VIEWS: 23 PAGES: 14 POSTED ON: 6/13/2011
Bio-identical Hormone Restorative Therapy Rebecca Cox, PharmD Dorneyville Pharmacy November 18th 2009 Objectives • Define and identify Bio-HRT • Contrast Bio-HRT to synthetic hormones • Address clinical guidelines for usage • Outline dosing guidelines Bio-identical Hormones • Exact copies of endogenous human hormones • Extracted from plants, synthesized in lab – Estrogen: estrone (E1), estradiol (E2), estriol (E3) – Progesterone – Testosterone – DHEA – Pregnenolone – Hydrocortisone/cortisol (adrenal gland) – Thyroid – Melatonin Goals of Bio-HRT • Alleviate the symptoms of low or imbalanced sex steroid hormones • Imitate the body’s natural processes • Anti-aging – Suzanne Somers Books Estrogen • Varying receptor affinity/receptivity/and metabolic pathways • Estradiol - potent receptor binding – Traditional symptom management (hot flashes and bone) • Estriol - – Highest levels in pregnancy – Weaker than estradiol’s receptor binding in most tissue • High affinity in vaginal and bladder tissue – Acts as an anti-estrogen/estradiol – Binds to ER-ß (prevents breast cancer) – Not pharmaceutically manufactured in U.S. (Wyeth Europe) • Estrone Bio-HRT Estrogen Utilization • Estradiol • Estriol • Bi-est * most utilized – Estradiol 20% : estriol 80% – Estradiol 50% : estriol 50% • Tri-est – Estriol 80% : estrone 10% : estradiol 10% Estrogen Verses Conjugated Equine Estrogen • Premarin® • Extracted from pregnant horse urine • 24 metabolites of horse estrogen • High levels of horse estrone and estradiol Progesterone • Counter-balance of estrogen • Up-regulates estrogen receptors • Receptors in uterus, breast, brain, nerves, blood vessels, skin, kidney, bone, hair follicle, etc. • Aids thyroid activity • Mood enhancement Progesterone Verses Progestin • Clinically superior in side • Synthetic molecule to mimic effect profile and quality progesterone: only similarity is effect on endometrial of life tissue • Decrease breast cancer • Increase risk of: risks – Breast cancer – Ischemic heart disease • No CV risks • Decrease HDL • No effect on HDL Holtorf K. MD. "The Bio-identical Hormone Debate: Are Bio-identical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly used Synthetic Versions in Hormone Replacement Therapy." Postgraduate Medicine, Volume 121, Issue 1, Jan 2009. Estrogen Dominance • Estrogen ratio higher and out of balance with progesterone • No ovulation, period continues • Estrogen stored in fat tissue • Overdosing of estrogen supplementation • Estrogen like chemicals in environment Clinical Application • If estrogen dominant then use progesterone only • Use progesterone only if mild menopause symptoms (1st step) • Always support estrogen therapy with progesterone Testosterone • Women secrete 0.3mg a day • Begins to decline in 30’s • Aids in muscle tone, energy, mental alertness, and libido • Can replace on a daily basis (in combination with estrogen/progest) • Can replace PRN in higher doses for libido Routes of Administration • Oral – Higher doses warranted due to first pass metabolism – May be superior in very thin women • Transdermal – Mimics body processes more closely than oral – Twice daily dosing superior to once daily dosing typically – No increase risk for venous thromboembolism or coagulation problems • Vaginal • Troche/lozenge (sublingual) Compounding • Prepare Bio-HRT individual prescription – Not one size fits all • Combine hormones into one prescription • Answer prescriber and patient questions • Help in dose determination and lab test interpretation THANKS!
Pages to are hidden for
"Bio identical Hormone Restorative Therapy"Please download to view full document