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Bio-Identical Hormone
     Replacement
         Julie Gorman, PharmD
          D’Lisa Haas, PharmD
        Kristen Riddle, PharmD
        Becca Mitchell, PharmD
 Pamela Sampson, Pharmacy Technician
“The Triad”




              PH
       IAN



                AR
    IC




                   M
  YS




                   AC
PH




                      IST
         PATIENT
What is “Natural”?
        Bio-identical hormones that are
              derived from plants
• Bio-Identical:
   – Hormones that are identical to those made in the
     human body
   – Same exact chemical structure as hormones
     produced by our bodies
• Plant-Derived:
   – Chemically processed from precursors found in
     yam or soy plants
What is “Synthetic”?
   “Patented,” “Conventional,” or “Artificial”

• Usually not found in nature, at least not in humans

• Chemically altered from human hormone

• Not identical in structure or activity to the natural
  hormones they emulate
Progesterone vs Progestin
                        Medroxyprogesterone acetate
                        (Provera)




•Bio-Identical, Human    •Synthetic analog
•Increases fertility     •Contraceptive
Life Stages
PRE-MENOPAUSE
• Begins with first menstrual period
• Monthly fluctuations of LH, FSH, estrogens &
  progesterone
• Most common problem is PMS
   – Neurotransmitter profile affected by fluctuating
     hormones (endorphin, serotonin)
   – Often successfully treated with stress reduction,
     diet, exercise
   – Treated with progesterone, SSRI’s
Life Stages
PERI-MENOPAUSE
• Time between onset of changes in hormonal secretions and
  onset of menopause
• Fluctuating hormone secretions due to intermixed normal &
  abnormal cycles
• Sometimes referred to as period of “Estrogen Dominance”

MENOPAUSE
• Termination of menstrual periods
   – Defined as missing 12 consecutive periods
   – Surgical hysterectomy
Signs & Symptoms of
            Hormone Imbalance
•   Depression           •   Irritability
•   Fatigue              •   Hair loss
•   Poor concentration   •   Fibroids
•   Hot flashes          •   Water retention
•   Breast tenderness    •   Cholestasis
•   Insomnia             •   Weight gain
•   Anxiety              •   Decreased libido
•   Painful menses       •   Breast & uterine cancer
•   Irregular bleeding
Estrogen Benefits & Risks
        Benefits of Adequate Estrogen                      Risks of Excess Estrogen
•   Increase metabolism                        •   Depression
•   Increase insulin sensitivity               •   Fluid retention
•   Maintain muscle mass                       •   Headaches
•   Improve sleep quality                      •   Poor sleep
•   Prevent Alzheimer’s                        •   Irritability/mood swings
•   Reduce cataracts                           •   Fatigue
•   Reduces overall risk of heart disease by   •   Increased risk of auto-immune diseases
    40-50%                                     •   Weight gain
•   Numerous cardiovascular benefits           •   Increased risk of breast & uterine cancer
•   Maintain collagen in skin
•   Decrease blood pressure
•   Maintain memory
•   Improves concentration
•   Maintain bone density
•   Increases energy & sexual interest
•   Decreases wrinkles
Promoting
         Healthy Estrogen Levels
•   Conservative, customized dosing
•   Diet high in grains & fiber
•   Moderate exercise
•   Stress reduction
•   Vitamins B2, B6, B12, Folic Acid
•   Omega-3 fatty acids (fish oil)
•   Healthy body mass index (BMI)
Progesterone & Testosterone
Progesterone                           Testosterone
•Helps balance estrogen                 Increases sexual interest
•Improves sleep                         Increases sense of emotional well-
•Natural calming effect                  being
•Lowers high blood pressure             Increases muscle mass & strength
•Helps the body use & eliminate fats    Helps maintain memory
•Lowers cholesterol                     Helps skin from sagging
•Increases metabolism                   Decreases excess body fat
•Natural diuretic                       Helps maintain bone strength
•Natural antidepressant
•Antiinflammatory                      Natural Ways to Improve Libido
•Stimulates new bone production        • Decrease calorie & increase protein
•Enhances action of thyroid hormones     intake
•Improves libido                       • Exercise
                                       • Get enough sleep
                                       • Lose weight
                                       • Reduce stress
Cortisol
•   Only hormone that increases with age
•   Made by the adrenal glands (on top of the kidneys)
•   Supposed to briefly increase during times of stress
•   Adrenaline is the “run from a bear” stress hormone while cortisol is our
    “stuck in traffic” stress hormone
•   Should start highest in the morning and gradually fall throughout the
    day

Functions:
• Balances blood sugar
• Weight control
• Immune system response
• Stress reaction
• Sleep
Cortisol Imbalance
             High Cortisol                       Low Cortisol
•   Fatigue                                    (Adrenal Fatigue)
•   Irritability                    •   Fatigue
•   Insomnia                        •   Low blood pressure
•   Sugar cravings & binge eating   •   Insomnia
•   Increased osteoporosis risk     •   Decreased sexual interest
•   Decreased immune system         •   Decreased immunity
•   Low energy                      •   Emotional paralysis
•   Night sweats                    •   Allergies
•   Increased cholesterol           •   Unresponsive hypothyroidism (does
•   Insulin resistance                  not respond to treatment)
•   Thin skin                       •   Feeling of being overwhelmed
•   Muscle weakness                 •   Emotional imbalances
•   Easy bruising                   •   Lack of motivation
•   Weight gain around the middle   •   Digestive problems
•   Impaired thyroid function
Balance is Key!




           CO
      D
   OI




              R
   YR




             T IS
 TH




   SEX HORMONES  OL
Our Goals
• Symptom improvement within 2 months
• Improved overall health & quality of life
• Hormone balance through:
  – Conservative dosing
  – Adequate, appropriate nutrition
  – Regular exercise
  – Stress management

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Consult Webinar

  • 1. Bio-Identical Hormone Replacement Julie Gorman, PharmD D’Lisa Haas, PharmD Kristen Riddle, PharmD Becca Mitchell, PharmD Pamela Sampson, Pharmacy Technician
  • 2. “The Triad” PH IAN AR IC M YS AC PH IST PATIENT
  • 3. What is “Natural”? Bio-identical hormones that are derived from plants • Bio-Identical: – Hormones that are identical to those made in the human body – Same exact chemical structure as hormones produced by our bodies • Plant-Derived: – Chemically processed from precursors found in yam or soy plants
  • 4. What is “Synthetic”? “Patented,” “Conventional,” or “Artificial” • Usually not found in nature, at least not in humans • Chemically altered from human hormone • Not identical in structure or activity to the natural hormones they emulate
  • 5. Progesterone vs Progestin Medroxyprogesterone acetate (Provera) •Bio-Identical, Human •Synthetic analog •Increases fertility •Contraceptive
  • 6.
  • 7. Life Stages PRE-MENOPAUSE • Begins with first menstrual period • Monthly fluctuations of LH, FSH, estrogens & progesterone • Most common problem is PMS – Neurotransmitter profile affected by fluctuating hormones (endorphin, serotonin) – Often successfully treated with stress reduction, diet, exercise – Treated with progesterone, SSRI’s
  • 8.
  • 9. Life Stages PERI-MENOPAUSE • Time between onset of changes in hormonal secretions and onset of menopause • Fluctuating hormone secretions due to intermixed normal & abnormal cycles • Sometimes referred to as period of “Estrogen Dominance” MENOPAUSE • Termination of menstrual periods – Defined as missing 12 consecutive periods – Surgical hysterectomy
  • 10. Signs & Symptoms of Hormone Imbalance • Depression • Irritability • Fatigue • Hair loss • Poor concentration • Fibroids • Hot flashes • Water retention • Breast tenderness • Cholestasis • Insomnia • Weight gain • Anxiety • Decreased libido • Painful menses • Breast & uterine cancer • Irregular bleeding
  • 11. Estrogen Benefits & Risks Benefits of Adequate Estrogen Risks of Excess Estrogen • Increase metabolism • Depression • Increase insulin sensitivity • Fluid retention • Maintain muscle mass • Headaches • Improve sleep quality • Poor sleep • Prevent Alzheimer’s • Irritability/mood swings • Reduce cataracts • Fatigue • Reduces overall risk of heart disease by • Increased risk of auto-immune diseases 40-50% • Weight gain • Numerous cardiovascular benefits • Increased risk of breast & uterine cancer • Maintain collagen in skin • Decrease blood pressure • Maintain memory • Improves concentration • Maintain bone density • Increases energy & sexual interest • Decreases wrinkles
  • 12. Promoting Healthy Estrogen Levels • Conservative, customized dosing • Diet high in grains & fiber • Moderate exercise • Stress reduction • Vitamins B2, B6, B12, Folic Acid • Omega-3 fatty acids (fish oil) • Healthy body mass index (BMI)
  • 13. Progesterone & Testosterone Progesterone Testosterone •Helps balance estrogen  Increases sexual interest •Improves sleep  Increases sense of emotional well- •Natural calming effect being •Lowers high blood pressure  Increases muscle mass & strength •Helps the body use & eliminate fats  Helps maintain memory •Lowers cholesterol  Helps skin from sagging •Increases metabolism  Decreases excess body fat •Natural diuretic  Helps maintain bone strength •Natural antidepressant •Antiinflammatory Natural Ways to Improve Libido •Stimulates new bone production • Decrease calorie & increase protein •Enhances action of thyroid hormones intake •Improves libido • Exercise • Get enough sleep • Lose weight • Reduce stress
  • 14. Cortisol • Only hormone that increases with age • Made by the adrenal glands (on top of the kidneys) • Supposed to briefly increase during times of stress • Adrenaline is the “run from a bear” stress hormone while cortisol is our “stuck in traffic” stress hormone • Should start highest in the morning and gradually fall throughout the day Functions: • Balances blood sugar • Weight control • Immune system response • Stress reaction • Sleep
  • 15. Cortisol Imbalance High Cortisol Low Cortisol • Fatigue (Adrenal Fatigue) • Irritability • Fatigue • Insomnia • Low blood pressure • Sugar cravings & binge eating • Insomnia • Increased osteoporosis risk • Decreased sexual interest • Decreased immune system • Decreased immunity • Low energy • Emotional paralysis • Night sweats • Allergies • Increased cholesterol • Unresponsive hypothyroidism (does • Insulin resistance not respond to treatment) • Thin skin • Feeling of being overwhelmed • Muscle weakness • Emotional imbalances • Easy bruising • Lack of motivation • Weight gain around the middle • Digestive problems • Impaired thyroid function
  • 16.
  • 17. Balance is Key! CO D OI R YR T IS TH SEX HORMONES OL
  • 18. Our Goals • Symptom improvement within 2 months • Improved overall health & quality of life • Hormone balance through: – Conservative dosing – Adequate, appropriate nutrition – Regular exercise – Stress management

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