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Common Questions

Do I need a prescription for Bioidentical hormone replacement therapy?

Yes, a prescription is required to receive bioidentical hormones. By using a compounding pharmacy, each bioidentical hormone medication is hand produced using the most advanced equipment from experienced pharmacists who specialize in formulating drugs. The dosage forms and strengths of the bioidentical hormones are formulated specifically for each unique patient and using the highest quality ingredients.

Do I need to worry about breast cancer?

Yes, every woman should worry about breast cancer. Please follow mammography guidelines and follow up with your practitioner if you are asked to do so. Recent studies have confirmed that mammograms are more effective at diagnosing breast cancer at an early stage than any other test. Although breast exams are good, it is clear that mammography is superior. Will BHRT cause Breast cancer? We know that estrogen will not cause a normal breast cell to become cancerous. However, if you already have a breast cancer cell in your body that is estrogen sensitive then it will grow at a faster rate. It is suspected that man made estrogens can have a more powerful effect than an identical compounded formulation.One of the major advantages of BHRT prescribed by a trained practitioner is the ability to monitor your progress and therefore help you to achieve the lowest effective dose possible for your therapy. In addition, Bi-Est creams are designed to specifically mimic your natural estrogens as opposed to synthetically altered ones sometimes found in traditional HRT.Breast cancer is a symptom that can be caused or made worse by estrogen dominance. Estrogen works safely and effectively in the body when it is present in normal amounts and is balanced by progesterone. Progesterone stimulated cells to grow toward differentiation and then inhibits estrogen-stimulated cell growth. Cancer cells are undifferentiated, therefore progesterone contains anti-cancer properties.

How does bioidentical hormone replacement therapy differ from conventional hormone replacement therapy?

Bioidentical HRT aims to replace the hormones in your body that are no longer producing. As you enter into menopause, most women experience a gradual decline in their Estrogen levels. This frequently is an erratic process as your ovaries may go for months at a time from low to no production to normal production, and then back again.Every woman is different. The point is that as your own hormonal levels wane, symptoms and health issues may arise. By replacing your body’s natural hormones, equilibrium can be established that can bring balance back to your body.Conventional HRT started with Premarin. Premarin stands for Pregnant Mares Urine. It has been used because it is an easy and cost effective way to isolate and purify large quantities of Estrogen. Unfortunately, Premarin also has numerous other estrogens in it that are not commonly seen by the human body. Although effective for many women, Premarin may cause numerous or even powerful side effects for some.

How much should I expect to pay?

We believe that the majority of patients are better treated if evaluated and followed with some level of hormonal testing. Depending on your unique situation, this may include blood, salivary, urine or a combination of the two tests. It is not uncommon for testing to range from $98- $275. If you are prescribed a medication from your practitioner, your compounded BHRT will typically carry between a $25-50 monthly co-pay per prescription. Nurtaceuticals are vitamins and minerals, which will be specifically recommended, based on your body’s personal deficiencies as supplementation to your medication. These are traditional over-the-counter products, and are NOT covered by insurance plans.

How often will I need to follow-up with my physician during therapy?

Traditionally you would follow up with your practitioner in three months, then annually if all is going well. Frequently, when starting a new therapy, this can result in monthly or quarterly visits for 6-12 months. Of course, any side effects or unexpected outcomes should always be immediately reported to your prescribing practitioner.

How soon will I see the results from using bioidentical hormone replacement therapy?

Every patient is unique. On average most women see improvement in their symptoms between 1 and 3 months after starting BHRT?

I had my ovaries removed when I was younger, do I still need BHRT?

Even though you no longer have ovaries, it still is suggested to consider hormone replacement therapy. The postmenopausal ovary is still responsible for producing testosterone. Testosterone is important for libido, may increase energy, and is important for building bones. In additional to this, HRT has been proven to decrease the onset of osteoporosis.

Is there a difference between over the counter progesterone cream and prescription progesterone medication?

Many consumers have noticed the over the counter versions of progesterone cream available at local drugstores and supermarkets. These products can often be very expensive and are not regulated by the FDA or the Board of Pharmacy. It is important to make sure that you are getting a safe and accurate medication and the only way to ensure that this is true is to have a large governing body regulating the labels. The over the counter creams are very variable in the amount of actual progesterone they may contain and may contain dangerous amounts of the hormone that exceeds your recommended level.If you are considering progesterone cream to alleviate menopausal symptoms or to increase your chances of fertility, it is important to first consult your practitioner and measure your progesterone levels to make sure that you do in fact have a deficiency. Then take your specific prescription for progesterone cream to a compounding pharmacy laboratory.

What about the Women’s Health Initiative Study?

The Women’s Health Initiative Trials analyzed the effects of conjugated equine estrogens (made from horse urine) and synthetic progestins (manmade progesterone) on females. With their structure appropriate for horses, these hormones are only approximately 30% identical to human hormones. These estrogens and progestins are not naturally found in humans and are the active ingredients in several well-recognized commercial hormone products including PremPro, Provera, and Premarin.The WHI is one of the most controversial studies of the decade. Initial reports from the study are still remembered as describing a 1/3 increase in the rates of Breast Cancer in women who took HRT. In fact, what was actually found was that there was a minimal increase in breast cancer, an initial increase in Venous thrombolic events (blood clots and stroke), and most importantly there was no link between HRT and heart disease as expected. In detail, in a group of approximately 10,000 women, the HRT group had 38 cases of breast cancer, while the placebo group had 30. Despite a 28% increase it was a small number, thus truly having a minimal effect on actual patient risk. Further, there was no stratification within the study taking into account patients with prior risk factors or significant family risk factors.Interestingly the second arm of that study which looked at women without uteruses (hysterectomy) continued on estrogen alone. This study recently ended and results have shown no increase in breast cancer. This calls into question the original study and whether it could have been flawed, or if the progestins that were used could have had a role to play in the outcomes.

What are bi-est and tri-est?

Bi-Est and Tri-Est are abbreviations for Bi Estrogen (Two Estrogens) and Tri-Estrogen (Three Estrogens). This refers to the amount of different Estrogens that are combined into one product. The goal of combination therapy is to more closely mimic the body’s natural production of Estrogen. The ovary produces numerous types of Estrogens that play different roles in balancing the body.It has been discovered that most patients can get better relief of symptoms by combining two of the most commonly produced Estrogens by a normal ovary. In the past this included Estradiol, Estriol and Estrone. Recently it has been of new concern that Estrone could be carcinogenic (cancer producing). Therefore Bi-Est (Estradiol and Estriol) is the preferred combination for Estrogen replacement therapy.

What are Bioidentical hormones?

Bioidentical Hormones are compounds that are created from naturally occurring and synthetic substances that are purified, combined and tested with in a laboratory to mimic those produced with in your body. Bioidentical Hormones are used to help treat hormonal imbalances that occur before, during, and after menopause. Commonly used Hormones include Estrogen’s, Progesterone’s, Testosterone, Thyroid, and others. The bio-identical hormones used for compounding or the formulation of various forms (tablets, capsules, suppositories, creams, troches, etc) come from plant sources such as soy or yam. They are processed so that the end result is absolutely no different than the human hormone. They do not need anything from the body such as certain enzymes to convert them to the actual hormone.

What are the advantages of creams vs. oral medication?

Delivering a medication to the skin is known as a transdermal application (cream, gel, oil). Although it depends on the type of medication you are using, in the case of hormones, it is usually more effective to use those that are cream based than oral capsules. This is due to the fact that hormones are metabolized in the liver; therefore, when taking a medication orally, you will lose approximately 4/5 of it before it reaches your tissues. This is why you much take 5 times the amount that your body normally requires when using oral medications.Creams, on the other hand, are absorbed through the skin into an underlying fat layer where it begins circulating into the blood almost immediately. They are more effective because the medication will hit the target tissue before it hits the liver.

What is a compounding pharmacy?

A compounding pharmacy is a facility that is capable of individualizing prescriptions. Whereas traditional medicines are made in large bulk quantities by generic facilities, a compounding pharmacy can respond to the individual recommendations by the prescribing practitioner to cater to your individual needs and not just the ‘average’ patient.A normal pharmacy is unable to fill the prescriptions for bioidentical hormone therapy because each medication is made by hand to cater to your unique dosages.

What is a saliva test and how do I perform one?

While blood testing is a good way to measure certain chemicals in your body, these tests reflect both bound and free forms of hormones and do not provide information about the bioavailable section of hormone, which can vary depending on the level of blood hormone binding proteins. In other words, saliva hormone testing tells us the amount of hormones in our body that are actually usable by our cells; while blood testing evaluates all circulating hormones regardless of their availability to our cells - and most importantly anyone can take a saliva test from the comfort of their home.Saliva testing is a widely accepted method to measure hormone levels. Anecdotally, we have found saliva testing to be much more revealing than blood testing for hormonal balancing. Saliva testing is performed by expelling ones saliva into a few different tubes. After one fills those tubes, they are sent off to a lab to be analyzed. The panel we recommend tests your estrogen progesterone testosterone DHEA and di-urinal cortisol levels and costs approximately $189. In short, saliva testing is an accurate and simple way for someone to assess the current levels of hormones in their body without having to make an expensive visit to a practitioner’s office or testing facility.

Why am I experiencing spotting/bleeding while using BHRT?

Spotting is a common side effect from any form of hormone replacement therapy and is the most common cause for discontinuance. Some vaginal bleeding is normal and to be expected. The three main reasons for bleeding are the buildup of endometrial tissue caused by estrogen replacement, the thinning of the atrophic lining caused by too high progesterone levels, and lastly the buildup of abnormal tissue inside of the uterus, which may be a sign of a serious condition such as uterine cancer.If bleeding is heavy, continuous, or occurs after your first three months on therapy, you should report it to your physician. If cancer and premalignant hyperlplasia have been ruled out after testing, commonly bleeding can be minimized after three months of therapy by either decreasing the estrogen replacement or increasing the progesterone replacement.

Why do I need to take progesterone?

Progesterone is responsible for regulating the menstrual cycle and balancing the effects of estrogen. One of Estrogen’s effects in the body is to cause growth of the endometrium, or lining of the Uterus. When estrogen is taken without Progesterone (un-opposed estrogen), an overgrowth (hyperplasia) of the uterine lining can occur. This usually results in spotting or bleeding, but can go on to create uterine cancer. It is for this reason which patients that have a uterus, it is recommended they take combined Estrogen and Progesterone therapy, for it is the progesterone that keeps the growth of the uterine lining in check. In younger women it is the monthly withdrawal of progesterone by the ovary that initiates your monthly cycle, and thins out the uterine lining. It has been shown that with the use of combined therapy the risk for uterine cancer is minimal.

Why don’t more Doctors suggest Bioidentical Hormones?

Most practitioners in the past trained using conventional (synthetic) HRT and, therefore, are more capable and comfortable prescribing them. In addition, many practitioners are unaware of how to prescribe these natural Bioidentical hormones. Due to the fact that many practitioners are inexperienced in treating with Bioidentical hormones, those who are trained, charge a cash fee for all visits. This causes a lack of compliance in follow-up visits from patients with these specialty practitioners and leads to weak patient-practitioner relationships. Since natural hormones cannot be patented, many companies are not able to gain the financial support to fund research and development to market these substances. Evidence about BHRT has been largely anecdotal, due to their individualized nature; there have been no large-scale studies performed causing reluctance in practitioners.

Why is vitamin/nutraceutical supplementation necessary when using hormone replacement therapy?

There are 3 main reasons why your practitioner may recommend nutritional supplementation while you are using bioidentical hormone replacement therapy. The first reason is that the metabolism of hormones requires nutrients such as vitamins and minerals. Therefore, if you’re going to ask your body to metabolize more hormones, it is important to provide your body with extra nutrients to ensure that you will not become deficient.The second reason is that hormone replacement therapy may increase your risk of some illnesses. Your practitioner may be acting proactively by providing you with nutrients that are going to protect your heart and your body’s cells.The third reason is that at the time of menopause, your body is going through many changes. Your provider may prescribe you nutrients in order to prevent the onset of osteoporosis, cancer, or other conditions which are associated with aging.

Why take hormones at all?

Hormonal health is a large and significant piece of the big picture of overall health. Hormone replacement therapy (HRT) was developed to replace the hormones the ovaries made during the reproductive years in a woman's life. And also reduce or eliminate menopausal symptoms. The goal of hormone therapy is not only to relieve these symptoms, but also to protect the body from other harmful side effects of aging such as osteoporosis and memory disorders such as Alzheimer's disease.