There are many reasons to consider hormone replacement therapy (HRT) for menopausal women, chief among them is relief from the bothersome, and sometimes embarrassing symptoms of menopause, such as hot flashes and night sweats. More importantly, HRT can protect women from cardiovascular disease, bone loss, and memory loss.  HRT also supports the cellular processes of growth and repair, slowing down the aging process and providing disease prevention.

The Brain on Estrogen

One of the most debilitating symptoms of menopause is memory loss and inability to concentrate.  For many women, this greatly affects their quality of life.  Estrogen benefits the brain by increasing blood flow, and therefore, the delivery of nutrients. Estrogen further protects the brain by maintaining the blood-brain barrier, and decreasing production of beta amyloid peptides found in Alzheimer’s disease.  Estrogen also improves brain function by increasing the availability of neurotransmitters, such as acetylcholine.

Estrogen and Cardiovascular Health

Estrogen has many beneficial effects on the cardiovascular system of menopausal patients.  Not only does estrogen increase blood flow through the arteries, it also maintains arterial elasticity, prevents plaque formation, and lowers blood pressure.  Estrogen benefits the lipid profiles of most menopausal patients, decreasing LDL and increasing HDL.  And estrogen replacement lowers the overall risk of heart disease by 40-50% in menopausal women.

 

Benefits of Compounded Estrogen – Bi-Est

Bi-Est is a combination of two estrogens: Estriol (E3) and Estradiol (E2).  Estradiol is the primary estrogen, and is found in most manufactured hormone replacement products.  Estradiol is responsible for relieving the majority of symptoms of menopause as well as beneficial effects on the bone, brain, and heart.  Estriol is a much weaker estrogen, but is more specific for vaginal tissue, providing more complete relief from vaginal symptoms, common in menopausal women.  Estriol also competitively binds to breast receptors, providing breast cancer protection from the more proliferative effects of Estradiol . Estriol has further cardiovascular benefits of decreasing LDL and increasing HDL.  Estriol is only available through compounding pharmacies.

Compounded HRT offers the greatest number of options for the prescriber. Bi-Est can be formulated in ratios (E3:E2), doses, and dosage forms (transdermal, vaginal, sublingual) that meet specific patient needs.

Oral vs. Transdermal

Transdermal hormone replacement is considered much safer for the patient. Adverse effects with oral estrogen replacement such as elevated liver enzymes, increased triglycerides, gallstones, increased SHBG (which subsequently decreases testosterone availability), and increased prothrombic (blood clots) effects are due to a phenomenon called first-pass metabolism.  First-pass metabolism is where everything that enters the gut is first filtered through the liver before entering the bloodstream.  Oral estrogen is metabolized by the liver, making it less bioavailable, and the metabolites produce unwanted side effects.  When Estrogen is produced by the ovaries, it is released directly into the bloodstream.  Transdermal therapy delivers the hormone directly to the bloodstream and receptors, more closely simulating natural production.

Bio-Identical vs Synthetic

Bio-Identical hormones are identical in chemical structure as the hormones produced by your own body.  They bind completely to the receptor and create the same effect as endogenously produced hormones. Synthetic hormones are similar in structure, but often have side chains preventing complete binding and often producing less than the same effect, and in some cases the opposite effect of endogenously produced hormones.  Many women do not experience adequate symptom relief and often more side effects with synthetic hormones.

Our pharmacist has received extensive training in Hormone Replacement Therapy.  If you would like to schedule a consultation to evaluate your hormone status, or get more information on compounded hormone replacement therapy, contact us at 334-478-3522.

 

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