Bioidentical HRT
Why do women seek hormone replacement therapy (HRT) around menopause?
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As women age, the decline in naturally occurring hormones diminishes leading to significant impairment physically, sexually, and mentally. In fact, nearly 75% of women are affected by bothersome symptoms that impact their functional status and quality of life between the ages of 45 and 55 years.
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According to the most recent menopausal hormone replacement guidelines, treatment "is an effective therapy that offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than 10 years."
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At SoCal Behavioral Medicine, Inc., we offer both conventional and bioidentical menopausal HRT, depending on our client's preferences. We utilize highly specialized compounding pharmacies that are licensed in the state of California.
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MENOPAUSAL SYMPTOMS THAT MAY BENEFIT FROM HRT
Reproductive tract changes
•Menstrual cycle cessation for 12+ months
•Atrophy or shrinkage of the vagina from reduced estrogen
Atrophic vaginitis
The vaginal canal becomes less lubricated and the vaginal walls thin. The tissue looses elasticity and microtears contribute to uncomfortable symptoms including itching, burning and dyspareunia (pain with intercourse).
Urinary tract changes
Post-menopausal women have a higher incidence of urinary tract infections and urinary incontinence.
The bladder and urethra shrink which causes common urinary tract symptoms including dysuria (pain with urination), nocturia (the need to urinate at night), urinary frequency, urgency incontinence, (sudden signal to urinate without sufficient time to get to the bathroom and subsequent involuntary leakage of urine) and stress incontinence (release of urine with coughing, lifting objects etc.)
Other menopausal symptoms
Insomnia
Vasomotor symptoms - hot flashes, night sweats, dizziness, and palpitations
Anxiety - increased irritability, panic attacks
Depression
Concentration difficulty
Anhedonia - lack of motivation
Decreased energy level
Decreased libido
CAUTIONS AGAINST USE of HRT
•Higher risk of developing dementia (conflicting data)
•Higher risk of developing blood clots (oral formulations)
•Higher risk of endometrial cancer when using estrogen only products
•Avoid in smokers (higher risk for blood clots; reduces benefits of estrogen)
•Migraines
CONTRAINDICATIONS for HRT
•Undiagnosed abnormal vaginal bleeding
•Breast cancer or a history of breast cancer
•Estrogen-dependent cancer
•Active DVT, pulmonary embolism, or history of these conditions
•Stroke or heart attack history
•Active arterial thromboembolic disease (for example, stroke or MI), or a history of these conditions
•Uncontrolled hypertension
•Liver disease
•Protein C, protein S, or antithrombin deficiency, or other known thrombophilic disorders
•Pregnancy
•Known anaphylactic reaction, angioedema, or hypersensitivity to hormone replacement products
BENEFITS OF POST-MENOPAUSAL HRT
Estrogen
•Bone loss prevention and fracture reduction
•Reduction of hot flashes and vasomotor symptoms
•Reduction of dyspareunia, vaginal dryness and burning
•Positive effect on cardiovascular risk, dementia, and mood
•Reduction of urogenital issues
Progesterone
•Cancer reduction risk i.e uterine and other female cancers
•Reduction of menopausal symptoms i.e. hot flashes, mental "fogginess"
•Reduces the negative effects of unopposed estrogen
Testosterone
•May improve libido, energy, cognition, and overall sense of well-being
COMMON FORMULATIONS OF HRT
Estrogens: oral (higher risk of clots/cancer), topical cream, transdermal patch, intravaginal preparations
Progesterones: oral, topical cream, transdermal patch, intravaginal preparations; (micronized considered less risks)
Testosterone: oral (higher risk of liver toxicity/elevated lipids), topical cream, injectable
RECOMMENDED TESTS PRIOR TO STARTING HRT
•Labs to include complete blood count, fasting lipid panel, blood sugar, and urinalysis
•EKG
•Thyroid screening
•Mammogram yearly
•PAP yearly
•Endometrial Ultrasound to measure wall thickness
REQUIRED TESTS
•Baseline labs
•Mammogram - yearly
•Pap - yearly
We look forward to working with you to find the best fit for your symptoms. Our goal is to provide safe effective treatments for menopausal women so they can continue living vibrant healthy lives.
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ADDITIONAL RESOURCES
Counseling Postmenopausal Women about Bioidentical Hormones
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Hormone Replacement Therapy for Menopausal Symptoms
Hormone therapy: Is it right for you?
Navigating Female Hormones: A Pharmacist’s Guide to HRT
Menopausal Hormone Replacement Therapy
The 2020 Menopausal Hormone Replacement Therapy Guidelines
Vaginal Atrophy