Dearest: My guest tonight is Paul Hueseman, Pharm.D., a graduate of the St. Louis College of Pharmacy where he completed the Doctor of Pharmacy Program. Paul has a wide array of experience that includes retail pharmacy, clinical practice in pediatrics, account management and clinical expertise in managed care and for a major pharmaceutical company. Paul has experience in natural hormone compounding. Paul is an expert in clinical assessment, disease management, and patient consultation. Along with Pete Hueseman, Power Surge's pharmaceutical consultant for 9 years, Paul is co-owner of Bellevue Pharmacy Solutions, a REAL pharmacy (not just an online vendor) devoted to compounding prescription, natural, bioidentical hormone products, i.e., progesterone, estradiol, estriol, estrone, bi-estrogen, tri-estrogen, DHEA, testosterone, pregnenolone and non-prescription as well. Paul, it's a pleasure to welcome you to Power Surge :) Paul Hueseman, Pharm.D.: Thank you, it is my pleasure to be here tonight to chat with everyone. Dearest: Thank you. Paul, for those who aren't familiar with the differences between synthetic hormones and natural, bio-identical hormones, could you please explain it to our audience? Paul Hueseman, Pharm.D.: Bio-identical hormones are chemically identical to what is in the human body. They are exact in structure to the hormones that are in the human body and are derived from natural sources. Bioidentical hormone replacement therapy also means that the replacement of the hormones occurs such that the hormones are replaced in the human body in similar ratios to what those hormones are in the human body. Synthetic hormones are not identical to what is in the human body. In other words, bioidentical means "human-identical". Dearest: In Suzanne Somers book, "The Sexy Years," she advocates the use of bio-identical hormones, which I think is terrific since Power Surge has endorsed bio-identicals for 10 years. However, she also recommends postmenopausal women cycling their bio-identical hormones which would result in continuing or the resumption of a menstrual cycle which may have stopped. Do you agree with this cycling method she advocates? (like what's sexy about having a period anyway?) Paul Hueseman, Pharm.D.: Suzanne Somers has done wonders for women experiencing hormone imbalances by empowering them with knowledge that there is alternatives out there and getting the word out. Dearest: Absolutely agree about that part, Paul. Paul Hueseman, Pharm.D.: She does, however, very strongly state in her book that women should continue to cycle and that if they do not and choose to take their progesterone continuously, it is like being eternally pregnant. This never made sense to me biologically and I had very in depth discussion about this with Dr. Phillip Warner, who is also one of Dearest's experts on Power-surge. We came to the conclusion that this is not true and to generate such similar hormone profile as that of pregnant woman, the progesterone would have to be dosed 1000 times higher than what we dose it. Therefore, my opinion is that this is only appropriate (to continue cycling) if it makes a woman more comfortable. Jane25: My periods started again after not having 1 in 2 years. I was on natural hormone prescription by Dr. Erica. My ob/gyn said the estrogen (estradiol) in the natural hormones likely triggered them again. Is this common? I know nothing about cycling them as I am seeing some of these others asking about. He, my ob/gyn, checked me out and I am fine. It is actually periods again. Thank you. Paul Hueseman, Pharm.D.: Yes, this is very common to resume having periods when starting hormone replacement therapy. You are reinitiating hormones that have been lacking for a period of time. Don't get confused though that you are ovulating, as it does not necessarily mean that you are. JRob1825: My biggest problem is my mood swings. They can be pretty severe. What natural remedy do you have for that? Paul Hueseman, Pharm.D.: Mood swings are very common in hormone imbalance. Commonly this is an imbalance of estrogen and progesterone. Generally, by balancing hormones we can help people with emotional swings, anxiety, weepiness, depression, etc. Too often, this is dismissed though as depression and gets a prescription for Paxil or Lexapro. JoviMuse: What besides hot flashes and emotional issues do bio- identical hormones help to recover (stop growth of hair on face, skin tone, etc.) after 5 years of menopause? Paul Hueseman, Pharm.D.: Yes, these are all common things that occur when the estrogen and progesterone balance get off. I do not mean to dismiss other important hormones though such as DHEA and testosterone, but let's focus here on estrogen. Commonly, when the estrogen and progesterone balance are off, or there is just an estrogen deficiency, there can be an androgen dominance that occurs whereby facial hair worsens. Also, it is common when estrogen is low in the body for the skin to become dry and thin, mucous membranes become thin, and hair thinning or hair loss can occur. CJJM: Have been on bio-identical hormones and Armour thyroid for about 5 weeks, this past week have been having burning tingling pain in feet, no swelling. I don't think its the bi-est or Progest, I've taken them before, could it be the Armour? last couple of days my hands too. My Doctor didn't know or seem to care. Paul Hueseman, Pharm.D.: If it was leg cramping, then I would tell you to be concerned about the thyroid dose being too high. Tingling generally occurs due to low thyroid (it is a neuropathy) thyroid is very involved in the nerve signals. Also, though the recent initiation of hormone therapy can result in some tingling just due to receptor-site activity that has not occurred in a while. Certainly though, if your doctor or pharmacist did not tell you already, you should be monitoring your heart rate (pulse) and making sure that it is normal and not too high, which would also indicate too high a dose. PaterD: I just got a prescription for the Climara patch (.05) and my doctor says that every 6 months I need to take a progesterone regime and will have a period. I thought I would need progesterone 3 weeks a month to balance the Climara. Can I use my Progest cream along with the Climara? Paul Hueseman, Pharm.D.: You can use the Progest cream along with the Climara, although it may not be a high enough dose to achieve protection against build up. Also, because Progest is not an FDA-approved product, and not you do not always know the exact dose you are getting. You should maybe talk to your doctor about having a natural progesterone cream, gel, or sublingual tablet compounded for you in a higher strength that you can be guaranteed by a pharmacist what you are getting. Dearest: Paul, isn't over the counter natural progesterone cream mostly effective in women in their earliest stages of perimenopause? Once her estrogen levels begin to decrease, will the progesterone cream help the more severe symptoms? Paul Hueseman, Pharm.D.: Dearest, that is correct. The over-the-counter progesterone cream is in fairly low doses and generally is not enough progesterone to help with symptoms in later stages of perimenopause. It is definitely not strong enough to help with severe PMS symptoms either. And finally, it is not high enough dose to really protect the bones from osteoporosis and protect against uterine build-up. Dearest: Thank you, Paul. ImperialGirl: How are these natural hormones different from the kind you can buy at Wal-Mart? I had no luck with these they did not help my hot flashes or menopausal symptoms. Paul Hueseman, Pharm.D.: I am not entirely sure what kind you can buy at Wal-Mart. If you mean what you can buy over the counter there, then all you can buy is herbs or OTC progesterone. If you mean, legend medications i.e. HRT regimens such as Premarin, PremPro, Climara, etc, then the difference comes down to bio-identical vs. animal derived or in the case of Climara, bio-identical estradiol (but only estradiol, not the other estrogens in the female body) and cookie-cutter patch / i.e. "one-size fits all". Francess: How does begin to find out which bio identical hormones they need? Paul Hueseman, Pharm.D.: Generally, I recommend one starts with a consultation process with an expert (such as myself, or one of my colleagues at Bellevue Pharmacy Solutions). We will consult with you and then order saliva testing to measure your hormone levels. Based on the combination of this consultation / medical history, and your lab results, we can identify where the deficiencies lie and make recommendations for you. PritiSuri: I am 41 years old. My periods stopped suddenly about 11 months ago, apart from some random spotting. My gyn suggested that I go on a 3 month course of hormones and suggested Premelle. I am concerned and so far have not followed the advise. I want to use natural progesterone. How do you determine a good progesterone cream and the right dosage? I also wish to know if there is a recommended medical practitioner in the NY area. Paul Hueseman, Pharm.D.: There are many great physicians in the NY area, and our staff can help you with this process as part of the suite of our services at Bellevue Pharmacy Solutions. In terms of a 3 month course of Premelle, why only 3 months? Does he think all symptoms will go away after this? You are very young to stop periods, but there could be different things that can make this happen such as great amount of stress, thyroid disorder, etc which are all very closely tied in with your sex hormones. By sex hormones, I mean estradiol, estriol, estrone, progesterone, DHEA and testosterone. BonnieCole: For 6 years I used the Progesterone cream (with good results) and taking 5 -7 days off each month. Now I have a very thick lining and the doctor is talking about me having an Ablation done. I did what Dr. Lee recommended. So should I (age 62) use it continuously to decrease the lining? I think that you were not getting high enough levels of progesterone to prevent this lining. I think it is fine to go off 5-7 days per month, although not necessary. Paul Hueseman, Pharm.D.: I think that you were not getting high enough levels of progesterone to prevent this lining. I think it is fine to go off 5-7 days per month, although not necessary. Sometimes, creams are not the best dosage form because a cream is "fat-loving" so it gets sucked into the fat cells and fat cells like to hold onto it. There is erratic release into the blood stream, so levels may be inconsistent. It may be better for you to try a different dosage form such as sublingual tablets or gel. Gels are hydrophilic (water-loving), so they do not get sucked into fat cells, they hang out in the dermal layer of the skin, allowing for more steady release into the bloodstream. Dearest: Paul, There are many conflicting opinions about estrogen dominance. Many say it's not estrogen dominance but the fluctuations and imbalance of hormones that cause menopausal symptoms. Can you share your thoughts on estrogen dominance, what it is and if/how it affects premenopausal women? Paul Hueseman, Pharm.D.: Estrogen dominance certainly most commonly occurs in peri-menopause or the menopausal transition. The reason for this is that progesterone production is the first hormone to decrease in the series of cascade of hormonal deficiencies that occur in menopause. The next, of course, is generally estrogen, then testosterone. You are correct though, Dearest, that it does not mean that a woman has TOO HIGH estrogen, but her estrogen relative to progesterone is high. In other words, the progesterone is so low, that the estrogen looks high. Therefore we often recommend higher doses of progesterone, combined with lower doses of estrogen. Dearest: But in my experience in Power Surge and talking with thousands of women, that period of time when the progesterone diminishes and estrogen is still high enough that just progesterone supplementation works - isn't very long - that the longest time is spent in lacking estrogen, progesterone and testosterone. And that period of time can last many years. Do you agree? Paul Hueseman, Pharm.D.: Definitely. In fact, like I said, it is rare we recommend just progesterone. Except severe PMS or early transition to peri-menopause. EloiseMajik: I recently started seeing a naturopath who checked my hormones and gave me Phyto Plus Progesterone Cream, PhytoEst Cream and Cimicifuga Dioscorea suppositories. Are these the same as the bio identical hormones you are talking about? Can the bioidentical ones be gotten by prescription or only as supplements as these are? Paul Hueseman, Pharm.D.: No these are not bioidentical hormones. They are herbal remedies. For example, PhytoEst cream is a phytoestrogen cream, meaning they are estrogen-like substances. We likely can work with your NP to prescribe natural HRT, as naturopaths can prescribe in many states. But the bioidentical HRT I talk about tonight definitely requires a prescription. Dragon-Fly: Gyn put me on Yasmin BCP (birth control pills) to control bleeding. I was desperate and told that surgery would be the only other alternative. I took them for one cycle and it made all my other peri symptoms more intense, including my blood pressure dropping too low. I don't see the logic in going on BCP when in the last couple of years I would go months without a period. Is there any other alternative to control bleeding that is lasting too long? A D&C was done in June and my thyroid is routinely checked and everything seems to be fine. Paul Hueseman, Pharm.D.: Yes, we commonly have women who present to us with initial symptoms of irregular menses. We can work with you with natural hormones instead of synthetic hormones that are in Yasmin to also control your bleeding, make it regular, and help to ease the extended heavy cycle you are experiencing. We cannot replace the birth control component though. I always want to caution women who are peri-menopausal, that they may still have eggs remaining that may develop if provided with the proper hormonal balance. Dearest: You can call for more information at Bellevue Pharmacy Solutions number, 1-800-728-0288, or E.mail at info@bpharmacysolutions.com Remember, if you have follow up questions, you can ask them at Power Surge's Ask The Pharmacist at www.power-surge.com/asktheexperts.htm Excellent answers, Paul. Thanks! Lisanne2: I just had an hysterectomy including ovaries this past week. I am 52 years old, and have had excessive bleeding for years. I have a follow up with my Ob/gyn next week, what should I be asking her about hormone replacements, types of testing, and the use of bio-identical hormones? Do I need to take any hormone replacements? I have not experienced any serious menopausal symptoms. Paul Hueseman, Pharm.D.: You have not experienced anything yet, because it just has not hit yet, there are still circulating estrogens in your body. I cannot believe that your OB-GYN would do a TAH / BSO and not provide you with some form of HRT immediately. I suggest that you do not do any initial testing, just get started on bioidentical HRT and then do the testing as a follow up to make sure that the levels are where they need to be. We could do a consultation with you and provide specific recommendations for your doctor to prescribe to. Then, after you are on the HRT for approximately 3-4 months, I would advise we test your hormone levels. I am telling you this to help you avoid a sudden flood of estrogen deficient symptoms. DrBSW51: I am taking .5 estradiol and 100mg Prometrium. I take them continuously. Is that the correct protocol if you haven't had a hysterectomy and are premenopausal? Also, I took the saliva test after having been on the hormones for 2 weeks, will the test still be accurate? Paul Hueseman, Pharm.D.: I do not think the test will be entirely accurate. Steady state is not truly reached until approximately 1 month. I don't understand why you are taking the estradiol and Prometrium continuously if you are pre / peri-menopausal. Generally, for peri-menopausal women, I recommend cycling the estrogen / progesterone to avoid bloating. NechMazelda: Are estradoil and Prometrium bio identical hormones? I have tried bio identical cream hormones for over 8 months and they weren't absorbing into my system so I switched to the pills, (estradoil and Prometrium) and I feel so much better but I still have occasional night sweats. Should my symptoms completely disappear? I am 48 years old and I had a complete hysterectomy at 40. I was using Dr. Erika Schwartz all this time and she wasn't able to get my dosage right and was hesitant to have me use the pills. I tried them anyway and, as I said, I feel much better and I need to know your opinion on the estradoil and Prometrium. I also have testosterone cream, but don't know if I should use it. I was told 3 days a week for it on the inner thigh. Your advice please. I am taking 1 mg of estradoil and 100mg Prometrium 2 times a day. If I take less I get severe symptoms. Paul Hueseman, Pharm.D.: The dose you are on seems about average, but could certainly be higher if you are still having symptoms. Estradiol and Prometrium are bio-identical hormones. But remember in the beginning of the chat where I provided a definition of bioidentical hormones? Estradiol is only 1 of the 3 hormones in the female human body. It is my opinion, that it is important to replace hormones in similar ratios to what is in the body also, thus the reason for Biest and Triest. Dearest: Paul, can you tell the women what the three estrogens are, please? Paul Hueseman, Pharm.D.: Yes, Estriol (approximately 60-80%); estradiol (17-beta) (approximately 10-20%); estrone (approximately 10-20%) Val51: My insurance will only pay for Saliva tests if I have an order from a Dr, how do I find a doctor in Altus or Lawton, Oklahoma that will order one? Also, are bio-identical hormones FDA approved? Paul Hueseman, Pharm.D.: Pharmacists are authorized to order saliva testing. You can contact Bellevue Pharmacy Solutions and we can order this test for you. If you have BCBS or United Healthcare insurance, Aeron Labs, the lab we work with can directly bill your health insurance. Bio-identical hormones are approved in specific formulations that are "legend" drugs, I.e. drugs that are manufactured in specific "cookie- cutter" strengths. For example - Prometrium is FDA approved (micronized progesterone), Climara (estradiol 17-B), etc. Dearest: Herbs and vitamins aren't FDA approved, but we all take them. Because pharmaceutical reps can't push them on the doctors. Paul Hueseman, Pharm.D.: That is correct. Also, please keep in mind. As pharmacists, we have certain ethics we uphold. We use only United States Pharmacopeia approved ingredients that are regulated in terms of consistency. Also, we have laws we have to uphold, or we can lose our livelihood - that piece of paper that allows us to practice. JanisPalps: In an nutshell I just got the call tonight. My doctor says my blood work FSH is 42. I have hot flashes and indigestion, thinning bones, hair, no periods and I'm only 42 but I'm afraid of estrogen. I'm on a heart event monitor because I get bad palpitations (magnesium helps. Thanks, Dearest!) but nothing makes me feel like myself and I'm only 42! I don't want to feel like I do. I feel very depressed, sometimes scary depressed. Would your product help me and is it affordable? I had my thyroid checked and it's normal supposedly although I have pain in my thyroid and nodules and am seeing an ENT tomorrow for that and I can't believe I'm in "premature ovarian failure" at such a young age. I'm under a tremendous amount of stress as well. :( Will your product be covered in NY? I heard it wasn't. Dearest: Never heard that, Janis. Paul Hueseman, Pharm.D.: The stress could be some of the cause of all of this. I would suggest you order a saliva test and include a test of your cortisol. You probably have some adrenal fatigue, which is overwhelming your thyroid. We need to talk more about your "fears" of estrogen. If your fear stems from the WHI study, then that is not uncommon. However, try to think of this perspective. At what point in life does everything seem to go wrong - 50's to 60's - right? Atherosclerosis (plaque in arteries), thinning of bones, fatigue, cancer, etc. Doesn't it make sense that this is timed with when the hormonal balance is lost? Also, we have excellent arguments that have been published to our disposal that dispute the WHI study (Women's Health Initiative) and indicate why these results were seen. The average age of women in this study was 63. At this point, the damage due to lack of estrogen in the body is done, or a great deal done. We also have excellent data available that demonstrates estrogen prevents diabetes, atherosclerosis, etc. DIDI123: I am still having periods every 25 days now. I just turned 50. I am having more anxiety before and during periods now then ever before. I had estradiol tested in February. It said 18 which I thought was low but my gynecologist said that everything is fine. I had the whole lipid panel. I still think my estrogen is low. I am on nothing. Does that sound low? I am still having periods. I am having anxiety more then before. I had my estrogen tested. It was 18. Isn't that low? Paul Hueseman, Pharm.D.: Didi, yes, that does seem low unless your doctor is using "post-menopausal" as his/her range for normal. The anxiety is probably due to estrogen deficiency / imbalance with progesteronel. HALA: What are the plants used in bio-identical and would you describe them as herbal when their compounded? Paul Hueseman, Pharm.D.: The plants from which bio-identical hormones are extracted are soy and yam. They are not herbal. Marlo: I just finished reading The Sexy Years by Suzanne Somers. She speaks very highly of the bio-identical hormones. She gets her period again. Is there any way you can alternate the hormones so you won't get one, or less of a period. Not till you are 80. If you have varicose veins, is it dangerous to take? Paul Hueseman, Pharm.D.: Yes, we can design a hormone regimen to fit your lifestyle. I have some patients who come to me and after reading Suzanne's book feel it is important to cycle, but do not want to do it monthly. So we design a regimen where they will have a period every 3 months. Also, I have no data that demonstrates it is dangerous to take hormones with varicose veins. ImperialGirl: My husband is concerned regarding the cost of the consult and saliva test and medications. We have a high deductible on our insurance. What is the cost for these things? Paul Hueseman, Pharm.D.: The cost is variable depending on the regimen, the number of hormones you require, etc. If you have prescription coverage on your insurance, then chances are high that we can get these covered for you through our pharmacy. Also, as far as cost of saliva testing, if you have BCBS insurance or United healthcare, then they cover this and the lab will directly bill it. If not, go to our website and review the saliva testing area and review the cost of testing. I generally recommend Estradiol, DHEA, testosterone, progesterone, and cortisol. You can manually submit the requisition form to your insurance company and may get some reimbursement. In addition, here is the link directly to this area on our website: http://www.bpharmacysolutions.com/hormone/lab.asp If you order this test from our site, please designate on the order form what type of medical insurance you have, if it is BCBS or United Healthcare insurance. These insurance companies can be directly billed and you will only be responsible for a co pay for the test up front. Other insurance companies will need to be manually billed by you sending your receipt / lab requisition form in and you may or may not receive some reimbursement. You will need to perform the test on day 21 of your cycle, if applicable. MsLatrobe: Why would a drop from .75 to .50 estradiol patch cause severe body pain and aching, as well as increase in in vulvar pain (vulvodynia sufferer). My gynecologist doesn't know why the awful pain when we dropped medications, but she put me back up to the .75. I take Synthroid 25 mcg daily, wear estradiol patch and use Prometrium (12 days of it) once every 60 days. My DHEA is 98 with lab norms 38- 186. Paul Hueseman, Pharm.D.: You have identified that this dose of estradiol is what you require. Why lower it if it is working for you? It is common to have joint pain with estrogen deficiency. Your body pain almost sounds like some form of Fibromyalgia, though. Dearest: Paul, are those links working again? Paul Hueseman, Pharm.D.: The online store at our website is under construction, so if you need to place an order for a vitamin or herbal supplement, please call the pharmacy. Also, please re-visit our website after October 1, because our new website will be launched and easier to navigate. Georgie-1: Great chat tonight, and can you tell us when your website updates will be ready to view? Paul Hueseman, Pharm.D.: October 1 Georgie-1: Thanks, I know they weren't working this afternoon. Dearest: Paul, thank you for spending this time educating women about bio-identical hormones and menopause. If anyone has further questions about bio-identical hormones, visit: www.bpharmacysolutions.com -- or you can E.mail them at consultph@bpharmacysolutions.com OR call their toll-free number 1-800-728-0288. by Power Surge. All Rights Reserved.