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Bio-Identical Hormone Replacement Therapy. Raylene Mote Pharm D Inland Compounding Pharmacy 24747 Redlands Blvd., Suite F Loma Linda, CA 92399 (909) 478-3842. Introduction.

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bio identical hormone replacement therapy
Bio-Identical Hormone Replacement Therapy
  • Raylene Mote Pharm D
  • Inland Compounding Pharmacy
  • 24747 Redlands Blvd., Suite F
  • Loma Linda, CA 92399
  • (909) 478-3842
  • As a member of the Baby-Boomer Generation, I am looking at the Perimenopausal and Menopausal Era with increased interest. I would like to share with you some of the information I have learned, which can be of benefit to you as well.
  • My name is Raylene Mote, Over the past 15 years, I have been compounding medications, starting with Progesterone suppositories, my interest in compounding has escalated to the point of starting my own Compounding Pharmacy
topics of discussion
Topics of Discussion
  • I would like to talk about Perimenopause and Menopause, and their symptoms, effects on the body and alleviation using Natural Bio-Identical Hormones
  • First, we will discuss the various Life Stages
life stages
Life Stages
  • Premenopause
    • Begins with the first menstrual period
    • Monthly fluctuations of LH, FSH, Estrogens, Progesterone
    • Most common problem is PMS
      • Neurotransmitter profile affected by fluctuating hormones
      • Often successfully treated with stress reduction, diet, exercise
      • Treated with Progesterone, St John’s Wort, 5-Hydroxytryptophan, SSRI’s
life stages5
Life Stages
  • Peri-menopause
    • Period between onset of changes in hormonal secretions and onset of menopause
    • Usually begins around age 45 to 49
    • Fluctuating hormone secretions due to intermixed normal and abnormal cycles
    • Still menstruating but experience menopausal symptoms
    • Sometimes referred to as a period of “Estrogen Dominance”
life stages6
Life Stages
  • Menopause
    • Termination of menstrual periods
    • Onset defined as missing 12 consecutive
    • Not all women experience problems
  • Post-menopause
    • The years following the cessation of menstruation (with or without HRT)
  • HRT to maintain vital functions such as heart protection, lipid profile, bone mass
functions of estrogens
Functions of Estrogens
  • Responsible for normal growth and development of female sex organs
  • Responsible for maintenance of secondary sex characteristics
  • Promote proliferation and growth of specific cells in the body
  • Protect against bone loss, heart disease and other aging dilemmas
  • Provide maintenance of anti-aging mechanisms
menopausal symptoms of estrogen deficiency
Hot Flashes

Hair Loss

Dry Skin

Sleep disruption

Night Sweats


Vaginal dryness

Vaginal atrophy


Memory Loss


Diminished Sex Drive

Painful intercourse

Urinary incontinence

Heart Palpitations

Menopausal Symptoms of Estrogen Deficiency
goals of bio identical hrt
Goals of Bio-identical HRT
  • Alleviate the symptoms caused by the natural decrease in production of hormones by the body
  • Replace the hormones to the extent to provide the positive benefits of hormone therapy
  • Bring the body back to hormonal balance
  • Imitate the body’s natural processes as much as is possible
synthetic vs natural vs bio identical
Synthetic Vs. Natural Vs. Bio-identical
  • “Patented” or “Conventional” or “Artificial”
  • Usually not found in nature or at least not in humans
  • Chemically altered from structure of human hormone
  • Not identical in structure or function to the bio-identical hormones they emulate
synthetic vs natural vs bio identical12
Synthetic Vs. Natural Vs. Bio-identical
  • “Natural” HRT
  • Should refer to what’s natural to the human body in physiological amounts and ratios
  • To layperson, natural means not man-made
  • May refer to plant or animal source
    • Precursors found in yam or soy plants
    • Premarin from pregnant horses’ urine
  • May refer to phytoestrogens or alternative therapies
synthetic vs natural vs bio identical13
Synthetic vs. Natural vs. Bio-identical
  • Hormones that have the exact molecular structure as those made in the human body
  • Produce the same physiological responses as endogenous hormones
  • Should be administered in a manner that imitates the body’s natural ratios and mechanisms
bio identical hormones
Bio-identical Hormones
  • Estrone (E1)
  • Estradiol (E2)
  • Estriol (E3)
  • Progesterone
  • Testosterone
  • Dehydroepiandosterone (DHEA)
  • Pregnenolone
  • Androstenedione
benefits of bio identical estrogen therapy
Benefits of Bio-identical Estrogen Therapy
  • Reduced risk of cancer
    • Estriol indicated to be the “safest” estrogen
    • Metabolites of Premarin, Estrone and Estradiol thought to be carcinogenic
  • Less potential undesirable side effects than with conventional synthetics
    • Only approximately 20% of women who start conventional HRT remain on it 2 years later
conventional estrogen therapy
Conventional “Estrogen” Therapy
  • Possible UNWANTED Side Effects
  • Breast tenderness, high blood pressure, gallstones, vaginal bleeding, fluid retention, blood clots, nausea and vomiting, headaches, leg cramps, impaired glucose tolerance, worsened uterine fibrosis and endometriosis, jaundice, and
  • Increased risk of endometrial cancer and breast cancer
estrogen dominance
Estrogen Dominance
  • Relative excess of estrogen
    • High fluctuations of peri-menopause
    • Overdosing of estrogen
    • Lack of progesterone to balance
  • Symptoms include:
    • Fatigue, breast tenderness, fluid retention, headaches, craving of sweets, decreased libido, heavy or irregular menstruation, weight gain, fibrocystic breasts, uterine fibroids, mood swings, loss of scalp hair
progestins vs progesterone
Progestins vs. Progesterone
  • Progestins are synthetic, man made molecules developed to mimic the actions of natural progesterone. Progestins do not have the full range of activity of natural progesterone
  • Natural progesterone is a molecule that is plant derived and is bio-identical to the hormone produced in our bodies
side effect profile

Slight to moderate drowsiness

Synthetic Progestins

Breast tenderness




Vision changes



And more……

Side Effect Profile
  • Oldest know sex hormone
  • Present in every human regardless of age (or sex)
  • Produced by the ovaries and adrenal glands
  • Secreted by the corpus luteum
  • Has receptors in almost every cell in the body
  • Acts on uterus, breasts, brain, smooth muscle, kidneys, bones and cellular membranes
  • Metabolized to other active hormones
functions of progesterone
Functions of Progesterone
  • Promote secretory changes in uterine endometrium
    • Counteracts prolific action of estrogens
  • Necessary for maintenance of pregnancy
    • Prepares and maintains uterine lining for implantation of fertilized egg
    • Decreases uterine contractions
  • Prepare breasts for lactation
effects of progesterone
Effects of Progesterone
  • Acts as a natural diuretic
  • Normalizes blood clotting
  • Stimulates osteoblast-mediated new bone formation (increases bone mass and density)
  • Precursor for other sex hormones
  • Maintenance of anti-aging mechanisms
effects of progesterone24
Effects of Progesterone
  • Anti-estrogen:
    • Suppresses nuclear estradiol receptors
    • Induces estradiol dehydrogenase
    • Suppresses DNA synthesis
  • Anti-mineralocorticoid effect
    • Blocks binding of aldosterone to renal receptors therefore causing sodium excretion
benefits of progesterone therapy
Benefits of Progesterone Therapy
  • Balances the effects of estrogens
    • Counteracts the symptoms of estrogen dominance, especially breast tenderness, fluid retention, headaches, break through bleeding, sleep disturbances, irritability, loss of libido, loss of scalp hair
  • Decrease uterine fibroids
  • Protects against fibrocystic breasts
  • Decreases cramping
benefits of progesterone
Benefits of Progesterone
  • Natural antidepressant
  • Helps normalize thyroid
  • Uses fat for energy
  • Restores libido
  • Has a positive effect on cholesterol
  • Builds bones and protects against osteoporosis
combination hormonal therapy
Combination Hormonal Therapy
  • In most cases, it is beneficial to use a combination of estrogen and progesterone to obtain hormonal balance
  • One without the other can lead to a dominance of one hormone
  • Estrogen and Progesterone have reciprocal actions at the cellular level
effects of testosterone
Effects of Testosterone
  • Enhances Libido
  • Provides cardiovascular protection (lowers cholesterol)
  • Enhances bone building (increases calcium retention)
  • Improves energy level, mental alertness, and a sense of well-being
  • Maintains muscular tone
  • Maintains skin and hair health
application of bio identical hormone replacement
Application of Bio-identical Hormone Replacement
  • It depends on the individual!!!
  • Determine needs/goals of the patient
  • Health evaluation
  • Individual factors for each patient
    • Hysterectomy
    • Thyroid function
    • History of hormonal cancer
    • Family history of heart disease, etc.
    • Weight
    • Diet, exercise, and stress influences
    • Previous pharmaceutical agents and response
adjunctive therapies
Adjunctive Therapies
  • Healthy diet
  • Regular Exercise
  • Lifestyle Modification
  • Nutritional Supplementation
  • Pharmaceutical Agents
  • Thank you for this opportunity to share with you today!!