Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Gynecomastia wikipedia , lookup
Growth hormone therapy wikipedia , lookup
Sex reassignment therapy wikipedia , lookup
Hyperandrogenism wikipedia , lookup
Hormone replacement therapy (female-to-male) wikipedia , lookup
Hormonal breast enhancement wikipedia , lookup
Hypothalamus wikipedia , lookup
Progesterone (medication) wikipedia , lookup
Progesterone wikipedia , lookup
Bioidentical hormone replacement therapy wikipedia , lookup
Hormone replacement therapy (menopause) wikipedia , lookup
Hormone replacement therapy (male-to-female) wikipedia , lookup
Bio-Identical Hormone Replacement Therapy 5/25/2017 Raylene Mote Pharm D Inland Compounding Pharmacy 24747 Redlands Blvd., Suite F Loma Linda, CA 92399 (909) 478-3842 1 Introduction 5/25/2017 As a member of the Baby-Boomer Generation, I am looking at the Perimenopausal and Menopausal Era with increased interest. I would like to share with you some of the information I have learned, which can be of benefit to you as well. My name is Raylene Mote, Over the past 15 years, I have been compounding medications, starting with Progesterone suppositories, my interest in compounding has escalated to the point of starting my own Compounding 2 Pharmacy Topics of Discussion 5/25/2017 I would like to talk about Perimenopause and Menopause, and their symptoms, effects on the body and alleviation using Natural Bio-Identical Hormones First, we will discuss the various Life Stages 3 Life Stages Premenopause Begins with the first menstrual period Monthly fluctuations of LH, FSH, Estrogens, Progesterone Most common problem is PMS 5/25/2017 Neurotransmitter profile affected by fluctuating hormones Often successfully treated with stress reduction, diet, exercise Treated with Progesterone, St John’s Wort, 5-Hydroxytryptophan, SSRI’s 4 Life Stages Peri-menopause 5/25/2017 Period between onset of changes in hormonal secretions and onset of menopause Usually begins around age 45 to 49 Fluctuating hormone secretions due to intermixed normal and abnormal cycles Still menstruating but experience menopausal symptoms Sometimes referred to as a period of “Estrogen Dominance” 5 Life Stages Menopause Post-menopause 5/25/2017 Termination of menstrual periods Onset defined as missing 12 consecutive Not all women experience problems The years following the cessation of menstruation (with or without HRT) HRT to maintain vital functions such as heart protection, lipid profile, bone mass 6 Functions of Estrogens 5/25/2017 Responsible for normal growth and development of female sex organs Responsible for maintenance of secondary sex characteristics Promote proliferation and growth of specific cells in the body Protect against bone loss, heart disease and other aging dilemmas Provide maintenance of anti-aging mechanisms 7 Any Questions? 5/25/2017 8 Menopausal Symptoms of Estrogen Deficiency Hot Flashes Hair Loss Dry Skin Sleep disruption Night Sweats Anxiety Vaginal dryness Vaginal atrophy 5/25/2017 Iritability Memory Loss Nervousness Diminished Sex Drive Painful intercourse Urinary incontinence Heart Palpitations 9 Goals of Bio-identical HRT 5/25/2017 Alleviate the symptoms caused by the natural decrease in production of hormones by the body Replace the hormones to the extent to provide the positive benefits of hormone therapy Bring the body back to hormonal balance Imitate the body’s natural processes as much as is possible 10 Synthetic Vs. Natural Vs. Bio-identical 5/25/2017 “Patented” or “Conventional” or “Artificial” Usually not found in nature or at least not in humans Chemically altered from structure of human hormone Not identical in structure or function to the bio-identical hormones they emulate 11 Synthetic Vs. Natural Vs. Bio-identical “Natural” HRT Should refer to what’s natural to the human body in physiological amounts and ratios To layperson, natural means not manmade May refer to plant or animal source 5/25/2017 Precursors found in yam or soy plants Premarin from pregnant horses’ urine May refer to phytoestrogens or alternative therapies 12 Synthetic vs. Natural vs. Bio-identical 5/25/2017 Hormones that have the exact molecular structure as those made in the human body Produce the same physiological responses as endogenous hormones Should be administered in a manner that imitates the body’s natural ratios and mechanisms 13 Bio-identical Hormones 5/25/2017 Estrone (E1) Estradiol (E2) Estriol (E3) Progesterone Testosterone Dehydroepiandosterone (DHEA) Pregnenolone Androstenedione 14 Benefits of Bio-identical Estrogen Therapy Reduced risk of cancer Less potential undesirable side effects than with conventional synthetics 5/25/2017 Estriol indicated to be the “safest” estrogen Metabolites of Premarin, Estrone and Estradiol thought to be carcinogenic Only approximately 20% of women who start conventional HRT remain on it 2 years later 15 Conventional “Estrogen” Therapy 5/25/2017 Possible UNWANTED Side Effects Breast tenderness, high blood pressure, gallstones, vaginal bleeding, fluid retention, blood clots, nausea and vomiting, headaches, leg cramps, impaired glucose tolerance, worsened uterine fibrosis and endometriosis, jaundice, and Increased risk of endometrial cancer and breast cancer 16 5/25/2017 17 Estrogen Dominance Relative excess of estrogen Symptoms include: 5/25/2017 High fluctuations of peri-menopause Overdosing of estrogen Lack of progesterone to balance Fatigue, breast tenderness, fluid retention, headaches, craving of sweets, decreased libido, heavy or irregular menstruation, weight gain, fibrocystic breasts, uterine fibroids, mood swings, loss of scalp hair 18 Progestins vs. Progesterone 5/25/2017 Progestins are synthetic, man made molecules developed to mimic the actions of natural progesterone. Progestins do not have the full range of activity of natural progesterone Natural progesterone is a molecule that is plant derived and is bioidentical to the hormone produced in our bodies 19 Side Effect Profile Progesterone Slight to moderate drowsiness Synthetic Progestins 5/25/2017 Breast tenderness Acne Bloating Depression Vision changes Thrombosis Migraine And more…… 20 Progesterone 5/25/2017 Oldest know sex hormone Present in every human regardless of age (or sex) Produced by the ovaries and adrenal glands Secreted by the corpus luteum Has receptors in almost every cell in the body Acts on uterus, breasts, brain, smooth muscle, kidneys, bones and cellular membranes Metabolized to other active hormones 21 Functions of Progesterone Promote secretory changes in uterine endometrium Necessary for maintenance of pregnancy 5/25/2017 Counteracts prolific action of estrogens Prepares and maintains uterine lining for implantation of fertilized egg Decreases uterine contractions Prepare breasts for lactation 22 Effects of Progesterone 5/25/2017 Acts as a natural diuretic Normalizes blood clotting Stimulates osteoblast-mediated new bone formation (increases bone mass and density) Precursor for other sex hormones Maintenance of anti-aging mechanisms 23 Effects of Progesterone Anti-estrogen: Suppresses nuclear estradiol receptors Induces estradiol dehydrogenase Suppresses DNA synthesis Anti-mineralocorticoid effect 5/25/2017 Blocks binding of aldosterone to renal receptors therefore causing sodium excretion 24 Benefits of Progesterone Therapy Balances the effects of estrogens 5/25/2017 Counteracts the symptoms of estrogen dominance, especially breast tenderness, fluid retention, headaches, break through bleeding, sleep disturbances, irritability, loss of libido, loss of scalp hair Decrease uterine fibroids Protects against fibrocystic breasts Decreases cramping 25 Benefits of Progesterone 5/25/2017 Natural antidepressant Helps normalize thyroid Uses fat for energy Restores libido Has a positive effect on cholesterol Builds bones and protects against osteoporosis 26 Combination Hormonal Therapy 5/25/2017 In most cases, it is beneficial to use a combination of estrogen and progesterone to obtain hormonal balance One without the other can lead to a dominance of one hormone Estrogen and Progesterone have reciprocal actions at the cellular level 27 Effects of Testosterone 5/25/2017 Enhances Libido Provides cardiovascular protection (lowers cholesterol) Enhances bone building (increases calcium retention) Improves energy level, mental alertness, and a sense of well-being Maintains muscular tone Maintains skin and hair health 28 Application of Bioidentical Hormone Replacement It depends on the individual!!! Determine needs/goals of the patient Health evaluation Individual factors for each patient 5/25/2017 Hysterectomy Thyroid function History of hormonal cancer Family history of heart disease, etc. Weight Diet, exercise, and stress influences Previous pharmaceutical agents and response 29 I Want a Second Opinion! 5/25/2017 30 Adjunctive Therapies 5/25/2017 Healthy diet Regular Exercise Lifestyle Modification Nutritional Supplementation Pharmaceutical Agents 31 Questions??? 5/25/2017 Thank you for this opportunity to share with you today!! 32