Bioidentical Hormones

1. Bioidentical Hormones Stephen F. Redding MD FACOG NCMP NAMS Certified Menopause Practitioner

2. Menopause Symptoms To treat or not to treat?

3. Menopause Symptoms Highly individualized. Debilitating symptoms. Mild symptoms.

4. Menopause Symptoms Goal of treatment: Improved quality of life

5. Menopause Symptoms One approach to treatment of these symptoms is Hormone Therapy (HT) “Natural” or “Bioidentical” Hormone regimens Traditional Hormone regimens

6. “Natural” or “Bioidentical”hormone regimens Much confusion among consumers and clinicians about the terms “natural,” “bioidentical” and “synthetic.”

7. “Bioidentical” • If a hormone is chemically identical to that found in the human body it can be said to be “bioidentical.”

8. “Natural” • If a substance originated in plant or animal, one can say it is “natural.”

9. “Natural” • If a substance originated in plant or animal, one can say it is “natural.” • Many drugs in clinical use today originate from plants.

10. “Natural” • If a substance originated in plant or animal, one can say it is “natural.” • Many drugs in clinical use today originate from plants. • Just because a substance is “natural” does not mean it is always safe.

11. “Synthetic” • Hormones that are chemically altered in the laboratory can be termed “synthetic.”

12. “Synthetic” • Hormones that are chemically altered in the laboratory can be termed “synthetic.” • A substance can be made that has hormone activity but is different chemically than the hormone it mimics.

13. “Synthetic” • Hormones that are chemically altered in the laboratory can be termed “synthetic.” • A substance can be made that has hormone activity but is chemically dissimilar to the hormone it mimics. • A substance can be altered to become bioidentical.

14. “Bioidentical” • Therefore, it’s possible for a ”bioidentical” hormone to be both “natural” and “synthetic.”

15. “Bioidentical” • Many commercially available products made by pharmaceutical companies are, in fact, “bioidentical.”

16. “Natural” or “Bioidentical”hormone regimens Bioidentical hormones for the treatment of menopause symptoms include estradiol, estriol, estrone, progesterone and testosterone.

17. Customized Hormone Dosing Hormone levels constantly change due to normal physiologic variations. Symptoms should be managed with the lowest effective dosages.

18. Customized Hormone Dosing Monitoring hormone levels through blood or saliva testing is therefore less important that the successful management of menopause symptoms.

19. Customized Hormone Dosing Bioidentical hormones can be administered as pills, topical sprays, creams, gels, lotions, patches, vaginal tablets, creams or inserts, injectables and implants.

20. “Compounded” Compounding is defined as “combining, mixing or altering of ingredients to create a customized medication for an individual patient in response to a licensed practitioner’s prescription. US FDA

21. Hormone Safety The Women’s Health Initiative (WHI) Study Widely publicized in 2002 Many women and physicians decided to immediately stop HT

22. Hormone Safety A consumer book recommends bioidentical hormone therapy (BHT) as a safer alternative to commercially prepared hormones.

23. Hormone Safety Some smaller more recent studies have suggested very reasonable safety and even health benefits to early onset HT.

24. Summary All women experience some degree of menopause symptoms for some period of time in their lives.

25. Summary The decision to treat menopause symptoms is highly individualized.

26. Summary Hormone therapy (HT) is a reasonable and perhaps even healthy choice for many women.

27. Summary Bioidentical hormones are available and make sense for the treatment of menopause symptoms.

28. Menopause IQ • Menopause is defined as: • 2 or more irregular periods after age 40 • The start of hot flashes • No menstrual period for 12 consecutive months • An increase in mood swings • The average age of menopause is: • 51 • 60 • 55 • 49

29. Menopause IQ • Menopause increases health risks like: • Heart disease • Sexually transmitted diseases • Osteoporosis • A & C • Women going through menopause should take: • Hormone therapy • It depend on the woman, her symptoms and her medical history • Bio identical hormone therapy • Estrogen therapy

30. Menopause IQ • The most accurate test to determine if a woman is in menopause is: • Follicle stimulating hormone (FSH) blood test • Complete blood count (CBC) • Urinalysis • None of the above • Which of the following are proven alternative therapies for menopause symptoms: • Black cohosh • Plant estrogens • Herbals • None of the above

31. Menopause IQ • During menopause, some doctors may prescribe which treatment? • Hormone therapy (HT) • Birth control pills • Benzodiazepines • A or B • Which is not a symptom of menopause? • Night sweats • Back pain • Headaches • Anxiety

32. Menopause IQ • If Menopause occurs in a woman younger than ____ years, it is considered to be premature. • 40 • 45 • 50 • 30 • Which factors can affect the timing of menopause? • Surgical removal of the ovaries • Chemotherapy and radiation • Medication • A & B

33. Menopause IQ • Hot flashes can last from a few minutes to a few hours. • True • False • About 15-28% of post-menopausal women can still bear children. • True • False

34. Menopause IQ • As a result of menopause, which of the following is least likely to occur. • Decreased estrogen levels • Vaginal atrophy • Osteoporosis • Osteoarthritis • Menopause decreases a woman’s risk for depression. • True • False