Aace Releases Guidelines For Menopausal Hormone Therapy
Am Fam Physician. 2012 Nov 1 86:864-868.
Guideline source: American Association of Clinical Endocrinologists
Evidence rating system used? Yes
Literature search described? Yes
Guideline developed by participants without relevant financial ties to industry? No
Available at:
Menopause is diagnosed in women who have not had menses for one year. After menopause, up to 85 percent of women have symptoms such as hot flashes, sweating, insomnia, and vaginal dryness and discomfort. Although most symptoms resolve spontaneously after about five years, symptoms continue in a substantial number of women. Menopausal hormone therapy is the most effective treatment for these symptoms. The goal of this therapy is to improve quality of life, but possible risks must be weighed against the benefits of therapy. Chronic disorders are associated with aging and menopause. The role of menopausal hormone therapy in the prevention of these conditions is controversial.
The American Association of Clinical Endocrinologists convened a task force to review available evidence on therapies for menopausal symptoms. The task forceâs guidelines include recommendations for prescribing menopausal hormone therapies, and for weighing the risks and benefits in individual patients.
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What Is Male Breast Enlargement
The most common reason why men are interested in male breast enlargement is that they are either cross-dressers or transgender, hoping to have a more realistic bust line in their clothing. Many of these men do not wish to undergo hormonal treatments that can cause weight gain and muscle loss, so they opt for natural male breast enlargement products that are easier on the body yet equally as effective.
Even though you may think that men could never have natural breasts, that is simply not the case. By altering a mans natural hormonal balance, a man will begin to grow breasts just like a woman would. Products that can help a man achieve this will usually not alter any other aspect of his body, which is also very important.
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Dr Laura Squire Chief Healthcare Quality And Access Officer At The Mhra Said:
Every response we receive will be vital in helping us gain a better picture of whether people think this form of vaginal HRT should be available over the counter.
The menopause can cause unpleasant symptoms and HRT-based medications form an important part of alleviating them. This is why its so important for us to hear what women think about this possible reclassification.
We want to hear from as many people, health care professionals and womens groups as possible.
Should this product be reclassified, topical HRT products containing estradiol will still be available on prescription from GPs.
The Commission on Human Medicines has advised that it is safe for this product to be made available as a Pharmacy medicines.
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Is Hrt Available Over The Counter In Pharmacies
Yes. The UKs medicines regulator, MHRA, has reclassifiedone specific form of local HRT, meaning that it is now available in pharmacies without needing to speak to your doctor or specialist for a prescription. This medication is Gina 10 microgram vaginal tablets . All other HRT including other kinds of HRT tablets will still require a prescription, following a consultation with your doctor or specialist, due to its associated risks.
What Else Can I Do To Ease Menopause Symptoms
There are many things you can do to curb hot flashes, night sweats, insomnia, vaginal dryness, and lost libido. Lifestyle changes â such as regular exercise, a healthy diet, relaxation techniques, and keeping a regular sleep schedule â can help. If you smoke, quit . Avoid caffeine and alcohol. Lubricants can greatly ease vaginal dryness and heighten sexual sensation.Stay active to avoid depression and seek social support from woemn like you
Your doctor can give you more information about these techniques and other treatment options. The use of selective serotonin reuptake inhibitors has become more common in women who are not good candidates for hormone therapy or prefer not to use hormones. Paroxetine is the only non hormonal therapy specifically approved by the FDA for hot flahes, but some relief has been found with gabapentin .
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Natural Alternatives To Estradiol
There are a variety of natural alternatives and supplements which may alleviate menopausal symptoms. There are certain food products believed to help increase estrogen levels naturally in your body such as soybeans and flax seeds. Adequate vitamin levels are necessary for estrogen production including vitamin D and the B vitamins. Adequate nutrients for your body play an important role in estrogen production.
While there is not a natural estrogen, over-the-counter herbal supplements may be key in relieving menopause symptoms. Black cohosh, a Native American herb, is thought to stimulate estrogen receptors. Evening primrose oil is also thought to be helpful. There is not a lot of scientific data for supplements, which is why they dont make claims of treatment but anecdotal evidence from menopausal women suggests it is helpful in relieving symptoms. You should speak to your prescriber regarding all of your health conditions before beginning supplement or herbal treatments.
Questions And Answers About Estrogen Pills For Men:
Will taking estrogen change my voice?
No, to alter your voice you need surgery and voice lessons.
Will male to female hormones change my body structure?
Unfortunately no, your body will not decrease in size. Are there any Clinical Trials for the effects of estrogen on the male body?
Are there any Clinical Trials for the effects of estrogen on the male body?
Yes, there is a clinical trial currently open at the Mayo Clinic. Here is a link to the trial. A Study to Evaluate The Effect of Transgender Hormone Therapy on Adipose Tissue Biology and Distribution https://www.mayo.edu/research/clinical-trials/cls-20454329
Progesterones activate the androgen receptors slightly, so may be used to improve libido and mood. in some cases, it may be indicated to maximize breast growth, though this is likely happening via weight gain. Of note, some studies show a possible increased risk for VTE, cardiovascular disease and/or breast cancer with use.
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This Prescription Medication Helps To Promote Sustainable Erections For An Eight
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Type Of Estrogen Or Estrogen
All body chemistries process supplements differently, and there are a wide variety of estrogen supplements that contain different types of estrogen or estrogen-increasing sources.
These include:
- Phytoestrogen: These compounds are similar to estrogen and are found in a variety of foods, including cruciferous vegetables like broccoli and kale.
- Isoflavones: This is a specific phytoestrogen found in soy products.
- Diindolylmethane: Diindolylmethane is naturally produced in the body, but may drop during perimenopause and menopause.
- Bioidentical estrogen: These compounds are lab-created, available without a prescription and closely mimic the bodys natural estrogen.
Other estrogen supplements might include herbal remedies in their formulations. Although less familiar to some, these natural medications can help treat the symptoms of perimenopause and menopause and include:
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Best Fertility Tracking App: Natural Cycles
Natural Cycles is a birth control app that has been cleared by the FDA. This is a type of nonhormonal birth control that uses a persons basal temperature to work out their fertility status. Basal temperature is a persons body temperature when they are at rest. During ovulation, a persons basal body temperature may rise, which can indicate that they are fertile.
To use the Natural Cycles app, a person must take their temperature at least five times a week when they wake up and before eating or drinking. They must then enter their temperature into the Natural Cycles app, which uses an algorithm that analyzes a persons temperature, period, and menstrual cycle data to assess if they are fertile or not on a particular day.
The app will indicate fertile days as red and nonfertile days as green. A person should use barrier methods of birth control on red fertile days.
The company states that people with irregular periods may find they have more red days than other users.
A person cannot use hormonal birth control while using the Natural Cycles app, as many hormonal birth control options stop ovulation from happening.
Natural Cycles states that its birth control app is 98% effective with perfect use and 93% effective with typical use.
Natural Estrogen Replacement: The Great Debate
Because bioidentical estrogen is in the same form as the estrogen in our bodies, some argue that our bodies recognize it easier and therefore it gives us less chance of unwanted side effects.
They contend that bioidentical hormones are clearly superior over synthetic hormones, while others say that there is not enough evidence to prove this.
I recommend talking to your doctor and looking into natural estrogens found in herbal supplements.
Years of women using these herbs with positive experiences along with the low possibility of side effects is a great reason to take natural estrogen supplements.
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Bioidentical Or Natural Hormones
Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.
Practitioners claim these hormones are a “natural” and safer alternative to standard HRT medicines.
However, bioidentical preparations are not recommended because:
- they are not regulated and it’s not clear how safe they are there’s no good evidence to suggest they’re safer than standard HRT
- it’s not known how effective they are in reducing menopausal symptoms
- the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but there’s no evidence that these levels are related to your symptoms
Bioidentical hormones are not the same as body identical hormones. A body identical hormone, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, they’re closely regulated and have been well researched to ensure they’re as effective and safe as possible.
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. You should have a complete physical exam, including blood pressure measurements, breast and pelvic exams, and a Pap test at least yearly. Follow your doctorâs directions for examining your breasts report any lumps immediately.
If you are taking hormone replacement therapy to treat symptoms of menopause, your doctor will check every 3 to 6 months to see if you still need this medication. If you are taking this medication to prevent thinning of the bones , you will take it for a longer period of time.
Before you have any laboratory tests, tell the laboratory personnel that you take hormone replacement therapy, because this medication may interfere with some laboratory tests.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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How Much Does Otc Birth Control Cost
The cost of OTC birth control will vary on the product. Prices typically range from $1020, but subscription services may cost more. Many OTC birth control products are single-use, which may make them expensive if used very regularly.
A person can consider how often they will need OTC birth control to help them choose the most cost-effective option for them.
Can I Get Birth Control Pills Without A Prescription
Planned Parenthood explains that birth control pills are only available with a prescription, and the cost can be up to $50 per pack. Birth control is covered by health insurance under the Affordable Care Act, although some plans may only cover certain brands or generic versions of birth control.
Levonorgestrel morning-after pills do not require a prescription, and they are available for people of any age group.
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Coverage And Cost Comparison Of Estriol Vs Estradiol
Currently, there are no FDA-approved drugs containing estriol for humans. Therefore, it is not usually covered by Medicare and insurance plans. Incurin is the brand name for estriol that is approved for dogs with urinary incontinence. The cost can vary depending on the pharmacy you purchase it from. SingleCare discounts for estriol are not currently available.
Estradiol is available as a generic skin patch. Brand names of estradiol include Minivelle, Climara, and Vivelle-Dot. Brand name estradiol average cash price can differ with Medicare and insurance plans but you can purchase a generic version for $33-$63 with a SingleCare discount card.
| Discounts on Estriol are not currently provided through SingleCare | $33-$63 |
Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
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Conditions Treated By Estriol And Estradiol
Estrogen is most commonly used as hormone replacement therapy for women experiencing symptoms of menopause. Estrogens are often combined with progesterone or other steroid hormones called progestins. Estradiol is FDA approved to treat symptoms of menopause. These symptoms include vasomotor symptoms such as hot flashes, night sweats, and flushing of the skin. Other menopausal symptoms include vaginal atrophy, or vaginal dryness, inflammation, and thinning.
Estradiol can also be used in late-stage breast cancer that has spread to other parts of the body. It is used to help decrease the severity of the cancer . For women with ER-positive breast cancer that has metastasized, high dose estradiol may be used as therapy. According to studies from Maturitas, if breast tumors express the ESR1 gene, the cancer may respond well to estradiol therapy.
Estradiol tablets are also approved to treat advanced prostate cancer that is androgen dependent. While estrogen levels can contribute to prostate cancer, estradiol can be used as palliative treatment in some men. Studies show that estradiol is an effective form of therapy for certain types of prostate cancer.
| Condition |
| Off-label |
Why Are These Restrictions Happening Now
The FDA has always had the authority to regulate the substances used in making compounded drugs however, until now, the agency has chosen to leave oversight to the states. Now, all of a sudden, the FDA has decided to regulate substances used in compounding. By doing this, the FDA is, in effect, regulating the practices of medicine and pharmacy rather than regulating the drugs being prescribed and sold. In my opinion, this is a huge overreach of power, and it waves a big red flag for me during this time of increasing government control over our bodies and our lives.
Further, the committees calling for the education of health care providers and pharmacists who currently prescribe, compound, and dispense cBHT is nothing more than a thinly veiled threat against these practitioners, who will be forced to practice medicine the way Big Government and Big Pharma dictate or risk losing their licenses and practices.
And, according to a newly proposed rule on September 5, 2020, it appears that the FDA is on a mission to ban other compounded natural therapies as well, including homeopathic remedies and natural substances, such as curcumin, that have been proven safe and effective for decades!
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