To treat or not to treat?

Highly individualized. Debilitating symptoms. Mild symptoms.

Goal of treatment: Improved quality of life

One approach to treatment of these symptoms is Hormone Therapy (HT) “Natural” or “Bioidentical” Hormone regimens Traditional Hormone regimens

Much confusion among consumers and clinicians about the terms “natural,” “bioidentical” and “synthetic.”

 If a hormone is chemically identical to that found in the human body it can be said to be “bioidentical.”

 If a substance originated in plant or animal, one can say it is “natural.”

1. Many drugs in clinical use today originate from plants.

 If a substance originated in plant or animal, one can say it is “natural.” 1. Many drugs in clinical use today originate from plants. 2. Just because a substance is “natural” does not mean it is always safe.

 Hormones that are chemically altered in the laboratory can be termed “synthetic.”

1. A substance can be made that has hormone activity but is different chemically than the hormone it mimics.

 Hormones that are chemically altered in the laboratory can be termed “synthetic.” 1. A substance can be made that has hormone activity but is chemically dissimilar to the hormone it mimics. 2. A substance can be altered to become bioidentical.

 Therefore, it’s possible for a ”bioidentical” hormone to be both “natural” and “synthetic.”

 Many commercially available products made by pharmaceutical companies are, in fact, “bioidentical.”

Bioidentical hormones for the treatment of menopause symptoms include estradiol, estriol, estrone, progesterone and testosterone.

Hormone levels constantly change due to normal physiologic variations. Symptoms should be managed with the lowest effective dosages.

Monitoring hormone levels through blood or saliva testing is therefore less important that the successful management of menopause symptoms.

Bioidentical hormones can be administered as pills, topical sprays, creams, gels, lotions, patches, vaginal tablets, creams or inserts, injectables and implants.

Compounding is defined as “combining, mixing or altering of ingredients to create a customized medication for an individual patient in response to a licensed practitioner’s prescription. US FDA

The Women’s Health Initiative (WHI) Study Widely publicized in 2002 Many women and physicians decided to immediately stop HT

A consumer book recommends bioidentical hormone therapy (BHT) as a safer alternative to commercially prepared hormones.

Some smaller more recent studies have suggested very reasonable safety and even health benefits to early onset HT.

All women experience some degree of menopause symptoms for some period of time in their lives.

The decision to treat menopause symptoms is highly individualized.

Hormone therapy (HT) is a reasonable and perhaps even healthy choice for many women.

Bioidentical hormones are available and make sense for the treatment of menopause symptoms.

 Menopause is defined as:  2 or more irregular periods after age 40  The start of hot flashes  No menstrual period for 12 consecutive months  An increase in mood swings  The average age of menopause is:  51  60  55  49

 Menopause increases health risks like:  Heart disease  Sexually transmitted diseases  Osteoporosis  A & C  Women going through menopause should take:  Hormone therapy  It depend on the woman, her symptoms and her medical history  Bio identical hormone therapy  Estrogen therapy

 The most accurate test to determine if a woman is in menopause is:  Follicle stimulating hormone (FSH) blood test  Complete blood count (CBC)  Urinalysis  None of the above  Which of the following are proven alternative therapies for menopause symptoms:  Black cohosh  Plant estrogens  Herbals  None of the above

 During menopause, some doctors may prescribe which treatment?  Hormone therapy (HT)  Birth control pills  Benzodiazepines  A or B  Which is not a symptom of menopause?  Night sweats  Back pain  Headaches  Anxiety

 If Menopause occurs in a woman younger than ____ years, it is considered to be premature.  40  45  50  30  Which factors can affect the timing of menopause?  Surgical removal of the ovaries  Chemotherapy and radiation  Medication  A & B

 Hot flashes can last from a few minutes to a few hours.  True  False  About 15-28% of post-menopausal women can still bear children.  True  False

 As a result of menopause, which of the following is least likely to occur.  Decreased estrogen levels  Vaginal atrophy  Osteoporosis  Osteoarthritis  Menopause decreases a woman’s risk for depression.  True  False