"The best way to explain natural (bio-identical) hormone-replacement therapy is to compare it to the history of insulin," explained Lisa Ploehn, clinical pharmacy specialist and owner of Main at Locust Pharmacy in Davenport. "Prior to using human insulin to treat diabetes, the medical field utilized animal insulin because it approximated that of humans'. However this therapy had unpleasant side effects that often resulted in complications. Eventually we were able to replicate human insulin, and it dramatically impacted the management of diabetes, because it gave them better control of the disease, thereby greatly improving the quality of life of patients."

According to Ploehn, after the Women's Health Initiative Study (WHIS) was published earlier this year, her pharmacy started receiving calls from women inquiring about the alternatives to the traditional hormone-replacement therapies, which use conjugated or synthetic hormones instead of natural ones. The WHIS covered hormone replacement in-depth and discovered several serious health-related problems that could be attributed to traditional hormone-replacement therapy, such as endometrial and breast cancer.

"We even received questions about the use of natural bio-identical hormone-replacement therapy, and if Main at Locust can compound these medications. We made the decision to become more knowledgeable regarding this therapy," she said.

In an effort to research all the emerging technology and information on hormone replacement, Ploehn sent University of Iowa clinical pharmacist (and part-time consultant to Main at Locust) Randy McDonough to a national conference on the subject of natural hormone-replacement therapy in Houston, Texas, as part of the pharmacy's commitment to providing the best possible health care to its female patients.

The data was so compelling that the pharmacy is sponsoring a free seminar on the subject of natural (bio-identical) hormone replacement this Friday, November 8, at Assumption High School Auditorium from 7 to 9 p.m. Anyone interested in attending should call (563)324-1641 extension 1 to register, although registering isn't mandatory to attend.

"The program we are offering Friday night is a good opportunity for women to explore the alternatives they have available to them," McDonough explained. "The safety and efficacy of hormone-replacement therapy are primary concerns and will be dealt with by an authority on the matter. Basically what's happening here is to utilize natural bio-identical hormones to replace what is naturally happening in a woman's body rather than using conjugated estrogen or synthetic estrogen, for example. It is a complex issue due to the complexity of the hormones themselves and how they function, as well as the financial incentives, or lack thereof, for drug companies to produce natural hormones instead of their own patentable versions."

What Is Hormone-Replacement Therapy?

Today, women dealing with menopause - whether during its onslaught, pre-menopausal stages, or its aftermath - are seeking alternatives to the traditional hormone-replacement therapy that uses urine from pregnant mares as its basic ingredient. While this formula has some properties that resemble human females' hormonal composition, it is far from a perfect match and often does not adequately treat the symptoms brought on by menopause. In some cases, the cure is worse than the disease, so to speak.

Menopause is defined as the period of time when a woman stops her menstrual cycling. This is caused by a slow transition in the balance of the hormones estrogen and progesterone from fully active to nearly idle. Pre-menopause is that period of time when the hormonal balance is shifting, causing all sorts of symptoms and reactions depending on the woman. Symptoms include hot flashes, night sweats, sleep disturbance, vaginal dryness, forgetfulness, slow healing, depression, and irregular menstruation. After menopause occurs, the risk of heart disease or stroke dramatically increases in women. Hormone-replacement therapy is designed to reduce these risks, as well as alleviate the difficult symptoms that accompany menopause.

The common hormone-replacement therapy is synthetic estrogen replacement (ERT), such as Premarin. The logic is that if estrogen is missing, then replacing it should solve the problems. However, there is a warning associated with this therapy that if used for more than one year there is an increased risk (as much as 14 percent) for endometrial cancer. The counter for this is to use synthetic progesterone (progestines), such as Provera, in tandem with estrogen, which fully defines hormone-replacement therapy (HRT) as we know it today. Unfortunately, this does not eliminate the increased risk of breast cancer in women who engage in HRT. Common sense points to the use of natural estrogen and progesterone rather than their synthetic counterparts. So why has this protocol gone under the radar?

According to Dr. Jonathan Wright in his book Natural Hormone Replacement for Women Over 45, the answer is primarily because the pharmaceutical companies cannot patent natural products, so there is no incentive for them to spend the $200 million plus in research and development required by the FDA to bring a drug to market. It is far more profitable to patent variations on the natural forms.

Wright explains that estrogen is actually made up of three different components: estrone (10 to 20 percent), estradiol (10 to 20 percent), and estriol (60 to 80 percent).

Premarin contains primarily estrone (approximately 75 to 80 percent) and equilin (6 to 15 percent), which is a hormone found exclusively in horses. There is a small measure of estradiol, but the greater problem with this formula is the significantly higher estrone content not found in our human configuration. Ignoring the fact that horse hormones can only approximate human ones, the abnormally high level of just one of the three estrogen components suggests that such therapy would fall far short of appropriate effectiveness. Other conventional therapies, such as Estraderm and Estrace, are 100-percent estradiol, again with none of the other two estrogen components that comprise human estrogen.

Nature dictates that all three estrogen components must be present in the percentages that the body utilizes them to be considered true replacement therapy. With the percentage imbalances of the synthetic hormone therapies, the absence of critical components of the estrogen hormone, and the introduction of a substance into the body that the body is not prepared to handle (such as equilin), it is not surprising that serious problems arise.

It must be acknowledged that for more than 30 years, the traditional therapies have been successfully prescribed to alleviate, or at least diminish, the many uncomfortable symptoms of menopause, but at what cost? Since the HRT protocols were introduced in 1969, the incidence of endometrial cancer has increased sharply in eight different areas in the U.S. where cancer-reporting systems are in place, "an increase which may be related to the rapidly expanding use of estrogens in the last decade," according to the official Premarin warning label.

How Natural Is Natural?

It is important to define "natural." In the case of natural (bio-identical) hormone replacement (NHR), "natural" refers to the structure of the hormone molecule, not its source. Natural hormones are produced from wild yams, which are "rich in precursor molecules easily converted by biochemists to other molecules that are identical in every way to natural estrogens, progesterone, testosterone, and other hormones," states Wright. "When analyzed biochemically, the molecules of estrogens, progesterone, and other molecules produced from wild yam precursor molecules are undistinguishable from those the human body produces itself." Contrarily, Wright further explains, patentable hormones are usually artificial and cannot be found anywhere in nature. These molecules are altered slightly by scientists, creating something that is not a part of nature. These substances mimic nature, and are able to be patented by the laboratories.

The primary advantage of NHR is the ability to tailor the therapy to each woman's specific needs. Compounding pharmacies, such as Main at Locust Pharmacy, can work with doctors to compound hormones in the correct dosages that not only address a woman's symptomology, but also to replicate nature's way of cycling these hormones. Hormones operate in an ebb-and-flow manner each month, and the percentages vary depending on a woman's metabolism, her age, and a host of other variables that make us each a unique creation. Science has identified, for the most part, what hormones are responsible for what symptoms. For example, the loss of memory has been being tied to a lack of estrogen. Several studies show that by applying an estradiol patch, memory and concentration improves

"In some cases, a woman might be experiencing an estrogen dominance, but deficient in progesterone," McDonough said. "What she needs is an infusion of progesterone, without supplementing estrogen. Yet many doctors simply prescribe Premarin, which adds additional estrogen and no progesterone. A diagnosis has not been done to determine what the patient actually needs or doesn't need."

Dr. Karla Polaschek, a Quad Cities physician, believes there is a definite place for natural hormone-replacement therapy. But determining treatment by analyzing hormone levels is not a methodology she endorses. "I don't advocate treatment based on a laboratory value," she said. "I treat my patients based on their symptoms, in other words how they are feeling. There are so many variables that can affect women's hormone levels, and those levels are constantly changing. A value [hormone level] can change from hour to hour, depending on what a women eats, how active she is, and so on. That is why I prefer treating my patients based on symptoms, not on lab values, at least where women's hormones (specifically estrogen and progesterone) are concerned."

McDonough agrees that it is a complicated process to identify the best treatment for individual women. Based on the risks with traditional therapies, the possibility of greatly reducing those risks with NHR makes the alternatives well worth exploring, especially if relief from the aggravating symptoms can also be achieved. "It is a constant learning curve and takes working with a physician and a compounding pharmacy to find the best possible combination of hormones to achieve the highest efficacy," he emphasized.

The free seminar on natural (bio-identical) hormone-replacement therapy that Main at Locust Pharmacy is sponsoring is for women who are menopausal, pre-menopausal, or post-menopausal; who had a hysterectomy; who have been diagnosed with "female problems"; who are currently undergoing hormone-replacement therapy; or who have a family history of breast cancer or osteoporosis. The guest speaker is Dr. Roby Mitchell, who utilizes NHR is his own practice with remarkable success. He will share his expertise in this matter, as well as answer questions from the audience. Also, Dr Wright's book is available at Main at Locust Pharmacy and is a must-read on this subject.

Main at Locust Pharmacy is a full-service pharmacy. Beyond filling and compounding prescriptions, the pharmacy has implemented a disease-management program that emphasizes the trio of doctor, patient, and pharmacist working together to manage a patient's illness. Main at Locust also provides wellness screening; analysis of body fat, cholesterol, bone density, blood glucose, and skin; and seasonal flu shots.

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