Answering Women’s Questions: Custom-Compounded Hormone Therapy

Q: I heard some people on TV talking about something called “custom-compounded” hormone therapy for hot flashes and other problems that women have after menopause. What is custom-compounded hormone therapy?

A: When people talk about custom-compounded hormone therapy, they are talking about the use of personalized, made-to-order hormone treatments. These hormone treatments are prepared by special pharmacies, which are called “Compounding Pharmacies.”

Custom-Compounded hormone therapy can be made in many different doses and forms, such as gels, lotions, tablets, and suppositories. The amount of hormone in these made-to-order products and the type of product (that is, whether it is a cream or a gel or some other type) are based on prescription from a doctor.

Q: Are the hormones used in custom-compounded hormone therapy more natural that the hormones used in other hormone therapy products? If so, do women get fewer side effects an better results with custom-compounded hormones compared with other hormone therapy products?

A: The hormones most commonly used in custom-compounded hormone therapy have the exact same chemical structure as the hormones that are found naturally in a woman’s body. For this reason, they are called “bioidentical” hormones.

The bioidentical hormones used in custom-compounded hormone therapy include 3 different types of estrogens: Estrone, estradoil and estroil and, if needed, progesterone. Sometimes, testosterone and a hormone called dehydroepiandrosterone (DHEA) are also used in custom hormone products. These bioidentical hormones are made in labs, just as many other hormones and drugs are. In fact, several hormone therapy products made by large drug companies use bioidentical hormones such as estradoil and progesterone.

Although some people claim that women will have fewer side effects and better results with bioidenical hormones, there have been no well-desgined studies to test these claims. Thus, women thinking about using custom-compounded hormone therapy should be given the same information about benefits and side effects as women using the hormone therapy products that are available from drug companies.

Women should also be aware that, unlike drugs sold in the United States, custom-compounded drugs are almost never tested for quality, purity, or potency by any government agency.

Q: In terms of breast cancer, heart disease, and other possible health risks, is it safer to use custom-compounded hormone therapy than to use the hormone products that are sold by big drug companies?

A: No, there is no proof that custom-compounded hormones are safer than other hormone products used to treat hot flashes and other menopausal symptoms. Until doctors and researchers show otherwise, women should not be led to believe that the risks of using custom-compounded hormone therapy are lower than the risks of using other hormone therapy products on the market.

Q: My friend tried custom-compounded hormone therapy. She said the pharmacy measured the hormones in her saliva to figure out how much hormone she needed to take. That sounds like a good idea. Does it work?

A: There is no good evidence that measuring hormone levels in saliva is helpful in figuring out which hormones to take or how much the dose should be. On the contrary, studies have shown that hormone levels in saliva can change a lot over the course of a single day and these chaning levels not connected in any consistent way to what is happening in a woman’s body.

What You Should Know About Gynecologic Cancer

Originally Printed by: The Female Patient®, Reproduced with Permission

Gynecologic cancer is the fourth most common cancer in women. an Estimated 1 in every 20 women will develop gynecologic cancer in her lifetime. No one can predict for sure who will get a gynecologic cancer. That is why it is so important for women to pay attention to their bodies. When gynecologic cancers are found early, treatment is most effective.

What are the Specific Gynecologic Cancers?

Gynecologic Cancers start in a woman’s reproductive organs. These cancers are named for the part of the body where the cancer starts. There are 5 main types of gynecologic cancer: ovarian, cervical, uterine, vaginal, and vulvar. Each cancer appears with different signs and symptoms and has different prevention strategies. All women are at risk for gynecologic cancers, and the risk increases with age. These cancers do not have to be life-threatening; there are early detection tools such as Pap tests.

Pay Attention to Your Health

Be familiar with your family history, and tell your gynecologist if there is a history of cancer in your family so she/he can recommend preventive steps. Learn the warning signs of these cancers, learn what is normal, and if you notice any unexplained signs or symptoms see a clinician right away. Some of these cancers have no warning signs, so it is important to make an appointment for an annual gynecologic exam and Pap test. Not all gynecologic cancers have tests to identify the individual cancer. The Pap test can screen for precancers and cell changes on the cervix. The human papillomavirus (HPV) test looks for the virus that can cause cell changes in cervical cancer.

The HPV vaccine protects against the types of HPV that cause cervical, vaginal, and vulvar cancers. It is recommended for 11- and 12-year-old girls. It is also recommended for females ages 13 to 26 who did not get any or all of the vaccine shots when they were younger.

What Are Some of the Signs or Symptoms of Gynecologic Cancers?

Ovarian Cancer: Pain in the pelvic or abdominal area, back pain, being tired all the time, bloating (are below stomach), change in bathroom habits, upset stomach or heartburn, discharge from the vagina that is not usual.

Cervical Cancer: Early on the cancer may not cause signs or symptoms. In the advanced stage, bleeding or discharge from the vagina that is not normal.

Uterine Cancer: Bleeding that is not normal for you — bleeding between periods, bleeding that is heavier or longer that 7 days even if light, bleeding or spotting after menopause.

Vaginal Cancer: Vaginal discharge or bleeding that is nor normal, a change in bathroom habits that is not normal, a pain in the pelvis and abdomen (especially when you have sex or urinate).

Vulvar Cancer: Itching, burning, or bleeding on the vulva that does not go away; color changes and skin changes on the vulva; sores, lumps, or ulcers that do not go away; or pain in the pelvis (especially upon urinating or having sex).

If you are diagnosed with one of these cancers, your clinician will recommend a gynecologic oncologist, a doctor who has been trained to treat cancers of a woman’s reproductive organs. When gynecologic cancers are found early, treatment can be effective.

To find out more information about gynecologic cancers, go to the CDC website at: www.cdc.gov/features/gynecologiccancers

What You Should Know About Pelvic Organ Prolapse

Originally Printed by The Female Patient®, reproduced with permission

Although no one talks about it much, pelvic organ prolapse is a fairly common problem. The term refers to one or more of the pelvic organs slipping downward from their usual positions.

Your Pelvis, the area between your hip bones in the lower part of your abdomen, encloses your vagina, uterus, bladder, urethra (tube through which urine passes during urination), and rectum. These organs are held in place by muscles, ligaments, and connective tissues. These support tissues can stretch or tear — causing the organs to drop lower in the pelvis. Factors such as menopause, obesity, and normal aging may also contribute.

Uterine and Vaginal Prolapse

Uterine prolapse occurs when the uterus slips downward into the vagina. Slight prolapse may be unnoticeable, but the uterus may drop down so far that its bottom portion, the cervix, is felt as a round bulge at or coming out of the vaginal opening. You may notice a feeling of fullness or pressure in the vagina, discomfort during sex or tampon use, and low back pain. In women who have had a hysterectomy (surgical removal of the uterus), the top part of the vagina may prolapse into the lower vagina.

Anterior Vaginal Prolapse

The anterior vaginal wall supports the bladder. When the vagina slips out of place the bladder will also fall. This prolapse is also called a cystocele. Anterior vaginal wall prolapse can affect bladder function. The muscles controlling urine release may or may not work efficiently, sometimes causing difficulty starting urination, incomplete bladder emptying, overactive bladder symptoms or leaking of urine with coughing, sneezing, laughing, or exercising.

Posterior Vaginal Prolapse

The posterior vaginal wall lies in front of the rectum. The rectum is where stool is stored before a bowel movement. When the posterior vaginal wall loses its support, the rectum can bulge upwards into the vaginal opening. This prolapse is often referred to as rectocele. Posterior vaginal wall prolapse can make bowel movements difficult, since bearing down makes the rectum bulge forward, rather than pushing the stool.

Testing Prolapse

Your health care professional diagnoses pelvic organ prolapse by taking a health history and doing a pelvic examination. Treatment is usually unnecessary if you have no bothersome symptoms. To help prevent prolapse, avoid straining with constipation and heavy lifting, and maintain a healthy weight. Kegel exercises or physical therapy to strengthen the pelvic support muscles may help control symptoms. If you prefer non-surgical treatment, or have a medical condition that makes surgery inadvisable, a pessary — removable device place in the vagina to support the pelvic organs — may be prescribed.

Surgery to return the organs to their proper positions and hold them in place is another way to correct prolapse. If surgery is recommended, be sure you understand the risks and the benefits. Having the information you need is key to making informed decisions about treatment.

What You Should Know About Extended-Cycle Oral Contraception

Originally Printed by: The Female Patient®, Reproduced with Permission

Has Menstruation Changed?

Today’s American woman has more periods in her lifetime than ever before — approximately 450 periods. Compare this to a century ago when women lived on farms or in rural areas — the had 150 periods in their lifetime. Scientists also believe that prehistoric women had only 50 periods throughout their childbearing years. Why the change? Back then, women entered puberty later in life, had more children, and breast-fed longer. Today’s woman enters puberty later in life, has fewer children, and does not breast-feed for as long a period of time, if at all.

In the United States, menstrual disorders are the most prevalent gynecologic disorder, affecting 2.5 million women from age 18 to 50 years. Approximately 65% of these women contact their health care provider because of menstrual-related symptoms, and 31% report spending about 10 days in bed each year because of menstrual-related symptoms. Surveys among women of all ages show that women want fewer periods.

Researchers have been studying the menstrual cycle for more than 70 years in order to develop therapies to treat these menstrual disorders. Along the way, they also discovered and effective way to suppress ovulation and provide safe contraception. Oral contraception, a.k.a “The Pill,” was first used in the 1960s and it changed the lives of women forever. Since then, lower doses that still provide better cycle control have been introduced and adapted. These options provided women with more choices for birth control and new opportunities for cycle control.

For scientists, the next logical step was to examine the consequences of cycle suppression. One new oral contraceptive has been approved by the US Food and Drug Administration (FDS), which not only provides safe and effective birth control but also allows women to manipulate their menses. Instead of a period every 28 days with conventional pills, this new regimen causes a period after 84 days. You will have 4 periods a year instead of 13.

Period Pros and Cons

The positive aspects of menstruation include validation of womanhood and reassurance of reproductive potential. It is a symbol of femininity and confirms that you are not pregnant. Many women incorrectly believe that monthly menstruation is necessary to cleanse or purge the body of toxins. Menstruation can be a nuisance and often causes back and abdominal pain, bloating, headache, breast tenderness, pain in the arms and legs, irritability, depression, and fatigue.

The biological purpose for having a period is to prepare the endometrium for pregnancy. If an egg is not fertilized within a certain amount of time, the levels of female hormones in your body — estrogen and progesterone — gradually lessen. When the levels of these hormones fall, the outer two thirds of the endometirum is shed —  thus, your period. The inner third stays to create a new lining in the uterus so that the cycle can begin again.

The Pill artificially induces bleeding during the placebo pill period. If you stay on an extended cycle of hormones, the hormones will prevent the endometirum from shedding and you will not have a period. The purpose of a period is to prepare your body for pregnancy. If you do not want to get pregnant, you don’t need to have an artificially induced period.

Suppression of ovulation is considered innovative and progressive. The first oral contraceptives were designed to simulate a woman’s natural cycle. The concept of a “Sunday start” was originally deigned to avoid weekend periods. Now, oral contraceptives can provide women with the opportunity to choose fewer periods.

If you are currently taking an oral contraceptive, you are on a 28-day cycle. Most packs contain 28 pills, 21 contain hormone and the other 7 contain no hormone. With the extended-cycle regime, however, instead of taking a 7-day break, you keep taking active pills for a full 84-days (7 weeks), and then use the 7 inactive pills, at which time your period will occur. The packaging has been carefully designed to keep track for you and make it as easy as possible to follow the regimen.

If you are not currently taking an oral contraceptive, then you should be aware that there are risks associated with taking oral contraceptives. These risks increase significantly if you: smoke; are obese; have a clotting disorder; or have high blood pressure, diabetes, and/or high cholesterol.

Extended-cycle contraception has been tested in clinical trials and was found to be safe and effective. Ninety-nine percent of women who take this regimen as directed will not get pregnant.

Extended-cycle contraception has been approved by the FDA and has been shown to be safe and effective in thousands of women. Most women who can safely take oral contraceptives can most likely take the extended regimen and control the number of menstrual periods they have each year. As your health care provider if the extended-cycle is right for you.

 

Heat Stroke

With the warm weather approaching, now is the time to think of heat stroke and safety measures.  People and pets die yearly of heat stroke, this has been stated many times yet it bears repeating.  Never leave a child or pet in the car during hot weather. Even a window cracked open will not expel the heat fast enough. Continue reading

Pain Medicine

No one wants to be in pain but when you are, what medication do you take? Drug stores have several shelves full of options. In reality there are only three basic choices, aspirin (acetylsalicylic acid/ASA), acetaminophen (Tylenol), and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). There are two non-prescription NSAIDs, ibuprofen (Motrin, Advil) and naproxen sodium (Aleve). Aspirin is a weak NSAID and labels often list it as one yet doctors seldom include aspirin when discussing NSAIDs. There are a couple brands available that use slightly altered forms of aspirin and usually contain the ingredient salicylate. Continue reading

What is an Allergy?

    What is an allergy?  Basically it is an over-exuberant attack by your immune system on something it recognizes as a foreign invader.  Exactly why the reaction gets so extreme to certain foods or medicines is not really understood.

    Your immune system “develops” allergies, you are not born with them and this development evolves over time.  The first time you take a medicine will usually be fine, but as you develop the allergy, antibodies form that remain after you are finished with the drug.  Then the next time you take that medication the already present antibodies attack the drug with you suffering the fallout.  Sometimes you may have an allergic attack the very first time you take a medication provided you are on it a long enough for the response to develop.  You may take something repeatedly without any problem, only to become allergic the tenth or the fiftieth time.  Once you become allergic it usually remains for life, however on occasion the allergy will just disappear. Continue reading

This entry was posted on December 16, 2013, in Dr Duffy and tagged .

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Herbal vs Natural Medicine

Natural medicine means derived from a natural, non-altered source, usually a plant (herbal) source but could be mineral (calcium), fungal (red yeast), or bacterial (probiotics).

Since in theory anyone can go out and pick a plant the government decided they have no role in regulating natural medicine.  This means there is no requirement to prove they work, nor any studies on safety including little control of quality. Continue reading