• Hormone Replacement Therapy Facts and FAQ's your OBGYN can help with

    on May 23rd, 2018

What is Hormone Replacement Therapy?

As we age our hormone levels decline, and as a results we begin to feel more tired, get sick more frequently, we do not heal as fast and slowly chronic disease like hypertension, high cholesterol, depression and weight gain, to name a few, makes its debut. We start to age and sometimes it happens very rapidly.

Hormone replacement therapy (HRT) is a method of treatment based of replenishing the vital sex hormones like estrogen, testosterone, or progesterone with either plant based substances, or synthetic hormones that have an identical structure as the hormones naturally produced by the body.

This is very different than using synthetic hormones like Premarin – a mix of 17 different types of equine estrogens, a drug synthetically produced by Wyeth –Aerst from pregnant mares urine.

Many patients mistakenly believe that bio-identical hormones are only available as a customized compounded prescription, however there are many bio-identical FDA approved synthetically made hormones, in the form of patches, gels, vaginal creams or tablets, or pills.

When you come in for your appointment you should expect Dr. Cernaianu to gather a detailed personal and family history and perform a comprehensive physical exam, determining the need for bio-identical hormone use.

Are there any risks associated with the use of Hormone Replacement Therapy?

  1. Taking daily hormones for extended periods of time (10-20 years) might increase your risk of Cancer.


  1. Taking hormones daily may increase your risk of clotting and thromboembolic events (a piece of the clot formed in the deep venous system of the legs breaks away and travels to the lungs, which is life-threatening). In most studies that analyze the relationship between venous thromboembolism and HRT, the route of hormone administration has been primarily oral (estrogen pills). It has been proposed that orally administered estrogen may have a pro-thrombotic effect related to high concentrations of estrogen in the liver. Studies that compared oral and transdermal Estrogen have demonstrated that transdermal estrogen has little or no effect in increasing clotting risk and may actually have beneficial effects on pro-inflammatory markers, including C-reactive protein, and it may also have a suppressive effect on tissue plasminogen activator antigen and plasminogen activator inhibitor activity.


There is adequate evidence in the medical literature that natural progesterone is not associated with an increased risk of venous thromboembolism, but synthetic progestins (eg, Provera) do increase the risk of clotting.


The relative risk of clotting in women who take Estrogen seems to be even greater if the patient has preexisting risk factors such as obesity, immobilization, fracture, increased age and underlying coronary vascular disease. Women with prothrombotic mutations, such as Leiden factor V, G20210A prothrombin mutation, protein C and protein S deficiencies, and other congenital thrombophilic disorders have higher risk of venous thromboembolism.

  (http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Postmenopausal-Estrogen-Therapy)


Are there any side effects associated with Hormone Replacement therapy?


Estrogen replacement can cause the following side effects:

- vaginal bleeding

- breast engorgement

- breast tenderness

- water retention

- weight gain

- headaches

- bloating or nausea

- darkening of the skin

- worsening of endometriosis

- growth of fibroids.


Progesterone replacement can cause some of the following side effects:

Testosterone therapy in women can have the following side effects:


Why should I take Hormones? Are there any benefits to using Hormone Replacement Therapy?


Each patient has a different reason for starting HRT. The purpose of the individualized comprehensive evaluation with Dr. Cernaianu is to determine if there are any benefits of taking HRT, whether there are risks, and if the benefits outweigh the possible risks.


Most common reasons why HRT should be considered would be:


Hot flashes and night sweats

Vaginal dryness

Vaginal atrophy

Painful intercourse

Decreased libido

Osteoporosis

Poor sleep

Fatigue

Depression and Irritability

Poor memory and lack of focus

Weight gain or difficulty loosing weight

Loss of muscle mass


According to www.menopause.org :


“There is no single way to ensure the best possible quality of life around menopause and beyond. Each woman is unique and must weigh her discomfort from lack of hormones against her fear of treatment. Risk is defined as the possibility or chance of harm; it does not indicate that harm will occur.


Generally, HRT risks are lower in younger women than originally reported for all women (ages 50-70). It is now believed that women taking estrogen alone (such as women who have had their uterus removed by a hysterectomy) have a more favorable benefit-risk profile than those taking combined Estrogen/Progesterone . This is especially true for younger menopausal women (in their 50s or within 10 years of menopause) than for older women.


Medical professionals have modified their views about the role of hormones as more research has been conducted. Experts agree that there is much they still have to learn. Although recent studies such as the WHI have provided some clarity for large populations, they don’t necessarily address all of the issues an individual woman faces. Only she, with the counsel of her physician, can do that.


Many factors will be part of a woman’s decision to use a particular hormone product—her age, her risks, her preferences, available treatment options, and the cost of the product. Do her potential benefits outweigh her potential risks? Only after examining and understanding her own situation and after a thorough consultation with her physician can a woman make the best treatment choice.”

http://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks


What types of Hormone Replacement Therapy are available?


- Estrogen is available by mouth as a pill, transdermal in the form of a gel, patch, pellet or a compounded cream, and vaginally as a cream, ring, or suppository.

- Progesterone is available by mouth as a pill, compounded capsule, and transdermal as a compounded cream. 

- Testosterone is available transdermal in the form of a compounded cream, gel or pellet, and injectable for men.


All the above are bio-identical hormone products not be confused with synthetic hormones who differ in structure from our own hormones. The most commonly used synthetic non bio-identical hormones are:

Synthetic Estrogens:

Premarin (a mix of multiple different type of equine estrogens extracted from pregnant mares urine) Cenestin (a combination of 9 synthetic estrogens derived from plants) or

Enjuvia ( a mix of conjugated estrogens)

Synthetic Progestins:

Medroxyprogesterone acetate – Provera

Synthetic Testosterone:

Methyl- testosterone in the patch Estra-test

Testosterone cypionate injected in the muscle


The concern about the use of bio-identical hormone therapy is really about custom-compounded recipes prepared by a pharmacist following a doctor’s order for a specific patient. These medications do not have FDA approval because individually mixed recipes have not been tested to prove that the active ingredients are absorbed appropriately, or provide predictable levels in blood and tissue. There is no scientific evidence that these natural compounded medications are safer or more effective than government-approved hormones, however they work well and many women feel significant improvement and relief from daily use of compounded hormones.


Please read the position of the Endocrine Society regarding the use of bio identical hormones, by clicking here: http://www.menopause.org/docs/default-document-library/bioidenticalht_endosoc7FEEC6FE637F.pdf?sfvrsn=2

There is no clear scientific evidence that salivary testing is superior over blood testing, plus it is very costly and not covered by insurance; at HERA Health Care we normally reserve salivary testing for adrenal hormones.


What is pellet therapy? What is sottopelle?

Sottopelle therapy consists in injecting pellets of bio identical estradiol and testosterone into the upper hip area, a simple procedure that is done under local anesthesia and takes 5 minutes.


The advantages of pellet therapy as opposed to other methods are:

The disadvantages of pellet therapy are:

For more information about sottopelle therapy please go to: www.sottopelletherapy.com


The decision to use a certain type of hormone depends on patient preference, risks and benefits profile, goals, fears and misconceptions, and last but not least cost.


At HERA Health Care we believe in avoiding hormones that are different in structure than the one produced by the human body, so Dr. Cernaianu uses only bio-identical hormones.


The choice for a certain type of Hormone Replacement Therapy belongs only to the patient, and we encourage our patients to ponder the risks and benefits, and how a certain method can help or perhaps aggravate other medical issues, and we initiate therapy only after all the information regarding hormone use risks and benefits has been discussed, and all questions have been answered to the patients’ satisfaction.


Is Dr. Mirela Cernaianu trained and knowledgeable in bio identical hormone replacement therapy or HRT?


Dr. Cernaianu specializes in bio-identical hormone replacement therapy.  She completed extensive training in the science of balancing hormones, including thyroid and adrenal support, by graduating from the Fellowship in Anti-Aging and Regenerative Medicine, and becoming a Sottopelle trained physician.  Dr. Cernaianu is Board Certified in Obstetrics and Gynecology.


At HERA Health Care we perform thorough examinations, we order routine and specialized lab testing prior to creating personalized treatment plans, we encourage our patients to ask questions and we empower them to become educated before making any decision.


The information presented here is meant to be informative and educational only, and by no means replaces your doctor’s advice or recommendations.

 

Once I decide to use hormone replacement therapy how often do I need to come see the doctor?


Regular follow ups are required to determine whether the therapy works, whether there are any side effects and whether the benefits justify the risks or side effects, and how we can mitigate the side effects. Compliance with recommended follow up appointments ensures you are safe and healthy, as are being up to date with all necessary medical tests like pap smear, mammogram, osteoporosis screening, annual physicals, cholesterol check etc.


Is my health insurance going to pay for my hormone replacement therapy, office visits or medical tests?


Like most doctors’ offices we expect that your copay will be paid promptly at the time of your visit. For certain insurance plans like Cigna, Aetna, Blue Cross and Blue Shield we can check some of the patient’s benefits online at the time of the visit, but ultimately it is your responsibility to check and verify your benefits prior to the visit. We also have no information regarding your medication benefits at the pharmacy, but we do have a general idea of how much compounding hormone medications should cost. Please contact your insurance plan to help you determine what your cost will be for medications.


We also offer discount prices for medical testing through Quest Diagnostics or PDL for patients who do not have insurance, have a high deductible or a Kaiser plan. We do not know whether or not the blood tests required to follow up your hormone replacement therapy are going to be covered – please call your insurance plan for questions. We can provide the diagnostic codes that pertain to your symptoms and medical condition, but any questions regarding your bill for any lab test (except prepaid tests) will have to be directed to the lab you used - our office does not handle billing issues regarding your lab tests.

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