Menopause and Hormone Replacement Therapy
Welcome to menopause and the next stage of your life. Menopause is an inevitable journey,
one you cannot skip over or avoid. The clinical definition is the cessation of menses for at least
one year before this wonderful new venture begins. All women cease menses; some do so
naturally, some unnaturally, and some surgically. However we transition into menopause, it
marks a significant time in our lives.
Now, putting all of the clichés and the labels aside, this time can be a continuation of a currently
fulfilling life or the beginning of something new, a new you. Life is not over or even slowing down
– far from it! Some careers are growing, some are launched; some relationships have bonded,
some have severed, and some new ones are formed; children leave home or are preparing to
do so, etc.
We are less fearful and reticent than we were at a younger age – less concerned for what
others think and more apt to please ourselves. This could be the best stage yet! So take care of
yourself, dress up, get out and mingle, and be proud of what you have accomplished and what
you will accomplish going forward. Today is the youngest age you will be the rest of your life.
With that said, let’s turn our attention to the confusion and controversy over what we are
supposed to do when the symptoms of this wonderful journey disrupt our days and keep us up
at night. We want to make the most of this time, right? And that means trying to feel our best. A
few of us have no symptoms whatsoever, and some may experience daily reminders. The
majority fall somewhere in the middle. For those of us who do face symptoms, we need to also
face the big question: “Is hormone replacement therapy right for me?”
True, studies are out there that support a concern for taking replacement hormones, but there
are also studies that support the good in hormone replacement therapy. We’re not going into
that issue here. We are just going to list the possible options that you can discuss with your
physician. The final decision is yours.
We have entered an era where 40 million baby boomers are experiencing menopause (or will
be soon), and these women are planning to accept it on their terms only…which translates to
going a different route from their mothers and trying to stay as youthful as possible. In Arlene
Weintraub’s recent book Selling the Fountain of Youth: How the Anti-Aging Industry Made a
Disease Out of Getting Old, she describes how popular this drive to be young at all costs has
become. The medical and economical possibilities for treating menopausal symptoms seem
overwhelming. The reports are endless, contradictory, and confusing to the majority of 50somethings who might be receiving the first chronic med prescriptions of their lives. Let’s try to
clear up some of that confusion.
First, what does “bio-identical” mean, and why does everyone want this type of hormone
replacement? The movement began with a group of physicians who founded the American
Academy of Anti-Aging Medicine (A4M) along with a book titled Ageless by Suzanne Somers.
Considering how good Ms. Somers looks for her age, her book has become a popular reference
in this debate and helped spawn the interest in replacing what our bodies have lost (i.e.,
hormonally) with what we can manufacture to resemble what was lost.
Without too much history or textbook references, bio-identical hormones can be loosely
described as those closely resembling the molecular structure of the hormones your body made
when you were younger. However, when these manufactured hormones include yams and soy
products in their ingredients, this definition can be confusing. Still, that’s the basic concept.
Bio-identical hormone replacement is supposed to be better and more natural than traditional
hormone replacement therapy, which is exactly what our mothers were prescribed. The word
“natural” draws attention because people think they are improving their bodies as opposed to
doing themselves harm. (I like to remind those women who automatically think “natural” is better
that opium and arsenic are also “natural” compounds.) It is good to remember that bio-identical
hormone therapy – if purchased as a personally compounded product at a compounding
pharmacy – is a form of alternative medicine.
Like traditional hormone replacement therapy, bio-identicals are prescribed to relieve symptoms
of menopause and possibly reduce the risk of osteoporosis. In addition, these alternative forms
can be billed as a cure for many other age-related illnesses. However, there is little evidence to
support many of these claims, and these compounded products share the same risks
associated with their FDA approved competitors.
These FDA approved bio-identical drugs available are typically covered by insurance, and your
physician can match an option to best fit your needs and lifestyle. A typical regimen for women
presenting with menopausal symptoms for the first time is: a (very small) patch form of a bioidentical for estrogen and an oral form of a bio-identical for progesterone. If you are
experiencing very uncomfortable vaginal dryness and chafing, a vaginal product used a couple
of days a week might also be added until these symptoms subside.
Lots more options exist around and outside of this above example. As a women and a
healthcare consumer who does not want to spend her precious free time reading through the
plethora of books written on the subject of HRT (Hormone Replacement Therapy) or BHRT
(Bio-Identical Hormone Replacement Therapy), you need a simplification. First, acknowledge
that you are going to experience some degree of physical, mental, emotional, or spiritual
change during this time in your life. Then, get the facts and make a personal decision. Keep in
mind that what is right for your mom or your sister or your friend may not be the best therapy for
you.
This article is intended to give you some insight so that you can make independent and
knowledgeable decisions. And the chart below can help you understand the possibilities in order
to determine the best therapy for you. An equine estrogen is made from horse urine; 17-B
estradiol is made from plants and is closest to what your body once made adequately. Oral
estrogen medications are also subject to drug interactions in the body as well as first pass
metabolism where is some potency is compromised.
Oral Estrogen Products
Composition
Conjugated Equine Estrogens
Synthetic Conjugated Estrogens
Estrified Estrogens Synthetic
17b-estradiol
Product Name
Premarin
Prempro
Cenestin
Enjuvia
Congest
Menest
Estrace
Various 17b-estradiol generics
Estradiol Acetate
Estropipate (a salt of estrone sulfate and piperazine)
Femtrace
Ortho-Est
Transdermal and Topical Estrogen Therapy Products
All 17B-Estradiol – non-synthetic estrogen produced in the body by women during the
reproductive years in the ovaries and in the adrenal cortex; estradiol is also produced in
the brain and in arterial walls.
Composition
Drug Name
17B-estradiol Patch
Alora
Climara
Fempatch
Menostar
Vivelle
Vivelle Dot
Estraderm
Various generics
17B-estradiol Transdermal Gel
Elestrin
Divigel
Estrogel
17B-estradiol Topical Emulsion
Estrasorb
17B-estradiol Transdermal Spray
Evamist
Vaginal Estrogen Therapy Products
Both synthetic and 17B-estradiol
Composition
Vaginal Creams
17B-estradiol
Conjugated Equine Estrogen
Vaginal Rings
17B-estradiol
Estradiol Acetate
Vaginal Tablets
Estradiol Hemihydrate
Oral Combination Estrogen Therapy Products:
Estrogen and Progesterone
Composition
Conjugated Estrogens +
Medroxyprogesterone Acetate Synthetic
Ethinyl Estradiol + Norethindrone Acetate
17B-estradiol + Norethindrone Acetate
17B-estradiol + Drospirenone
Drug Name
Estrace Vaginal Cream
Premarin Vaginal Cream
Estring, 90 Days
Femring, 90 Days
Vagifem
Vagifem LD
Drug Name
Premphase
Prempro
Femhrt
Activella
Angeliq
Transdermal Continuous-Combined Regimen Patch
Composition
Drug Name
17B-estradiol + Norethindrone Acetate
CombiPatch
17B-estradiol + Levonorgestrel
Climara Pro
Progesterone
A female hormone produced in the ovaries during ovulation; belongs to a class of
hormones called progestins. Progesterone is a naturally produced human progestogen.
If a woman has an intact uterus during menopause and is electing hormone replacement
therapy, progesterone is necessary to protect from endometrial cancers.
Oral Capsules and Tablets
Composition
Drug Name
Micronized Progesterone
Prometrium
Medroxyprogesterone Acetate
Provera
Various generics
Norethindrone
Micronor
Nor QD
Various generics
Norethindrone Acetate
Aygestin
Various generics
Norgestrol
Ovrette
Megestrol Acetate
Megace
Various generics
Intrauterine Device: Progestin
Levonorgestrel
Mirena, 5-year use
Vaginal Gel: Progesterone
Progesterone
Prochieve, 4 and 8%
Crinone, 4 and 8%
There are additional products not listed, such as injections and various generic names of many
of the oral and transdermal patch drugs. Also not mentioned, and I will not go into them here,
are the over-the-counter products and those you can order through the mail. Many of those
products are considered nutraceutical options; black cohosh and red clover are among these
types of remedies for the symptoms of menopause.
In the end, it is your body, and you should consult with your physician before and during your
course of therapy.
REFERENCES:
1. WebMD
2. Wikipedia
3. North American Menopause Society