Hormone replacement for menopausal women

January 14, 2009 12:00:00 AM PST
As a woman reaches middle-age, the production of hormones like progesterone, testosterone and estrogen change. These changes can result in many unpleasant symptoms like hot flashes, sleep disturbances, weight gain, decreased libido and many others. However, there's no need to suffer. Peter Koshland, director of pharmacy and compounding for Elephant Pharm, shares information on custom treatments to fit your individual needs.

The most common hormones:

  • Estrogens
  • Progesterone
  • Testosterone

Symptoms of Menopause from hormone imbalance in women include:

  • Hot flashes
  • Low energy
  • Irritability
  • Bone loss
  • Weight gain
  • Decreased libido
  • Insomnia

What are Bio-Identical Hormones?

Bio-identical hormones have the same chemical structure as hormones that are made by the human body. The term "bioidentical" does not indicate the source of the hormone, but rather refers to the chemical structure. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. Bioidentical hormones are able to follow predictable metabolic pathways so that essential active metabolites are formed in response to hormone replacement therapy. They also are recognized by our body's cells for the exact function they are intended for.

Differences between Bio Vs. Synthetic Hormone Replacement Therapy:

Synthetic: "One-size fits all"
Synthetic hormone replacement therapy applies a one-size-fits-all procedure to every patient; regardless of their individual hormonal requirements. Some synthetic hormone replacement therapy makes use of equine hormones (i.e. extracted from horse's urine) or synthetic "progestin's" that are different than the hormones our body produces. Recent clinical trials have shown that a combination of Premarin (equine estrogen conjugates) and Provera (medroxyprogesterone) is more harmful than placebo.


Bio-Identical: "Custom-Treatment"
Bioidentical hormones are tailor-made to suit each person according to their own hormonal make-up. They are engineered to be identical to the patient's hormones. These treatments are individualized and require an analysis of the patient's hormones (usually obtained from saliva) so that they can be replicated properly. Bio-identical hormones are tailor-made to suit each person according to their own hormonal make-up.

How does one approach treatment with BHRT?

1) We recommends a saliva test for determining proper doses. It allows one to measure the free, unbound, biologically-active hormone as it travels by passive diffusion from the capillaries into the saliva.

2) The pharmacy works with your doctor to create a formulation (compounding) treatment, specifically tailored to your unique needs.

What is compounding?

Compounding is the process of creating "custom" prescriptions. Some conditions are best treated with medications that are not available in standard commercial formulations. With a compound prescription, you get the most effective treatment, delivered in the most appropriate or convenient dosage form.

Where can one go for compounding in the Bay Area?

By compounding, BHRT treatments are available in different forms:

  • Topical creams and gels
  • Orally dissolving sublingual troches and drops
  • Oral sustained-release capsules
  • Suppositories

How should I talk to my doctor or pharmacist about it?

A great place to start is to purchase a saliva test. This will provide a snapshot of a person's hormone levels and give guidance as to what approach is best to treating their symptoms. These results can be taken to one's doctor to obtain a prescription. If the doctor has questions about what approach might be best, they should call the compounding provider for guidance. Patients are best served when there is good communication between the pharmacist, the doctor and the patient.

Once hormone therapy has started, symptoms should be monitored by the patient and a follow-up saliva test should be performed in about 6 months.

About Peter Koshland:
With an undergraduate degree in chemistry from Georgetown University and Doctorate in Pharmacy (Pharm.D.) from the University of California, San Francisco School of Pharmacy (the number one pharmacy school according to U.S. News & World Report), Dr. Koshland has a commitment to the symbiosis of science, wellness, and customer care that is unmatched in the industry. He joined Elephant Pharm in 2005 as a pharmacist at the Berkeley location, and before being named to his current position, worked as Pharmacist-in-Charge at the San Rafael store. There, Dr. Koshland was instrumental in establishing Elephant Pharm's custom prescription compounding service, which has grown 500% under his direction. He has been responsible for raising general awareness of compounding to both patients and doctors alike.

For more information, visit Elephant Pharmacy Web site at www.elephantpharmacy.com.