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Hormone replacement therapy

A Precision Medicine Approach

With aging, injury, surgery and through the disease process, endocrine organs which synthesize and secrete hormones decline.  Therapeutic replacement of these hormones is known as hormone replacement.  Using meta-analytic data pooling results from thirty studies involving 26,708 postmenopausal women, menopausal hormone replacement has been shown to reduce mortality by 39% in women who initiated hormones prior to age 59 (PMID 15209595).  Hormone replacement in women has been a specialized area of clinical focus for Dr. Parker for ten years.  Patients generally seek out her guidance for secondary or tertiary opinions regarding hormonal treatment options for perimenopause, menopause and, less commonly,  post-menopause.  Each case is considered on an individual basis.   Safety and efficacy of care guide her hormone prescribing standards, and is   consistent with the treatment goals and evolving risk assessment of the individual woman.  She employs a prevention-based holistic approach for timely initiation and continued use of hormone replacement as an integral part of the whole-person approach to women in menopause.


Dr. Parker does not rely on a particular protocol for hormonal prescribing practices.  Rather, she reviews and critiques primary medical literature using an evidence-based perspective in order to serve the unique needs of each individual within in clinical setting.  She has undergone extensive hormonal prescribing studies through the Age Management Medicine Group, the North American Menopause Society, the American Academy for Restorative Medicine, and has also trained with the American Academy of Anti-Aging Medicine  with specific emphasis in hormonal replacement in men and women. She has had the distinct honor of clinical tutelage and mentorship with thought leaders in hormone replacement over several years of study, and she continues to refine her craft with ongoing education and research.   


Dr. Parker  practices the principle of Primum non nocere (Latin meaning First, Do No Harm, as listed as the first edict of the Hippocratic Oath of physicians)  with conscientious prescribing techniques for all medications.  She uses molecularly exact hormones, commonly known as bio-identical hormones, with a preference for FDA-approved versions of these applications.  Conjugated equine estrogen hormones are not prescribed because they are predominantly comprised of estrone sulphate, and estrone is metabolized into 4-OHE1(E2), a carcingenic metabolite.   She sources alternatives to paraben-based hormone prescriptions, since parabens have been associated with breast tumors in women (PMID: 31918794).   She does not use or recommend pellet therapy based on the uncontrollable side effects which can occur with their use, but she does work with women who have used pellets with other providers and need to recover from their use. 


Most women undergoing menopause do not elect for hormone replacement therapy based in large part of the lack of menopausal hormone therapy being adopted by conventional care for all women.  Hormone replacement is best administered under a precision medical model where the woman is more carefully screened and monitored than the conventional medical model of annual visits.  The data from the Women's Health Initiative study of 2002 is usually cited as a reason to prevent women from using hormone replacement.  It is essential that women and their doctors realize that the women in this study initiated hormone replacement  on average ten years after menopause, were overweight, and were predominantly smokers.  Furthermore, the hormonal interventions  used in this study were not molecularly exact, and were instead  forms of hormones which were en vogue circa 2002, namely oral conjugated equine estrogens (CEE) as a monotherapy or in combination with medroxyprogesterone acetate (CEE+MPA).  The Womens Health Initiative study essentially proved that  oral-doses of CEE+MPAs carried additional risks in the aforementioned population of women.  This data cannot be generalized to younger, non-smoking women, who are not overweight  and who take FDA-approved bioidentical hormones such as the Vivelle dot (estrogen patch/17-beta estradiol) or oral micronized progesterone (Prometrium).   Molecularly exact 17-beta estradiol and micronized progesterone  cannot be included in the same category as conjugated equine estrogens and medroxyprogesterone acetate.    When the term 'menopausal hormone replacement therapy' is discussed by Dr. Parker, please know that she is referring specifically  to molecularly exact forms of 17-beta estradiol and progesterone only.   The harm women experienced with CEE and MPA, rather than 17-beta estradiol and progesterone (P4), has been explored in a recent paper entitled,  Human versus non-human sex steroid use in hormone replacement therapies part 1: Preclinical data, and published in the journal Molecular Cellular Endocrinology, 2019 Jan 15;480:12-35, by researchers  Atwood & Ekstein.  For more information, please refer to their academic paper on pubmed.gov (PMID: 30308266).  Their main concern is the address ongoing misinformation about confusing medroxyprogesterone acetate with bio-identical progesterone.  Both of the substances fall under the umbrella term of being a progestagen.  However, MPA is described has distinct differences compared with progesterone.  This topic is reviewed in detail in the clinical setting. 

  

Potential Benefits of Hormone Replacement Therapy include: 


  • Neuroprotective
  • Improved processing speed and memory
  • Prevention of brain atrophy in phenotypically sensitive women at risk
  • Relief of menopausal symptoms
  • Metabolic regulation
  • Cardiovascular support
  • Bone and joint support
  • Mood support
  • Sleep support
  • Vaginal support
  • Tissue repair and regeneration


Contraindications to Menopausal Hormone Therapy include:


  • Possibility of pregnancy 
  • Undiagnosed vaginal bleeding  (requires assessment prior to possible treatment) 
  • Liver dysfunction or disease (must be resolved in order to start therapy) 
  • Estrogen sensitive cancers of the breast or endometrium 
  • Clotting disorders, including phospholipid antibodies and Factor V Leiden 
  • History of stroke or heart attack
  • History of deep vein thrombosis or pulmonary embolism 

  


Learn More

Find out whether you are an ideal candidate for Dr. Parker's precision medicine approach to hormone replacement therapy by scheduling an initial appointment with us.