By Andrew (Andy) Stein, RPh, PharmD, and Martha Sloane, MSN, WHNP-BC
What’s the most challenging part of menopause?
For highly symptomatic women—those who are unable to sleep because their night sweats are so severe, for example—making sense of conflicting treatment information can be as hard as waking up with soaked sheets.
The average American woman experiences menopause at 51—when she may be in the prime of her career, or enjoying the freedom of the empty nest. For her, untreated menopausal symptoms are more than an annoyance. Unpredictable mood swings, vaginal dryness and hot flushes in the middle of meetings can be a nightmarish intrusion into everyday life. But research linking the replacement of hormones lost during menopause to an increased risk of heart disease, stroke and breast cancer are frightening many women away from any intervention—even though hormone therapy also decreases the risk of osteoporosis and colon cancer.
The good news: Other research indicates that bioidentical HRT, used at the lowest possible dose, for the shortest possible interval, can be an option for women whose symptoms are preventing them from living their best lives. These bioidenticals, derived from plant sources, have the same structure as the hormones made by women’s ovaries.
Why the change in outlook? The landmark Women’s Health Initiative study of more than 160,000 post-menopausal women, indicating that hormone replacement was associated with serious diseases, has since received further scrutiny. Several factors may have contributed to this result—e.g., the use of synthetic hormones and the women’s ages (50-79; an average of 63). Those women who were ten or more years past menopause could have been developing pre-diabetes, coronary heart disease, and other conditions predisposing them to more illness.
Subsequent studies of women using bioidentical hormones are more encouraging. For example, two studies of women in the Northeastern US and in Europe, the KEEPS Trial and the French E3N Cohort Study, showed no increased risk of heart events or breast cancer over five to nine years. These findings offer a ray of hope for women who want to take back their lives. The trick is to start at the onset of menopause, before their ovarian function further declines.
Then the question becomes how and where to start. The bioidenticals on the market typically come in “standard” strengths, and there are limited options for customizing doses.
However, they can be compounded (custom made) to tailor the dosage and format to each woman’s size and body chemistry. The formats can include slow release progesterone capsules for those with sleep issues, and suppositories, creams, lotions and ointments, applied locally to bypass the gastrointestinal (GI) tract.
Should you choose the compounding route, make sure that:
In short, if you or a friend is experiencing menopause, there’s no need to throw your “midlife plan” into the furnace. Carefully supervised, “custom-made” bioidentical therapies can glide you through menopause—no sweat!
About the Authors: Andrew (Andy) Stein, RPh, PharmD, is owner/general manager/pharmacist with Bird’s Hill Compounding Pharmacy of Needham—a full-service pharmacy offering “standard” medications, one-of-a-kind, compounded therapies, and nutritional resources to improve patients’ health and wellness. For more information about the pharmacy and its online store, please see birdshillpharmacy.com.
Martha Sloane, MSN, WHNP-BC, is the owner of La Femme Ageless, a menopause hormone consulting practice based in Needham. She has been working as a nurse practitioner specializing in women’s health for more than 30 years. See lafemmeageless.com.