Structural differences exist between human, synthetic and animal hormones. In order for a replacement hormone to fully replicate the function of hormones which were originally naturally produced and present in the human body, the chemical structure must exactly match the original. There are significant differences between hormones that are natural to humans and synthetic or horse preparations. Side chains can be added to a naturally-occurring hormone to create a synthetic drug that can be patented by a manufacturer.
Natural hormones include estrogens, progesterone, testosterone, dehydroepiandrosterone (DHEA), and natural thyroid hormones. Natural hormone therapy has been prescribed in Europe since the 1950s and have been widely used in North America since the 1990s. Our compounding pharmacists work with patients and practitioners to provide customized hormone therapy with the needed hormones in the most appropriate strength and dosage form to meet each woman's specific needs. Hormone therapy should be initiated carefully after a woman's medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and adjustments are essential.
- For women (below age 60) and closer proximity to onset of menopause (within 10 years), the absolute risks of heart disease, stroke, deep venous thrombosis (DVT), and breast cancer, related to hormone therapy, are lower.
- Women who are at greater risk for and have a higher frequency of hot flashes and night sweats are more likely to derive quality-of-life benefits from hormone therapy. Thus, the benefit-risk ratio becomes much better because of the lower absolute risk and the greater likelihood of deriving quality-of-life benefits.
- Transdermal hormone therapy has the advantage of avoiding first-pass liver metabolism, and therefore it's less likely to increase clotting protein or triglyceride levels and avoids some of the other concerns associated with the oral route of administration. The observational studies suggest that the risks for DVT, pulmonary embolism, and possibly even stroke are lower with the transdermal than the oral route. As of yet, there are no large-scale randomized trials doing direct head-to-head comparisons.
The risk for cardiovascular events, both heart disease and stroke, will be greater in older women. If you are going to use hormone therapy in women who are more distant from the onset of menopause or who have significant risk factors such as diabetes or hypertension, it is preferable to go with the low-dose transdermal formulation rather than oral hormone therapy.
- In contrast to the vasomotor symptoms (hot flashes and night sweats), genitourinary symptoms actually progress over time. About 50% of women are seriously affected by these symptoms in terms of decreased quality of life, poor sexual health, and discomfort with sexual activity. Genitourinary conditions and also are associated with urinary tract infections and physical health. These symptoms are undertreated and under-recognized, and clinicians should ask about them because many women are very uncomfortable bringing up the subject. Low-dose vaginal estrogen is the most effective treatment and does not increase the blood level of estrogen above the usual postmenopausal range. In terms of the evidence base and the clinical trial data, there is no evidence of an increased risk for heart disease, stroke, DVT, dementia, or breast cancer with low-dose vaginal estrogen.
- Women with early menopause (either premature ovarian insufficiency or early surgical menopause)—who have an increased risk for heart disease, cognitive decline, bone loss, and osteoporosis - are particularly good candidates for hormone therapy.
- The WHI observational follow-up urges caution when considering initiating hormone therapy at an older age in women with diabetes, as these women are at the greatest risk for cognitive decline.
REASONS FOR CHOOSING COMPOUNDED MEDICATIONS INCLUDE:
- Patient allergies or failure to respond to commercial products
- Adverse reactions to commercial preparations. For example, if a patient has a reaction to an adhesive on a patch, we can compound the needed medication as a transdermal cream.
- Need for a dose or dosage form that is not commercially available. For example, transdermal and vaginal creams may offer potential advantages because non-oral administration bypasses first-pass hepatic metabolism.