This survey examined patients' opinions on three types of hormone replacement therapy (HRT): bioidentical hormone replacement therapy (BHRT), standard hormone replacement therapy (SHRT), and no therapy. The majority of patients using BHRT reported positive views (86%) and experienced relief of menopausal symptoms, while more patients using SHRT reported neutral or negative views. Fewer adverse effects were reported for patients using BHRT compared to SHRT. The results suggest patients may be more satisfied with BHRT due to increased monitoring by physicians and pharmacists, though limitations include variability in compounded formulations and lack of large studies on BHRT safety and efficacy.
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.
Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.HRT can be administered orally( in pill form), vaginally( as a cream), or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.
Hormone replacement therapy in Post menopausal womenPOOJA KUMAR
HRT-what you need to know! why opt for it? who should take it? contraindications. estrogen therapy, progestins, tibolone.
*Associations with osteoporosis, breast cancer, endometrial cancer
There is so much confusion in our society revolving around hormone replacement therapy as to whether they cause harm or whether they heal, repair, and regenerate. Should we use them? Should we stay away from them? We get messages on a daily basis from social media, advertisements on TV, from our doctors, from your Aunt Martha, or whoever decides to chime in. We hear things like…..
•Hormones cause cancer, especially estrogen
•Don’t stay on hormones for very long
•Only take the smallest dose
•“Doping”
•It hasn’t been studied enough
•It hasn’t been studied on a large enough population
•It hasn’t been studied long enough
People with no education, training, or experience in treating hormone deficiencies and hormone replacement therapy give very profound statements regarding hormones and people’s health. This, coupled with social media’s highway of information and distribution, is why we are so confused about hormone replacement therapy. Our society is more confused about hormones and more afraid of hormone replacement therapy then any other time in history. The fear instilled in doctors and women purposely keeps them away from taking them.
#MTR #Moxie #HRT
http://menopausemoxie.com/underground-hrt/
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.
Hormone Replacement Therapy(HRT) is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency.HRT can be administered orally( in pill form), vaginally( as a cream), or transdermally ( in patch form) because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. It can be used before, during and after menopause.
Hormone replacement therapy in Post menopausal womenPOOJA KUMAR
HRT-what you need to know! why opt for it? who should take it? contraindications. estrogen therapy, progestins, tibolone.
*Associations with osteoporosis, breast cancer, endometrial cancer
There is so much confusion in our society revolving around hormone replacement therapy as to whether they cause harm or whether they heal, repair, and regenerate. Should we use them? Should we stay away from them? We get messages on a daily basis from social media, advertisements on TV, from our doctors, from your Aunt Martha, or whoever decides to chime in. We hear things like…..
•Hormones cause cancer, especially estrogen
•Don’t stay on hormones for very long
•Only take the smallest dose
•“Doping”
•It hasn’t been studied enough
•It hasn’t been studied on a large enough population
•It hasn’t been studied long enough
People with no education, training, or experience in treating hormone deficiencies and hormone replacement therapy give very profound statements regarding hormones and people’s health. This, coupled with social media’s highway of information and distribution, is why we are so confused about hormone replacement therapy. Our society is more confused about hormones and more afraid of hormone replacement therapy then any other time in history. The fear instilled in doctors and women purposely keeps them away from taking them.
#MTR #Moxie #HRT
http://menopausemoxie.com/underground-hrt/
provide recommendations for alternative drug treatments to address.docxsimonlbentley59018
provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples
Week 9 Initial Post- Mel Mal,
COLLAPSE
Top of Form
This case study presents a particularly hard case to untangle. The 46-year-old women is exhibiting the night sweats, hot-flushing, and genitourinary symptoms common in menopause. The patient is still getting a regular period, so these symptoms are most likely pre-menopausal, as periods stop in true menopause. In a patient with no familial history increasing the patient’s risk for breast cancer, an estrogen or combination estrogen/progestin therapy would most likely be initiated (Rosenthal et al. 2021). This therapy would likely reduce the uncomfortable symptoms, however in a patient with a family history of breast cancer, the therapy can increase the likelihood of breast cancer occurrence.
Luciano et al., found that both estrogen therapies and combined estrogen/progestin therapies increased the risk for breast cancer (2020). It is important to notice that this study notes that the risks for patients who take the therapy on a short-term basis are at a slightly lower risk, however this patient is young at 46 years old and would possibly need a long-term medication solution.
On the opposite side, Carr summarizes the North American Menopause society’s 2022 updated guidelines on hormonal replacement therapy and explains that a patient with menopausal symptoms can take combined hormone therapy until at least the mean age of menopause (53) without any significant increase in breast cancer (2022). With the newest recommendations, I would recommend that the patient start a combined estrogen and progestin hormone therapy for reduction in symptoms. With this recommendation is the caveat that the patient will need regular visits to re-evaluate the need for the therapy with hopeful cessation of treatment within three to five years to keep any increase in breast cancer risk to a minimum.
The lowest dose medication should be used for the shortest time period in order to reduce comorbidity risk so this patient recommendation will be to start Prempro 0.3mg/1.5mg daily and then reevaluate for effectiveness and need to increase dosage (Rosenthal et al., 2021).
The patient also needs adjustments in her hypertension medication. The patient is currently on Norvasc 10mg daily, and HCTZ 25mg daily. This therapy is within guidelines because she is on Norvasc, a calcium-channel blocker, and Hydrochlorothiazide, a thiazide diuretic, are being used to potentiate each other’s effects. In cases where a thiazide diuretic is ineffective in controlling HTN, a loop diuretic may be added. In this patient, we will recommend adding Furosemide to hopefully control the hypertension. This dosage will start low, at 20mg daily, (taken in the morning to decrease nocturia), with regular home blood pressure checks as well as in office re-evaluation to determine how effective the medication and dosage are (.
For this Discussion, review the case Learning Resources and the .docxevonnehoggarth79783
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 2 Me
Treatment of a Patient with Insomnia
The case presented this week, is that of a 75-year-old widow who just lost her spouse 10-months ago. Th patient presents with chief complaints of insomnia. Past medical history of DM, HTN, and MDD is reported. Since the passing of her husband, she states her depression has gotten worse .
Web only rx16 pharma wed_200_1_hagemeier_2fleming_3vernachio
FINAL Poster Prsentation
1. Hormone Replacement Therapy: Survey of patients regarding
their opinion of symptom relief
Kathy Chowa, Dieter Steinmetz, R.Ph.b
aWestern University of Health Sciences College of Pharmacy, Pomona, CA bCoast Compounding Pharmacy, Oceanside, CA
Background
Many women who are experiencing menopause suffer from hot flashes, vaginal
dryness, night sweats, depression, irritability, sleep disturbances, changes in memory
and cognition.1 These symptoms can be unbearable and decrease quality of life,
hence many women turn to hormone therapy replacement to help relieve their
symptoms.
There are two types of hormone replacement therapy – FDA approved standard
hormone replacement therapy (SHRT) and compounded bioidentical hormone
replacement therapy (BHRT). However, the FDA approved products that are
considered standard of care raised safety concerns when the Women’s Health
Initiative found that they increased breast cancer, stroke, venous thromboembolism,
coronary heart disease, dementia; therefore, the risk outweigh such benefits as
preserving bone health and endometrial cancer.2
Women who seek out alternative treatment turn to bioidentical hormone therapy
compounded by compounding pharmacies which are advertised as safer, better, and
a more natural way to treat menopause symptoms.3 A paper written by the American
College of Obstetricians and Gynecologists claim that compounded products are
inferior to FDA approved products and that they lack safety and efficacy data which
poses additional risks.4
Currently, there are no large scale studies done on the safety and efficacy of
compounded bioidentical hormone therapy. Hence, the idea of surveying current
patients on all hormone replacement products and their experience on bioidentical
hormone therapy and standard hormone therapy came about. The results from this
survey can give us more insight and information on bioindentical hormone therapy
itself.
Hypothesis
Objective
My objective is to survey patient opinion for each class of hormone replacement
therapy available in today’s market.
The study includes an exploration of patient’s symptom relief and number of self
reported ADRs.
There may be more negative views about HRT for those who have not tried it,
including mixed views from patients who have tried standard HRT and very positive
views for those who have tried BHRT.
Acknowledgements
References
I would like to thank patients at Coast Compounding and Rite Aid pharmacy that
participated in the survey. And many thanks to Dr. Dieter Steinmetz, Dr.Rasial Hamid,
Reginald Villacorta, and Dr.Klotz for all your guidance and help that made this project
possible.
1. Jones M.D., M.A., F.A.C.O.G, Lisa M. "Menopause and Menopause Treatments Fact
Sheet." Womenshealth.gov. Ed. Songhai Barclift, M.D., F.A.C.O.G. U.S. Public Health Service, 16 July
2012. Web. 01 Apr. 2014.
2. "Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women Principal Results
From the Women's Health Initiative Randomized Controlled
Trial."Http://jama.jamanetwork.com/article.aspx?articleid=195120. Jama-Express, 17 July 2002. Web.
24 Mar. 2014.
3. What are bioidentical hormones? Natural. Bioidentical. Compounded. Confusion about these terms is
only adding to the confusion over hormone therapy. Harv Womens Health Watch 2006; 13:1-3. Print.
4. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and
American Society for Reproductive Medicine Practice Committee. "Compounded Bioidentical
Menopausal Hormone Therapy." Fertility and Sterility 98.2 (2012): 308-12. Print.
Study Population
Inclusion Criteria
Menopausal or post-
menopausal women who
have not used, have used,
or are using HRT w/wo a
hysterectomy
Bioidentical Hormone
Replacement Therapy
(BHRT)
N= 72
No Therapy
N = 47
Standard Hormone
Replacement Therapy
(SHRT)
N= 39
Exclusion Criteria
- Men
- Perimenapausal women
- Women who have menses.
Methods
Methods are IRB approved. Many self reported anonymous surveys were done.
Each survey asked the patients for the type of their hormone replacement medication,
treatment time frame in years, medical conditions (stroke, blood clots, breast cancer,
uterine cancer), symptoms before and after treatment using a scale from 1 to 5 (1 – no
symptoms, 5 – severe symptoms), and their opinion on the hormone therapy they are
currently on (positive, neutral, negative).
The setting for the survey was both at Coast Compounding pharmacy and at a retail
pharmacy at a chain pharmacy(with the manager’s approval).
Study Design
Results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
BHRT
SHRT
No Therapy
86%
49%
2%
11%
13%
57%
3%
38%
40%
Positive
Neutral
Negative
Table 1: Average years of patients on Hormone Replacement Therapy
Table 2: Frequency of self-reported adverse drug events (Stroke, Blood Clots,
Breast Cancer, Uterine Cancer)
*Three patients reported being diagnosed with breast cancer
Bioidentical Hormone Replacement Therapy (BHRT) 4.60
Standard Hormone Replacement Therapy (SHRT) 6.22
No Treatment BHRT SHRT
Before After Before After
2 3 1 1 5*
Table 3: Averages of Self reported symptoms before/after therapy
(5 = severe; 1 = no symptom)
No
Treatment
N=47
Bioidentical
N=72
Standard
N=39
Before After Before After
Hot Flashes 2.81 3.39 1.46 3.74 2.03
Night Sweats 2.91 3.44 1.50 3.33 1.82
Vaginal Dryness 2.32 2.63 1.67 2.82 2.05
Depression 1.94 2.42 1.56 2.15 1.67
Headache 1.81 2.22 1.56 2.36 1.77
Foggy Thinking 1.96 2.78 1.74 2.49 1.82
Anxiety 2.21 2.76 1.76 2.31 1.85
Irritability 2.34 3.10 1.75 2.67 1.97
Insomnia 2.30 3.47 2.04 2.90 1.97
Decreased Libido 2.17 2.86 1.89 2.62 1.79
Fatigue 2.38 3.15 1.90 2.69 1.92
P-value <0.05.
P-value was determined by chi-square test.
Discussion
Patients may be more satisfied with BHRT therapy due to more frequent patient
monitoring from the physician and pharmacists. For patients in the SHRT group,
patient’s rated that they obtained relief from SHRT (table 3), but felt more negatively
towards it. Possible reasons are due to the reports from WHI being harmful may have
women feeling more negatively towards it.2 Physicians and pharmacists may not have
monitored the patient, including spending less time with them on their medication as
well. Results in the no therapy group did not meet expectations as majority felt
neutral about HRTs rather than more negative. Possibly due to less severe symptoms
than in patients in the SHRT and BHRT group.
Limitations in the study are of the following: patients who come to a compounding
pharmacy may also be the ones who are satisfied their compounded medication and
the discontinued population was not available for survey. Compounded medications
are customized medication to the patient, so it is very hard to generalize
“bioidenticals” since each patient is getting a different dose, different active
ingredients, and using ifferent cream bases.
What was unanticipated was the amount of self reported relief patients in the BHRT
were responding. The American College of OBG/YN speak of compounded products
in a negative light, claiming that dose is inconsistent and efficacy is questionable yet in
table 3, patient reported relief using BHRT are similar to SHRT group.4 Interesting to
note, even though less patients were surveyed in the SHRT group compared to BHRT
group, frequency of self reported ADRs were higher in the after-SHRT group than in
the after-BHRT group. Potential studies can focus on the efficacy and safety of
compounded products compared to standard of care hormone replacement products.
Challenges for future experiments that may present would be the money to fund such
a large study, choosing what cream base, what dose and what ingredients to use for
the compounded products.