This document discusses compounded bioidentical hormone therapy (CBHT). It defines bioidentical hormones as compounds that have the same chemical structure as endogenous hormones. CBHT involves custom-compounded formulations prescribed by a healthcare provider and dispensed by a pharmacy. Several medical organizations recommend against CBHT due to lack of FDA approval and standardization. The document reviews the endocrine system, plant-derived hormone precursors, hormone receptors, and formulations like bi-est and tri-est. It notes concerns about estriol and increased breast cancer risk with testosterone supplementation.
This document discusses anti-aging therapies through balancing bio-identical hormones. It notes that Suzanne Somers uses many hormones like growth hormone, thyroid hormone, estradiol and progesterone in her regimen. The document defines anti-aging as making lifestyle changes like diet, exercise and supplementing bio-identical hormones to natural levels to influence cellular changes that improve health. It states that hormones decline with age and are critical for metabolism, gender differences, energy and mood. Optimal hormone levels through bio-identical replacement can prevent diseases and improve quality of life without proven harm.
Bio Identical Hormone Replacement Therapy PresentationAzani Medical Spa
Dr. Monica Carezani Gavin, Diplomate of the American Academy of Anti-Aging Medicine, explains bio identical hormone replacement therapy (BHRT). BHRT as used by Suzanne Somers and Dr. Phil\'s wife and talked about by Oprah. Dr. Gavin provides BHRT through her medical practice Azani Medical Spa in Bethlehem Pa.
Although typically not thought of as a major medical concern, hormone imbalances affect millions of people all over the world and can dramatically hinder the daily lives of both men and women. As we age, hormone levels such as Testosterone, Estrogen and Thyroid, Progesterone, DHEA, Pregnenolone, Melatonin and Cortisol drop or become imbalanced.
Bio Identical or Natural Hormone Replacement Therapymiddela
The document discusses bioidentical hormone restoration as a means to replace hormones lost due to aging. It argues that losing hormones is not adaptive and leads to various health issues. Restoring youthful hormone levels through bioidentical replacements can improve health, prevent disease, and enhance quality of life by treating symptoms caused by hormone deficiencies. Common hormones that decline with age include testosterone, growth hormone, DHEA, progesterone, and estrogen.
This document summarizes options for treating menopause symptoms including hormone replacement therapy and bioidentical hormones. It discusses formulations, dosages, administration routes, side effects and risks of both approaches. Specifically, it notes that bioidentical hormones have an identical chemical structure to human hormones, while synthetic hormones only mimic some functions. Transdermal delivery and lower doses of bioidentical hormones may provide a more favorable risk-benefit profile.
A sweet manual to hormone replacement treatment products and services. Call now to speak with one of our clinical specialists now to get you started on the path to youthfullness.
Bio-identical hormone replacement therapy aims to restore declining hormone levels to those of a 30-year old using natural hormones that are molecularly identical to those produced by the human body. It can improve well-being, quality of life, and promote a longer, healthier lifespan by reducing the risk of diseases like heart disease, cancer, diabetes, and osteoporosis. The therapy prescribes hormones derived from plant sources like soy and yam oils that are not associated with the side effects of synthetic hormones.
Bioidentical Hormone Replacement presentation version 2Paul Cox
This document discusses hormone optimization for men through regenerative and integrative medicine approaches. It provides background on the author's qualifications and outlines key concepts in functional and anti-aging medicine like optimizing the body's self-repair mechanisms with hormones, lifestyle changes, and supplements. Specific hormone pathways like thyroid and testosterone are examined, symptoms of deficiencies are defined, and testing and treatment options like bioidentical hormones, gels, injections, and implants are described. The benefits of hormone optimization are stated to include increased energy, mood, mental clarity, fitness and sex drive. Brief patient testimonials endorse the positive effects.
This document discusses anti-aging therapies through balancing bio-identical hormones. It notes that Suzanne Somers uses many hormones like growth hormone, thyroid hormone, estradiol and progesterone in her regimen. The document defines anti-aging as making lifestyle changes like diet, exercise and supplementing bio-identical hormones to natural levels to influence cellular changes that improve health. It states that hormones decline with age and are critical for metabolism, gender differences, energy and mood. Optimal hormone levels through bio-identical replacement can prevent diseases and improve quality of life without proven harm.
Bio Identical Hormone Replacement Therapy PresentationAzani Medical Spa
Dr. Monica Carezani Gavin, Diplomate of the American Academy of Anti-Aging Medicine, explains bio identical hormone replacement therapy (BHRT). BHRT as used by Suzanne Somers and Dr. Phil\'s wife and talked about by Oprah. Dr. Gavin provides BHRT through her medical practice Azani Medical Spa in Bethlehem Pa.
Although typically not thought of as a major medical concern, hormone imbalances affect millions of people all over the world and can dramatically hinder the daily lives of both men and women. As we age, hormone levels such as Testosterone, Estrogen and Thyroid, Progesterone, DHEA, Pregnenolone, Melatonin and Cortisol drop or become imbalanced.
Bio Identical or Natural Hormone Replacement Therapymiddela
The document discusses bioidentical hormone restoration as a means to replace hormones lost due to aging. It argues that losing hormones is not adaptive and leads to various health issues. Restoring youthful hormone levels through bioidentical replacements can improve health, prevent disease, and enhance quality of life by treating symptoms caused by hormone deficiencies. Common hormones that decline with age include testosterone, growth hormone, DHEA, progesterone, and estrogen.
This document summarizes options for treating menopause symptoms including hormone replacement therapy and bioidentical hormones. It discusses formulations, dosages, administration routes, side effects and risks of both approaches. Specifically, it notes that bioidentical hormones have an identical chemical structure to human hormones, while synthetic hormones only mimic some functions. Transdermal delivery and lower doses of bioidentical hormones may provide a more favorable risk-benefit profile.
A sweet manual to hormone replacement treatment products and services. Call now to speak with one of our clinical specialists now to get you started on the path to youthfullness.
Bio-identical hormone replacement therapy aims to restore declining hormone levels to those of a 30-year old using natural hormones that are molecularly identical to those produced by the human body. It can improve well-being, quality of life, and promote a longer, healthier lifespan by reducing the risk of diseases like heart disease, cancer, diabetes, and osteoporosis. The therapy prescribes hormones derived from plant sources like soy and yam oils that are not associated with the side effects of synthetic hormones.
Bioidentical Hormone Replacement presentation version 2Paul Cox
This document discusses hormone optimization for men through regenerative and integrative medicine approaches. It provides background on the author's qualifications and outlines key concepts in functional and anti-aging medicine like optimizing the body's self-repair mechanisms with hormones, lifestyle changes, and supplements. Specific hormone pathways like thyroid and testosterone are examined, symptoms of deficiencies are defined, and testing and treatment options like bioidentical hormones, gels, injections, and implants are described. The benefits of hormone optimization are stated to include increased energy, mood, mental clarity, fitness and sex drive. Brief patient testimonials endorse the positive effects.
This document discusses menopause and hormone therapy. It covers topics like the definition of menopause, common symptoms during menopause, medical intervention guidelines, and safety and benefits of hormone therapy. It provides information on different hormone therapy options, guidelines from medical societies on hormone therapy use, and the effects of hormone therapy on conditions like osteoporosis and cardiovascular disease.
Hormone replacement therapy outlines the definitions, physiological changes, symptoms, diagnosis, and treatment options associated with menopause. It discusses indications and contraindications for HRT and provides details on different HRT regimens. Side effects of estrogen and progestogen are listed. Large studies on HRT like the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study are summarized, noting their findings on risks and benefits of HRT use.
Natural treatments for menopause and fatigueDrLam.com
Progesterone side effects is made from pregnenolone, which in turn comes from cholesterol. Production occurs at several places. In the women, it is primarily made in the ovaries just before ovulation and increasing rapidly after ovulation.
Hormone replacement therapy (HRT) involves administering hormones to supplement a lack of natural hormones or substitute other hormones. It is primarily used as a medical treatment for post-menopausal symptoms but can also treat hormone deficiencies in men. There are several types of HRT including testosterone replacement therapy, transgender hormone therapy, and menopausal hormone therapy. Menopausal HRT provides benefits like relieving vasomotor symptoms and protects bone and cardiovascular health but also carries risks like increased breast cancer risk.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
1. The document summarizes two patient cases involving menopause and hormone replacement therapy (HRT). The first case is a 52-year-old woman experiencing menopausal symptoms who is continuing HRT. The second case is a 51-year-old woman with Sheehan's syndrome who is being weaned off HRT.
2. The document then reviews recommendations and guidelines for HRT use, including that it remains the most effective treatment for vasomotor symptoms. It discusses the immediate effects of HRT on various systems and considerations for progestogen use.
3. Alternative treatments to HRT are also mentioned, including SSRIs, venlafaxine, and phytoestrog
Menopause is defined as the absence of menstrual periods for at least 12 months. It typically occurs between ages 45-55, though can happen as early as age 30. Menopause is caused by a loss of responsiveness of the ovaries to hormones like FSH and LH, causing lower estrogen and progesterone levels. Common symptoms include irregular periods, hot flashes, mood changes, and increased risk for osteoporosis and heart disease. Treatment options include hormone replacement therapy, antidepressants, lifestyle changes, and lubricants to relieve vaginal dryness.
This document discusses andropause and sarcopenia, which are age-related declines in testosterone and muscle mass. It provides evidence that testosterone levels and muscle mass begin declining in the late 30s and accelerate after age 70. Intrinsic and extrinsic factors like lower hormone levels and muscle protein breakdown contribute to sarcopenia. The document recommends addressing these issues with a balanced diet, exercise, stress reduction, sleep, and potentially testosterone therapy. It summarizes several studies showing that natural supplements like tongkat ali can safely and effectively increase testosterone levels and muscle mass. The document promotes Andraiz T, a supplement containing these ingredients, to help treat andropause and sarcopenia symptoms.
The document discusses menopause management options, focusing on phytoestrogens as a natural alternative to hormone replacement therapy (HRT). It notes that phytoestrogens from soy and other plants can act as selective estrogen receptor modulators (SERMs) to provide estrogenic effects without the health risks of HRT. Isoflavones like genistein are the most studied phytoestrogens and may help reduce menopausal symptoms and long-term conditions like osteoporosis and heart disease. The document reviews the sources, types, and pharmacology of various phytoestrogens.
This document is a biography and overview of services provided by Dr. Robert A. Jason, a board certified gynecologist of over 24 years who specializes in bio-identical hormone replacement therapy and cosmetic gynecology procedures. Dr. Jason discusses the healing and anti-aging benefits of bio-identical hormones he has witnessed in his practice. He also describes how hormonal therapy can help women as young as 65 regain robust sexual health and libido through procedures like laser vaginal rejuvenation. The document promotes the benefits of optimizing natural hormone levels through bio-identical replacement therapy to prevent disease and promote health and well-being.
2014 :Updated information on Hormone Replacement TherapyHesham Al-Inany
This document provides an overview of hormone replacement therapy (HRT) and discusses its risks and benefits. It summarizes that:
1) HRT remains the most effective therapy for relieving menopausal symptoms like hot flashes, but comes with some health risks.
2) The risks of HRT, like breast cancer and cardiovascular disease, depend on factors like a woman's age, time since menopause, and type of HRT regimen used. Younger postmenopausal women who use HRT have a reduced risk of cardiovascular disease.
3) Different progestogen components and routes of administration in HRT regimens can impact health risks like thromboembolism and stroke differently.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
Women are as unique as their fingerprints, inside and outside. It is this fundamental premise that prompted Marla Ahlgrimm R. Ph. nearly 30 years ago to develop her revolutionary approach to helping women balance their unique hormone fingerprint, bioidentically, one woman at a time, with The Restore® Program. Learn why and how in this presentation.
This document summarizes the current research on hormone replacement therapy (HRT) for menopausal women. It finds that while HRT can help reduce osteoporosis and improve quality of life, it also increases risks of cancer, blood clots, and heart disease. Large clinical trials found no cardiovascular benefit to HRT and higher risks with combined estrogen-progestin therapy. More research is still needed but HRT should not be seen as an anti-aging treatment given lifestyle factors have a major influence on women's health outcomes. Non-estrogen therapies may be better options for osteoporosis prevention.
Tibolone is an effective treatment for managing menopause symptoms. It provides relief from vasomotor symptoms like hot flashes and night sweats comparable to conventional hormone therapy. It also improves urogenital symptoms and has benefits for bone and sexual health. Tibolone has a lower risk of side effects like vaginal bleeding and breast pain compared to estrogen plus progestin therapy. It does not increase the risk of endometrial hyperplasia or breast cancer. Tibolone is a good alternative to conventional hormone therapy for managing menopause symptoms with fewer side effects.
In this presentation, I talk about a brief description of menopause, hormonal changes during menopause, symptoms, and how HRT can be helpful during menopause. The advantages, risk factors and its methods of function are also included in this presentation.
I don't know anything about Hormone Replacement Therapy before I take this topic. As I know something, I like to share my idea in the way of powerpoint to all us.
This document discusses menopause and andropause (the male equivalent). It defines menopause as when a woman's monthly menstrual cycle ends permanently, usually occurring around age 50. Andropause is a slow decline in testosterone production in men with age. Both result in lower sex hormone levels and can cause symptoms. The document reviews hormone production and roles, common symptoms, and natural treatment options focused on supporting the body's own hormone balance rather than external replacement.
The document discusses the health effects of menopause and the potential benefits and risks of menopausal hormone replacement therapy (HRT). It summarizes several studies that have examined the link between HRT and various cancers. The risks of HRT include a small increased risk of breast cancer with long-term use (10+ years) and an increased risk of endometrial cancer, especially with long-term or high-dose use without progestogen. However, short-term HRT appears to have little to no increased cancer risk. The document concludes that the decision to use HRT requires weighing its potential benefits against the individual woman's health risks.
SpectraCell Laboratories utilizes advanced technology and provides high quality service to physician clients to become a leader in innovative clinical testing that understands its ultimate responsibility is towards patient care. The document then discusses SpectraCell's micronutrient testing which measures the functional levels of vitamins, minerals, and other nutrients within white blood cells to provide a more accurate assessment of an individual's long term nutritional status compared to standard blood tests. This micronutrient testing allows physicians to tailor personalized treatment plans for their patients based on each patient's specific nutritional needs.
The document discusses issues with standard hormone replacement therapy (HRT) and provides information about better alternatives. It notes that doctors are often misinformed about HRT due to flawed studies and fail to properly individualize treatment for each patient. The document advocates for bioidentical, cyclic HRT tailored to the specific needs and biology of each woman as a superior approach.
This document discusses the risks of combining herbal supplements and conventional medications, especially in geriatric patients. It notes a lack of regulation and standardization of herbal products that can lead to interactions and adverse effects when taken with prescription drugs. Clinical evidence shows some herbal supplements like St. John's Wort, garlic, and ginger can interact with anti-coagulant medications by interfering with metabolic enzymes or platelet function. The presentation emphasizes the importance of discussing all medications and supplements with a pharmacist to help prevent potential harmful interactions and adverse outcomes.
This document discusses menopause and hormone therapy. It covers topics like the definition of menopause, common symptoms during menopause, medical intervention guidelines, and safety and benefits of hormone therapy. It provides information on different hormone therapy options, guidelines from medical societies on hormone therapy use, and the effects of hormone therapy on conditions like osteoporosis and cardiovascular disease.
Hormone replacement therapy outlines the definitions, physiological changes, symptoms, diagnosis, and treatment options associated with menopause. It discusses indications and contraindications for HRT and provides details on different HRT regimens. Side effects of estrogen and progestogen are listed. Large studies on HRT like the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study are summarized, noting their findings on risks and benefits of HRT use.
Natural treatments for menopause and fatigueDrLam.com
Progesterone side effects is made from pregnenolone, which in turn comes from cholesterol. Production occurs at several places. In the women, it is primarily made in the ovaries just before ovulation and increasing rapidly after ovulation.
Hormone replacement therapy (HRT) involves administering hormones to supplement a lack of natural hormones or substitute other hormones. It is primarily used as a medical treatment for post-menopausal symptoms but can also treat hormone deficiencies in men. There are several types of HRT including testosterone replacement therapy, transgender hormone therapy, and menopausal hormone therapy. Menopausal HRT provides benefits like relieving vasomotor symptoms and protects bone and cardiovascular health but also carries risks like increased breast cancer risk.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
1. The document summarizes two patient cases involving menopause and hormone replacement therapy (HRT). The first case is a 52-year-old woman experiencing menopausal symptoms who is continuing HRT. The second case is a 51-year-old woman with Sheehan's syndrome who is being weaned off HRT.
2. The document then reviews recommendations and guidelines for HRT use, including that it remains the most effective treatment for vasomotor symptoms. It discusses the immediate effects of HRT on various systems and considerations for progestogen use.
3. Alternative treatments to HRT are also mentioned, including SSRIs, venlafaxine, and phytoestrog
Menopause is defined as the absence of menstrual periods for at least 12 months. It typically occurs between ages 45-55, though can happen as early as age 30. Menopause is caused by a loss of responsiveness of the ovaries to hormones like FSH and LH, causing lower estrogen and progesterone levels. Common symptoms include irregular periods, hot flashes, mood changes, and increased risk for osteoporosis and heart disease. Treatment options include hormone replacement therapy, antidepressants, lifestyle changes, and lubricants to relieve vaginal dryness.
This document discusses andropause and sarcopenia, which are age-related declines in testosterone and muscle mass. It provides evidence that testosterone levels and muscle mass begin declining in the late 30s and accelerate after age 70. Intrinsic and extrinsic factors like lower hormone levels and muscle protein breakdown contribute to sarcopenia. The document recommends addressing these issues with a balanced diet, exercise, stress reduction, sleep, and potentially testosterone therapy. It summarizes several studies showing that natural supplements like tongkat ali can safely and effectively increase testosterone levels and muscle mass. The document promotes Andraiz T, a supplement containing these ingredients, to help treat andropause and sarcopenia symptoms.
The document discusses menopause management options, focusing on phytoestrogens as a natural alternative to hormone replacement therapy (HRT). It notes that phytoestrogens from soy and other plants can act as selective estrogen receptor modulators (SERMs) to provide estrogenic effects without the health risks of HRT. Isoflavones like genistein are the most studied phytoestrogens and may help reduce menopausal symptoms and long-term conditions like osteoporosis and heart disease. The document reviews the sources, types, and pharmacology of various phytoestrogens.
This document is a biography and overview of services provided by Dr. Robert A. Jason, a board certified gynecologist of over 24 years who specializes in bio-identical hormone replacement therapy and cosmetic gynecology procedures. Dr. Jason discusses the healing and anti-aging benefits of bio-identical hormones he has witnessed in his practice. He also describes how hormonal therapy can help women as young as 65 regain robust sexual health and libido through procedures like laser vaginal rejuvenation. The document promotes the benefits of optimizing natural hormone levels through bio-identical replacement therapy to prevent disease and promote health and well-being.
2014 :Updated information on Hormone Replacement TherapyHesham Al-Inany
This document provides an overview of hormone replacement therapy (HRT) and discusses its risks and benefits. It summarizes that:
1) HRT remains the most effective therapy for relieving menopausal symptoms like hot flashes, but comes with some health risks.
2) The risks of HRT, like breast cancer and cardiovascular disease, depend on factors like a woman's age, time since menopause, and type of HRT regimen used. Younger postmenopausal women who use HRT have a reduced risk of cardiovascular disease.
3) Different progestogen components and routes of administration in HRT regimens can impact health risks like thromboembolism and stroke differently.
This document summarizes evidence-based guidelines on hormone replacement therapy. It discusses that HRT can effectively treat hot flashes and vaginal atrophy but may increase risks of breast cancer, heart disease, and blood clots if used long-term. Larger studies like the Women's Health Initiative found these health risks outweighed benefits for chronic disease prevention. Recommendations are that HRT only be used at lowest effective doses for shortest time to treat menopausal symptoms.
Women are as unique as their fingerprints, inside and outside. It is this fundamental premise that prompted Marla Ahlgrimm R. Ph. nearly 30 years ago to develop her revolutionary approach to helping women balance their unique hormone fingerprint, bioidentically, one woman at a time, with The Restore® Program. Learn why and how in this presentation.
This document summarizes the current research on hormone replacement therapy (HRT) for menopausal women. It finds that while HRT can help reduce osteoporosis and improve quality of life, it also increases risks of cancer, blood clots, and heart disease. Large clinical trials found no cardiovascular benefit to HRT and higher risks with combined estrogen-progestin therapy. More research is still needed but HRT should not be seen as an anti-aging treatment given lifestyle factors have a major influence on women's health outcomes. Non-estrogen therapies may be better options for osteoporosis prevention.
Tibolone is an effective treatment for managing menopause symptoms. It provides relief from vasomotor symptoms like hot flashes and night sweats comparable to conventional hormone therapy. It also improves urogenital symptoms and has benefits for bone and sexual health. Tibolone has a lower risk of side effects like vaginal bleeding and breast pain compared to estrogen plus progestin therapy. It does not increase the risk of endometrial hyperplasia or breast cancer. Tibolone is a good alternative to conventional hormone therapy for managing menopause symptoms with fewer side effects.
In this presentation, I talk about a brief description of menopause, hormonal changes during menopause, symptoms, and how HRT can be helpful during menopause. The advantages, risk factors and its methods of function are also included in this presentation.
I don't know anything about Hormone Replacement Therapy before I take this topic. As I know something, I like to share my idea in the way of powerpoint to all us.
This document discusses menopause and andropause (the male equivalent). It defines menopause as when a woman's monthly menstrual cycle ends permanently, usually occurring around age 50. Andropause is a slow decline in testosterone production in men with age. Both result in lower sex hormone levels and can cause symptoms. The document reviews hormone production and roles, common symptoms, and natural treatment options focused on supporting the body's own hormone balance rather than external replacement.
The document discusses the health effects of menopause and the potential benefits and risks of menopausal hormone replacement therapy (HRT). It summarizes several studies that have examined the link between HRT and various cancers. The risks of HRT include a small increased risk of breast cancer with long-term use (10+ years) and an increased risk of endometrial cancer, especially with long-term or high-dose use without progestogen. However, short-term HRT appears to have little to no increased cancer risk. The document concludes that the decision to use HRT requires weighing its potential benefits against the individual woman's health risks.
SpectraCell Laboratories utilizes advanced technology and provides high quality service to physician clients to become a leader in innovative clinical testing that understands its ultimate responsibility is towards patient care. The document then discusses SpectraCell's micronutrient testing which measures the functional levels of vitamins, minerals, and other nutrients within white blood cells to provide a more accurate assessment of an individual's long term nutritional status compared to standard blood tests. This micronutrient testing allows physicians to tailor personalized treatment plans for their patients based on each patient's specific nutritional needs.
The document discusses issues with standard hormone replacement therapy (HRT) and provides information about better alternatives. It notes that doctors are often misinformed about HRT due to flawed studies and fail to properly individualize treatment for each patient. The document advocates for bioidentical, cyclic HRT tailored to the specific needs and biology of each woman as a superior approach.
This document discusses the risks of combining herbal supplements and conventional medications, especially in geriatric patients. It notes a lack of regulation and standardization of herbal products that can lead to interactions and adverse effects when taken with prescription drugs. Clinical evidence shows some herbal supplements like St. John's Wort, garlic, and ginger can interact with anti-coagulant medications by interfering with metabolic enzymes or platelet function. The presentation emphasizes the importance of discussing all medications and supplements with a pharmacist to help prevent potential harmful interactions and adverse outcomes.
Bio-identical Hormone Optimization for Women, teacher presentationPaul Cox
This document discusses regenerative and integrative medicine, which aims to optimize the body's self-repair mechanisms through hormones, lifestyle changes, and supplements. It focuses on hormone optimization for women, explaining how hormone systems can fail and symptoms of menopause. Different hormone replacement options are described, including bioidentical hormones that have the same chemical structure as what the body produces, reducing risks. Safety studies on bioidentical progesterone are summarized, finding no increased breast cancer risk unlike synthetic progestins.
Birth Control, Big Money and Bad Medicine: A Deadly Trifecta in Women’s HealthHormones Matter
This document discusses the complex interactions of hormones in the body and argues that the oversimplified view of contraceptive hormones only impacting reproduction is flawed. It notes that hormones are synthesized throughout the body, act on multiple receptor types, and influence many physiological systems beyond just the reproductive system, including the brain, mitochondria, immune function and metabolism. The use of synthetic exogenous hormones in contraceptives is presented as an overly simplistic approach that fails to consider the full effects of hormones since they are similar but not identical to endogenous hormones and can impact health in unintended ways.
This document discusses the complex interactions of hormones in the body and argues that the oversimplified view of contraceptive hormones only impacting reproduction is flawed. It notes that hormones are synthesized throughout the body, act on multiple receptor types, and influence many physiological systems beyond just the reproductive system, including the brain, mitochondria, immune function and metabolism. The use of synthetic exogenous hormones in contraceptives is presented as an overly simplistic approach that fails to consider the full effects of hormones since they are similar but not identical to endogenous hormones and can impact health in unintended ways.
An Integrative Choice for Cancer Support in Small Animals
FREE Live Webinar on May 7th, 10am Pacific / 1pm Eastern
Register at: www.naturalpetrx.com
Guest: Dr. Nancy Scalan, DVM
Host: Geoff D\'Arcy D.O.M
This document discusses menopausal hormone therapy (MHT), also known as hormone therapy (HT). It defines key terms and outlines the history and background of MHT, including findings from the Women's Health Initiative trial in the late 1990s that raised safety concerns and led to a decline in MHT use. The document discusses guidelines for evaluating candidates for MHT and outlines potential benefits and risks to consider for individual patients. It also provides tables listing FDA-approved MHT drug products available in the US, including oral, transdermal, and vaginal estrogen therapies alone or in combination with progestogens.
Menopause role of isoflavones by dr alka mukherjee nagpur m.s.indiaalka mukherjee
Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(-)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women
Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.
Soy products can take several weeks or more to reach their maximal benefit. For example, a 2015 review found that soy isoflavones take more than 13 weeks to reach just half of their maximum effect. Traditional hormone therapy, on the other hand, takes about three weeks to show the same benefit.
It’s packed with nutrition
Soy is low in saturated fat and calories. It’s also high in these beneficial nutrients:
• fiber
• protein
• omega-3 fatty acids
• antioxidants
It may help to reduce your risk of heart disease
Eating tofu and other soy-based foods a few times a week can help you cut back on some animal-based protein sources, such as steak or hamburger, that are high in saturated fat and cholesterol.
The document discusses the use of herbal medicine in Western society. It notes that those most likely to use herbal medicine are well-educated, higher-income women. While 70% of Americans regularly use herbal medicines, most do not disclose this to their doctors due to potential drug interactions. Some of the most commonly used herbal medicines in the US include echinacea, St. John's wort, and ginkgo. The document outlines factors to consider when evaluating clinical trials of herbal medicines and criticisms of such trials, noting their quality is often superior to pharmaceutical drug trials. It stresses the importance of consulting medical professionals when using herbal supplements due to potential side effects and interactions.
The document discusses hormone therapies and their application protocols used in treatment. It provides details on various hormones including estrogens, progestogens, and their classification. It describes different hormone therapy regimens including sequential and continuous combined preparations. Application methods like oral, transdermal, and local administration are outlined. Guidelines for irregular bleeding management and contraindications for hormone therapy are also summarized.
The document discusses drugs that affect women's health and sexuality. It covers female sex hormones estrogen and progesterone, which are responsible for female sexual development and maintaining pregnancy. It also discusses conditions that can occur when estrogen levels drop, such as menopause and osteoporosis. The remainder of the document focuses on estrogen and progesterone drugs, including conjugated estrogen, oral contraceptives, and bisphosphonates like alendronate, outlining their uses, mechanisms of action, and important considerations for nursing care.
(1) A whole foods, plant-based diet can help prevent and treat prostate cancer by avoiding alcohol and dairy while emphasizing fiber from vegetables, beans, fruits, and whole grains. Exercise also boosts survival and reduces progression.
(2) Dean Ornish found that a low-fat vegan diet halted and reversed prostate cancer progression in some men.
(3) Stress management techniques like mindfulness meditation, yoga, spending time in nature, and social support can benefit prostate cancer prevention and treatment by reducing stress.
This document discusses how consuming animal products leads to higher rates of cancer. It notes that 90% of cancers in wealthy countries are "affluent cancers" linked to diet and hormones. Higher consumption of animal products correlates with greater levels of hormones like estrogen in the body, which promote cell growth and cancer. Evidence shows hormone replacement therapy increases breast cancer risk, and cutting out animal products may help cancer remission by removing excess hormones. The document concludes that while humans have adapted to eat some animal foods, plant-based diets are healthier for cancer prevention.
Nutrition cancer wellness: integrative techniques for cancerAshwani Garg, MD
(1) A doctor discusses nutrition and lifestyle techniques for cancer wellness and prevention based on general principles from cancer organizations. Exercise, fiber-rich foods, stress management like mindfulness are recommended.
(2) One study found prostate cancer patients following a plant-based diet had reduced risk of disease progression compared to a non-treatment group.
(3) While more research is needed, some studies indicate cannabinoids, breast milk, and massage/yoga/acupuncture may provide benefits for cancer patients, but patients should discuss any treatments with their doctor.
Similar to Bhide Bioidentical hormone replacement therapy and Evidence Based Treatment of Menopausal Symptoms (20)
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
Key Areas Covered:
Texting and Email Communication: Understand the compliance requirements for electronic communication.
Encryption Standards: Learn what is necessary and what is overhyped.
Medical Messaging and Voice Data: Ensure secure handling of sensitive information.
IT Risk Factors: Identify and mitigate risks related to your IT infrastructure.
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Bhide Bioidentical hormone replacement therapy and Evidence Based Treatment of Menopausal Symptoms
1. Compounded Bioidentical
Hormone Therapy
Vandana Y. Bhide, MD
Instructor, Division of Hospital Internal Medicine
Board Certified, Internal Medicine, Pediatrics
Diplomate, American Board of Integrative and
Holistic Medicine (Non-ABMS)
2. Disclosures
• American Medical Seminars-CME lectures (No
pharmaceutical funding)
• Will discuss non-FDA approved compounded
estrogen, progesterone, testosterone
products, including estriol (investigational new
drug)
• Non-FDA approved dietary supplements and
3. Objectives
• Distinguish the risks and
benefits of bioidentical
hormones
• Analyze herbal agents and
dietary supplements used
for vasomotor and other
menopausal symptoms
4. 62 YO asymptomatic female
requests “bioidentical” hormones
as anti-aging treatment to
A. Conjugated equine estrogen alone to reduce risk of breast
cancer
B. Bi-est 3.0 and topical progesterone cream
C. Avoid bioidentical hormones
D. Tri-est and compounded oral micronized progesterone
E. Estradiol patch and micronized progesterone
Audience Response Question 1
promote rejuvenation, longevity, maintain mental
alertness, improve bone density. She does not
want “synthetic” hormones or patches. She has
intact uterus. You advise
5. 52 YO female with peanut allergy requests treatment
of vasomotor symptoms and genitourinary syndrome
of menopause. You recommend
Audience Response Question 2
A. Estradiol patch and conventional oral micronized
progesterone
B. Estradiol patch and compounded progesterone
cream
C. Estradiol patch and compounded oral micronized
progesterone
D. Avoid postmenopausal hormone replacement
E. Soy sauce, yam flavored frozen yogurt, reruns of
“Three’s Company”
6. Bioidentical Hormone Replacement
• Compounds that have the same chemical and
molecular structure as hormones that are
produced in the human body (National
Menopause Society, Endocrine Society)
• Extracted from plants
Santen, RJ et.al. Postmenopausal hormone therapy: an Endocrine Society scientific statement.
J Clin Endocrinol Metab. 2010 Jul; 95(7 Suppl 1):s1-s66.
• Bioidentical hormone therapy recognized by
FDA, Endocrine Society as a marketing term
• Not necessarily based on scientific evidence
Rosenthal MS. The Wiley Protocol: an analysis of ethical issues. Menopause 2008;15:1014–22.
7. Compounded Bioidentical
Hormone Therapy (CBHT)
• Up to 2.5 million women use CBHT
• In response to concerns about risks of PMHRT in
WHI/HERS/PEPI/Million Women studies
• Many women think CBHT safe because “natural”
• Bioidentical does not mean natural
Sood, Richa et.al. Counseling Postmenopausal Women about Bioidentical Hormones: Ten Discussion
Points for Practicing Physicians. J Am Board Fam Med 2011;24:202–210.
• Custom compounded by pharmacy health care
provider’s prescription
8. Recommend Against CBHT
•North American Menopause Society
•American Congress Obstetricians and Gynecologists
•American Society Reproductive Medicine
•Endocrine Society
•American Association of Clinical Endocrinologists
•Women's Health Practice and Research Network of the
American College of Clinical Pharmacy
•U.S. Food and Drug Administration
9. Human Estrogens
• Estrone (E1) -highest concentration in
menopause
• Adipose tissue-converts estrone to estradiol
• Adrenal hormone androstenedione converted to
estrone
• 17β-estradiol (E2)
• Most active biologically
• Ovarian follicle/corpus luteum
• Estriol (E3)-16α-hydroxylation of estrone and
estradiol
• Placenta
• Low levels outside of pregnancy
• Not converted to estradiol
• Short half life, least potent
10. Progesterone
• Formed as cholesterol is converted to
estrogen and androgens
• Secreted by ovary
• Production stops after menopause
Pattimakiel, Lynn and Thacker, Holly L. Bioidentical hormone therapy: Clarifying the
misconceptions. Cleve Clin J Med 2011 Dec;78(12):829-836.
11. • Before menopause, made in ovary, adrenal
cortex
• Peripheral conversion androstenedione and
dehydroepiandrosterone (DHEA) to
testosterone
• Androgen levels decline over time,
unaffected by menopause
Pattimakiel, Lynn and Thacker, Holly L. Bioidentical hormone therapy: Clarifying the
misconceptions. Cleve Clin J Med 2011 Dec;78(12):829-836.
Testosterone
12. Hormone/Steroid Classes
• Class A- Found in nature
• Conjugated equine estrogens (sulfate
esters)
• 50% estrone sulfate
• 50% estrogens native only to horses
• Extracted from pregnant mare's urine
Bhavnani, Bhagu R. and Stanczyk, Frank Z., Misconception and Concerns about
Bioidentical Hormones Used for Custom-Compounded Hormone Therapy. The
Journal of Clinical Endocrinology and Metabolism. Dec 2011. 97 (3).
13. Hormone/Steroid Classes
• Class B-native to the body
• Chemically synthesized from plant sources
• Mexican yam (Dioscorea villosa), soybean
• Sterols diosgenin and stigmasterol
• Mexican yam converted to progesterone,
dehydroepiandrosterone, androstenedione,
testosterone
• Soy converted to estradiol, estrone, estriol,
synthetic conjugated estrogens
Bhavnani, Bhagu R. and Stanczyk, Frank Z., Misconception and Concerns about Bioidentical
Hormones Used for Custom-Compounded Hormone Therapy. The Journal of Clinical
Endocrinology and Metabolism. Dec 2011. 97 (3).
14. Hormone/Steroid Classes
• Class B-native to the body
• Humans lack enzymes to convert diosgenin
and stigmasterol to
estrogens/progestins/androgens
• No hormones are extracted intact from plant
source
• Chemical synthesis of 17β estradiol from
diosgenin requires at least 15 reactions
Bhavnani, Bhagu R. and Stanczyk, Frank Z., Misconception and Concerns about
Bioidentical Hormones Used for Custom-Compounded Hormone Therapy. The
Journal of Clinical Endocrinology and Metabolism. Dec 2011. 97 (3).
15. Compounded Bioidentical Hormones
• Amount of hormone extracted depends on
chemical process/alcohol used for
extraction
• Actual amount of hormone may be variable
• All compounded bioidentical hormones are
manmade
16. Non Bioidentical
Hormones
• Conjugated equine estrogen (CEE)
• Equilin sulfate (mares)
• Estrone sulfate
• Extracted from urine pregnant mares
• Ethinyl estradiol used in combined oral
contraceptives
• Medroxyprogesterone
17. FDA approved Bioidentical Hormones
• 17β-estradiol
• Oral
• Transdermal patch
• Transdermal bypasses hepatic metabolism
• Results in estrone:estradiol ratio of 1:1
• Similar to pre-menopausal levels
• Vaginal ring
• Creams and gels
• Progesterone (oral)
• Brand name progesterone is micronized in peanut oil
Files, Julia A. et.al. Bioidentical Hormone Therapy Mayo Clin Proc. 2011 Jul; 86(7): 673–680.
18. Advantages of Compounded Hormones
• FDA-approved progesterone micronized in
peanut oil.
• Compounded progesterone can eliminate peanut oil
• Cellulose or olive oil
• Dosage and component flexibility
• Low-dose formulations
• Possible reduced cost
• Separate co-pays for estrogen patch/micronized
progesterone
• Highly individualized prescriptions
Committee on Gynecologic Practice and the American Society for Reproductive Medicine Practice
Committee, Compounded Bioidentical Menopausal Hormone Therapy. No 532, August 2012
(Reaffirmed 2014). Obstet Gynecol 2012;120:411–5.
20. CBHT Delivery
• Troches (lozenges) for
buccal administration
• Vaginal suppositories
• Creams, gels, lotions
• Sublingual tablets
• Subdermal implants
ACOG Committee on Gynecologic Practice and the
American Society for Reproductive Medicine Practice
Committee. Number 532, August 2012. (Reaffirmed 2014).
21. Bi-est Estriol: Estradiol
80%:20% or 90%:10%
• Bi-est 2.0
• 1.6 mg estriol and 0.4 mg estradiol
• Bi-est 2.5
• 2.0 mg estriol and 0.5 mg estradiol
• Bi-est 3.0
• 2.4 mg estriol and 0.6 mg estradiol
• Absorption of Bi-est not as consistent as
estradiol patch
Sood R, Warndahl RA, et al. Bioidentical compounded hormones: A pharmacokinetic evaluation
in a randomized clinical trial. Maturitas 2013;74:375.–382.
22. Tri-est
• Estriol:Estrone:Estradiol
• 80%:10%:10% (8:1:1 ratio)
• 1.25-2.5 mg/day
Davis, Ruth et.al. Risks and Effectiveness of Compounded Bioidentical Hormone
Therapy: A Case Series. J of Women’s Health. 23 (8) 2014.
23. Estrogen Receptors
• α receptor activation responsible for
proliferative effects of estrogens
• Ovary, endometrium, breast cancer cells
• β receptor activation balances α-
receptor effects
• Endothelial cells, bone, kidney, lung
Files, Julia A. et.al. Bioidentical Hormone Therapy Mayo Clin Proc. 2011 Jul;
86(7): 673–680.
24. Estrogen Receptors
• Estrone –mostly binds to to estrogen
receptor α
• 17β-estradiol -binds to estrogen α and β
receptors
• Estriol -weak binding to estrogen receptor α
and β
25. Estriol
• Safety of estriol unknown
• Estriol may stimulate breast cancer cells
Lippert C, Seeger H, Mueck AO.The effect of endogenous estradiol metabolites on the
proliferation of human breast cancer cells. Life Sci. 2003 Jan 10;72(8):877-83.
• Protection against breast cancer unproven
McBane, Sarah E. et.al. Use of Compounded Bioidentical Hormone Therapy in Menopausal
Women: An Opinion Statement of the Women's Health Practice and Research Network of
the American College of Clinical Pharmacy. 34 (4); 410–423, April 2014.
• Estriol not approved by FDA
• FDA: “Pharmacies should not compound drugs
containing estriol unless the prescriber has a valid
investigational new drug (IND) application.”
US Department of Health & Human Services, Food and Drug Administration. Transcript of FDA press
conference on FDA actions on bio-identical hormones.
http://www.fda.gov/downloads/NewsEvents/Newsroom/MediaTranscripts/ucm122174
26. Estrogen-Testosterone Therapy &
Breast Cancer Risk in Natural
Menopause
• 2.5 X in current users of estrogen plus
testosterone vs women who never used HT
• Significantly higher compared to estrogen-only
therapy (P=0.007)
• Slightly more than estrogen and progesterone
therapy (P = 0.11)
• HT with testosterone-17.2% increased risk of
breast cancer per year of use
Tamimi, RM, et al . Combined Estrogen and Testosterone Use and Risk of Breast Cancer in
Postmenopausal Women. Archives of Internal Medicine 2006,166:1483-1489.
27. Salivary Hormone Levels
• Anti-Aging doctors-urine/serum hormone
levels unreliable because measure protein
bound, biologically inactive hormone
• Free hormone moves freely into salivary
glands and represents ultrafiltrate of serum
• Salivary levels are not reliable Schmidt, Peter. The 2012 Hormone
Therapy Position Statement of The North American Menopause Society. Menopause.
2012 Mar; 19(3): 257–271.
• Saliva samples do not remain stable in storage
• Interassay test results can be variable
• Affected by diet, time of day
Hodis HN, Mack WJ. Postmenopausal hormone therapy in clinical
perspective. Menopause 2007; 14:944–957.
• Dose on symptom relief rather than
estrogen/ progesterone/testosterone levels
28. Controversial-Progesterone
Transdermal creams and gels
• Salivary and capillary levels high but serum levels
remain low
• Do serum or salivary levels represent tissue
levels?
• Progesterone cream does not achieve serum
levels to prevent endometrial proliferation
Du, J.Y., Sanchez, P., Kim, L., Azen, C.G., Zava, D.T., and Stanczyk, F.Z.Percutaneous progesterone
delivery via cream or gel application in postmenopausal women: a randomized cross-over study of
progesterone levels in serum whole blood saliva capillary blood. Menopause. 2013; 20: 1107–1226.
29. Regulation Compounded Hormones
• Dietary Supplement Health and Education
Act of 1994 (DSHEA)
• Compounded hormones considered to be
supplements
• Dietary supplements are not required to
prove safety or efficacy
• Cannot claim treatment or curative
properties
• Compounded pharmacies regulated by
state boards of pharmacy
30. Labeling Hormones
• FDA requires Black Box warning on
conventional hormones based on WHI
concerns
• Compounded preparations are not regulated
by FDA and have no official package insert
• Exempt from Black Box warning that hormones
may lead to serious injury or death
• Pharmacies are not required to report adverse
events
31. FDA Testing Internet Bioidentical Hormones
• 29 compounded drugs from 12 compounding
pharmacies
• 10 products (34%) failed quality test
• 9 products (one of which was progesterone)
contained less active ingredient than indicated
U.S. Food and Drug Administration. Report: limited FDA survey of compounded drug products.
Silver Spring (MD): FDA; 2009.
http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompoundin
g/ucm155725.htm
32. Summary Compounded HRT
• Not FDA approved
• Treat symptomatic menopausal women
• Use lowest possible dose for shortest duration
Goodman NF, Cobin RH, Ginzburg SB, Katz IA, Woode DE. American Association of Clinical
Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of
menopause: executive summary of recommendations. Endocr Pract 2011;17:1–25.
• FDA approved bioidentical estradiol and
progesterone available
• Longterm safety estriol unknown
• Avoid progesterone cream and testosterone
• Compounded micronized progesterone for
peanut allergic patients
33. 62 YO asymptomatic female
requests “bioidentical” hormones
as “anti-aging” treatment to
A. Conjugated equine estrogen alone to reduce risk of breast
cancer
B. Bi-est 3.0 and topical progesterone cream
C. Avoid bioidentical hormones
D. Tri-est and compounded oral micronized progesterone
E. Estradiol patch and micronized progesterone
Audience Response Question 1
promote rejuvenation, longevity, maintain mental
alertness, improve bone density. She does not want
“synthetic” hormones or patches. She has intact
uterus. You advise
34. 62 YO asymptomatic female
requests “bioidentical” hormones
as “anti-aging” treatment to
A. Conjugated equine estrogen alone to reduce risk of breast
cancer
B. Bi-est 3.0 and topical progesterone cream
C. Avoid bioidentical hormones
D. Tri-est and compounded oral micronized progesterone
E. Estradiol patch and micronized progesterone
Audience Response Question 1
promote rejuvenation, longevity, maintain mental
alertness, improve bone density. She does not want
“synthetic” hormones or patches. She has intact
uterus. You advise
35. 52 YO female with peanut allergy requests treatment
of vasomotor symptoms and genitourinary syndrome
of menopause. You recommend
Audience Response Question 2
A. Estradiol patch and conventional oral micronized
progesterone
B. Estradiol patch and compounded progesterone
cream
C. Estradiol patch and compounded oral micronized
progesterone
D. Avoid postmenopausal hormone replacement
E. Soy sauce, yam flavored frozen yogurt, reruns of
“Three’s Company”
36. 52 YO female with peanut allergy requests treatment
of vasomotor symptoms and genitourinary syndrome
of menopause. You recommend
Audience Response Question 2
A. Estradiol patch and conventional oral micronized
progesterone
B. Estradiol patch and compounded progesterone
cream
C. Estradiol patch and compounded oral micronized
progesterone
D. Avoid postmenopausal hormone replacement
E. Soy sauce, yam flavored frozen yogurt, reruns of
“Three’s Company”
37. Vandana Y. Bhide, M.D.
Beyond Hot Flashes:
Botanicals for
Menopausal Symptoms
38. 52 YO female with hypertension requests
“herbal” non-hormonal approach to menopausal
symptoms including vasomotor symptoms, mood
changes, anxiety, and insomnia. What evidence
based regimen could you suggest?
A. Trial of meditation, Black Cohosh, valerian
B. Avoid soy isoflavanes in patient with history
of breast cancer
C. Inform patient of the risk of hepatotoxicity
with kava kava
D. Inform patient of medication interactions
with St. John’s Wort
F. All of the above
39. 1994 Dietary Supplement Health and
Education Act (DSHEA)
• Products containing dietary ingredient,
including vitamins, minerals, amino
acids, animal extracts, probiotics,
enzymes, herbs or other botanicals
• Not required to undergo FDA review for
safety and effectiveness
• Cannot claim to diagnose, treat, cure or
prevent any disease
41. Mind-Body Therapies Menopausal Symptoms
• 2010 – met-analysis 21 studies
• Meditation, yoga, tai chi
• Reduced frequency and intensity of hot
flashes, mood and sleep changes, stress
symptoms, muscle/joint pain
Innes KE, Selfe TK, Vishnu A. Mind-Body therapies for menopausal symptoms: a systematic
review. Maturitas. 2010;66(2):135–149.
NIH National Center for Complementary and Alternative Medicine.
https://nccih.nih.gov/health/menopause/menopausesymptoms?nav=gsa
42. Vasomotor Symptoms-
Potential Serotonergic Botanicals
• Black Cohosh
• Kudzu (vine-legume Pueraria labata)
• Kava Kava-hepatotoxicity
• Dong Quai-increased INR with warfarin
• Licorice-hypokalemia, interacts with
spironolactone
Bunchorntavakul, C. and Reddy, K. R. (2013), Review article: herbal and dietary
supplement hepatotoxicity. Alimentary Pharmacology & Therapeutics, 37: 3–17.
43. Vasomotor Symptoms-
Potential Phytoestrogens
• Soy
• Red clover
• Kudzu
• Mexican yam
• Chasteberry
• Licorice
• Rhubarb
• Hops
• Phytoestrogens-weak
estrogen agonists, partial
agonists, or antagonists to
endogenous estrogens
• Bind estrogen β receptor
• ? Add progesterone for
endometrial protection
• Avoid in women with or at
risk for breast, uterine, or
ovarian cancer
Hajirahimkhan,
Atieh et.al. Botanical Modulation of Menopausal Symptoms:
Mechanisms of Action? Planta Med 2013; 79(07): 538-553.
45. Black Cohosh
(Actaea racemosa
and Cimicifuga
racemosa)-
Buttercup family
• Roots and rhizomes (underground stems)
• Extracts are standardized to 26 deoxyactein
content (chemicals called saponins)
• Usual dose 20 mg tablet bid
• Vasomotor symptoms-conflicting results
• Rare reports liver damage/failure
• No known drug-drug interactions
46. Soy (pea plant)
• Soy protein 20-60 gm (34-80 mg isoflavones) daily
• Studes mixed results
• Modestly decreased frequency and severity of hot
flashes
• Moderate strength of evidence improved anxiety
symptoms: 7 trials, n=853
Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, Ziegler KM, Aronson N. Menopausal
Symptoms: Comparative Effectiveness Review No. 147. (Prepared by Blue Cross and Blue Shield
Association Technology Evaluation Center Evidence-based Practice Center under Contract No.290-
2007-10058-I.) AHRQ Publication No. 15-EHC005-EF. Rockville, MD: Agency for Health care
Research and Quality; March 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
47. Soy Isoflavones-daidzein, genistein, glycitein
• Isoflavones bind estrogen receptor (ER) β- act as
selective estrogen receptor modulators (SERMs)
• Daidzein-isoflavone found in soy
• 75% of western women, 50% of Asians do not
have intestinal bacteria that convert daidzein into
the active metabolite S-(−)equol
• S-Equol, daidzein, genistein extracts may be
more beneficial than soy
• Soy intake prior to puberty may be protective of
breast cancer
Clarkson TB, Utian WH, Barnes S, et al. for the NAMS Isoflavone Translational Symposium Panel.
The role of soyisoflavones in menopausal health: report of The North American Menopause
Society/Wulf H. Utian Translational Science Symposium in Chicago, IL. (October, 2010).
Menopause 2011; 18: 732–753.
48. SE5-OH- Soy Isoflavane (Phytoestrogen)
• 126 equol non-producing postmenopausal
Japanese women 10mg/day S-(−)equol or
placebo for 12 weeks
• Soy germ with a strain of equol-producing Lactococcus
bacteria (generally recognized as safe) (GRAS).
• Soy Isoflavane daidzein broken down into S-(−)equol
• Only 30% to 50% Western women have lactic acid
secreting bacteria to convert daidzein to equol
• p=0.009 reduction in hot flashes and neck or
shoulder muscle stiffness
• Avoid soy/daidzein supplements in breast cancer
Takeshi Aso, Shigeto Uchiyama, Yasuhiro Matsumura, Makoto Taguchi, Masahiro Nozaki, Kiyoshi
Takamatsu, Bunpei Ishizuka, Toshiro Kubota, Hideki Mizunuma, and Hiroaki Ohta. Journal of
Women's Health. January 2012, 21(1): 92-100.
49. • Isoflavones require P450-metabolism to form
active phytoestrogens daidzein and genistein
• NCCAM RCT-black cohosh vs red clover vs
HRT vs placebo
• No better than placebo, not as effective as
HRT
Geller SE, Shulman LP, van Breemen RB, et al. Safety and efficacy of black cohosh and red
clover for the management of vasomotor symptoms: a randomized controlled trial.
Menopause. 2009;16(6):1156–1166
• Cochrane Review- no improvement with
Promensil (red clover extract) but extracts with
high (> 30 mg/d) levels of genistein
consistently reduced hot flashes
Lethaby Anne et.al. Phytoestrogens for menopausal vasomotor symptoms. The Cochrane
Library. 10 Dec. 2013.
Red clover (Trifolium pretense)-legume
50. Diascorea alata
(Purple Yam)
• 50 Taiwanese menopausal women two sachets
Diascorea extracts or placebo X 12 months
• Improvement in all Greene Climacteric Scale
symptoms except sexual function
• Most improvement in “insomnia,” “feeling tense or
nervous,” “excitable,” “musculoskeletal pain”
Hsu, CC et.al. The assessment of efficacy of Diascorea alata for menopausal symptom treatment in
Taiwanese women. Climacteric. 2011 Feb;14(1):132-9.
Grant MD, et.al. Menopausal Symptoms: Comparative Effectiveness Review No. 147. (Prepared by Blue
Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center
under Contract No.290-2007-10058-I.) AHRQ Publication No. 15-EHC005-EF. Rockville, MD: Agency
for Health care Research and Quality; March 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
51. St. John’s Wort
• Effective short term treatment mild to
moderate depression
• Interacts with multiple medications via P450
system in liver
• 301 German menopausal women vs placebo
X 16 wks
• St. John's wort and black cohosh
combination effective for hot flashes and
psychological symptoms
Uebelhack, Ralf et. al. Black Cohosh and St. John’s Wort for Climacteric Complaints: A
Randomized Trial. Obstetrics & Gynecology. Feb. 2006. 107 (2) 247-255
52. French Maritime Pine (Pinus pinaster)
• Polyphenols (antioxidants found in vegetables)
• 155 menopausal Taiwanese women
• 100 mg Pycnogenol or placebo BID X 6 months
• Women’s Health Questionnaire (somatic, depressed,
vasomotor, memory, attractiveness, anxiety, sexual,
sleep, menstrual problems)
• Superior to placebo p<0.01 to p<0.001 for each
• HDL increased/LDL decreased significantly
Yang, Han-Ming et.al. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on
the climacteric syndrome in peri-menopausal women. Acta Obstetricia et Gynecologica. 2007; 86: 978-
985)
Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, Ziegler KM, Aronson N. Menopausal
Symptoms: Comparative Effectiveness Review No. 147. (Prepared by Blue Cross and Blue Shield
Association Technology Evaluation Center Evidence-based Practice Center under Contract No.290-2007-
10058-I.) AHRQ Publication No. 15-EHC005-EF. Rockville, MD: Agency for Health care Research and
Quality; March 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
53. Proprietary combination of evening primrose
oil, damiana, ginseng, royal jelly (Lady 4)
• 120 Egyptian women
• Menopause Rating Scale II (MRS-II)
• 86.7% vs 56.7% “much or very much improved”
vs placebo p < 0.001
Yakoot, M, Salem A, Omar AM. Effectiveness of a herbal formula in women with menopausal syndrome.
Forsch Komplementmed. 2011;18(5):264-8. Epub 2011 Oct 10.
Natural Medicines Comprehensive Database. http://naturaldatabase.therapeuticresearch.com/
nd/Search.aspx?cs=MAYO&s=ND&pt=9&Product=menopause&btnSearch.x=6&btnSearch.y=9
• Avoid if highly bee allergic
54. Standardized extracts of black cohosh,
dong quai, milk thistle, red clover,
American ginseng, chaste-tree berry
• 50 Israeli women peri/menopausal
• Phyto-Female or placebo X 3 months
• 47% vs 19% placebo-eliminated hot flashes
• 73% decrease in hot flashes, 69% reduction of
night sweats, improved sleep quality
• No liver test or estradiol/FSH level changes
• No change transvaginal ultrasound
Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep:
randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007;23:117-22.
55. Vitamin E 400 IU daily vs placebo
• 51 Iranian women placebo X 4 wks,
Vitamin E X 4 wks
• Decrease in # (5) and severity of hot
flashes p < 0.0001
Ziaei S.,Kazemnejad A. ,Zareai M. The Effect of Vitamin E on Hot Flashes in
Menopausal Women. Gynecol Obstet Invest 2007;64:204–207.
Grant MD, Marbella A, Wang AT, Pines E, Hoag J, Bonnell C, Ziegler KM, Aronson N.
Menopausal Symptoms: Comparative Effectiveness Review No. 147. (Prepared by
Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-
based Practice Center under Contract No.290-2007-10058-I.) AHRQ Publication
No.15-EHC005-EF. Rockville, MD: Agency for Health care Research and Quality;
March 2015. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
56. Ethyl-eicosapentainoic Omega 3 fatty Acids
and Vasomotor symptoms
• E-EPA = 45; placebo = 46
• Average number hot flashes/day 2.8
• EPA:decreased by 1.58/day
• Placebo: decreased 0.5
• p=0.04
• No change QOL
Lucas M, Asselin G, Merette C, et al. Effects of ethyl-eicosapentaenoic acid omega-3
fatty acid supplementation on hot flashes and quality of life among middle-aged women:
a double-blind, placebo-controlled, randomized clinical trial. Menopause 2009;16:357-66.
57. Valerian (Valeriana officinalis)
• ? GABA inhibitor
Yurchesen,M. et.al. Evid Based Complement Alternat
Med. 2015.
• Extracted from root/rhizomes
• Randomized, triple-blind, controlled trial
• 100 postmenopausal women in Iran
• Pittsburgh Sleep Quality Index
• 530 mg concentrated valerian extract or placebo
twice daily X 4 weeks.
• 30% valerian group vs 4% placebo group with sleep
quality improvement (P < 0.001).
S. Taavoni et.al., Menopause 2011 Sept; 18(9): 951-5.
58. Valerian
• Cytochrome P450 3A4
• Lovastatin,
itraconazole,
fexofenadine
• Avoid with alcohol,
benzodiazepines,
anesthesia (stop 2 wks)
• 400-900 mg valerian
extract up to 2 hours
before bedtime for 28
days
59. Kava Kava-Helped Anxiety but
not Hot Flashes
• GABA, dopamine D2, benzodiazepine, opioid
(µ and δ), serotonin, histamine (H1 and H2)
receptor binding activity
• Hepatotoxicity
• Stems/leaves may be more toxic than roots
• Solvent used for extraction may contribute to
toxicity
Yurcheshen M, Seehuus M, Pigeon W. Updates on Nutraceutical Sleep Therapeutics and
Investigational Research. Evidence-based Complementary and Alternative Medicine :
eCAM. 2015;2015:105256. doi:10.1155/2015/105256.
60. Kava Kava (Piper methysticum)
• Meta-analysis Cochrane Review
• 700 patients in 12 randomized,
controlled studies
• “The data available…suggest that
kava is relatively safe for short-
term treatment (1 to 24 weeks)…”
Pittler M. H., Ernst E. Kava extract versus placebo for treating
anxiety. Cochrane Database of Systematic Reviews. 2003
(Republished 2010 including additional studies).
61. Dehydroepiandrosterone (DHEA)
• 12 weeks intravaginal DHEA daily vs placebo
• Vaginal suppository 0.25% (3.25 mg) or 0.50%
(6.5 mg) DHEA
• Helped vaginal atrophy, burning, itching, libido,
dyspareunia
• Must be converted to estrogen to be effective
• No increase in serum estradiol levels
• Dietary Supplement in US
Archer, David. Dehydroepiandrosterone intra vaginal administration for the
management of postmenopausal vulvovaginal atrophy. Journal Steroid Biochemistry
and Molecular Biology. 145. Jan 2015,139–143
Labrie F, Archer D, Bouchard C, et al. Intravaginal dehydroepiandrosterone
(Prasterone), a highly effective efficient treatment of dyspareunia. Climacteric.
2011;14(2):282–288.
62. Homeopathic Vaginal Gel for GSM
• 186 women received daily oral isoflavones and
Lactobacillus sporogenes
• 103 women also used vaginal gel containing
isoflavones
• Calendula officinalis extract 1X
• Lactobacillus sporogenes
• Lactic acid
• Vaginal dryness, itching, burning, erythema,
dyspareunia significantly reduced with gel
• Calendula-drowsiness when taken with
benzodiazepines, phenobarbital, or zolpidem
Tedeschi, Christina et.al. Comparison of vaginal gel isoflavones versus no topical treatment in
vaginal dystrophy: results of a preliminary prospective study. Gyn Endo 2012. 28 (8).
64. Weight Loss Agents-No Benefit Proven Saper, Robert
B. et.al. Common Dietary Supplements for Weight Loss American Family Physician. 2004. 70 (9); 1731-8.
• Apple cider vinegar
• Acai Berries (Avoid prior
to MRI)
• Cascara
• Chitosan
• Chromium
• Conjugated linoleic acid
• Dandelion
• Ephedra (Withdrawn)
• Ginseng
• Glucomannan
• Green tea
• Guar gum
• Guggul
• Hydroxycitric acid
• Laminaria
• L-carnitine
• Licorice
• Psyllium
• Pyruvate
• Spirulina
• St. John’s Wort
• Vitamin B5
65. 52 YO female with hypertension requests
“herbal” non-hormonal approach to menopausal
symptoms including vasomotor symptoms, mood
changes, anxiety, and insomnia. What evidence
based regimen could you suggest?
A. Trial of meditation, Black Cohosh, valerian
B. Avoid soy isoflavanes in patient with history
of breast cancer
C. Discuss risk of hepatotoxicity with kava
kava
D. Discuss medication interactions with St.
John’s Wort
F. All of the above
66. 52 YO female with hypertension requests
“herbal” non-hormonal approach to menopausal
symptoms including vasomotor symptoms, mood
changes, anxiety, and insomnia. What evidence
based regimen could you suggest?
A. Trial of meditation, Black Cohosh, valerian
B. Avoid soy isoflavanes in patient with history
of breast cancer
C. Discuss risk of hepatotoxicity with kava
kava
D. Discuss medication interactions with St.
John’s Wort
F. All of the above
Class A steroids
The steroids in class A are found in nature and are formulated into drugs without undergoing any chemical modifications. For example, conjugated equine estrogens are estrogens in the form of sulfate esters, which are simply extracted from pregnant mare&apos;s urine and do not undergo chemical modification. Approximately 50% of conjugated equine estrogens consist of estrone sulfate, and the remaining approximate 50% consists of equine estrogens. Equine estrogens are native to the horse but not the human.
Nonbioidentical estrogen products include conjugated equine estrogens (CEE), which is extracted from the urine of pregnant mares. The two predominant estrogens found in CEE are equilin sulfate (native to horses) and estrone sulfate.10
Other nonbioidentical products include ethinyl estradiol, which is used in most combined oral contraceptives. It is formed after a minor chemical modification of estradiol that makes it one of the most potent estrogens. The ethinyl group at carbon 17 of ring D of the steroid nucleus greatly slows the hepatic and enzymatic degradation of the molecule and, thereby, makes oral ethinyl estradiol 15 to 20 times more active than oral estradiol.
Mestranol is an inactive prodrug that is converted in the body to ethinyl estradiol.
Scavenger of free radicals
Report prepared by BCBS