WOMEN’S HEALTH ISSUES Part 1 Presented by: Tom Schnorr R.Ph., C.C.N. Apothecary Shop 11645 Angus Rd #1 Austin, TX 78759 NATURAL HORMONE REPLACEMENT THERAPY THE USE OF BIO-IDENTICAL PLANT DERIVED HORMONES IN WOMENS HEALTH Menopausal Symptoms of Estrogen Deficiency Hot flashes Hair loss Dry skin Sleep disruption Night sweats Anxiety Vaginal dryness Vaginal atrophy Irritability Memory loss Depression Nervousness Diminished sex drive Painful intercourse Urinary incontinence Heart palpitations Synthetic vs. Natural vs. Bioidentical “Synthetic” HRT “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 functions to the bio-identical hormones they emulate Synthetic vs. Natural vs. Bioidentical “Natural” HRT Should refer to what’s natural to the human body in physiological amounts and ratios To layperson, natural means not man-made May refer to plant or animal source Precursors Premarin® found in yam or soy plants from pregnant horses’ urine Synthetic vs. Natural vs. Bioidentical “Bio-identical” Hormones 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 Conventional “Estrogen” Therapy Possible Unwanted Side Effects Breast tenderness, high blood pressure, gallstones, vaginal bleeding, fluid retention, blood clots, nausea & vomiting, headaches, leg cramps, impaired glucose tolerance, worsened uterine fibrosis and endometriosis, jaundice, and Increased risk of endometrial cancer and breast cancer Bio-identical Hormones Estrone (E1)* Estradiol (E2)* Estriol (E3)* Progesterone* Testosterone* Dehydroepiandosterone (DHEA) Pregnenolone Androstenedione Bio-identical Estrogens There are three major estrogens produced by our bodies: 100 80 % Estrone (E1) Estradiol (E2) Estriol (E3) 60 40 20 0 Estrone Estradiol Estriol Bio-identical Estrogens Human Estrogen Premarin Estradiol 10-20% Estrone Estriol 10-20% Estradiol (& others) 5-19% Estrone 75-80% Equilin 6-15% 60-80% Bio-identical Estrogens Human Estrogen Tri-Est (original) 2.5 mg Estradiol 10-20% Estrone 10-20% Estriol 60-80% Estradiol 0.25 mg (10%) Estrone 0.25 mg (10%) Estriol 2.0 mg (80%) Bi-est (Original) 2.5mg Estradiol 0.5mg (20%) Estriol 2.0mg (80%) Benefits of Estrogen Replacement Reduced risk of heart disease Cardiovascular benefits Improves the lipid profile by: Lowering LDLs (bad cholesterol) Increasing HDLs (good cholesterol) ? The cardiovascular risks are reduced by more than half. Benefits of Estrogen Replacement in Osteoporosis Imbalance in bone formation and bone resorption Reduces incidence of osteoporotic fractures by 50%. Works by preventing bone resorption. Urogenital Atrophy Vaginal epithelium has the highest concentration of estrogen receptors in the body. Decreased vascularity Thinning of the blood vessel walls Thin vaginal epithelium Increased vaginal discharge Decreased elasticity Frequent urinary tract infections Atrophic vaginitis Reduced risk of cancer Additional Benefits of Bio-identical Estrogen Replacement Estriol indicated to be “safest” estrogen Metabolites of Premarin®, Estrone, and Estradiol thought to be carcinogenic Less potential undesirable side effects than with conventional synthetics Only approximately 20% of women who start conventional HRT remain on it 2 years later Effects on the Skin Skin water content Collagen Skin thickness Estrogen helps reduce risk of memory disorders by (ex. Alzheimer’s): Benefits of Estrogen Replacement Stimulating acetylcholine production Promoting new growth of nerve connections in the brain Increased reaction time, mental alertness, verbal ability, and cognitive capacity. Estrogen Dominance Relative excess of estrogen High fluctuations of peri-menopause Overdosing of estrogen Lack of progesterone to balance Symptoms include: Fatigue, breast tenderness, fluid retention, headaches, sweet cravings, decreased libido, heavy or irregular menstruation, weight gain, fibrocystic breasts, uterine fibroids, mood swings, loss of scalp hair ESTROGEN DOMINANCE POTENTIAL CAUSES OF ESTROGEN DOMINANCE EXCESSIVE CALORIE INTAKE DIET SUGARS AND HIGHLY REFINED STARCHES STRESS CORTISOL ANOVULATORY CYCLES PHARMACUTICALS BIRTH CONTROL PILLS ENVIROMENTAL EXPOSURE TO XENOESTROGENS NUTRIENT DEFICIENCIES IMPAIRED LIVER FUNCTION ERT AND HRT Benefits of Progesterone Therapy Balances the effects of estrogens 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 Progestins vs. Progesterone 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 bio-identical to the hormone produced in our bodies. Progesterone Oldest known sex hormone Present in every human regardless of age 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 Side Effect Profile Progesterone Slight to moderate drowsiness Synthetic Progestins Breast tenderness Acne Bloating Depression Vision changes Thrombosis Migraine And more………. Progesterone works in harmony with Estrogens to prevent bone loss and promote bone growth. Natural Progesterone has been shown to increase bone density as much as 15%. Medroxyprogesterone does NOT have the same action on bone density. Progesterone and Osteoporosis Combination Hormonal Therapy 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. Testosterone in Women Women produce about 0.3 mg of Testosterone daily pre-menopausal. Women rely on adrenal androgens androstenedione and DHEA for 50% of their total supply of testosterone. Production by the ovary varies with the menstrual cycle, peaking at ovulation due to the LH surge. Benefits of Testosterone Maintaining normal libido and response Increasing bone mineral density and preventing further decline into osteoporosis Maintaining lean body mass, strength and stamina Improved mood, memory and structural integrity of the brain itself Benefits of Testosterone Increased levator ani support and control of sphincters Provides cardiovascular protection (lowers cholesterol) Maintains skin and hair health Improved quality of life Dosing Guidelines PMS Progesterone Oral administration of SR capsules 25 to 400 mg daily Twice a day dosing Give cyclically days 14 through 25 Topical administration 5 to 50 mg daily Dose 2 or more times a day Give cyclically days 14 through 25 Dosing Guidelines Peri-Menopause Oral administration of SR capsules Progesterone 25 to 200 mg daily Dose once or twice a day Give cyclically days 14 through 25 Tri-estrogen or Bi-estrogen If Progesterone alone doesn’t control symptoms 0.625 to 2.5 mg daily Dose once or twice a day Give cyclically days 1 through 25 Continue Progesterone as above Dosing Guidelines Peri-Menopause Topical administration Progesterone 5 to 50 mg daily Once or twice a day dosing Give cyclically days 14-25 Bi-estrogen If Progesterone alone doesn’t control symptoms 0.625 to 1.25 mg daily Apply once or twice daily Give cyclically days 1-25 Continue Progesterone as above Dosing Guidelines Menopause—Surgical Oral administration of SR capsules Tri-estrogen or Bi-estrogen 1.25 to 2.5 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Progesterone 25 to 200 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Testosterone 1.25 to 2.5 mg daily, dosed once a day 5 to 25 mg daily, dosed once a day DHEA (Optional) Dosing Guidelines Menopause—Surgical Topical administration Bi-estrogen 0.625 to 1.25 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Progesterone 20 to 50 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Testosterone 0.25 to 2.0 mg daily, dosed once a day 2.5 to 10 mg daily, dosed once a day DHEA (Optional) Dosing Guidelines Post-Menopause Oral administration of SR capsules Tri-estrogen or Bi-estrogen 1.25 to 2.5 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Progesterone 25 to 200 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Testosterone 1.25 to 2.5 mg daily, dosed once a day 5 to 25 mg daily, dosed once a day DHEA (Optional) Dosing Guidelines Post-Menopause Topical administration Bi-estrogen 0.625 to 1.25 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Progesterone 20 to 50 mg daily, dosed once or twice a day May use continuously or stop 3-5 days per month Testosterone 0.25 to 2.0 mg daily, dosed once a day 2.5 to 10 mg daily, dosed once a day DHEA (Optional) Dosing Guidelines Post-menopause Hormone replacement therapy is needed to maintain vital functions such as cardiovascular, liver, bone, brain, skin, etc., even when the patient is asymptomatic as far as the typical symptoms of menopause. Use lower doses if patient is asymptomatic. Patient/physician may decide to use cyclically and continue a natural menstrual cycle Dosing Guidelines Cancer risk patients Progesterone Oral SR capsules 50 to 200 mg daily, dosed twice a day 20 to 50 mg daily, dosed twice a day Topical Estriol Oral SR capsule 2 to 8 mg daily, dosed once or twice a day 0.5 to 4 mg daily, dosed once or twice a day Topical Triturate up until symptoms become tolerable Indole-3-Carbinol, FOS, Iodine, anti-oxidants, nutrition, diet, and exercise should be considered Adjunctive Therapies Phytoestrogens Black Cohosh Dong Guai Chaste Berry Soy Others Licorice root, Mother Wort, Flaxseed, Evening Primrose Oil, Chamomile, Skull Cap, Valerian Root Adjunctive Therapies Other Factors Healthy Diet Regular Exercise Lifestyle Modification Nutritional Supplementation Pharmaceutical Agents QUESTIONS??? Dosing Guidelines Please note: dosing guidelines are meant to be used as a reference only and are the sole opinion of the author based on his experiences. They in no way indicate a recommendation for any product, patient, or clinical situation. Individual dosage should be determined based on the results of a hormone/total health evaluation of each patient.
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