Posts made in June, 2008

No Bones About It

Posted by Liz on Jun 14, 2008 in bone health | 0 comments

Estrogen is important for maintaining bone health, in particular, bone density (or the amount of bone present in the skeleton). Although genetics and environmental factors are important, after age 35, women
(and men) start to lose their bone density at a rate of 0.3% to 0.5% a year. This is a natural part of the aging process. However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density, leading to osteoporosis. The Menopause Blog has a few good entries on osteoporosis and menopause and I encourage you to visit the site.

Meanwhile, it appears that a plant extract that used been used medicinally in Thailand for over a century may have estrogen-like effects on bone metabolism. (Bone metabolism is a term used to describe the continuous cycle of breakdown (or resorption) and build-up (or deposition) that occurs.) Known as Pueraria mirifica (White Kwao Krua), this plant is rich in isoflavones, or plant-derived compounds with estrogen-like activity.

The study, which appeared in the journal Menopause showed that Peuraria mirafica significantly decreased a bone-specific marker involved in resorption compared to placebo, suggesting that there was less bone resoprtion in women given the active treatment.

Although the researchers caution that firm conclusions cannot be drawn from such a small study group (71 women), they are conclude that preliminary findings are hopeful and show that Peuraria mirifica may have some benefits for menopausal health.

Bioidenti what?

Posted by Liz on Jun 13, 2008 in women's health | 0 comments

Bioidentical hormones (also known in many circles as “compounded biodentical hormones”) are compounds that have exactly the same chemical and molecular structure as hormones produced in the human body. The term is most often used in the context of estrogen and progesterone (and androgens), although any hormone can be made this way. Notably, there are a few of these agents that are actually FDA-regulated and available from retail and not compounding pharmacies (meaning that dosage and purity are theoretically on par with synthetic types).

There’s been a lot of hullaballoo over these products from many of the major associations that are involved in women’s health (e.g. The Endocrine Society, North American Menopause Society) primarily because: 1) they are not regulated by the FDA or have any oversight whatsoever and 2) potency is inconsistent. In fact, the FDA sent warning letters to nine pharmacies in January due to what the agency felt were unsupported claims about safety and effectiveness.

FDA does not just randomly go after pharmacists who practice traditional compounding and who don’t make false claims about their products. Traditional compounding, in fact, involves the preparation of a drug for a specific patient based on a doctor’s request.

Consequently, FDA action might have been driven, in party, by Wyeth Pharmaceuticals, who filed a Citizens Petition that claimed: 1 that compounding pharmacies were not actually compounding but “manufacturing” mimics of approved agents; 2) that they used a form of estrogen known as “estradiol” not commonly found in “traditional” hormone therapies; 3) that they were engaging in illegal promotional practices. (BTW, Wyeth manufactures several estrogen products, including Premarin, Prempro, and Premphase.) You can read the rest of the petition here.

It’s important to recognize that not all compounded products are bad. In fact, compounding pharmacies continue to provide options to patients with contraindications to commercially-produced therapies. An article in a large monograph sponsored by the North American Menopause Society explains that pharmacies were compounding micronized progesterone years before an agent (Prometrium) was approved in the US. It also goes on to highlight several advantages that compounded hormones might offer over conventional products, including greater dosing flexibility, lower doses for women who are especially sensitive and the avoidance of potential allergens.

Organizations such as the International Academy of Compounding Pharmacists (IACP) have become quite outspoken about what they consider to be the FDA’s interference in physician decisions to prescribe estriol to their patients. Congress has even introduced a bipartisan-sponsored bill (Resolution 342) to reverse the FDA’s decision on estriol. There’s a website that further explains these efforts.

In the meantime, if you decide you want to try bioidentical hormones, speak to your health practitioner. S/he can devise a regimen that best meets your needs (and not the needs of the masses) and may be able to recommend a credible compounding pharmacy. The IACP might also be able to assist with your search.

Cool!

Posted by Liz on Jun 11, 2008 in hot flash | 1 comment

Hey Hot flashers! Big news! I mean really big!

I just read an article extolling the virtues of a new device in development that claims to “beat the heat of a hot flash.” Denise Polacek, PhD, founder of Life Quality Technologies, has designed a wearable device the size of a heart monitor that will track temperature on the surface of your skin and then automatically turn on a thermoelectric cooler when you need it. This is welcome news for those of you who don’t want to do the HRT shuffle. I don’t know much else but I’m going to try to track this story a bit deeper and see if I can locate Denise for an interview.

In the meantime, no surprise but evidently a hot flash heats up the skin by 1.5 degrees F in just 30 seconds. Yikes! No wonder we’re all sweating!

Share and share alike

Posted by Liz on Jun 10, 2008 in Uncategorized | 1 comment

I’m all for spreading the word. I ran across this great post on rebranding the term “menopause.” Had to share. If you don’t believe me, check it out for yourself!

Spray that flash away

Posted by Liz on Jun 9, 2008 in estrogen, hot flash | 0 comments

The FDA just approved a low-dose estradiol spray to treat moderate-to-severe hot flashes. Approval was largely based on a study, published in the journal Obstetrics & Gynecology, which showed significant declines in the frequency and severity of hot flushes after 4 to 12 weeks. Interestingly, women using the placebo spray also experienced declines in flush frequency although not to the extent as the prescription product, which is called Elestrin.

This form of estrogen carries the same risks as other forms, although delivery through the skin does bypass the liver and general metabolism to reduce some of the side effects of oral estrogen. Still, a key consideration remains the imbalance between estrogen and progesterone that I discussed in a previous post. This can become even worse with hormone replacement therapy (HRT) that focuses on the estrogen component at the expense of the progesterone component.

Clearly, I’m not huge advocate of HRT although I do believe that it is an individual decision that every woman must make for herself. I’ll be interested in monitoring responses to Elestrin. Has anybody tried it?