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What Hormones Are Used in HRT?
HRT typically includes some type of estrogen, and, if a woman has an intact uterus, natural micronized progesterone or, more commonly, a progestin (a drug with progesterone-like actions on the uterus) to prevent endometrial cancer.
Estrogen replacement therapy (ERT) refers to taking some form of estrogen alone. Estrogen taken by itself is also referred to as unopposed estrogen—meaning that no progesterone or progestin is taken to counteract the effects of estrogen on the uterus. Unopposed estrogen can cause endometrial cancer (cancer of the lining of the uterus). ERT is an option mainly for women who have had a hysterectomy (removal of the uterus).
Women with symptoms during perimenopause might decide to take low-dose birth control pills (which contain both estrogen and progestin). Some women may benefit from taking natural progesterone alone, or progesterone combined with a low dose of estrogen. A low-dose estrogen patch works particularly well to provide a steady amount of estrogen, preventing the wide swings in estrogen levels that many women experience during perimenopause.
conventional hormone replacement drugs
In the United States, the most frequently prescribed estrogen product for HRT is conjugated equine (horse) estrogens (brand name Premarin). The most frequently prescribed progestin for HRT is medroxyprogesterone acetate (MPA).
bio-identical hormones COMPOUNDED
There are many alternatives to conventional drug products, including natural or bio-identical hormones, which are identical in chemical structure to the hormones naturally produced by our bodies. This type of HRT is referred to as natural hormone replacement therapy, or NHRT.
NHRT is available both in brand-name products and from compounding pharmacies, which can supply any of the bio-identical hormones alone or combine them into one dose in the form desired (e.g, sublingual tablets, oil caps, or cream).
HRT is usually taken in one of two regimens:
Sometimes other schedules, such as continuous estrogen with intermittent progestin/progesterone, are used. Your healthcare provider can help you decide what regimen is right for you.
Dosages prescribed for ERT, HRT and NHRT vary and can be adjusted to meet a womans specific needs. Relatively low doses of estrogen and estrogen/progestin have been found to be effective for treating symptoms of menopause and can also maintain bone density. Low doses of estrogen found to be effective in recent studies include, for example, doses of conjugated equine estrogen (Premarin) as low as .3 mg (compared to the "standard" dose of .625 mg) alone or combined with a reduced dose of progestin; doses of oral estradiol as low as .25 mg; and a transdermal patch dose of .025 micrograms. Using lower doses of estrogens and progestins also reduces side effects from the drugs.
There are dozens of possible ways to take HRT, and ideally, hormone therapy should be tailored to your particular needs. Talk with your healthcare provider to learn more about HRT benefits and risks in order to choose what options might be right for you. A compounding pharmacist is also able to answer questions regarding hormones and HRT.
Alarming News! - FDA Bans Estriol
The FDA announced on January 9, 2008 that the hormone estriol can no
longer be used in estrogen medications customized for women by compounding
pharmacies. Estriol is a component of 90 percent or more of these customized
Doctors condemn FDA decision to ban estriol following pressure from drug lobby
"The FDA claims that it is taking estriol off the market because it is not a component of any FDA approved drug, despite the fact that the hormone has been used for decades without problems. Estriol has a long standing United States Pharmacopoeia monograph, an accepted standard for drug ingredients absent significant health risks. Other common drugs that are not components of FDA approved drugs include aspirin.
"The FDA action is in response to a "citizen petition" filed by the giant drug maker Wyeth Pharmaceuticals. Wyeth is the maker of Premarin and Prempro, two hormone treatments for women that have been linked to cancer, heart disease and stroke by a 2002 Women's Health Initiative, National Institute of Health (NIH) study. Millions of women have discontinued taking Wyeth's hormone products as a result of the WHI study, which was halted because of the serious health risks that were discovered in 2002.
"The FDA has succumbed to pressure from Wyeth in its attempt to clear the market of safer alternatives to its unsafe products," said Erika Schwartz, M.D., a co-founder of BHI, the Bioidentical Hormone Initiative, a not-for-profit medical organization comprised of conventionally trained, practicing physicians who have successfully treated patients with bioidentical hormones for years.
"The FDA should protect the interest of women, not the profits of Wyeth."
The campaign to discredit compounded bioidentical hormones enrages physicians.
January 14, 2008 excerpt from Bioidentical
"Thus, it is critical that women be given the information that these natural hormones do not have the negative side effects of the synthetic hormones and in no way pertain to the conclusions reached by the Women's Health Initiative (WHI) study. Natural hormones are a safe and more conservative approach to hormone replacement therapy that does not carry the risks associated with Premarin and Provera.
"There are no legitimate medical, scientific or legal reasons for the FDA to take this action," said Dr. Schwartz. "It would require countless women to return to their doctors and alter the medications they have used both safely and effectively for years. If the FDA has its way, since estriol is available in Europe, a woman will need a passport, not a prescription to get her medication.
"The citizen petition filed by Wyeth with the FDA requested that estriol be removed from the market, along with other requests to remove customized medications that compete with their flawed products. The petition created a tremendous backlash from women, doctors and pharmacists. Over 77,000 comments, a near record, were filed with the FDA in response to the petition, all but a handful opposing Wyeth's request.
"The few comments in support of the Wyeth petition were filed mostly by organizations with substantial financial ties to Wyeth," said Dr. Schwartz. "The FDA has chosen to protect Wyeth's wealth rather than women's health. This is a shameful act for this agency to take.”
IF THIS ISSUE IS IMPORTANT TO YOU
On January 9, 2008, FDA took action to impose harmful restrictions on the compounding and dispensing of bio-identical hormone replacement therapy (BHRT), specifically compounded medicines containing the drug estriol. This action has critical implications for pharmacists, patients and physicians.
You can learn more about the problem from the compounding pharmacists' point of view by clicking here.
Should you care to oppose the FDA's Action to Restrict BHRT, click
here to visit a website that provides more information and ways to
Page uploaded September 2002, Updated March 2008
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