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Bioidentical Hormones-2-1
Bioidentical Hormones-2-1
OB/GYN
during the menopause transition, such as vaginal dryness, hot ashes and night sweats. Commonly reported side effects of estrogen hormone therapy include: headache, breast pain, irregular vaginal bleeding or spotting, bloating and nausea.
Bioidentical
When something is bioidentical, it is structurally identical to the substance as it naturally occurs in your body. Most Bioidentical estrogens and progesterone come from soy (estrogen) or yams (progesterone). Once the hormones are extracted from the plant source, they can be processed to be used by a womans body. There are two main types of bioidentical hormones: those that are FDA-approved and commercially available with a prescription, such as Estrace and Estrogel, and those that are mixed on an individual basis for women in compounding pharmacies, which are not FDA-aproved.Estrogen products produced via compounding are typically called biestrogen or tri-estrogen, since they contain varying amounts of the two or three types of estrogen. The individual prescription is typically created based on a saliva test that identies the form of estrogen in which a woman is decient. However, saliva testing is not reliable, nor is it used to determine or to monitor therapy. If you chose to have your bioidentical hormones custom made for you in a compounding pharmacy, you need to understand that their production, the purity of the product and the safety of the dose designed for you are unregulated. Continued On Next Page
Facts
If a woman decides to use hormones, it is more a question of which type of therapy best meets her individual menopausal needs than whether she will use hormone therapy or not. However, few facts should be claried and
1-Oral: most hormone formulations still come in a pill form. The only Bioidentical oral form is Estrace (micronized estradiol: estrogen in
smaller particles for better absorption).
2-Transdermal Gel: Estrogel (estradiol gel) is applied once a day to the arm, from wrist to shoulder. This bioidentical estrogen is a clear,
odorless gel that dries on the arm in two to ve minutes.
3-Lotion: Estrasorb (estradiol topical emulsion) is a bioidentical estrogen. Women apply this white, lotion-like emulsion to both their legs
(thighs and calves) on a daily basis.
4-Vaginal cream: Estrogens creams include Estrace (micronized estradiol cream), ogen (estropipate cream), ortho dienestrol cream, and
Premarin (conjugated estrogen cream). These creams are generally used to treat vaginal symptoms. Only estrace is a bioidentical estrogen cream.
5-Vaginal Ring: There are two rings currently available: Femring (estradiol acetate) and Estring (estradiol).Only Estring is a bioidentical
form of estrogen in a ring. The ring is a small piece of circular plastic silicone that is inserted into the vagina like the diaphragm, where it releases a steady dose of estrogen for three months, at which point it is replaced.Estring is approve d to treat vaginal symptoms whereas Femring is also approved to treat hot ashes, and night sweats.
6-Patches: Ranging from smaller than a dime in size to nickel and half-dollar sizes, estrogen patches are typically applied to the abdomen or
upper buttock. They are designed to stay on even when showering or swimming. They have varied dosing, with some needing to be changed once a week, others twice weekly. You have to rotate where you wear the patch. Bioidentical patches include Vivelle Dot, Alora, Climara, Menostar and Estraderm which all are estradiol.
7-Vaginal Tablet: Less messy than a cream, Vagifem is an estradiol tablet inserted into the vagina via a disposable applicator. The general
dose is one tablet daily for the rst two weeks, followed by one tablet twice weekly. It is a bioidentical hormone used for vaginal symptoms.
8-Injection: Before there creams and vaginal pills, there was delestrogen (estradiol valerate), an injection. Still available in the USA, this
form of estrogen is taken once every four weeks. It is not, however a bioidentical formulation.
9-Progesterone: to reduce the risk of endometrial cancer, progesterone is prescribed along with estrogen-only hormone therapy
products.There are two forms of bioidentical progesterone currently available: Prometrium (oral capsule) and Prochieve (vaginal gel). In conclusion, the new approach to hormone therapy is to focus rst on the symptoms, the match the treatment for the specic symptom that is affecting your quality of life. Discuss those issues with your provider in detail.