What is gastroesophageal reflux disease

Supplement Sampler Bio-Identical Hormones
• There is limited evidence to understand the potential harm of prolonged hormone therapy. • Therapy should be guided by unique patient need. • Use the lowest most effective dose for the shortest amount of time necessary. Main Source
Effect on
Increased by
also with most potential side effects (BC, Heart Dz) The main estrogen in compounded hormones (Bi-est, Tri-est). Least potent estrogen. *Note: The term "natural hormone therapy" is misleading since many prescription hormones are "natural"
or bio-identical.
University of Wisconsin Integrative Medicine Bio-identical Hormones: The use of hormones that are structurally identical to endogenous hormones.
Thus when estradiol is prescribed, you are prescribing bio-identical hormones. [Non bio-identical
hormones are mainly equine estrogens (Premarin) and medroxyprogesterone (Provera), which are
rarely used anymore since the Women's Health Initiative study. Some use compounding pharmacies to
create combinations of the above bio-identical hormones. The two most common formulations are Bi-Est
and Tri-Est. These can be delivered through capsules, creams, gels, and troches.]
Bi-Est (E3,E2)= 80% Estriol, 20% Estradiol
Tri-Est (E3,E2,E1)= 80% Estriol, 10% Estradiol, 10% Estrone
Point/Counterpoint for Prescribing Estriol:
Point: Estriol dominant hormone prescribing allows lower dosing of estradiol which may reduce the risk
of BC and heart disease.
Counterpoint: Estriol is much less potent than estradiol and larger doses may be needed for a similar
effect negating the potential benefit.
Point: Estriol is safer than estradiol and can be used as a vaginal cream to help with dryness and
atrophy associated with menopausal symptoms. Estriol helps with vaginal elasticity in preparation for
birth Patients with hx of BC or strong risk who need help with vaginal atrophy/dryness when lubricants
are not enough may benefit from E3 cream, 0.5 mg vaginally for two wks and then every 2-3 days.
Counterpoint: Did nature intend us to give the pregnancy estrogen this late in the lifespan? Will this
stimulate nesting in our 55 year old patients? ☺ We don't know of the potential long term risks of estriol.
Main Source
Effect on Breast
Cholesterol´Pregnenolone´PGE Neutral-reduced risk? PGE reduces breast Neutral-reduced risk? Label should state that thin skin on abdomen, inner thigh or inner forearm daily. *Medroxyprogersterone (MPA, Provera) may increase the risk of BC (1.4 RR) compared to oral micronized progesterone (0.9 RR) (Fournier et al. Int J Cancer. 2005;114) *Another source of PGE is milk. Most cows are milked when pregnant which increases the PGE content. But non-organic milk has other hormones (IGH) that may be harmful. University of Wisconsin Integrative Medicine A practical non-controlled study of 189 menopausal women were treated with bio-identical estrogen and progesterone, with or without DHEA and testosterone and followed for 12 mths in a clinic in Minneapolis, MN. Ninety-eight percent had symptom control, 90% improved mental clarity and 60% who complained of weight gain with menopause lost an average of 14.8 lbs (This was a surprise finding; no other weight loss recommendations were given). The protocol they used is described below. (Mahmud, K. Natural hormone therapy in menopause. Gynecological Endocrinology. 2010;26(2):81-85.) Limitations: An observational study in a clinic with a pro-hormone bias. No control group with short-term follow-up. Lab Level
(hot flashes) or down (breast tenderness) as needed. sedation to help sleep. Could also use Rx micronized PGE (eg. prometrium) 100 mg orally at bedtime. Dehydroepiandrosterone 25 mg orally daily if serum lifestyle stress; (↓DHEA,↑Cortisol) Better to help reduce stress than to prescribe DHEA. *Note: Many clinicians don't order lab levels for estrogen and progesterone due to variability and added cost.
An option is to dose hormones based on symptoms starting low and increasing as needed. If testosterone or
DHEA are considered, serum levels should be ordered and found to be low prior to prescribing.

Except for estriol and estrone, most of the above hormones can be prescribed traditionally (estradiol,
micronized progesterone, testosterone) or found over the counter (DHEA, PGE cream). Compounding
pharmacies mainly help by placing the hormones in various delivery forms such as creams, sublingual
tablets, suppositories, troches, etc. The hormones are generic and relatively inexpensive.
There are many compounding pharmacies in the U.S. One of the largest in the nation is in Madison,
Wisconsin. o speak
directly to pharm
Brought to you by your colleagues in the UW Dept. of Family Medicine Integrative Medicine Program. Date created: March 2010
University of Wisconsin Integrative Medicine

Source: https://www.fammed.wisc.edu/files/webfm-uploads/documents/outreach/im/ss_bio-identical-hormones.pdf


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