When women enter menopause about 45-50 years of age, their estrogen and progesterone drop precipitously, causing a long list of unpleasant symptoms such as hot flashes, mood swings, and sleep disturbances. The drop in estrogen also leads to greater risk for cardiovascular disease and accelerated bone loss that may lead to osteoporosis and increased fracture risk. Women are faced with making a decision to start taking hormone replacement therapy (HRT) to hopefully alleviate most of the symptoms and risks associated with menopause. First and foremost, the patient must find a healthcare practitioner who is qualified to administer appropriate HRT. For healthcare practitioners, first identifying the hormone problem (usually low estrogen) can be done through observation of symptoms and lab testing. Physicians rely on pharmacists well trained in hormone therapy to help them determine the optimal hormone formula and type, and what method of delivery and dosage to use.
Peter Koshland, PharmD, presented a webinar for ZRT Laboratory on the 10 key takeaways for HRT for women. Dr Koshland is President/CEO of Koshland Pharm, a compounding pharmacy in San Francisco that works closely with patients and their doctors to prescribe medications tailored to individual needs. He is also an Assistant Clinical Professor of Pharmacy at the University of California at San Francisco (UCSF), and a graduate of Georgetown University and the UCSF School of Pharmacy.
Pharmacists see a lot of patients - especially in terms of HRT - so it makes sense to utilize their expertise because of the knowledge they have in this area. They can play a large part in helping patients and their healthcare providers with product selection and symptom management.
- There’s an odd misconception around the idea that it’s natural for women who are going through menopause to live in a hormone-deprived way for about a third of their life (menopause).
- It’s an unnatural state and it’s not good physiologically as the abrupt loss of hormones at menopause can accelerate the aging process and lead to disease that otherwise could have been prevented with appropriate hormone therapy.
- When hormones are not present or balanced, there are fundamental changes in the way the body works.
The key takeaway: There are great tools that can help reestablish reasonable hormone function in women safely and effectively. We want to protect our patients’ bones, their brains, and muscles. Without estrogen, these protective effects go away.
Hormones are safe:
The key takeaway: At the core of the decision, hormones are safe. Of course, there are exceptions and side effects but there has been such an overfocus on the exceptions, side effects, and perceived risks, some of which haven’t been validated in the literature. The research we have should give healthcare practitioners more confidence in prescribing HRT.
A person’s overall health impacts hormone therapy success:
- If we give hormone replacement to an unhealthy person, we may not get the desired outcomes.
The key takeaway: We should encourage our patients to look deeper into their overall health status and address any underlying health issues.
Different routes of administration behave differently. There are lots of options for delivering hormones into the body including:
- Transdermal patches
- Topical gels and creams
- Subdermal pellets
- Subcutaneous injection
The key takeaway: There are ways to safely switch or move patients from one delivery and dosage form to another. Different patients need different therapeutic deliveries.
Each hormone test type has limitations and advantages:
- Serum testing
- Saliva testing
- Cycle mapping
- Blood spot testing
- Urine testing
The key takeaway: Match the type of testing with the type of supplementation. It has a great impact on the clinical usefulness of hormone assessments.
General testing considerations:
- Does the lab have clinical support to help interpret labs?
- What is the most patient-friendly, economical, and clinically relevant test to evaluate hormonal imbalance?
The key takeaway: It’s a good idea to become familiar with the testing labs that have a proven reputation for excellence and provide the best product and service. Be sure to vet the lab.
Develop a relationship with a good compounding pharmacy committed to quality:
- Where does the pharmacy source its active pharmaceutical ingredients?
- What specific procedures does the pharmacy follow to ensure quality?
- How is the pharmacy accountable to the prescriber and to the patient?
The key takeaway: Talk to the pharmacy and ask key questions about their service.
Everyone has their own protocol – find yours
It’s important for practitioners to find their own protocol. You don’t want to reinvent the wheel with every patient. You want to have:
- An effective way to evaluate your patients
- A good starting regimen
- Know there are ways to change the delivery and dosage of hormone to optimize the benefits
- Have a good solid foundation to your approach to treating patients with hormones
We hope you’ll tune into Dr. Koshland’s webinar on HRT. He covers so much more including a discussion on baseline testing, key hormones in a comprehensive hormone replacement plan, optimal dosing, and compounded options. If you’re interested in finding a compounding pharmacist in your area, please refer to ZRT’s Find a Provider locator.