Treatment Options for Menopause

Menopause refers to the time in a woman's life when monthly cycles of menstruation cease and the level of hormones produced by the ovaries decreases. Menopause most often occurs in the late 40s or early 50s. It also, however, can be caused by surgical removal of both ovaries, known as an oophorectomy, or by a hysterectomy, which involves the removal of the uterus as well as ovaries.

Although the above definition seems simple, most women who have experienced menopause, either naturally or surgically, would not describe the process as simple.

Hormone replacement therapy (HRT) has long been the accepted treatment for the symptoms of menopause (Table). Conventional therapies, however, have come into question in recent years, leaving women scrambling for alternative treatment options to relieve their symptoms.

When the Women's Health Initiative Trial was halted in July 2002, the school of thought regarding the treatment of menopausal symptoms changed quickly and dramatically. It was discovered during the course of the study that the long-term use of conjugated estrogens/medroxyprogesterone acetate tablets (Prempro) may actually increase a woman's risk of breast cancer, heart disease, and stroke. The National Institutes of Health (NIH) therefore recommended that the use of Prempro be restricted to the short term for the relief of acute symptoms. As a result, alternative therapies and bioidentical HRT began getting more attention than ever before.

Symptoms of Menopause

Following the NIH's announcement and the new guidelines for HRT, it became clear that, whereas women did not want to risk their health, they were not willing to sit by and suffer quietly, either. Although menopausal symptoms are a natural occurrence in the course of a woman's life, they can be extremely disruptive and unpleasant. They may occur alone or in combination with one another, and, when they are severe, they can have a major negative impact on a woman's quality of life. For this reason, many women are turning to more natural methods of symptom relief that pose less risk to their long-term health.

Bioidentical HRT

One option women are turning to in increasing numbers is bioidentical hormone replacement therapy (BHRT). It differs from conventional HRT in that it utilizes naturally occurring sex steroid hormones as opposed to synthetic chemicals not normally found in the human body. The major benefit of BHRT is that it can be customized according to the needs of the individual patient by a compounding pharmacist. Many physicians are now educating themselves on the proper use of BHRT and its benefits so that they may respond to the growing demand from the patient population.

BHRT carries many options in form, dosage, and route of delivery. Some of the most common components are as follows:

• Tri-estrogen: a preparation consisting of the 3 primary estrogens found in a woman's body; estriol, estrone, and estradiol
• Bi-estrogen: a formula consisting of estriol and estradiol
• Progesterone: a hormone prevalent during pregnancy that provides balance and prevents symptoms
• Testosterone: present in both men and women
• Dehydroepiandrosterone: a precursor to testosterone; available both by prescription and over the counter

Common routes of delivery include the following:

• Transdermal creams and gels
• Oral capsules
• Sublingual troches
• Sublingual drops
• Vaginal gels and creams

With BHRT, the possible therapies are nearly limitless, and they may be adjusted to find the proper balance for each patient. A compounding pharmacist is often an excellent resource for information regarding BHRT and the different options it provides. Some pharmacists work in conjunction with physicians and patients to provide dosing guidance as well.

Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Solutions in Edmond, Okla.