1. Bio-Identical Hormone Replacement Therapy
Raylene Mote Pharm D
Inland Compounding Pharmacy
24747 Redlands Blvd., Suite F
Loma Linda, CA 92399
(909)
9/22/2018

2. Introduction
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 Pharmacy
9/22/2018

3. Topics of Discussion
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
9/22/2018

4. Life Stages Premenopause Begins with the first menstrual period
Monthly fluctuations of LH, FSH, Estrogens, Progesterone
Most common problem is PMS
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
9/22/2018

5. Life Stages Peri-menopause
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”
9/22/2018

6. Life Stages Menopause Post-menopause
Termination of menstrual periods
Onset defined as missing 12 consecutive
Not all women experience problems
Post-menopause
The years following the cessation of menstruation (with or without HRT)
HRT to maintain vital functions such as heart protection, lipid profile, bone mass
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7. Functions of Estrogens
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
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8. Any Questions?
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9. Menopausal Symptoms of Estrogen Deficiency
Hot Flashes
Hair Loss
Dry Skin
Sleep disruption
Night Sweats
Anxiety
Vaginal dryness
Vaginal atrophy
Iritability
Memory Loss
Nervousness
Diminished Sex Drive
Painful intercourse
Urinary incontinence
Heart Palpitations
9/22/2018

10. Goals of Bio-identical HRT
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
9/22/2018

11. Synthetic Vs. Natural Vs. Bio-identical
“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
9/22/2018

12. 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 man-made
May refer to plant or animal source
Precursors found in yam or soy plants
Premarin from pregnant horses’ urine
May refer to phytoestrogens or alternative therapies
9/22/2018

13. Synthetic vs. Natural vs. Bio-identical
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
9/22/2018

14. Bio-identical Hormones
Estrone (E1)
Estradiol (E2)
Estriol (E3)
Progesterone
Testosterone
Dehydroepiandosterone (DHEA)
Pregnenolone
Androstenedione
9/22/2018

15. Benefits of Bio-identical Estrogen Therapy
Reduced risk of cancer
Estriol indicated to be the “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
9/22/2018

16. Conventional “Estrogen” Therapy
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
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17. 9/22/2018

18. Estrogen Dominance Relative excess of estrogen Symptoms include:
High fluctuations of peri-menopause
Overdosing of estrogen
Lack of progesterone to balance
Symptoms include:
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
9/22/2018

19. 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
9/22/2018

20. Side Effect Profile Progesterone Synthetic Progestins
Slight to moderate drowsiness
Synthetic Progestins
Breast tenderness
Acne
Bloating
Depression
Vision changes
Thrombosis
Migraine
And more……
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21. Progesterone 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
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22. Functions of Progesterone
Promote secretory changes in uterine endometrium
Counteracts prolific action of estrogens
Necessary for maintenance of pregnancy
Prepares and maintains uterine lining for implantation of fertilized egg
Decreases uterine contractions
Prepare breasts for lactation
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23. Effects of Progesterone
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
9/22/2018

24. Effects of Progesterone
Anti-estrogen:
Suppresses nuclear estradiol receptors
Induces estradiol dehydrogenase
Suppresses DNA synthesis
Anti-mineralocorticoid effect
Blocks binding of aldosterone to renal receptors therefore causing sodium excretion
9/22/2018

25. 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
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26. Benefits of Progesterone
Natural antidepressant
Helps normalize thyroid
Uses fat for energy
Restores libido
Has a positive effect on cholesterol
Builds bones and protects against osteoporosis
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27. 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
9/22/2018

28. Effects of Testosterone
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
9/22/2018

29. Application of Bio-identical Hormone Replacement
It depends on the individual!!!
Determine needs/goals of the patient
Health evaluation
Individual factors for each patient
Hysterectomy
Thyroid function
History of hormonal cancer
Family history of heart disease, etc.
Weight
Diet, exercise, and stress influences
Previous pharmaceutical agents and response
9/22/2018

30. I Want a Second Opinion!
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31. Adjunctive Therapies Healthy diet Regular Exercise
Lifestyle Modification
Nutritional Supplementation
Pharmaceutical Agents
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32. Questions??? Thank you for this opportunity to share with you today!!
9/22/2018