function properly
Slight deficiency can impact health
Levels decline with age
Not rely on blood tests alone for diagnosis
AACE guidelines suggest TSH<3.0 (0.5-2.0)
Critical for heart health and immune function
24. Wren 1971 347 patients, ages 43-86, high risk/sx. Heart dz.
9% low thyroid by testing
Treated all patients with Thyroid hormone
-Mortality decreased by 50%
-70% reduction in episodes of chest pain
-50% reduction in heart attacks
-22% reduction in cholesterol
-80% of patients felt better, more alert & motivated
25. Cortisol Produced in the adrenal gland from progesterone
It is the body’s major defense against stress, including infections & injuries
Natural anti-inflammatory hormone
Critical for function of the immune system
Involved in blood sugar regulation
Every living cell in the body requires a cortisol molecule to function
26. Functions of Cortisol Sleep
Influences testosterone/estrogen ratio
Influences DHEA/insulin ratio
Affects the pituitary/thyroid/adrenal system
27. Pregnenolone Precursor hormone to DHEA, estrogens, progesterone and testosterone “Mother Hormone”
Produced in the brain, promotes greater growth of brain cells.
Potent memory and mood enhancer
Used to treat fatigue and depression
Prevents age-related decline in neurogenesis in the hippocampus.
Hypothyroidism can cause low pregnenolone http://www.lef.org
28. Functions of Pregnenolone
Regulates the balance between excitation and inhibition in the nervous system.
Increases resistance to stress
Improves energy both physically and mentally
Enhances nerve transmission and memory
Reduces pain and inflammation
29. Pregnenolone Used in the Treament of Arthritis
Depression
Memory loss
Fatigue
Moodiness
30. Melatonin Improves sleep disorders and prevents jet lag
Potent antioxidant
Low levels have been seen in cancer patients
High doses have been used to treat breast cancer
Levels decline after age 45
31. Functions of Melatonin Sleep
Mood
Immune function
Antioxidant activity
Blocks estrogen from binding to estrogen receptors
Stimulates the parathyroid gland which regulates bone-formation.
Stimulates the production of growth hormone.
32. Estrogen Dominance Condition in which there is too much estrogen (E1, E2, xenoestrogens) in proportion to progesterone and phytonutrients
33. Etiology of Estrogen Dominance Insufficient production of progesterone
Overproduction of estrone and estradiol
Conventional Hormone Replacement Therapy
Chemicals/ Pollutants
Insulin Resistance (refined carbohydrates)
Stress (elevated cortisol)
Lack of Phytonutrients found in fruits and vegetables
Lack of fiber
34. Symptoms Mood Swings, PMS
Anxiety, Irritability, Depression, Fatigue
Fibrocystic breasts, breast tenderness, cysts
Uterine fibroids, heavy bleeding
Weight gain, water retention, bloating
Headaches, infertility
Symptoms of low thyroid, increased TBG
Increased risk of breast, uterine cancer, and prostate cancer
35. Prevention of Estrogen Dominance Progesterone supplementation
Bioidentical HRT (balanced)
Stress reduction
Get rid of chemicals, pesticides etc.
Improved diet, reduce carbohydrates, whole foods
Exercise
Fiber / supplements / flaxseed / I3C / DIM
36. Estrogen Deficiency Hot flashes, night sweats
Vaginal dryness, urinary urgency, incontinence
Foggy thinking, memory lapses
Tearful, depressed
Insomnia
Heart palpitations
Bone loss, aches, pains
Thinning skin, hair loss
37. Progesterone Deficiency Hot flashes, night sweats
Vaginal dryness, incontinence
Foggy thinking, memory lapses, depression
Insomnia
Heart palpitations
Bone loss, aches, pains
FCB, water retention, anxiety, PMS
Increased risk of breast & uterine cancer
Hair loss on top of the head, unwanted body hair
38. Progesterone Excess Sleepiness
Breast tenderness
Mild depression
Bloating
Water retention
Increased insulin resistance
Weight gain
39. Testosterone Deficiency Decreased libido, erectile dysfunction
Decreased energy, fatigue, lack of endurance
Decreased concentration, memory loss
Bone loss, muscle mass loss (cardiac muscle)
Increased heart disease (CAD,CHF) & diabetes
Aches, pains, decreased coordination
Hot flashes, vaginal dryness, incontinence
Dry, thinning skin, wrinkles, hair loss, graying hair
40. Testosterone Deficiency cont. Increased BMI
Increased waist circumference
Elevated insulin levels
Elevated glucose levels
Elevated systolic and diastolic blood pressure
Elevated total cholesterol and LDL
Elevated triglycerides
Reduction in healthy HDLs
41. Androgen Excess Excessive facial hair (women)
Loss of scalp hair (women)
Tender breasts (women)
Acne, oily skin
Anxiety, aggression
42. Cortisol Deficiency Usually caused by constant emotional and physical stressors
Can also be caused by low progesterone as seen in perimenopause or in women who have had their ovaries removed
Overwhelming fatigue
Immune dysfunction
Sugar cravings
Salt cravings
Low blood pressure, weak rapid heartbeat
43. Cortisol Deficiency cont. Allergies, asthma, hives, itching
Sinusitis, chemical sensitivities, dermatitis
Aches, pain, muscle stiffness
Arthritis
Hair loss in patches or from the top of the head
44. What happens before you actually “burn out” your adrenal glands and you’re living the high stress lifestyle with chronically elevated cortisol?
45. Consequences of Cortisol Excess Fatigue
Sleep disturbances
Bone loss
Weight gain waist, increased belly fat
Loss of muscle mass, thinning skin
Anxiety
Memory lapse
Irritability
46. Consequences of Cortisol Excess Decreased immune system
Increased risk for osteoporosis
Sugar cravings
Low energy
Night sweats
Binge eating
Increased cholesterol, triglycerides and blood sugar
47. Chronic Stress/ Elevated Cortisol Suppresses the immune system
Affects hormone balance
- Increases estrogen dominance (decreases SHBG, induces aromatase, competes with Progesterone receptors)
- Suppresses testosterone
- Elevates insulin
- Major source of hot flashes
48. Stress Related Illness Cancers
Heart Disease, High Blood Pressure
Depression, headaches
Chronic fatigue, chronic pain
Ulcers, Inflammatory Bowel Disease
Colds, flu
Graying hair, hair loss
49. Thyroid Deficiency Basal Body T < 97, TSH > 3.0, low T4 or T3
Decreased metabolism, weight gain
Fatigue, lack of endurance, fibromyalgia
Muscle weakness, aches, pains, joint stiffness
Headaches, decreased concentration, brain fog, memory problems
Depression, mood swings, irritability, PMS
Elevated cholesterol
Dry skin, dry brittle hair, hair loss (balding all over)
50. Thyroid Excess Weight loss/gain
Fatigue, weakness, decreased muscle mass
Shakiness, restlessness, rapid heartbeat
Shortness of breath
Heat intolerance, increased thirst, sweating
Anxiety, panic attacks
Anemia, hives, itching
Hair loss, brittle nails
51. Elevated Insulin
Increases estrogen dominance (decreases SHBG, elevates cortisol, effects ER, increases aromatase) and the risk of breast cancer
Increases inflammation: increases the risk of heart disease, arthritis, and cancer
Increases hunger and obesity
Increases LDL & Triglycerides/decreases HDL
Decreases lifespan
52. Hormone Imbalance Symptoms overlap
Men and women at any age
GET TESTED blood vs. saliva vs. 24h urine
‘Low normal’ levels may not be optimal
53. Conclusion It’s all about balance
Hormones in balance are the key to health
Each person is a unique individual
Levels must be measured and treatments customized
It only makes sense to restore hormones with their bioidentical equivalent
Hormone balance is about disease prevention
The patient must be an active participant
54. Bioidentical Hormone ReplacementCompounding Pharmacy
Capsules (oral) SR or oil capsules
Creams/gels (skin or mucous membranes)
Sublingual troches/drops/tablets
Injections (HGH, testosterone cypionate)
Vaginal Suppositories, Troches, and Creams
55. Oral Capsules Convenient
Absorb best with a fatty meal
First pass through the liver (metabolites)
Testosterone converts to estradiol and is rapidly degraded
Conventional HRT has been shown to cause liver damage and increase the risk of thrombosis
Variability in absorption
56. Creams & Gels Variability in absorption: individual, site, surface area, and the thickness of skin
Maintains a consistent level of hormones in the bloodstream avoiding the peaks and valleys
Avoids first pass through the liver
Does not increase the risk of blood clots
Easy to adjust dosage
57. Mucous Membrane Application Consistent absorption
Do not store in fatty tissue
No need for a separate vaginal preparation
Single cream
Cost effective
58. Vaginal Suppositories & Creams Used for their effect on vaginal/bladder tissue
Reverse incontinence
Treat vaginal dryness, urgency, and UTI’s
Low systemic absorption
59. SL Tablets, Drops & Troches Avoids first pass through the liver
Rapid onset of action
Convenient
Careful not to swallow saliva
Multiple doses to maintain blood levels
Drops make it easy to increase or decrease dosage which is useful in perimenopause
Variability of absorption
60. Men USP Testosterone (cream/gel, sublingual tablet, patch, injection)
DHEA SR 25 to 50mg capsule
Progesterone Cream (5-10 mg./day)
Arimidex, Zn, Saw palmetto, B6, Chrysin, nettle etc.
DRE and PSA(<2.6) prior to starting therapy
PSA @ 3, 6, & 12 mos. If PSA > 4.0 prostate bx.
FU estradiol & testosterone levels @ 3-6 mos.
61. Women Progesterone cream, gel, troche, sl drops, or tabs
DHEA 5 to 10mg./day
Bi-Estrogen with Progesterone (cream, gel, oral capsules, sublingual tablets, troches, or drops)
Testosterone (cream, gel, sl tablets, troche, or drops)
Combination cream (E3, E2, P, T, DHEA, Pr)
62. Conclusion BALANCE
Individual
Levels
Bioidentical Hormones
Diet and Lifestyle
Disease Prevention
Active Participant
63. Recommended Reading www.lef.org www.lammd.com
What Your Doctor May Not Tell You About Breast Cancer John Lee/David Zava
What Your Doctor May Not Tell You About Menopause / Perimenopause John Lee
The Testosterone Syndrome Shippen/Fryer
Natural Hormone Balance Uzzi Reiss
Natural Woman, Natural Menopause Laux/Conrad
The Hormone Solution Thierry Hertoghe
Adrenal Fatigue James Wilson
64. Recommended Reading cont. Safe Uses of Cortisol William Mck. Jefferies
Hypothyroidism: The Unsuspected Illness Broda O. Barnes
Thyroid Power Richard Shames
The Thyroid Solution Ridha Arem
Solved: the Riddle of Illness Stephen E. Langer
The Wisdom of Menopause Christine Northrup
The Miracle of Natural Hormones David Brownstein
The Sexy Years Suzanne Somers
65. Websites/Links http://scholar.google.com/ Search engine
http://www.salivatest.com/store/bhrt_index.html Data/Abstracts
http://www.lef.org/protocols/prtcls-txt/t-prtcl-130.html Testosterone protocol
http://lammd.com/A3R_brief_in_doc_format/progesterone.cfm#ProgesteroneandMen
http://www.lammd.com/A3R_brief_in_doc_format/Estrogen_Dominance.cfm
66. Websites/Links http://www.drlam.com/A3R_brief_in_doc_format/progesterone.cfm Progesterone
http://www.lammd.com/A3R_brief_in_doc_format/adrenal_fatigue.cfm Adrenal fatigue
http://www.lef.org/protocols/prtcls-txt/t-prtcl-104.html Thyroid protocol
http://www.lef.org/protocols/prtcls-txt/t-prtcl-022.html Breast cancer protocol
67. Websites/Links http://www.sogc.org/SOGCnet/sogc_docs/common/guide/pdfs/ps142.pdf HRT in women with breast cancer
http://www.thorne.com/pdf/journal/2-6/soyisoflavones.pdf Information on Soy