Despite so much information about menopause being available online, in magazines, and on other media, I’m always surprised when I give workshops and find that women are still confused about menopause definitions .
We can’t play a game properly if we don’t know the rules, and today’s blog post focuses on definitions about menopause, so when we talk or read about menopause we know what the terms mean and are able to understand the information better.
To start with, I and many other menopause experts tend to use the words menopause, menopause change, menopause transition, and even perimenopause interchangeably—but each has a specific meaning.
Let’s start with menopause.
What is menopause?
All women will go through menopause if they live long enough and for most it is a normal and natural event.
Menopause is the end of ovarian function, that means the ovaries stop producing eggs, ovulation stops, and consequently periods stop as well. Menopause is the end of ovulation, menstruation, and fertility. The word menopause literally means the end (pause) of menses, the plural Latin for what we medically call menstrual flow.
How do you know when you are in menopause? How do you know it was the last period? Menopause is confirmed when you haven’t had a period for 12 consecutive months.
If you are experiencing irregular periods and want to track them to determine when you reach menopause then I suggest you download or print the Menstrual Calendar. When you haven’t bled for 12 months in a row you’ve reached menopause. Congratulations! Celebrate this milestone! I can help you throw a Menopause Party!
Menopause usually happens between 40 and 60 years of age, and the average age of menopause in North America is 52. Smokers may experience menopause a few years earlier.
Some women may experience early menopause, before 40 years old.
Induced menopause occurs when a woman undergoes removal of both ovaries and/or chemotherapy and radiation treatments for certain types of cancer that damage the ovaries. Women who experience induced menopause usually experience more severe symptoms due to the very sudden drop in estrogen levels.
A hysterectomy, removal of the uterus without removal of the ovaries, doesn’t cause menopause but the ovaries may end the production of estrogen 2-3 years earlier than usual. Because a woman without a uterus no longer has menstrual bleeding she’s not able to judge if she’s in menopause based on bleeding patterns. For these women other symptoms of hormonal change and decline plus blood tests may be necessary to determine menopause. Otherwise blood tests aren’t necessary or recommended to determine if a woman is in menopause.
What is perimenopause?
Perimenopause is the years leading up to menopause (cessation of periods) and may start in the 30s or 40s. It’s impossible to predict how long perimenopause will last, usually 4-8 years. I also like to refer to perimenopause as the menopause transition because it is a journey.
Most women have regular menstrual cycles, they bleed every 24-31 days and when estrogen production by the ovaries starts fluctuating the time between periods changes and women experience longer or shorter cycles. This is usually the first change noticed in perimenopause.
Women may also experience changes in flow, bleed more heavily or more lightly, have spotting, or miss periods. This unpredictability upsets and frustrates many women. Not knowing when the next period is going to come, when or if ovulation is going to occur, and experiencing spotting can be annoying and upsetting. I jokingly say that if a women in perimenopause wants to know when her next period will come all she has to do is book a beach vacation…!
Women who are sexually active and who do not wish to get pregnant must use a method of birth control until 12 months after the last period – some experts suggest 24 months because ovulation is unpredictable during perimenopause but may happen.
What is postmenopause?
Postmenopause are the years after menopause is confirmed. Since menopause is confirmed 12 months after the last menstrual period, the day after that, and till their death, women are in postmenopause. With the population aging and women living well past their 80s, many women spent one-third of their lives in postmenopause.
It’s important to understand the protective effect of estrogen against diseases like stroke and heart attack, osteoporosis, and diabetes to help us make healthy lifestyle choices to ensure healthy aging and prevent disease. I’ll be writing about this in a future blog.
I hope I made things clearer than mud!
Now we can talk about this topic and know exactly what we mean when we use words like menopause, menopause transition, perimenopause, and postmenopause. Let’s talk about menopause!
There’s help. I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
MenopausED profiled on ShareYourStories.online
/in Menopause, Sexual Health/by Teresa Isabel DiasI founded MenopausED to help women navigate “the change” — the menopause transition. Now I’m very pleased to have my business MenopausED profiled on ShareYourStories.online by entrepreneur and business coach Trish Tonaj.
Trish is a coach working with Entrepreneurs and Enterprise Leaders. “Love, laughter and adventure” is Trish’s personal mantra and focus for achieving life’s balance between wealth and wellbeing.
In her interview with me, I summarize my motivation in founding MenopausED:
There’s a lack of resources when it comes to the care of women in midlife, and especially during the menopause transition…In general, women aren’t aware of the physical, emotional, and cognitive changes of the menopause transition. Some women breeze right through menopause but many have their quality of life affected by the hormone changes of midlife (40+). I demystify menopause and talk about sexual health.
I was so proud to have my business MenopausED profiled on ShareYourStories.online. You can read the full interview here.
And remember, there’s help, I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Let’s Talk About Menopause
/in Menopause, Perimenopause/by Teresa Isabel DiasLast month I wrote a blog for MOMPRENEURS titled “Let’s Talk About Menopause”.
In the blog, I ask perhaps the most perplexing question of menopause: If all women go through menopause, why are most unprepared for it?
I take you through my personal journey and I address some of the major symptoms of menopause:
And I define a few terms: perimenopause, menopause, and postmenopause.
My conclusion is happily upbeat: “Menopause is part of midlife and has some bumps but it doesn’t have to be all doom and gloom. Even though each woman experiences menopause in her own way, we all share many similar experiences. We are not alone, and there’s help!”
You can read my full post “Let’s Talk About Menopause” here.
And remember, there’s help, I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Menopause Definitions: (peri)menopause
/in Menopause, Perimenopause/by Teresa Isabel DiasDespite so much information about menopause being available online, in magazines, and on other media, I’m always surprised when I give workshops and find that women are still confused about menopause definitions .
We can’t play a game properly if we don’t know the rules, and today’s blog post focuses on definitions about menopause, so when we talk or read about menopause we know what the terms mean and are able to understand the information better.
To start with, I and many other menopause experts tend to use the words menopause, menopause change, menopause transition, and even perimenopause interchangeably—but each has a specific meaning.
Let’s start with menopause.
What is menopause?
All women will go through menopause if they live long enough and for most it is a normal and natural event.
Menopause is the end of ovarian function, that means the ovaries stop producing eggs, ovulation stops, and consequently periods stop as well. Menopause is the end of ovulation, menstruation, and fertility. The word menopause literally means the end (pause) of menses, the plural Latin for what we medically call menstrual flow.
How do you know when you are in menopause? How do you know it was the last period? Menopause is confirmed when you haven’t had a period for 12 consecutive months.
If you are experiencing irregular periods and want to track them to determine when you reach menopause then I suggest you download or print the Menstrual Calendar. When you haven’t bled for 12 months in a row you’ve reached menopause. Congratulations! Celebrate this milestone! I can help you throw a Menopause Party!
Menopause usually happens between 40 and 60 years of age, and the average age of menopause in North America is 52. Smokers may experience menopause a few years earlier.
Some women may experience early menopause, before 40 years old.
Induced menopause occurs when a woman undergoes removal of both ovaries and/or chemotherapy and radiation treatments for certain types of cancer that damage the ovaries. Women who experience induced menopause usually experience more severe symptoms due to the very sudden drop in estrogen levels.
A hysterectomy, removal of the uterus without removal of the ovaries, doesn’t cause menopause but the ovaries may end the production of estrogen 2-3 years earlier than usual. Because a woman without a uterus no longer has menstrual bleeding she’s not able to judge if she’s in menopause based on bleeding patterns. For these women other symptoms of hormonal change and decline plus blood tests may be necessary to determine menopause. Otherwise blood tests aren’t necessary or recommended to determine if a woman is in menopause.
What is perimenopause?
Perimenopause is the years leading up to menopause (cessation of periods) and may start in the 30s or 40s. It’s impossible to predict how long perimenopause will last, usually 4-8 years. I also like to refer to perimenopause as the menopause transition because it is a journey.
Most women have regular menstrual cycles, they bleed every 24-31 days and when estrogen production by the ovaries starts fluctuating the time between periods changes and women experience longer or shorter cycles. This is usually the first change noticed in perimenopause.
Women may also experience changes in flow, bleed more heavily or more lightly, have spotting, or miss periods. This unpredictability upsets and frustrates many women. Not knowing when the next period is going to come, when or if ovulation is going to occur, and experiencing spotting can be annoying and upsetting. I jokingly say that if a women in perimenopause wants to know when her next period will come all she has to do is book a beach vacation…!
Women who are sexually active and who do not wish to get pregnant must use a method of birth control until 12 months after the last period – some experts suggest 24 months because ovulation is unpredictable during perimenopause but may happen.
What is postmenopause?
Postmenopause are the years after menopause is confirmed. Since menopause is confirmed 12 months after the last menstrual period, the day after that, and till their death, women are in postmenopause. With the population aging and women living well past their 80s, many women spent one-third of their lives in postmenopause.
It’s important to understand the protective effect of estrogen against diseases like stroke and heart attack, osteoporosis, and diabetes to help us make healthy lifestyle choices to ensure healthy aging and prevent disease. I’ll be writing about this in a future blog.
I hope I made things clearer than mud!
Now we can talk about this topic and know exactly what we mean when we use words like menopause, menopause transition, perimenopause, and postmenopause. Let’s talk about menopause!
There’s help. I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Despite the fact that I’m not doing anything differently I’m putting on weight
/in Exercise, Diet, Weight/by Teresa Isabel DiasThat’s a common complaint of women going through the menopause transition. Metabolism gets slower with age (many men get a beer belly in their 30s) and women in perimenopause tend to accumulate fat around the middle, even if their weight doesn’t go up. It’s a combination of decreased estrogen, decreased energy, and sometimes sleep difficulties around the change. The most important thing is that you do your best to avoid weight gain.
How?
Eat smarter and exercise smarter.
Smarter nutrition
Eat less carbs, drink water not sugary drinks (pop, lattes, cocktails), avoid processed foods (pretty much everything that comes in a box), and eat lots of vegetables, fruits, legumes, fish, lean meat (chicken and turkey, no beef), grains, and nuts.
Smarter exercise
There’s one word: “MOVE”, that you must remember and practice EVERY DAY. So, exercise at least 5 days a week, 30 minutes per day. Avoid injuries by cross-training and target the middle section, the core of your body, with proper resistance weight exercises to get rid of the muffin-top.
My journey through perimenopause was very much like any other woman’s, a combination of more bread than needed, less activity due to injury, fatigue, and inability to go to the gym, and one day I couldn’t fit into a beloved dress. That set me in motion to prove I could reverse the weight gain and, dare I dream, slim my waistline.
I did it!
Here’s how I did it:
Watch Dr. Annette Santoro, OB/GYN Chair of the University of Colorado School of Medicine, talk about weight gain in menopause in this NAMS video.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Look after your needs and pamper yourself!
/in Diet, Exercise/by Teresa Isabel DiasToday and every day look after your needs and pamper yourself. I don’t mean spending a whole day at the spa, getting your nails done, or going shopping. What I mean is that every day you should grant your body and your mind what they need most:
If you face life with positivity (in my work I say [meno]PAUSE-itivity!!!) everything will look better and we know positive thoughts attract positive actions.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
World Menopause Day -October 18th
/in Sexual Health/by Teresa Isabel DiasThis year’s World Menopause Day theme is Sexual Wellbeing After Menopause.
Sexual health is a state of physical, emotional, mental and social wellbeing related to sexuality. Sexuality after menopause isn’t something women talk about with their partners, friends and even their doctors’. This MUST change.
Symptoms like poor sleep, fatigue, hot flashes, weight gain, low self-esteem, vaginal dryness, painful sex, and others, keep women from being intimate with their partners and severely impair their relationships, mental health, social functioning and quality of life. This affects thousands of woman but most think they are the only one.
A survey evaluated the impact of vulvovaginal symptoms on the sexual relationship between postmenopausal women and their male partners, it included 4100 females and 4100 males representing nine different countries. 55% of women and 61% of men reported intimacy avoidance because sex would be painful.
Most women assume this is part of aging and they must put up with it. No, women shouldn’t put up with it, women should talk to their health care providers about it -there are therapies available- lubricants, moisturizers and hormone therapy applied vaginally.
To learn more about what menopause means to your vagina read my blog, The Menopausal Vagina Dialogue:
https://menopaused.org/2017/01/29/menopausal-vagina-dialogue/
Please read this comprehensive booklet from the International Menopause Society:
https://www.sigmamenopause.com/sites/default/files/images/IMS%20GP%20booklet%202018%20v2%20FINAL%20caucasian.pdf
Do not suffer in silence, reach out and don’t let your vagina ruin your relationships.
Menopause shouldn’t be taboo. Let’s talk about menopause.
There’s help. I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Hormone Therapy for pharmacists & women in the know
/in Hormone therapy, Menopause/by Teresa Isabel DiasWith so much misinformation and fear about hormone therapy (HT) some women suffer through menopause needlessly. I’m excited to share with pharmacists, and women who want to learn more, the latest blog I wrote for the Ontario Pharmacists Association (OPA)
Pharmacists are accessible healthcare providers and should know the latest information about HT to provide information about menopause management.
Pharmacists should be aware of the latest information about menopause therapies, including HT in order to help women make informed decisions regarding their menopause treatment.
Hormone Therapy: Women’s Health Initiative (WHI) Revisited
https://beyondthecounter.wordpress.com/2018/03/15/hormone-therapy-womens-health-initiative-whi-revisited/
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
BioIdentical Hormones – Be Informed! Part 3
/in Bioidentical therapy, Hormone therapy/by Teresa Isabel Dias3. HT is made from plants or herbs, like yams, soy, or chasteberry. Bioidentical hormone therapy doesn’t contain drugs. Does it?
Some women choose bioidentical hormone therapy (BHT) because they believe it is natural, meaning that it is made from plants, not drugs, therefore it is safe.
According to Dr. Margery Gass, a NAMS-certified menopause practitioner in Cleveland, Ohio, “There is no hormone out there that women can use that can be harvested from the field, or the trees, or anyplace else” , “All go through laboratories and have to be processed with multiple chemical steps to be in the form that humans can use.”
If a custom-compounded cream claims to contain only plant-base, natural ingredients i.e. yams, it will not be used effectively by the body. If you want to use natural yams to stop hot flashes you’ll have to eat several bushels a day …
One of the definitions of drug by the Food and Drug Administration (FDA) is “a substance (other than food) intended to affect the structure or any function of the body”. Therefore, if a compound, whether made from plants or manufactured by a pharmaceutical company, has a measurable physiologic effect in the human body it is a drug.
If a hormone, a plant or an herb helps treat symptoms, it is a drug.
Beware of false marketing claims regarding products containing only natural ingredients and offering great relief for menopause symptoms. Like everything else in life, if it sounds too good to be true, it probably is!
Post-market product testing done by FDA has uncovered inconsistencies in ingredients, dose, and quality. The frequency of problems investigated by the FDA concerning compounding pharmacies’ false claims regarding efficacy, manufacturing, and safety has increased since 2008, e.g., products claimed to be all natural actually contained hormones. Custom-compounded preparations may vary among pharmacies and aren’t necessarily exactly the same each time you purchase them. Bioidentical hormones are sought by women looking for natural treatments for menopause. That’s understandable since the Women’s Health Initiative Trials results made public many years ago scared women and healthcare providers about hormone therapy (you can read more on this in the previous, second, blog of this series- BHT is natural, therefore is safe. Is it?).
The lack of accurate and up-to-date information on the safety of hormone therapy makes women vulnerable to unsubstantiated, unethical claims made by companies focused on profit.
The natural product business is a billion-dollar industry, very well marketed and advertised, fraught with misinformation and false claims. Many of the claims are made by celebrities disguised as experts, with no medical background, who are being paid to tout the benefits of such products.
With so much information in the media it is difficult for most women to separate the wheat from the chaff; to tell apart evidence-based information from paid commercials disguised as real information.
Custom-compounded bioidentical hormone products must be used with caution.
Women have to educate themselves—question compounders of bioidentical hormone therapy about the ingredients used in the products, demand proof of efficacy and safety of BHT; ask their healthcare providers for accurate, evidence-based therapies that have been tested, are regulated and approved by FDA and Health Canada, and backed by respectable Societies. Before choosing a product, be informed, be safe!
The first blog of this series Bioidentical-Be informed! is
1. BioIdentical Hormones
and the second blog in the series is
2. BioIdentical Hormones – Be Informed! Part 2: Biodentical Hormone Therapy is natural, therefore bioidentical therapy is safe. Is it?
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
BioIdentical Hormones – Be Informed! Part 2
/in Hormone therapy, Bioidentical therapy/by Teresa Isabel Dias2. Biodentical Hormone Therapy is natural, therefore bioidentical therapy is safe. Is it?
There are a lot of medicines made from natural sources but does that mean that bioidentical therapies are safe? For example, tiotropium is a derivative of atropine from Atropa belladonna, a tall bushy herb of the nightshade family, and is used in the treatment of chronic obstructive pulmonary disease (COPD), a chronic inflammatory lung disease that causes obstructed airflow in the lungs. Is the plant Atropa belladonna safe? Probably not—it is also called Deadly Nightshade because it is a highly poisonous plant. However, the synthesized product called tiotropium is very useful in the treatment of COPD. Natural doesn’t mean safe, and man-made, synthesized in the laboratory, doesn’t have to mean “bad”.
In the previous blog – Are the bioidentical hormones (BH) used by local pharmacies to compound formulations different from the bioidentical hormones used by pharmaceutical companies in commercially-available products?
I wrote that chemicals extracted from plants need to be modified, synthesized into human-like hormones that can be used by the human body. A few laboratories in the world synthesize plant extracts into bioidentical hormones which are sold to compounding pharmacies and pharmaceutical companies, and used to make bioidentical hormone products sold worldwide with or without prescription. Some women choose bioidentical hormone therapy (BHT) because they believe it is natural and therefore safe and risk-free. We may link the demand for other than commercially-available bioidentical hormone therapy (BHT) to the Women’s Health Initiative (WHI) trial conclusions.
Bioidentical hormone products are hard to reproduce-there’s batch-to-batch variation even in the same pharmacy
In 2002 the study was stopped because some of the participants who were taking estrogen plus progestin (a synthetized progestogen, not bioidentical micronized progesterone), had an increase in heart disease and stroke compared with those taking placebo (“sugar pills”). Reports showed a small but significant increase in cardiac events as well as a higher incidence of breast cancer. The media jumped on the news, omitted some of the details, exaggerated others, and women and healthcare providers alike became very scared of hormone therapy (HT). Having lost trust in FDA-approved drugs, and with few options to treat hot flashes and other menopause symptoms, women turned to custom-compounded bioidenticals. Celebrities with no medical background and paid to advertise, touted the benefit of these products in the media and encouraged women to buy them without informing them of their benefits and potential risks.
Could custom-compounded BHT be a safer option?
If commercially-available and custom-compounded products contain the same ingredients shouldn’t they have the same risks?
Why don’t we hear about custom-compounded BHT causing heart problems and breast cancer?
Pharmaceutical manufacturers of hormone therapy are bound by law to report to the FDA or Health Canada all the adverse drug reactions (ADRs) experienced by persons taking their drugs, during trials and post-marketing. Prescription HT products, e.g. tablets, patches, gels, creams, ovules, made by Big Pharma must be accompanied by a Consumer Information Leaflet explaining what the medication is for, how it should be used, possible ADRs, Black Box Warnings (which warn prescribers about serious adverse reactions or special problems), and more. However, compounding pharmacies aren’t obliged by law to provide customers with package inserts containing warnings and precautions, or any other information, for bioidentical hormone products. If information isn’t provided with the product—e.g., no standard label, no information regarding possible ADRS, absence of Black Box Warnings and precautions—it may give customers the illusion that the product is safer than commercially-available drugs, but it probably isn’t if it contains the same hormone ingredients. Women may not want to take conventional HT because of the increased risk of stroke, heart attack, blood clots, and breast cancer, but they shouldn’t be blinded by false or absent information about the safety of custom-compounded BHT. Products containing estriol (a type of estrogen hormone) are promoted as being effective without increasing the risk of breast or uterine cancer, but if both commercially-available drugs and custom-compounded products contain the same ingredients (hormones), then it is expected that both will cause the same therapeutic and adverse effects. There’s a lot of misleading and false claims online regarding BHT—do not buy bioidentical hormone products online. There’s no guarantee they contain what’s written on the label, they could have more or less of what is required, or they could have added ingredients that may cause harm.
What you don’t know can hurt you
Women should engage in discussion with unbiased healthcare providers and should educate themselves—learn from reputable, science- and evidence-based, reliable resources—before choosing a product. Be informed, be safe!
The first blog of this series Bioidentical-Be informed! is
1. BioIdentical Hormones
and the third blog in the series is
3. BioIdentical Hormones – Be Informed! Part 3: HT is made from plants or herbs, like yams, soy, or chasteberry. Bioidentical hormone therapy doesn’t contain drugs. Does it?
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
BioIdentical Hormones – Be Informed! Part 1
/in Hormone therapy, Bioidentical therapy/by Teresa Isabel DiasBioIdentical Hormones – Be Informed!
Bioidentical hormones isn’t a scientific term and it means different things to different people. The Endocrine Society defines bioidentical hormones (BH) as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.” The FDA (Food and Drug Administration) doesn’t recognize the term bioidentical and regards it as a marketing term. NAMS (North American Menopause Society) states that bioidentical “refers to all hormones that are chemically identical to those made in the human body” and “some well-tested, government-approved, brand-name prescription hormones meet the definition of bioidentical”. There’s no official, standardized definition for bioidentical hormones and this causes a lot of confusion and misinformation. Some women believe:
1. Bioidenticals hormones are compounded in a pharmacy and therefore are different from hormones manufactured by pharmaceutical companies.
2. BHT is natural, therefore is safe
3. BHT is made from plants or herbs, like yams, soy or chasteberry and doesn’t contain hormones
I have not been paid, endorsed, or subsidized by any pharmaceutical company or compounding pharmacy to write this blog. My intention is not to endorse a particular product over another, my goal is to educate, bring awareness, inform, and demystify some common beliefs about bioidentical therapy (BHT). I will write several blogs on the topic and in the first I’ll try to answer the following question:
1. Are the bioidentical hormones (BH) used by local pharmacies to compound formulations different from the BH used by pharmaceutical companies in commercially-available products?
Estrogens, (estradiol, estriol and estrone), progesterone, and testosterone are some of the hormones produced by the human body. Medications that provide any of these ingredients can be considered bioidentical. Several pharmaceutical companies manufacture commercially-available medications that contain some of these hormones. There are no hormones in the wild that can be used by women straight from the plant source. The source of the bioidentical may be a plant like yams or soybeans, but in order for it to have an effect in the human body it has to be synthetized and converted into a chemical with a structure similar to a human hormone. This is done in a few laboratories in the world- they synthesise plant extracts into hormones and sell them to pharmaceutical companies and compounding pharmacies which in turn compound them into products that are sold in different forms e.g., capsules, tablets, creams, and others. Pharmacies and big pharmaceutical companies use the same hormone ingredients to make their products. In other words, bioidentical hormone therapy (BHT) products custom-compounded in the pharmacy contain the same hormones found in commercially-available products. Why should women buy custom-made compounded BHT, usually more expensive, and not covered by private insurance? Compounding pharmacies can formulate products for women with allergies to a commercially-available product, individualize dosing and combinations of hormones, create products without binders, dyes, or preservatives, and compound medications with different routes of administration. However, women must be cautious with custom-made, unregulated BHT. I will discuss issues of safety in another blog; in this blog I want to bring awareness about how the same hormone can have very different effects depending on the route of administration. The route of administration is the way the drug is delivered to the body, e.g., by mouth, by injection, intravenously, or topically (cream, ointments or gels).
For compounding bioidentical hormone products
Women with an intact uterus who are taking systemic (tablets, patches, or gels) estrogen therapy for menopause symptoms must also take a progestogen (natural progesterone or a synthetic progestin) to prevent overgrowth of the lining of the uterus (endometrium). Overgrowth of the endometrium- endometrial hyperplasia- may lead to uterine cancer. The estrogen acts like a fertilizer and thickens the endometrium and the progesterone is the lawn mower, it must be taken to prevent endometrial overgrowth. The most commonly prescribed progestogen is progesterone, the brand name is Prometrium—capsules of micronized progesterone. It is government-approved and sold by prescription only. In order for Prometrium to be approved by FDA and Health Canada, the pharmaceutical company that developed this product had to present data from randomized control trials showing that this formulation—capsules of micronized progesterone—was used in the trials, and data obtained supports the evidence that micronized progesterone taken by mouth prevents endometrial growth. We should not extrapolate the results of the trials done with capsules of micronized progesterone to progesterone used topically—applied to the skin. Data on progesterone applied to the skin is scarce and there’s no good evidence that progesterone used this way is effective at preventing endometrial overgrowth, and potentially cancer, in women also taking systemic estrogen. Hence, if a woman with an intact uterus takes estrogen therapy and uses progesterone cream she may not be protecting her endometrium from overgrowth—the amount of progesterone absorbed through the skin may not be sufficient to “mow the lawn” and the endometrium may grow unchecked with a resulting increase in the risk of uterine cancer. This is one example of how the same hormone, progesterone, manufactured into capsules by pharmaceutical companies and into unapproved creams, can act differently, and have very different health outcomes, depending on the route of administration. Bioidentical hormone therapy (BHT) employs the same hormones e.g., estradiol, estriol, estrone, and progesterone, whether it is compounded in a community pharmacy or a big pharmaceutical company. Women have choices: they can buy commercialized or custom-made products but they should educate themselves—learn from reputable, science- and evidence-based, reliable resources—before choosing a product. Women should question BH compounders about the ingredients used in the products and demand proof of efficacy and safety of BHT. Being informed about bioidentical therapy may be the difference between developing uterine cancer and not… Be informed, be safe! Want to know more about bioidenticals or hormone therapy in general? Contact me.
The second blog of this series Bioidentical-Be informed! is
2. BioIdentical Hormones – Be Informed! Part 2: Biodentical Hormone Therapy is natural, therefore bioidentical therapy is safe. Is it?
and the third blog in the series is
3. BioIdentical Hormones – Be Informed! Part 3: HT is made from plants or herbs, like yams, soy, or chasteberry. Bioidentical hormone therapy doesn’t contain drugs. Does it?
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
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