Women’s Health

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What Are Compounded Hormones (CHRT)?

CHRT or Compounded Hormone Replacement Therapy has many benefits that synthetic or manufactured hormones do not possess and is a therapy option that should be considered by most anyone experiencing significant symptoms of hormonal imbalance that are negatively affecting their quality-of-life. The distinction with CHRT from traditional manufactured hormones is that the molecular structure of the involved hormones is identical to that of the human sex hormones naturally created in our bodies. Drug manufactures are unable to obtain an exclusive patent on these naturally occurring chemicals and therefore minimal CHRT products are produced by the industry and that is the reason ProCompounding Pharmacy is here to serve you!

Symptoms of hormone imbalance include:

  • Weight Gain
  • Hot Flashes
  • Mood Swings
  • Anxiety
  • Insomnia
  • Irregular Menstrual Cycles
  • Reduced Libido
  • Painful Intercourse
  • Urinary Incontinence
  • Infertility
  • Night Sweats
  • PMS
  • Memory Lapses
  • Osteoporosis
  • Fibrocystic Breast

CHRT Hormones you need to know.

Estrogen

Estrogen stimulates the growth of tissue, such as development of breast and reproductive organs, and ensures their function. In the brain, it boosts the synthesis and function of neurotransmitters that affect sleep, mood, memory, libido, and cognitive factors such as learning and attention span.

Estrogen decreases the perception of pain, preserves bone mass, and increases HDL – the good cholesterol. It also preserves the elasticity and moisture content of the skin, dilates blood vessels, and prevents plaque formation in blood vessel walls.

Estradiol (E2)

The most potent form of estrogen made by the ovaries, adrenals and fat cells when older. Estradiol affects the functions of most of the body’s organs.

Estriol (E3)

The weakest and least active form of estrogen primarily functioning during pregnancy.

Estrone (E1)

The primary estrogen after menopause produced mostly by fat cells.

Progesterone

Progesterone is made primarily by the ovaries. The adrenal glands, peripheral nerves, and brain cells produce lesser amounts. Progesterone ensures the development and function of the breasts and female reproductive tract. In the brain, progesterone binds to certain receptors to exert a calming, sedating effect. It improves sleep and protects against seizures.

Progesterone is also a diuretic. It enhances the sensitivity of the body to insulin and the function of the thyroid hormones. It builds bone and benefits the cardiovascular system by blocking plaque formation in the blood vessels and lowering the levels of triglycerides. Progesterone also can increase libido and contribute to the efficient use of fat as a source of energy.

Testosterone

Testosterone is manufactured in women by the ovaries and adrenal glands, enhances libido and sexual response. It strengthens ligaments, builds muscle and bone, assists brain function, and is associated with assertive behavior and a sense of well-being. The level of testosterone influences both stamina and restful sleep. It has a protective effect against cardiovascular disease in both men and women.

Dehydroepiandrosterone (DHEA)

DHEA is made primarily by the ovaries and adrenal gland. Smaller amounts are produced in the skin and brain. DHEA is the most abundant circulating hormone. It provides protection against the effects of physical stress and inflammation.

DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, and enhances immune system function.

DHEA facilitates the rapid eye movement (REM) phase of sleep, enhances memory, and assists in maintaining normal cholesterol levels. DHEA can be converted in into estrogen and testosterone through fat, muscle, bone and liver.

Cortisol

Cortisol is made by the adrenal glands. It regulates the immune response, stimulates the production of glucose, aids short-term memory, and helps the body adapt to stress by increasing heart rate, respiration, and blood pressure.

The level of cortisol increases early in the morning to prepare to meet the demands of the day. It gradually decreases throughout the day and reaches its lowest point late in the evening (a pattern known as “circadian rhythm”).

Pregnenolone

Pregnenalone is the precursor (building-block) for all other steroid hormones. It is converted directly into DHEA and/or progesterone. DHEA converts to testosterone and estrogens. Additionally, progesterone converts to estrogens, cortisol, and aldosterone.

It is this succession of conversions that makes human life possible. Without pregnenolone, there can be no human steroid hormone production. Made from cholesterol, pregnenolone is a natural steroid hormone produced primarily in the adrenal glands, but in smaller amounts by many other organs and tissues of the human body, including liver, brain, skin, gonads, and even the retina of the eye. Like many health-promoting hormones, levels of pregnenolone drop with age.

Hormone replacement therapy (HRT) is commonly used to treat menopausal symptoms such as hot flashes, vaginal dryness, mood swings, sleep disorders, decreased libido, and to decrease the risk of fractures secondary to osteoporosis. The terms “natural” or “Compounded” hormone mean that no matter what the precursor ingredient used in synthesis; the resulting molecular structure is identical to a hormone that human beings make in their bodies.

Until recently, HRT was thought to reduce the risk of heart disease and bone fractures caused by osteoporosis, in addition to treating common menopausal symptoms. In the early 1990s, a group of investigators conducted a study known as the Women Health Initiative (WHI), to identify the benefits and risks of HRT specifically estrogen with or without progesterone. They found that while replacement did in fact decrease the incidence of colon cancer and fractures in those without a diagnosis of osteoporosis and improve menopausal symptoms, there was an increased incidence of thromboembolic disease, breast cancer, coronary artery diseases, and strokes. The study was prematurely terminated and the investigators concluded that the risks of HRT outweigh its benefits. Soon after that, the Heart Estrogen/progestin Replacement Study (HERS) confirmed the WHI’s findings and concluded that HRT had no protection against coronary artery disease. Both studies used synthetic hormones (Premarin® and PremPro®) whose molecular structure was not identical to those found in the human body.

The WHI study raised several safety concerns regarding the use of synthetic hormones in HRT. As a result, a trend promoting the use of hormones that are structurally identical to those actually found in the body has begun. These hormones are known as “Compounded” hormones, and they are thought by many to have fewer side effects than the synthetic hormones which contain side chains and are not identical to those hormones found in the body. Compounded Hormone Replacement Therapy (CHRT) goals include relief from the traditional menopausal symptoms, protection from conditions that natural hormones usually protect against, and establishment of hormonal balance. The hormones are primarily derived from the yam and soybean plants before being altered in the lab to create the compounded hormones. The term “Compounded” is not recognized by FDA, and there is no data on the efficacy or safety of Compounded hormones.

Hormones commonly used in CHRT include estrogens (estrone, estradiol and estriol), progesterone, and androgens. The estrogens are thought to relieve menopausal symptoms, such as vaginal thinning and dryness, depressed mood, poor energy levels, and sleep problems. The normal balance of estrogens in the female body is 10% estrone, 10% estradiol, and 80% estriol, but the actual levels fluctuate. Estrone (E1) is the main estrogen produced in the body after menopause. Estradiol (E2) is the most potent of the estrogens and is the primary estrogen produced before the onset of menopause. Estriol (E3) is believed to protect against breast cancer and is produced in higher concentrations during pregnancy. It also alleviates several vaginal and urinary symptoms of menopause. Premarin® (Wyeth) is a synthetic estrogen product that is extracted from the urine of pregnant mares, and sometimes referred to as conjugated equine estrogens. Premarin® contains estrone and at least 10 other estrogens (some sources claim as much as 100 estrogens) not found in the human body. Estrone comprises 75% of Premarin®, much more than the amount naturally found in the body. Estrogen is given unopposed by progesterone usually only in cases of hysterectomy; otherwise, estrogen is given with progesterone. Commonly prescribed compounded formulations include Bi-Est, which is commonly used and comprised of estriol (80%) and estradiol (20%), and Tri-Est, containing all three naturally occurring estrogens in concentrations naturally found in the body.

Compounded hormones are compounded at ProCompounding Pharmacy in Johnson City, TN. Women usually hear about the option by word-of-mouth and after consulting with their physician and obtaining a prescription, they come into the pharmacy to consult with a pharmacist by appointment. The pharmacist speaks with the patient about their current symptoms, current HRT method, and past medical history. While there are saliva and blood tests to determine hormonal levels, developing the proper individualized compound for each patient is guided by symptoms. When starting a new hormone regimen it usually takes 1-3 months to establish the correct dosage and combination of hormones.

Although the use of compounded hormones is increasing in popularity, and the idea of replacing the body’s hormones with identical hormones seems logical, there have not been studies done on their safety, efficacy, or long-term effects. Therefore, caution must be exercised in prescribing and using compounded hormones in hormone replacement therapy.

Our pharmacists are available for personal counseling sessions by appointment. This allows them one-on-one time with patients, free from interruptions. Private consultations focus on all aspects of your health, including current medications and supplements, and personal health history. Such details will help our pharmacist determine the best therapy for you. Call us at (423) 975-0597 to schedule your hormone consultation.

Pregnenolone Overview

http://www.lef.org/magazine/mag2007/nov2007_report_pregnenolone_01.htm