Restoring Hormone Balance Booklet


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Is Hormone Therapy something you're considering to help "feel like yourself" again? If you are, this is a must-have resource for you. This convenient booklet provides a thorough overview of Hormone Therapy, natural vs. synthetic prescriptions, testing, measuring and symptom tracking, delivery forms, non-prescription suggestions for symptom relief and much, much more. Download for free and start educating yourself today!

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Restoring Hormone Balance Booklet

  1. 1. Restoring Balance works Three simple steps to hormone therapy that Bioidentical hormone therapy as individual Restore® as you!
  2. 2. Our Mission Since the first woman suffering with symptoms of hormone imbalance walked through our doors almost thirty years ago, our mission has been one thing and one thing only — to provide women, and men, with options for healthy living and healthy aging by supporting hormone balance — one unique individual at a time. Madison Pharmacy Women’s Health America, Inc. A S S O C I A T E S Madison Pharmacy Associates, LLC • Restore, LLC Madison BioDiagnostics, LLC • Cyclin Pharmaceuticals, Inc.
  3. 3. Table of Contents The Women’s Health America Story 5 Is Hormone Therapy Right For You? 7 PMS Assessment Menopause Assessment 8 Other Considerations 9 Personal Symptom Chart 10 WHA Self-Care Plan 12 Three Steps To Hormone Therapy That Works 15 Step 1. Baseline Testing 16 Step 2. Individualized Prescriptions 18 Bioidentical (Natural) and Synthetic Hormones What to Take 19 Patch, Pill or Cream? 24 When to Take It 26 Step 3. Follow-up Testing 27 Restore® Clinical Services Makes It Simple 29 Real Life Success Stories 31 Putting It All Together 37 Copyright © 2006 Women’s Health America, Inc. All rights reserved. This material is provided for educational purposes only. It is not intended to treat, diagnose, cure, or prevent any disease and has not been evaluated by the FDA. Always seek the advice of your healthcare provider with questions or before undertaking any diet, exercise, or other health program.
  4. 4. 4 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  5. 5. WHA The WHA Story Our story began more than 25 years ago when a young pharmacist, Marla Ahlgrimm, was approached by a doctor who needed help with his patient — a 35-year-old woman who suffered two weeks each month with severe mood swings, irritability, and depression. Through research, Marla found that in Europe they had a name for the woman’s condition — premenstrual syndrome. She also discovered that treatment options prescribed there weren’t available in the United States. Marla worked with the woman’s doctor to develop a special prescription that would modify the woman’s hormonal fluctuations. Through Marla’s work, the woman became the first patient diagnosed with severe PMS (now known as premenstrual dysphoric disorder, or PMDD) in the United States, and the first to use natural progesterone. “The cloud lifted,” was the exact phrase the woman used. Doctors learned of Marla’s success and soon brought new patients to her to have individualized prescriptions filled. In 1982, in response to the demand for customized prescription services, Marla co-founded Madison Pharmacy Associates, the first compounding pharmacy in America to specialize in women’s hormonal health. Over the years, many of Marla’s patients began coming to her for help with other concerns, How to including menopause. She and her staff Use This continued their research and developed even Booklet more innovative, individualized hormone This booklet is designed to therapies, and Women’s Health America, Inc., provide the information you need was born. A few years later, Restore® Clinical to make starting a program of Services was developed, offering comprehensive low-dose, bioidentical hormone hormone therapy that included hormone testing, therapy easy and worry free. individualized prescription care, and free follow- We invite you to share it with up testing to monitor outcomes. your healthcare provider. If you Today, the nurses, pharmacists and staff of have questions or concerns, Women’s Health America have used Marla’s please call us for additional unique approach to work with more than 10,000 information. healthcare providers, offering individualized We can help! hormone therapy to more than 300,000 women — restoring balance, one woman at a time. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 5
  6. 6. 6 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  7. 7. You Is Hormone Therapy right For You? You probably picked up this booklet because something’s not right — you just haven’t felt like yourself lately. Maybe it’s PMS. Perhaps you’re approaching menopause and your hormone levels are starting to change. You’d like to find out more about why you feel the way you do and how to feel like yourself again. You’ve come to the right place. Let’s start with a couple of simple assessments to see if hormone imbalance might be the source of your discomfort. PMS ASSESSMENT If you are still menstruating and your symptoms appear regularly during the two weeks prior to your monthly period, you may be suffering with premenstrual syndrome. Evaluate your symptoms with our PMS Assessment. Never Sometimes Often Do you ... Score – 0 Score – 5 Score – 10 Find yourself crying for no reason? Have dramatic mood swings? Crave sweets, carbohydrates or chocolate? Fly off the handle, feel irritable, anxious or hostile? Have uncomfortably swollen, tender breasts? Have weight gain, especially around the middle? Have headaches, migraines and/or low back pain? TOTAL If your total score is 5 to 20, we recommend the Women’s Health America Self-Care Plan on page 12 as the place to start for managing your symptoms. If symptoms continue, you may also consider measuring your hormone levels. (See page 16.) If self-care is not enough, or you scored more than 20, we recommend talking with your healthcare provider about your symptoms and measuring your hormone levels with a simple saliva hormone test. (See page 16.) If your hormone levels are outside of the normal therapeutic range, hormone therapy may be an appropriate treatment. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 7
  8. 8. Menopause Assessment If you have reached menopause, either naturally or surgically, and you no longer have periods, our Menopause Assessment will help you evaluate your symptoms. If you are still having periods, but they have become irregular, or if you think you are starting to experience symptoms of menopause, we recommend you take the PMS Assessment and the Menopause Assessment, combine your score, and review our recommendations. Never Sometimes Often Do you ... Score – 0 Score – 5 Score – 10 Have less energy, strength and endurance than you used to have? See more wrinkles every time you look in the mirror? Find it easier to gain weight and harder to gain muscle — especially in your midsection? Have difficulty getting a good night’s sleep without waking up repeatedly? Have hot flashes or night sweats? Just not care about sex the way you used to? Find yourself starting to do something and not being able to remember what it was? TOTAL If your total score is 5 to 20, we recommend the Women’s Health America Self- Care Plan on page 12 as the place to start for managing your symptoms. If symptoms continue, you may also consider measuring your hormone levels. (See page 16.) If self-care is not enough, or you scored more than 20, we recommend talking with your healthcare provider about your symptoms and measuring your hormone levels with a simple saliva hormone test. (See page 16.) If your hormone levels are outside of the normal therapeutic range, hormone therapy may be an appropriate treatment. 8 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  9. 9. Other Considerations The Benefits of Hormone Therapy Go Beyond Symptom Management Whatever you scored in your symptom assessment, remember that hormone therapy is not just about keeping symptoms at bay. Far beyond mere symptom alleviation, supplemental hormones play a key role in long-term health and wellness. They can keep you looking and feeling younger. Hormones also assist in prevention of diseases such as osteoporosis, cardiovascular disease, Alzheimer’s — and even certain types of cancer. If you have a family history of any of these diseases, if you had an early menopause, or if you have had your ovaries removed in a hysterectomy, bioidentical hormone therapy may offer distinct long-term health benefits for you. Not All Hormone Therapy Is Created Equal Your hormone profile is as unique as your fingerprints or your DNA. And yet, when it comes to hormone therapy, women are often treated as if we are all exactly alike. It’s no wonder that an estimated 60 to 80 percent of women who begin conventional hormone therapy stop taking their medication. Standard-brand one size fits all prescriptions just don’t work for most women. For hormone therapy to be right for you, your healthcare provider must consider your specific needs, background, and lifestyle. You are a unique individual who deserves careful, individualized treatment at the lowest effective dose. Individualized Hormone Therapy You can expect a better outcome from individualized hormone therapy than from a one size fits all treatment where the same dose of the same synthetic hormones is prescribed for most patients. From conventional to customized medication, your bioidentical hormone therapy can be individualized by utilizing hormones, dosages and delivery systems that meet your unique needs. Lowest Effective Dose Unlike one size fits all dosing, the lowest effective dose of a hormone is the precise amount needed by an individual woman to relieve moderate to severe symptoms and maintain optimal health without undesirable side-effects. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 9
  10. 10. Personal symptom chart When considering whether or not to begin hormone therapy, a Personal Symptom Chart can be a useful tool for you and your healthcare provider. Charting symptoms on a daily basis will help show the pattern and severity of your symptoms and their relationship to your menstrual cycle or menopause. The chart is also a useful tool for recording and evaluating changes in your symptoms after beginning a program of hormone therapy. For greatest accuracy, we recommend you set aside a specific time to complete your chart each day. Rate the level at which you experience each symptom, using the scale of: 1 – Mild 2 – Moderate 3 – Severe If you do not experience the symptom at all, leave the box blank. After you’ve carefully charted your symptoms for four or more weeks, discuss your findings with your healthcare provider. Together, you’ll be able to see if there is a pattern and discuss treatment options. And remember — if you have questions, we are always happy to help. Call us at 800.558.7046 Monday – Friday 8am – 5:30pm CST Restore® Restore® is an exclusive program of Women’s Health America, Inc. Madison Pharmacy Associates, LLC • Restore, LLC • Madison BioDiagnostics, LLC • Cyclin Pharmaceuticals, Inc. 1289 Deming Way • PO Box 259690 • Madison, WI 53725-9690 • 800.558.7046 • Fax 888.898.7412
  11. 11. Patient Name________________________________ Personal Symptom Chart 1-Mild 2-Moderate 3-Severe Date ________________________ Year __________ DAY OF CYCLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Food cravings – carbs/salty/sweet Headaches or migraine Breasts tender/sore/swollen Rapid changes in mood Low back and/or joint pain Warm/flushed skin Bloating/water retention Fatigue/tired Anxiety Weight gain Irritability/anger Muscle weakness Depression Nervousness Lack of energy/endurance Acne/oily skin SYMPTOMS Rapid/irregular heartbeat Forgetfulness Hot flashes/night sweats Vaginal dryness/pain/itching Trouble controlling urine/leaking Lack of sex drive/libido Difficulty falling/staying asleep Foggy thinking Weight loss Hand tremors Decreased focus/attention Women’s Health America • 800.558.7046 • Fax 888.898.7412 • Heavy or irregular periods TALLY:
  12. 12. Women’s Health America self-care plan Many women find a few simple self-care measures go a long way in helping to manage hormonal symptoms. That’s why — whether you choose prescription hormone therapy or not — we recommend our self-care plan as the foundation of any symptom management program. STEP ONE: Your Healthy Diet Instead of “three squares,” try eating three small meals and three snacks daily. Frequent small meals keep your blood sugar stable and avoid energy highs and lows. As you plan your meals and snacks, include a mix of these healthy foods: • Lean sources of protein — most women do not eat enough! • Legumes (lentils and beans) • Foods with soy protein (soy nuts, soy milk, or tofu) • Raw and leafy vegetables and fresh fruit • Low-fat milk, cheese, and yogurt • Whole grain bread, cereal, and pasta • Fish with Omega-3 fatty acids (tuna, mackerel, herring, sardines, salmon, shellfish) Foods to avoid include salty lunch meat, sausage, bacon, high-fat cheeses such as brie, white bread, cake, cookies, jam, honey, molasses, high-salt snacks like potato chips, caffeinated drinks, coffee, tea, soda, and alcohol. STEP TWO: Get Physical! Moderate exercise is great for overall fitness and helps reduce stress. Exercise raises HDL (“good cholesterol”) and reduces triglycerides (fats) in the blood. It builds strong bones, increases heart and lung capacity, and reduces fluid retention. It also causes the release of endorphins, nature’s mood elevators, and increases oxygen and blood flow to muscles, reducing tension. Research shows even a moderate amount of exercise can help. In one study as little as 1 hour and 10 minutes of aerobics, 50 minutes of running, or 1 hour and 20 minutes of swimming a week relieved symptoms. A brisk 20 to 30 minute walk three times a week is a favorite exercise routine among many women who contact Women’s Health America. And, because walking is a weight- bearing form of exercise, it has the added benefit of building strong bones. Other forms of 12 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  13. 13. weight-bearing exercise include dancing, tennis, certain yoga poses, running, and weight training. The quantity and type of exercise are less important than exercising regularly. We recommend about 20 minutes of exercise three or four times a week. STEP THREE: The Right Nutritional Supplements for You Our ProCycle® vitamin/mineral supplements were developed to support a woman’s healthy hormone balance. ProCycle® PMS was specially developed for women with PMS. This therapeutic nutritional supplement contains a balanced combination of B vitamins, magnesium, and calcium. ProCycle PMS contains a beneficial 2-to-1 ratio of magnesium to calcium, shown to help regulate muscle relaxation and blood sugar, and to promote sound sleep. Magnesium may also help reduce the risk of heart attack, stroke, and hypertension, and help prevent migraines in pregnant women. ProCycle® Gold is designed exclusively for women during perimenopause, menopause and beyond. It contains a precise ratio of vitamin E, B vitamins, magnesium, calcium, zinc, and boron. The calcium citrate in ProCycle Gold is easily absorbed. ProCycle Gold is ideal for women using hormone therapy, as well as those who can’t take estrogen or prefer to manage their menopausal symptoms by combining diet and exercise. For more information about either ProCycle® vitamin or to order, call 800.588.7046 or visit STEP FOUR: Stress Management The hectic pace of women’s lives can make it difficult to find time to relax. That makes it even more important to set a regular time to slow down. For most women, relaxation isn’t just one thing — it’s a balance of social, physical, creative, and spiritual activities. But remember, if you experience ongoing physical symptoms or illness, don’t assume they’re “just stress.” Talk to your healthcare provider. STEP FIVE: Educate Yourself Self-care also includes taking time to learn about your body and options for healthy living. We recommend that every woman read The HRT Solution by Marla Ahlgrimm, R.Ph. and John Kells. Self Help for Premenstrual Syndrome by Michelle Harrison M.D. and Marla Ahlgrimm, R.Ph., is another helpful reference for those with PMS. For these books and the latest women’s health information, simply visit our online bookstore at Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 13
  14. 14. 14 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  15. 15. Steps Three Steps to Hormone Therapy That Works You’ve identified your symptoms and discussed them with your doctor. Your self-care plan is in place as the foundation of your symptom management. You’ve done some research and decided you would like to try hormone therapy — but before you take any pills, apply patches, or rub in creams, you need the answers to some questions. What should you take? How much should you take? When should you take it? Answering these questions involves three simple steps: Three Simple Steps 1. BASELINE TESTING Measuring your hormone levels before starting 1. Baseline Testing hormone therapy is essential for determining your 2. Individualized prescriptions unique hormone profile. We also recommend a baseline 3. Follow-up testing measurement of your rate of bone loss for use in developing a self-care or prescription plan for preventing osteoporosis. 2. INDIVIDUALIzED HORMONE PRESCRIPTIONS When individualizing your prescription, there are many options to choose from. Should you choose bioidentical or synthetic hormones? Which dosage form is best for you? Our staff of nurses and pharmacists is here to help you and your healthcare provider understand your options and make those critical decisions. 3. FOLLOW-UP TESTING Periodic saliva hormone and NTx urine rate of bone loss testing are the most accurate and convenient ways to monitor how well your hormone therapy prescription(s) are working. These tests show if your medications have brought your hormone levels and rate of bone loss within the optimal range. If you are experiencing symptoms of overdosing or underdosing, follow-up testing takes the guesswork out of finding where adjustments need to be made. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 15
  16. 16. Step 1: Step 1: Baseline Testing Would you take blood pressure medication without first knowing what your blood pressure is? Then why begin hormone therapy without first measuring your hormone levels. Before taking any hormone medication, it just makes sense to know what your hormone levels are and if they are within the recommended therapeutic range. Baseline hormone testing for women should include: • Estradiol • DHEA • Progesterone • Cortisol • Testosterone We recommend saliva hormone testing over serum (blood) hormone testing for its precision and convenience. Saliva hormone testing is precise Saliva or When measuring hormone levels, you want to know Serum Testing? how much of the hormone is “free” or available to work for you. Your saliva contains only the “free” Blood (serum) tests do not always distinguish between free and bound form of your hormones, so it is an excellent way to forms of hormones, so the results measure this. Blood tests, on the other hand, of a blood test are less precise measure both the free and the inactive, or “bound” than saliva testing. form of hormones. This measurement is less useful since bound hormones are no longer available to work for you. Saliva hormone testing is convenient The convenience of saliva testing is another plus. Our test kit allows you to collect saliva samples in the privacy of your home and use the mailer provided to send them back to our lab for evaluation. This is easier, more convenient and more cost-effective than making an appointment with a local lab for serum testing. Results from your saliva test are sent to your healthcare provider along with our suggestions for your individualized hormone therapy prescription. 16 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  17. 17. NTx urine testing measures rate of bone loss Osteoporosis is one of the greatest health concerns for women. Though many believe osteoporosis is a normal part of the aging process, this is not true. Lifestyle and diet are putting younger generations at a higher risk than the generations that went before them. That is why we also recommend an NTx urine test to measure rate of bone loss. The NTx urine bone loss test is a simple and affordable test where a urine sample can be collected at home and mailed to our lab for analysis. Results can be used to: • Help assess who will receive the greatest long-term bone health benefit from hormone therapy. • Determine the probability of bone mass decreasing in a postmenopausal woman if she does not initiate hormone therapy. • Monitor response once hormone therapy is begun. In as little as three months, NTx measurements can show the effect of your bone loss prevention self-care plan and/or prescription therapy. This is a distinct advantage over the one to two years required to see a change in bone densitometry (DEXA) measurements. You can understand why NTx bone marker technology plays such an essential role in preventing and managing the bone loss that leads to osteoporosis. DEXA testing simply is not enough. Bone Remodeling Strong, healthy bone is continually maintained through the two phases of bone remodeling: resorption (removal) and formation. Bone-resorbing cells called osteoclasts remove old bone by releasing acids and enzymes to remove minerals and collagen. Cross- linked N-telopeptides (NTx) are released into the bloodstream during osteoclastic activity. Once the osteoclasts have done their job, protein-secreting cells called osteoblasts are recruited to the newly resorbed areas on the bone where they deposit new collagen to form new bone. Approximately 20% of bone tissue is replaced annually by this process. When resorption and formation are in balance, there is no net change in bone mass. Disease states, such as osteoporosis, occur when resorption is more active than formation. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 17
  18. 18. Step 2: Step 2: Individualized Prescriptions The consulting pharmacists at Madison Pharmacy Associates work with many women and their healthcare providers to individualize hormone therapy regimens, and are available to advise you and your healthcare provider. Before getting started, it is important to understand why we use only natural, bioidentical hormones in our prescription formulations. Bioidentical (Natural) and Synthetic Hormones Bioidentical and synthetic hormones are very different — the difference is in the molecular structure. A bioidentical hormone has a molecular structure that is identical to the hormones naturally produced by the body. That’s why bioidentical hormones are also referred to as “natural.” A “synthetic” hormone has a molecular structure similar to but not exactly the same as the hormones produced by your body. This difference can mean synthetic hormones interact differently in your body, producing substantially different effects. For example, let’s look at the difference between the synthetic progestins and bioidentical progesterone. The synthetic progestins, such as commonly prescribed Provera®, are similar to the progesterone your body produces, but the subtle molecular differences can significantly influence the hormone’s action. Synthetic progestins can cause side-effects of irritability, nausea, depression, and water retention in some women. Bioidentical progesterone is identical to the hormones made in the body, and many women find it easier to tolerate. PROGESTERONE CH3 You can see that the C O CH3 synthetic hormone O C O medroxyprogesterone O C CH3 acetate, commonly known as Provera® (bottom), has a different molecular CH3 structure than natural MEDROxYPROGESTERONE progesterone (top). ACETATE (PROVERA) 18 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  19. 19. What To Take: Estrogen, Progesterone, Testosterone There is no set combination or dosage of hormones that works for every woman. Hormone therapy typically includes estrogen, progesterone, and/or testosterone. However, it is also important to measure your levels of DHEA and cortisol as these hormones may influence levels of the other three. Which hormones you need and the amount you need depend upon your individual hormone levels and symptoms. • PREMENSTRUAL SYNDROME: Symptoms of PMS such as mood swings, cravings for sweets and chocolate, anxiety, irritability, and crying for no reason may be associated with low levels of progesterone and relatively elevated levels of estrogen. • PERIMENOPAUSE: Declining levels of estrogen and progesterone, and, in some cases testosterone, may be associated with perimenopause symptoms such as hot flashes and sleep disturbances. • MENOPAUSE AND BEYOND: Lower levels of estrogen, progesterone, and testosterone which are typical after menopause, may be associated with hot flashes, sleep disturbance, bone loss, and loss of libido. Let’s look more closely at these hormones and what they do in our bodies. While we tend Estrogens: They’re not all alike to think of estrogen’s “Estrogen” is often used as a general term, relationship to our but it is actually a category of hormones. Of reproductive function first, this the many types of estrogen our bodies make, hormone actually nourishes and three are produced in major amounts. protects our bodies in hundreds of ways, from our hearts, to our Many women call Women’s Health bones, to our skin and hair. In the America and the consulting pharmacists uterus, estrogen causes the lining at Madison Pharmacy Associates to ask (endometrium) to thicken if there is a “natural estrogen” they can and build up each month take. They are often surprised to learn until it is sloughed as that commercially manufactured and a menstrual frequently prescribed forms of estrogen are period. bioidentical (or natural) estrogens. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 19
  20. 20. Choosing among estradiol, estrone and estriol is a Estrogen decision best made based on the specific symptoms Bioidentical estrogens, that need to be managed. Specially compounded derived from soy, include estrogens like Biest or Triest combine two or three estrone, estradiol, and estriol. Estrogen protects against: of the natural estrogens: estradiol, estrone, • Osteoporosis and estriol. • Alzheimer’s disease • Colon cancer Estradiol • Urinary incontinence Estradiol is the most potent form of estrogen, • Tooth loss/decay and the one produced in the largest amounts Estrogen enhances: by a woman’s ovaries before menopause. • Mental sharpness/memory Estradiol levels decline after menopause. The • Brain molecules like brand names Estrace®, Estraderm®, Vivelle®, serotonin and endorphins Alora®, FemPatch™, Estring®, and Climara® • Sleep contain bioidentical estradiol. • Mood • Digestion Estrone • Sex drive Estrone is the predominant estrogen in a woman’s • Skin tone body after menopause. When ovarian function declines, the fat cells in a woman’s body take over the role of synthesizing estrone. Estriol Estriol is known as the “weak” or “forgotten” estrogen. Primarily produced in large amounts by the placenta during pregnancy, estriol is also converted in small amounts by the liver. The fact that estriol is “weak” has pluses and minuses. Estriol has been used vaginally to manage vaginal dryness, urinary infections, and stress incontinence. Estriol does not provide as much heart and bone protection as other more potent estrogens like estradiol and estrone. However, low doses of estriol typically have little or no effect for most women on breast or uterine tissue, so estriol avoids the risk of breast or uterine cell abnormalities associated with estradiol and estrone. Estriol can be taken alone, without progesterone, because it has little to no effect on the uterine lining. A woman who suffers from vaginal dryness and/or incontinence with no family history of heart disease or osteoporosis and with cholesterol and bone density levels within normal ranges, may be a good candidate for estriol. Estriol is not commercially available in the U.S. and must be compounded by a pharmacist. 20 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  21. 21. Progesterone The balance of progesterone and estrogen in a woman’s body is very important. At different times in her life, an imbalance in these hormones can result in symptoms of PMS, perimenopause, or menopause. Symptoms of progesterone imbalance include mood swings, anxiety, cravings for sweets, depression, weight gain, bloating, and breast tenderness. When taken alone as a medication, estrogen can cause the cells in the uterine lining to become crowded or malformed. Progesterone, on the other hand, controls that effect, protecting you from endometrial abnormalities. You can choose between synthetic forms of progesterone (progestins) and bioidentical progesterone (progesterone USP), which must be compounded by a pharmacist. At Madison Pharmacy Associates, we only Progesterone use bioidentical progesterone in The balance of progesterone our formulations. and estrogen in a woman’s body is very important. Progesterone Arriving at the right bioidentical USP (Natural Progesterone estradiol/progesterone combination Cream, Prometrium®, Crinone®) is for you can take some time and a bioidentical progesterone derived adjustment. For many women, from wild yam or soy. Progesterone: 0.5 mg of estradiol and 100 mg of • Decreases risk of endometrial cancer progesterone USP is a good starting • Stabilizes blood sugar, thyroid dosage. The dosage of progesterone, function, and mineral balance however, may vary depending on the • Is necessary for fertility and route of administration, and whether maintaining a pregnancy you are on a continuous or cyclical • Increases energy and sex drive regimen. If the initial dose gives you • May help protect against breast uncomfortable side-effects or doesn’t cancer, fibrocystic breasts, alleviate your symptoms, your healthcare and osteoporosis provider can adjust the dose or try a • Regulates fluid balance different route of administration such as a • Has a calming effect patch, cream or tablet, depending on your • Enhances mood individual situation. Testosterone While traditionally thought of as the “male” hormone, testosterone plays a dramatic role in many aspects of a woman’s physiology and quality of life, Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 21
  22. 22. including libido, sexual satisfaction, bone density, sense of well-being, TESTOSTERONE vasomotor symptoms, and body An androgen, produced in men and in substantially smaller amounts composition. Testosterone is particularly in women, this hormone declines in important because it activates the sexual both men and women as they age. circuits in the brain. Testosterone: At menopause when our ovaries no longer • Builds and promotes muscle tone release eggs, they also stop producing the • Increases energy • Decreases fatigue potent forms of estrogen (estradiol and • Increases sex drive estrone) and progesterone, and they slightly • Enhances well-being decrease production of testosterone, which • Strengthens bone changes the ratio of testosterone to estrogen and progesterone. Today it is not unusual to include testosterone in a woman’s hormone therapy regimen. Transdermal patches, sublingual tablets, topical gels, and oral capsules can be prescribed and individually compounded for each patient using bioidentical testosterone. DHEA Another critical hormone manufactured in the adrenal glands is dehydroepiandros- terone, commonly known as DHEA. DHEA has received a great deal of media attention and is often referred to as the fountain of youth hormone. Levels of DHEA peak at about 20-25 years DHEA of age then begin to decline. DHEA protects Called the “fountain of youth” hormone, DHEA helps protect against the effects of stress. The decline of against ailments associated with DHEA levels that comes with age correlates aging such as cancer, diabetes and with a general decline in immunity, memory, heart disease. libido, energy, and lowered resistance to age- DHEA: related diseases. • Enhances brain function and memory • Supports the immune system Unfortunately, DHEA’s fountain of youth • Helps prevent blood clots reputation has led to a dramatic increase in its over-the-counter usage. We say unfortunately, because there are some significant potential side- effects from taking too much of this hormone. 22 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  23. 23. Remember, hormones are powerful substances the body produces to carry out critical functions, and the level of one hormone can affect the level of another. When other hormones are balanced, DHEA levels typically increase without supplementation. On the other hand, too much DHEA can “cascade” or turn into other hormones in the body, creating imbalance and the side-effects associated with it. DHEA is also a mild blood thinner and stimulant, which can lead to over-stimula- tion of the thyroid. People who take aspirin, blood thinners, stimulants, or a thyroid prescription may need to have dosages altered if they are also taking DHEA. Though DHEA is available without a prescription, measuring your hormone levels before supplementing this hormone is as important as with any other hormone. Cortisol The most important and potent hormone produced in the adrenal glands is cortisol, known as the stress hormone. Cortisol helps in responding to and coping with stress, injury, and infection. It also affects the activity of other hormones such as insulin, thyroid, and DHEA. Cortisol is involved in balancing blood CORTISOL sugar, protein synthesis, proper immune Often referred to as the “stress” hormone. function, and REM sleep — the deep sleep Cortisol helps: where the body is relaxed, but the brain is • Cope with stress and injury active and dreaming. It also affects rate of • Control weight gain bone breakdown. • Balance blood sugar • Maintain immune function Chronic stress may decrease your cortisol • Aid protein synthesis level while acute stress may elevate it. As • Improve REM sleep with other hormones, too little or too much cortisol can be damaging. The symptoms of too little cortisol include fatigue, sugar craving, allergies, molecular sensitivity, stress, cold body temperature, and heart palpitations. Too much cortisol can result in sleep disturbances, depression, bone loss, weight gain in the midsection, thin skin, and loss of muscle mass. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 23
  24. 24. Patch, Pill, or Cream? There are many forms of bioidentical hormone therapy to choose from, ranging from conventional forms like the estradiol patch, to customized forms like the Even-Release Oral Tablet or the aplía™ Metered Transmucosal Applicator — available exclusively from Madison Pharmacy Associates. There are several factors you and your healthcare provider will want to consider when choosing the dosage form that is best for you. These include: • Symptom Management. Identifying the symptoms you want to manage will help determine the appropriate dosage form. For example, the level of heart and bone protection differs with various hormone dosage forms. Your individual profile and family history may also come into play. • Convenience. Some women choose the form of hormone therapy that is easiest for them to remember to take. • Cost. For some women, cost factors into their decision. Points to keep in mind When deciding between oral, vaginal cream, transdermal patch, or transdermal cream estrogen, here are a few points to keep in mind: • The skin patch may be a good choice for you if your triglyceride levels are abnormally high. Transdermal estrogen does not raise triglyceride levels. Oral estrogen appears to increase triglyceride levels somewhat because it passes through the liver. • The aplía™ Metered Transmucosal Applicator, may be a convenient tool for you if you are using multi-hormone therapy creams. Each metered dose is quickly absorbed transmucosally, without all the mess of most creams. • The adhesive on the estrogen skin patch sometimes causes skin irritation and the patch is more expensive than oral estrogen. • Estrogen in cream form is very effective in treating urinary and vaginal problems. • Vaginal estrogen creams may not protect against heart disease or bone loss. 24 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  25. 25. Available Exclusively from Madison Pharmacy Associates Several of our dosage forms have been developed by and are available exclusively from Madison Pharmacy Associates. IG OR IN ™ Metered Transmucosal Applicator TM MPA AL S Our latest advancement in precise, controlled hormone replacement therapy dosing - aplía™! Convenient and discreet, the aplía applicator is designed to administer a metered dose of multi-hormone cream directly to the vaginal opening or labial area. An FDA approved devise, aplía offers a convenient alternative to messy creams. IG OR IN s Customized Transmucosal Even-Release Oral Tablet MPA AL Applicator S This breakthrough progesterone delivery system introduced in 1986, combines slow, Even-Release of medication with the convenience of dosing once or twice daily. IG OR IN Rapid Act Sublingual Tablet MPA AL S Our innovative sublingual (under tongue) delivery system is convenient, pleasantly orange-flavored, and dissolves under the tongue in less than one minute. Sublingual tablets can be compounded using hormones such as progesterone, testosterone, DHEA, estradiol, estriol, Triest, Biest, and pregnenolone, either singly or in combination. IG OR IN Customized Transdermal Patch MPA AL S This is not a standard-dose, one size fits all patch, but one that is created and dosed just for you. The innovative patented matrix of our transdermal patch acts as a reservoir for continuous delivery of individual or combined hormone therapy. IG OR IN MPA Percutaneous Gel AL S s Customized Transdermal Patch Our patented gel delivery system allows the natural matrix of the skin to deliver continuous, consistent absorption of individual hormones or hormone combinations with the convenience of once a day dosing. IG OR IN Oral and Chewable Tablets MPA AL S Oral tablet dosages can be compounded using single or a combination of hormones including progesterone, estradiol, estriol, DHEA, pregnenolone, testosterone, Biest, and Triest. Chewable tablets can be formulated for those who have difficulty swallowing medication. IG OR IN Micronized “In Oil” Oral Capsule MPA AL S These oral capsules can be compounded with a single or combination of hormones including progesterone, estradiol, estriol, Triest, Biest, DHEA, liothyronine, thyroid, and pregnenolone. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 25
  26. 26. IG OR IN MPA AL Creams and Ointments S Hormone creams and ointments offer complete strength and dosage flexibility. Studies show that wild yam and hormone creams available over the counter vary widely in content, effectiveness, potency, quality, and price. Prescribed hormone creams assure you a quality therapeutic product, often at a lower price than those products available without a prescription, and are subject to insurance reimbursement. IG OR IN Anti-Aging Facial Serum MPA AL S Estriol, the mildest of all estrogens, has been shown to reverse the signs of skin aging and wrinkling in perimenopausal and menopausal women. With a prescription from your health- care provider, Madison Pharmacy Associates can compound an estriol facial cream just for you. IG OR IN Suppositories and Vaginal Tablets MPA AL S A variety of hormones can be compounded in suppository form for vaginal or rectal use. Using specialized vaginal tablet disintegrant systems, we compound a variety of vaginal hormone tablets that require no special storage conditions and need limited vaginal moisture to dissolve. Conventional Estradiol Patch Low-dose, commercially prepared, bioidentical estradiol patches such as Climara® and Vivelle® are also available from our pharmacy. When to take it There are two regimens to choose from when individualizing your hormone therapy: cyclical and continuous combined. CYCLICAL is recommended for women still cycling because it mimics a menstrual pattern. Using this regimen, you take progesterone on days 14-28 of a 28-day cycle; estrogen (if needed) days 1-21; and testosterone (if needed) daily. When you finish taking progesterone each month, you experience bleeding as your body “withdraws” from the hormone progesterone, and the endometrial lining sloughs away. CONTINUOUS COMBINED is recommended for women who are no longer having menstrual cycles. Using this regimen, you take estrogen and progesterone every day. This eliminates breakthrough bleeding though there may be some initial spotting in the first one to three months. Women also experience fewer side-effects with this regimen. Consult with your healthcare provider to determine which regimen is best for you. 26 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  27. 27. Step 3: Step 3: Follow-up Testing According to Dr. Wulf H. Utian, Executive Director of North American Menopause Society: 1) No single hormone “recipe” exists that will fit every woman. The first regimen you try may not work for you, but don’t give up. Your doctor should fine- tune your hormone regimen to your individual needs, your risk factors, your symptoms and your lifestyle, before and during therapy. 2) The therapy must be evaluated at least annually by both you and your healthcare provider, sooner if you experience side-effects or problems. Follow-up testing is the most scientific and accurate way to take the guesswork out of finding the right “hormone recipe” for you and for evaluating your therapy. A follow-up hormone test and NTx urine test will show your healthcare provider exactly how your body has responded to the hormone medications you are taking. Test results can than be used to help s NTx Testing determine any adjustments that may be needed. Follow up Testing After three months of initial therapy, it’s time to measure your hormone levels and NTx bone metabolism again to see how they have changed, and if they are now within the desired therapeutic range. The results of these tests, along with your symptom chart, will help you and your healthcare provider decide if any change to your medication is advised. An annual evaluation thereafter will help you and your healthcare provider know if your hormone levels are within the desired therapeutic range or if additional adjustments may be beneficial. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 27
  28. 28. 28 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  29. 29. Restore Restore® Clinical Services Makes It Simple Individualized, low-dose hormone therapy is the wave of the future, but it is new for many healthcare providers. Fortunately Women’s Health America and Madison Pharmacy Associates have successfully used this approach for more than twenty years. Our Restore® Program was the first and remains the only comprehensive hormone therapy program of its kind to provide testing, individualized prescriptions, and on-going evaluation. Our Restore nurses and pharmacists work with you and your healthcare provider to make the best therapeutic decisions for your unique needs. The Restore® Program includes: “The Restore® 1. Baseline testing. We provide analytical measurement program from of saliva to determine your levels of estrogen, progester- Women’s Health America one, testosterone, DHEA, and cortisol. NTx urine is provides customized dosing used to measure rate of bone resorption. for individual patients, 2. Individualized bioidentical prescriptions. merging the patient clinical We work with your healthcare provider to customize needs with supporting your prescription at the lowest effective dose recom- laboratory data. It’s the future mended for your symptoms and medical history. of hormone therapy.” 3. Follow-up saliva hormone and NTx urine - Claude Hughes, M.D.,Ph.D., testing. At three months, follow-up testing helps to Duke University determine necessary lifestyle/medication adjustments Medical Ctr. needed to maintain hormone levels in a therapeutic range, avoiding the side-effects of overdosing and the consequences of underdosing. Restore® offers a revolutionary fourth step — FREE annual follow-up testing. The Restore clinical team assists in evaluating and adjusting your ongoing plan of care to assure optimal therapeutic outcomes at the lowest effective dose for as long as your hormone prescriptions are filled through our pharmacy, Madison Pharmacy Associates. Getting Started Getting started in the Restore® program is easy. Simply have your healthcare provider complete a Restore enrollment form and fax it to us at Women’s Health America. We’ll take care of the rest — from mailing your sample collection kit to faxing results to your healthcare provider. Please call our Restore® Specialists at 800.558.7046 if you would like more information for you or your healthcare provider. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 29
  30. 30. 30 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  31. 31. Real Life Real Life Success Stories Thousands of women have used saliva hormone testing as part of an individualized hormone therapy program. The following stories illustrate the success of this revolutionary approach. Jane Ann Jane Ann is a 49 year-old financial planner who relied on a self-care program that included a healthful diet, a regular workout, and ProCycle® Gold vitamin-mineral supplement to manage her occasional hot flashes. Gradually, in spite of everything she was doing on her own, Jane Ann’s hot flashes became a daily (and nightly) occurrence. A person who prides herself on keeping details within her grasp, Jane Ann also noticed a few gaps in memory that concerned her. She would call a client on the phone and, right after saying hello, forget why she called. Or, plucking a report from her shelf, she would search through it and suddenly forget what she was looking for. Jane Ann decided to discuss her concerns with her doctor during her routine annual physical exam. She told him she had not had a period for quite a few months. During their conversation, she admitted that, along with her other symptoms, she was also feeling close to tears more frequently, often without any reason she could identify. Jane Ann’s doctor listened intently and then explained to her that her symptoms, combined with her age and the fact that her cycles seemed to be waning, led him to believe she was entering menopause and her estrogen level was low. He gave her a prescription for Premarin® and Provera®, a commonly prescribed combination of conjugated estrogens and a synthetic progestin. A week later, Jane Ann was on the phone with her doctor, reporting that her symptoms seemed worse. Her normally cheerful outlook was bleak, her breasts were very tender, and she felt bloated. She didn’t understand what was happening. (continued) Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 31
  32. 32. Having just returned from a seminar on saliva hormone testing, Jane Ann’s doctor suggested running a saliva hormone test to measure her free hormone levels. After reviewing the results of the saliva measurement, he could see that her estradiol level was now above the expected range of 3 to 5pg/ml for a woman who is still having her menstrual cycle. Jane Ann’s estradiol level was 18.7 pg/ml. Her doctor correctly surmised that her symptoms were being exacerbated by the excess amount of estrogen she was getting from her prescription. To find the right dose of hormone for Jane Ann, her doctor consulted with a Madison Pharmacy “... many Associates pharmacist knowledgeable in saliva women find hormone test interpretation and individualized, “bioidentical” bioidentical hormone dosage. Knowing that many women find “bioidentical” hormones hormones — which are molecularly identical to the — which are hormones a woman’s body produces — easier to molecularly tolerate, the pharmacist suggested changing Jane Ann’s prescription from Premarin® and Provera® identical to the to bioidentical estradiol and oral micronized hormones a progesterone. He also suggested adjusting her woman’s body dosages to 0.5mg of estradiol and 100 mg of progesterone, to be taken twice a day. produces — easier to Within a day or two, Jane Ann felt like herself again. A follow-up saliva test 30 days later tolerate ...” showed that indeed, her estradiol level was 3.2 pg/ml and her progesterone level was 0.4 ng/ml. Both were well within the ranges that occur in a woman who is still menstruating. Jane Ann’s hot flashes were under control, she wasn’t teary any longer, and best of all, she felt like herself again. 32 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  33. 33. Celeste Celeste is a healthy and active woman. When she started to have perimenopausal symptoms at 47, she decided to try self-help measures to get herself through the change. She read books on natural approaches to menopause, adjusted her diet, began an exercise regimen, and took nutritional supplements and herbs. Three months later, she still found herself crying at the drop of a hat, craving foods like pasta, chocolate and potatoes, and having increasingly hotter hot flashes. Both she and her husband grew frustrated. One night, her husband even bolted upright in bed and said, “What is it with you and the covers? One minute they’re on, the next minute they’re flying off!” Celeste continued her search for answers to her perimenopausal woes. She found an over-the-counter natural progesterone cream on the Internet. When Celeste received her cream, she read the instructions. She assumed that even though her periods had become irregular, she should take the dose recommended for a premenopausal woman who is still menstruating. For several weeks, while Celeste was using the cream, she had good results: improved mood, fewer food cravings, less frequent hot flashes, and more restful sleep. But, within a short time, her symptoms seemed to be returning. She wondered if she might be farther along in the change than she had originally thought. “Maybe “On top of I’m not using enough of the cream,” she wondered. everything else, She decided to apply more. Almost immediately, Celeste began feeling sleepy all the time. On top of her sex drive was everything else, her sex drive was dwindling, and dwindling, and she was becoming increasingly worried. What if she was becoming it wasn’t the change at all? What if something was really wrong with her? She stopped using the cream increasingly and made an appointment with her doctor. worried.” Celeste told her doctor what was happening and he ordered a blood test to measure her hormone levels. The results showed that her estrogen and progesterone levels were what you would expect in a woman who is still menstruating. “Your hormones look fine,” her doctor told her. “Maybe you are just having a hard time adjusting to your body changing.” Celeste was puzzled and frustrated. She intuitively knew this wasn’t just in her head — something was going on with her hormones. (continued) Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 33
  34. 34. She stopped using the progesterone cream and spent a few more late nights on the Internet. There she found some interesting information from Women’s Health America on saliva hormone testing. She was intrigued enough to call her doctor and ask if saliva testing would be appropriate for her. Although he wasn’t familiar with saliva hormone testing, he agreed to review the information Celeste had found. A few days later he called back to say he was willing to order the saliva hormone test and consider the results. Celeste had two saliva hormone tests, 30 days apart. At first, her progesterone levels were .03 ng/ml, well below the target range for a woman her age who was still menstruating. After consulting with a Madison Pharmacy Associates pharmacist, Celeste’s doctor offered her the option of continuing to use the over-the-counter cream she had in a lesser amount, or he could give her a prescription cream. In either case, it was important to monitor the dosage more closely than Celeste had been able to do when she applied the over-the-counter cream in varying amounts. Celeste chose to use the prescription cream. She began feeling better right away. After another month of using her new prescription progesterone cream, Celeste was feeling quite well. However, her follow-up saliva test showed that her progesterone level was slightly above the expected range. This information indicated that her dosage could be decreased. Her doctor lowered her dosage again, this time recommending that she use only 10 mg of cream a day, in two doses of 5 mg each. Celeste felt terrific using this amount, and 30 days later her saliva test showed her progesterone level at .4 pg/ml — right within her target range. Three very important things were accomplished in Celeste’s case: • First, she and her doctor were able to obtain a precise picture of her free hormone levels using saliva testing. • Second, together with a pharmacist knowledgeable in individualized, bioidentical hormone therapy, Celeste’s doctor was able to adjust her dosage to exactly what she needed. • Third, Celeste and her doctor have an ongoing means of monitoring her progress with follow-up testing and dosage adjustment as needed. As Celeste’s body continues to change, her hormonal level requirements may change, too. When they do, she and her doctor can respond with more information and less guesswork. 34 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  35. 35. Frieda and Sam Having too much of a hormone can cause uncomfortable side-effects, but as Frieda experienced, too little of a hormone can cause discomforts as well. Frieda and her doctor used saliva testing to determine which hormones she needed to help with her declining sex drive. A widow at 56-year-old, Frieda had recently married Sam. Even though they were happy and very much in love, both Frieda and Sam felt like their relationship lacked the sexual spark they had each known in the past. Frieda had seen headlines about testosterone’s ability to re-ignite her desire. She asked her doctor if testosterone might help her and Sam feel more interested in lovemaking again. Frieda’s doctor wasn’t ready to take that step without more information. He talked with Women’s Health America about measuring Frieda’s estradiol, progesterone, DHEA, cortisol, and testosterone levels so he could have the most complete picture of her hormonal profile. We suggested he also measure Sam’s levels of estradiol, DHT, DHEA, and testosterone. Frieda “With Frieda and Frieda’s baseline saliva test showed low estrogen Sam’s hormones and progesterone, but the amount of DHEA, back in balance, cortisol, and testosterone her body was producing were fine. In Frieda’s situation, balancing her the newlyweds progesterone and estrogen levels was all that were worry-free, was needed to restore her libido. Supplemental testosterone might have produced unwanted side- and began looking effects. Thanks to saliva testing, Frieda didn’t have forward to a long to worry about side-effects because she was taking and fulfilling exactly what she needed. relationship.” Sam Sam’s baseline saliva test showed that his testosterone level was below the normal therapeutic range. To bring his hormones back into balance, his doctor prescribed a 20 mg/gm testosterone gel to be applied once daily. Like Frieda, Sam also started to feel like himself again. With Frieda and Sam’s hormones back in balance, the newlyweds were worry-free, and began looking forward to a long and fulfilling relationship. Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 35
  36. 36. 36 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  37. 37. A Note Putting It All Together A note from Marla Ahlgrimm, R.Ph. Founder and CEO, Women’s Health America, Inc. Hormones control many aspects of our lives. Hormone imbalance can be the source of PMS and the many unwelcome symptoms of perimenopause, menopause, and for men, andropause. The natural decline in hormone levels as we age can also be the source of health problems like osteoporosis and cardiovascular disease. Self-care can go a long way toward managing symptoms of hormone imbalance and decline. When self-care is not enough, saliva testing is a simple means for assessing many of the variables involved in choosing a hormone therapy program. These variables include the individuality of your own hormone profile, the unique way you absorb and utilize hormones, and the way your needs change over time. With its emphasis on balance and synergy, the goal of our Restore® program for individualized hormone therapy is to put an end to overdosing and underdosing of critical hormones. This comprehensive approach using bioidentical hormones, saliva testing, and free follow-up testing is designed to take the confusion out of hormone replacement while meeting each woman’s individual needs. Remember, there are many variables to consider in hormone therapy. Everything from how old you are to the level of stress in your life affects what is going on with you hormonally. Who you are and how your body works is a key factor in the way your hormone restoration program will work for you. Our revolutionary, individualized approach to hormone therapy is a giant leap forward in healthcare and anti-aging. I hope you found the information in this booklet valuable. If you still have questions about whether hormone therapy is right for you, please call us at 800.558.7046 or visit We can help! In good health, Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 37
  38. 38. 38 Women’s Health America • 800.558.7046 • Fax 888.898.7412 •
  39. 39. WHA Women’s Health America • Madison Pharmacy Associates From conventional to customized, our pharmacy can fill all your bioidentical hormone therapy prescriptions. • Madison BioDiagnostics Our full line of laboratory services includes saliva hormone testing, NTx urine bone loss analysis, and more. • Restore® — Exclusively from Woman’s Health America, Inc. This innovative program for comprehensive hormone therapy combines low-dose, bioidentical hormone therapy with baseline testing and free follow-up testing to monitor outcomes. • Free Follow-up Testing FREE annual hormone testing and NTx bone loss analysis are provided for anyone who’s hormone prescription(s) are filled through Madison Pharmacy Associates. • Health Care Provider Referral Use our preferred provider listing to locate hormone therapy healthcare professionals in your area. • You’ll find extensive information about bioidentical hormone therapy, PMS, menopause, perimenopause, andropause, and more on our website. Questions about which services are right for you? Our staff of professionals are available to answer your questions Monday through Friday 8:00 a.m. to 5:30 p.m. CST 800.558.7046 Madison Pharmacy Women’s Health America, Inc. Madison Pharmacy O C I A T E • S A S S Associates, LLC Restore, LLC Madison BioDiagnostics, LLC • Cyclin Pharmaceuticals, Inc. 1289 Deming Way • PO Box 259690 • Madison, WI 53725-9690 800.558.7046 • Fax 888.898.7412 Women’s Health America • 800.558.7046 • Fax 888.898.7412 • 39
  40. 40. We wrote the book on hormone therapy by Marla Ahlgrimm, R. Ph. and John M. Kells, with Christine Macgeen Rodgerson Everything you and your healthcare provider need to know about why synthetic hormone therapy has not worked for many women - and “The HRT Solution why natural hormone therapy does - is right should be the bible of hormone replacement here. Marla Ahlgrimm explains the difference for any woman who is on in clear, concise terms illustrated with real-life hormones or considering stories from patients. taking them. Any other approach just isn’t good The HRT Solution introduces a new approach enough.” to hormone therapy that is natural and as - Christine Northrup, M.D. individual as you. Testing to assess and monitor author of The Wisdom of Menopause and Women’s hormone levels is combined with customized, Bodies, Women’s Wisdom low-dose therapy using bioidentical hormones, identical to those your body naturally produces. Only $14.95 plus shipping and handling Order by phone at 800.558-7046 or online at Madison Pharmacy A S S O C I A T E S Restore® is an exclusive program of Women’s Health America, Inc. Madison Pharmacy Associates, LLC • Restore, LLC • Madison BioDiagnostics, LLC • Cyclin Pharmaceuticals, Inc. 40 Women’s Health America 259690 • Madison, WI• 53725-9690 • 800.558.7046 • Fax 888.898.7412 1289 Deming Way • PO Box • 800.558.7046 Fax 888.898.7412 • REV 04-2010 Ref #: RRBKLT-02