A How To Guide For Bioidentical Hormone Replacement Therapy


By Jean Ohliger, APRN


a healthy diet, adequate sleep, and effective stress management. Stress Management


G Stress management includes individual practices such as


meditation, yoga, prayer, and positive thinking. Stress management also includes management of any chronic health problems, thyroid dysfunction, and hormonal imbalances, specifically ovarian and adrenal hormone imbalances. Ovarian hormones include estradiol, estriol, estrone, progester- one, and testosterone. These hormones are produced by the ovaries during the years after menarche (the beginning of menstrual periods) and before menopause (the permanent stopping of menstrual peri- ods). They also are produced in small amounts in the adrenal gland. Other adrenal hormones are cortisol, DHEA, and 7- KetoDHEA.


Bio-identical Hormone Therapy


Bio-identical hormone therapy may be prescribed for hormonal imbalances. Bio-identical hormones are hormones whose composi- tion is exactly the same as that of the hormones produced in the body. Most of them are derived from plant sources such as yams. The term ‘bio-identical hormone’ is mistakenly used sometimes to mean only the compounds created at compounding pharmacies. In fact, some FDA-approved ovarian hormone preparations also are bio-identical.


Because it is not possible to get patents on substances which


are naturally occurring, pharmaceutical companies tend to focus on the delivery systems of the hormones, for example, the matrix system of a patch or a particular gel composition. In the pharmaceu- tical industry, FDA approval is given for the delivery system, not the hormone ingredient.


Compounding Pharmacies Compounding pharmacies utilize the same hormone products


in the preparation of their medications. The bases of the various compounded preparations are proprietary; while the specific hor-


22 Natural Nutmeg - December 2014


ood health and wellness depend upon support of the adre- nal glands. There are four basic keys to providing adrenal support—taking the appropriate vitamins and supplements,


mones in the preparations are identical, the bases may vary from pharmacy to pharmacy. This property also allows the pharmacy to adjust the preparation to a patient’s needs, such as an allergy or sensitivity to certain compounds. The final preparation itself is not FDA-approved per se.


Compounding prescriptions may be covered by some insurance companies. In addition, the compounded prescriptions may be fairly reasonably priced, and self-payments may actually be less costly than some insurance copayments.


Customers should use diligence in selecting a compound-


ing pharmacy. Websites such as PCAB (Pharmacy Compounding Accreditation Board), PCCA (Professional Compounding Center of America) and IECP (International Academy of Compounding Phar- macists) can offer guidelines for selecting pharmacies.


Applying Bio-identical Hormones Bio-identical hormones can be delivered in the following ways:


Orally, through pills or troches (similar to lozenges); Transdermally (applied to the skin), through patches, gels, or creams; and Vagi- nally, through creams or suppositories. The cream medications can be delivered in syringes (without the needles) or in click pens. The transdermal preparations should be applied to rotating sites, where the skin is somewhat thin—inner wrist, inner elbow, behind the knee, or behind the ear. Application of creams to fatty tissue, such as the abdomen, buttocks, or breasts, will affect the absorption of the medication, leading to storage of these medications in the tissue. Increasingly, vaginal preparations are being used in order to avoid transference of the medication. Transference has been an issue with transdermal medications be- cause the medication, when applied to inner wrist areas, could be transferred to others, such as children or spouses.


Saliva Testing


Adequate testing, in combination with review of symptoms, will help to determine the best possible medication combinations to be ordered. Saliva testing from certain laboratories determines levels of estradiol, progesterone, testosterone, cortisol, and DHEAS. Blood testing identifies only the amount of unbound hormone in the blood while saliva testing provides levels of hormones in the tissues.


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