Hormone Therapy


Anyone who has been through puberty knows that hormones have a powerful effect on one’s body. Hormones affect many areas of your health, including your mood, your metabolism, and your sexual and reproductive function. If your hormones become unbalanced, whether due to menopause, andropause or other factors, you may end up feeling like a stranger in your own skin. However, personalized hormone replacement therapy (HRT) is a way to restore balance and help you feel like yourself again.

Many women have concerns about:

• Pre-menstrual syndrome (PMS)

• Irregular menstrual cycle

• Moodiness

• Infertility

• Post-partum depression

• Weight gain

• Endometriosis

• Fibrocystic breasts

• Sleep disturbances

• Hot flashes

• Night sweats

• Decreased libido

• Painful sexual intercourse

• Vaginal dryness


Many men have concerns about:

• Erectile dysfunction

• Low libido

• Loss of zest for life

• Prostate and bladder health

• Aches and pains

• Fungal infections

• Hair loss

• Excessive sweating

• Chronic bad breath

• Aging skin


No two people are alike and Premier pharmacists understand this fact.

A Premier pharmacist can provide a hormone evaluation for the patient to fill out. Our pharmacists are experienced in HRT and may assist the healthcare provider in helping interpret the results of blood serum and saliva tests which measure a patient’s hormone levels. The healthcare provider, Premier pharmacist, and the patient can use the results of these diagnostic tools to help determine a course of treatment which will give the patient the exact amount of hormones her body needs.

Working closely with the patient and their healthcare provider, a Premier pharmacist can help a patient start and maintain a hormone replacement regimen that brings their hormones back into balance and closely mimics what her body has been doing naturally for years. With a healthcare provider’s prescription, a Premier pharmacist can prepare hormones in a variety of strengths and dosage forms, including:

• Capsules

• Topical creams, gels, and foams

• Vaginal creams

• Suppositories

• Sublingual drops or troches

Once the therapy is begun, the pharmacist will continue to work with the woman and her prescriber to make sure the HRT is working correctly, adjusting the dosage if necessary, ensuring that the medication is just right for her body.


What is perimenopause?

Overview

Perimenopause means "around menopause" and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years. Perimenopause is also called the menopausal transition.

Women start perimenopause at different ages. You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.

The level of estrogen — the main female hormone — in your body rises and falls unevenly during perimenopause. Your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. Treatments are available to help ease these symptoms.

Once you've gone through 12 consecutive months without a menstrual period, you've officially reached menopause, and the perimenopause period is over.

Symptoms

Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

  • Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.

  • Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.

  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.

  • Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.

  • Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.

  • Changes in sexual function. During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.

  • Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.

  • Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

When to see a doctor

Some women seek medical attention for their perimenopausal symptoms. But others either tolerate the changes or simply don't experience symptoms severe enough to need attention. Because symptoms may be subtle and come on gradually, you may not realize at first that they're all connected to the same thing — rising and falling levels of estrogen and progesterone, another key female hormone.

If you have symptoms that interfere with your life or well-being, such as hot flashes, mood swings or changes in sexual function that concern you, see your doctor.

Causes

As you go through the menopausal transition, your body's production of estrogen and progesterone rises and falls. Many of the changes you experience during perimenopause are a result of decreasing estrogen.

Risk factors

Menopause is a normal phase in life. But it may occur earlier in some women than in others. Although not always conclusive, some evidence suggests that certain factors may make it more likely that you start perimenopause at an earlier age, including:

  • Smoking. The onset of menopause occurs one to two years earlier in women who smoke than in women who don't smoke.

  • Family history. Women with a family history of early menopause may experience early menopause themselves.

  • Cancer treatment. Treatment for cancer with chemotherapy or pelvic radiation therapy has been linked to early menopause.

  • Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still produce estrogen. But such surgery may cause menopause to occur earlier than average. Also, if you have one ovary removed, the remaining ovary might stop working sooner than expected.

Complications

Irregular periods are a hallmark of perimenopause. Most of the time this is normal and nothing to be concerned about. However, see your doctor if:

  • Bleeding is extremely heavy — you're changing tampons or pads every hour or two for two or more hours

  • Bleeding lasts longer than seven days

  • Bleeding occurs between periods

  • Periods regularly occur less than 21 days apart

Signs such as these may mean there's a problem with your reproductive system that requires diagnosis and treatment.


References

  1. Lobo RA, et al. Menopause and care of the mature woman. In: Comprehensive Gynecology. 7th ed. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed April 30, 2019.

  2. Casper RF. Clinical manifestations and diagnosis of menopause. https://www.uptodate.com/contents/search. Accessed April 30, 2019.

  3. McNamara M, et al. In the Clinic. Perimenopause. Annals of Internal Medicine. 2015;162:ITC1.

  4. AskMayoExpert. Menopausal hormone therapy. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

  5. North American Menopause Society. The Menopause Guidebook. 8th ed. Mayfield Heights, Ohio: North American Menopause Society; 2015.

  6. Menopause and menopause treatments. Office on Women's Health. http://www.womenshealth.gov/publications/our-publications/fact-sheet/menopause-treatment.html. Accessed Aug. 25, 2016.

  7. Ferri FF. Menopause. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Aug. 24, 2016.

  8. Welt CK. Ovarian development and failure (menopause) in normal women. https://www.uptodate.com/contents/search. Accessed April 30, 2019.

  9. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 128. Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women. Obstetrics and Gynecology. 2012;120:197. Reaffirmed 2016.

  10. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 141. Management of menopausal symptoms. Obstetrics and Gynecology. 2014;123:202. Reaffirmed 2018.

  11. Jameson JL, et al., eds. Menopause and postmenopausal hormone therapy. In: Harrison's Principles of Internal Medicine. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2018. https://accessmedicine.mhmedical.com. Accessed April 30, 2019.

  12. Santen RJ, et al. Menopausal hot flashes. https://www.uptodate.com/contents/search. Accessed April 30, 2019.

  13. Leach MJ, et al. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007244.pub2/abstract. Accessed Aug. 30, 2016.

  14. Bedell S, et al. The pros and cons of plant estrogens for menopause. Journal of Steroid Biochemistry and Molecular Biology. 2014;139:225.

  15. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and the American Society for Reproductive Medicine Practice Committee. Committee Opinion No. 532: Compounded bioidentical menopausal hormone therapy. Obstetrics & Gynecology. 2012;120:411. Reaffirmed 2018.

  16. Sood R, et al. Paced breathing compared with usual breathing for hot flashes. Menopause. 2013;20:179.

  17. Fisher TE, et al. Lifestyle alterations for the amelioration of hot flashes. Maturitas. 2012;71:217.

  18. Rosen HN, et al. Overview of the management of osteoporosis in postmenopausal women. https://www.uptodate.com/contents/search. Accessed April 30, 2019.

  19. Chen YP, et al. Acupuncture for hot flashes in women with breast cancer: A systematic review. Journal of Cancer Research and Therapeutics. 2016;12:535.

  20. AskMayoExpert. Bioidentical hormones. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

What is menopause?

Overview

Menopause is the time that marks the end of your menstrual cycles. It's diagnosed after you've gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States.

Menopause is a natural biological process. But the physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt your sleep, lower your energy or affect emotional health. There are many effective treatments available, from lifestyle adjustments to hormone therapy.

Symptoms

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

  • Irregular periods

  • Vaginal dryness

  • Hot flashes

  • Chills

  • Night sweats

  • Sleep problems

  • Mood changes

  • Weight gain and slowed metabolism

  • Thinning hair and dry skin

  • Loss of breast fullness

Signs and symptoms, including changes in menstruation can vary among women. Most likely, you'll experience some irregularity in your periods before they end.

Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods also tend to happen on shorter cycles, so they are closer together. Despite irregular periods, pregnancy is possible. If you've skipped a period but aren't sure you've started the menopausal transition, consider a pregnancy test.

When to see a doctor

Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care as you age may include recommended health screening tests, such as colonoscopy, mammography and triglyceride screening. Your doctor might recommend other tests and exams, too, including thyroid testing if suggested by your history, and breast and pelvic exams.

Always seek medical advice if you have bleeding from your vagina after menopause.

Causes

Menopause can result from:

  • Naturally declining reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines.
    In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — your ovaries stop releasing eggs, and you have no more periods.

  • Surgery that removes the ovaries (oophorectomy). Your ovaries produce hormones, including estrogen and progesterone, that regulate the menstrual cycle. Surgery to remove your ovaries causes immediate menopause. Your periods stop, and you're likely to have hot flashes and experience other menopausal signs and symptoms. Signs and symptoms can be severe, as hormonal changes occur abruptly rather than gradually over several years.
    Surgery that removes your uterus but not your ovaries (hysterectomy) usually doesn't cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone.

  • Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures may still be desired. Radiation therapy only affects ovarian function if radiation is directed at the ovaries. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, won't affect menopause.

  • Primary ovarian insufficiency. About 1% of women experience menopause before age 40 (premature menopause). Premature menopause may result from the failure of your ovaries to produce normal levels of reproductive hormones (primary ovarian insufficiency), which can stem from genetic factors or autoimmune disease. But often no cause of premature menopause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.

Complications

After menopause, your risk of certain medical conditions increases. Examples include:

  • Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men. So it's important to get regular exercise, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to reduce your cholesterol or blood pressure if it's too high.

  • Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists.

  • Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may have urinary tract infections more often.
    Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve symptoms of incontinence. Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes that can result in urinary incontinence.

  • Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido).
    Water-based vaginal moisturizers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet or ring.

  • Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.

References

  1. Menopause basics. Office on Women's Health. https://www.womenshealth.gov/menopause/menopause-basics. Accessed Sept. 8, 2020.

  2. Casper RF. Clinical manifestations and diagnosis of menopause. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  3. Jameson JL, et al., eds. Menopause and postmenopausal hormone therapy. In: Harrison's Principles of Internal Medicine. 20th ed. McGraw Hill; 2018. https://accessmedicine.mhmedical.com. Accessed Sept. 9, 2020.

  4. Frequently asked questions: Women's Health FAQ047. The menopause years. American College of Obstetricians and Gynecologists. https://www.acog.org/patient-resources/faqs/womens-health/the-menopause-years. Accessed Sept. 9, 2020.

  5. American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics & Gynecology. 2014; doi:10.1097/01.AOG.0000441353.20693.78.

  6. Santen RJ, et al. Menopausal hot flashes. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  7. Menopause and your health. Office on Women's Health. https://www.womenshealth.gov/menopause/menopause-and-your-health. Accessed Sept. 15, 2020.

  8. Welt CK, et al. Ovarian development and failure (menopause) in normal women. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  9. North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017; doi:10.1097/GME.0000000000000921.

  10. Welt CK. Pathogenesis and causes of spontaneous primary ovarian insufficiency (premature ovarian failure). https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  11. Welt CK. Clinical manifestations and diagnosis of spontaneous primary ovarian insufficiency (premature ovarian failure). https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  12. Heart disease facts. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/facts.htm. Accessed Sept. 8, 2020.

  13. MenoNote: Vaginal dryness. The North American Menopause Society. http://www.menopause.org/publications/consumer-publications/-i-menonotes-i-. Accessed Sept. 9, 2020.

  14. AskMayoExpert. Menopausal hormone therapy (adult). Mayo Clinic; 2019.

  15. Menopause symptoms and relief. Office on Women's Health. https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief. Accessed Sept. 15, 2020.

  16. North American Menopause Society. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015; doi:10.1097/GME.0000000000000546.

  17. Menopausal symptoms: In depth. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/menopausal-symptoms-in-depth. Accessed Sept. 8, 2020.

  18. Yoga, Kegel exercises, pelvic floor physical therapy. North American Menopause Society. https://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/yoga-kegel-exercises-pelvic-floor-physical-therapy. Accessed Sept. 9, 2020.

  19. Black cohosh. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  20. Red clover. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  21. Kava. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  22. Dong quai. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  23. DHEA. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  24. Wild yam. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Sept. 9, 2020.

  25. Menopause. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/home-use-tests/menopause. Accessed Sept. 16, 2020.

  26. Bachmann G, et al. Treatment of genitourinary syndrome of menopause (vulvovaginal atrophy). https://www.uptodate.com/contents/search. Accessed Sept. 8, 2020.

  27. Burnett TL (expert opinion). Mayo Clinic. Sept. 18, 2020.

What are hot flashes?

Overview

A hot flash is the sudden feeling of warmth in the upper body, which is usually most intense over the face, neck and chest. Your skin might redden, as if you're blushing. A hot flash can also cause sweating. If you lose too much body heat, you might feel chilled afterward. Night sweats are hot flashes that happen at night, and they may disrupt your sleep.

Although other medical conditions can cause them, hot flashes most commonly are due to menopause — the time when menstrual periods become irregular and eventually stop. In fact, hot flashes are the most common symptom of the menopausal transition.

There are a variety of treatments for bothersome hot flashes.

Symptoms

During a hot flash, you might have:

  • A sudden feeling of warmth spreading through your chest, neck and face

  • A flushed appearance with red, blotchy skin

  • Rapid heartbeat

  • Perspiration, mostly on your upper body

  • A chilled feeling as the hot flash lets up

  • Feelings of anxiety

The frequency and intensity of hot flashes vary among women. Hot flashes may be mild or so intense that they disrupt daily activities. They can happen at any time of day or night. Nighttime hot flashes (night sweats) may wake you from sleep and can cause long-term sleep disruptions.

How often hot flashes occur varies among women, but most women who report having hot flashes experience them daily. On average, hot flash symptoms persist for more than seven years. Some women have them for more than 10 years.

When to see a doctor

If hot flashes affect your daily activities or nighttime sleep, consider seeing your doctor to discuss treatment options.

Causes

Hot flashes are most commonly caused by changing hormone levels before, during and after menopause. It's not clear exactly how hormonal changes cause hot flashes. But most research suggests that hot flashes occur when decreased estrogen levels cause your body's thermostat (hypothalamus) to become more sensitive to slight changes in body temperature. When the hypothalamus thinks your body is too warm, it starts a chain of events — a hot flash — to cool you down.

Rarely, hot flashes and nights sweats are caused by something other than menopause. Other potential causes include medication side effects, problems with your thyroid, certain cancers and side effects of cancer treatment.

Risk factors

Not all women who go through menopause have hot flashes, and it's not clear why some women do have them. Factors that may increase your risk include:

  • Smoking. Women who smoke are more likely to get hot flashes.

  • Obesity. A high body mass index (BMI) is associated with a higher frequency of hot flashes.

  • Race. More black women report having hot flashes during menopause than do women of other races. Hot flashes are reported least frequently in Asian women.

Complications

Hot flashes may impact your daily activities and quality of life. Nighttime hot flashes (night sweats) can wake you from sleep and, over time, can cause long-term sleep disruptions.

Research suggests that women who have hot flashes may have an increased risk of heart disease and greater bone loss than women who do not have hot flashes.

References

  1. AskMayoExpert. Hot flashes (adult). Mayo Clinic; 2019.

  2. Santen RJ, et al. Menopausal hot flashes. https://www.uptodate.com/contents/search. Accessed Feb. 18, 2020.

  3. American College of Obstetricians and Gynecologists. Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics & Gynecology. 2014; doi:10.1097/01.AOG.0000441353.20693.78. Reaffirmed 2018.

  4. Lobo RA, et al. Menopause and care of the mature woman. In: Comprehensive Gynecology. 7th ed. Elsevier; 2017. https://www.clinicalkey.com. Accessed Feb. 18, 2020.

  5. North American Menopause Society. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017; doi:10.1097/GME.0000000000000921.

  6. North American Menopause Society. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015; doi:10.1097/GME.0000000000000546.

  7. Hickey M, et al. Non-hormonal treatments for menopausal symptoms. BMJ. 2017; doi:10.1136/bmj.j5101.

  8. Hot flashes: What can I do? National Institute on Aging. https://www.nia.nih.gov/health/hot-flashes-what-can-i-do. Accessed Feb. 18, 2020.

  9. Menopausal symptoms: In Depth. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/menopause/menopausesymptoms. Accessed Feb. 18, 2020.

  10. Sood R, et al. Association of mindfulness and stress with menopausal symptoms in midlife women. Climacteric. 2019; doi:10.1080/13697137.2018.1551344.

  11. Menopause FAQs: Hot flashes. North American Menopause Society. https://www.menopause.org/for-women/menopause-faqs-hot-flashes. Accessed March 18, 2020.

Ask your Practitioner or Premier Pharmacist about compounded medications today