There are many conflicting studies on whether estrogen increases or has any effect on breast cancer development. Studies have proven that the length of estrogen use may play a role in the development or exacerbation of breast cancer. The longer the duration of use the greater the risk. There is also information that suggest progestins with estrogen may increase risk. If estrogen is used for 5 years or less consensus panels agree that there is no evidence of an increase in risk of breast cancer. It is important to also keep in mind that the longer a woman lives without any type of cancer, the lower her risk of breast cancer for the rest of her life. There are several risk factor analysis tests available to assess a patient’s risk of breast cancer. Each patient should discuss with her physician risk factors for breast cancer before ruling out the use of estrogen replacement. In addition, it is important to know that if a woman develops breast cancer and is taking estrogen replacement she is more likely to develop a cancer that is more easily detectable and less fatal as compared to a woman who develops breast cancer that is not taking estrogen replacement.

There are numerous reasons for what time in life, if ever a woman should decide to begin taking estrogen replacement. Some of the major reasons women decide to try estrogen replacement are to alleviate menopausal symptoms. Women suffer from hot flashes and night sweats, vaginal dryness, "mental fog" or poor short-term memory. On the other hand, some women are at high risk of developing osteoporosis and want bone protection that estrogen provides. The decision of when to start therapy has for some women been when the symptoms are unbearable and are affecting their daily lives. If a significant amount of bone has been lost and she is at high risk for fractures estrogen therapy may be consider. Other diseases estrogen may prevent include colorectal cancer and Alzheimer’s.

For some women it is necessary to continue estrogen replacement for as long as the symptoms of menopause persist (hot flashes, night sweats). For some women it is a lifetime commitment for protection against osteoporosis and other diseases. The protection against osteoporosis, quality of life improvements, and secondary disease prevention are reasons for a lifetime commitment to estrogen replacement. The recommendation by many professional organizations is 5 years or less. It is still a debate and studies have not proven whether the benefits of long-term use of estrogen outweigh the possible risks. Discuss with you physician the optimal amount of time you should be estrogen.

It is a distinct possibility that patients will experience break through bleeding, spotting, withdrawal bleeding, or change in menstrual flow. It depends particularly on what regimen the patient is taking—for example: is there an "estrogen-free" week or is estrogen therapy continuous throughout the month? Is the patient taking progesterone in conjunction with the estrogen?

Most women will report that they experience a positive change in their mood and an increase in energy. Other women will report no change in mood.

If a patient is experiencing side effects with estrogen therapy a blood test to determine the estradiol (E2) blood levels may be required to assess if the patient’s estrogen level is too high. Some adverse effects associated with estrogen therapy can be attributed to an inappropriate dose of estrogen. Headache, for instance, is a common indicator of either too high of an estrogen dose or too low. Your physician may run a verity of labs to check cholesterol, liver enzymes, thyroid function, DHEA-S, testosterone, progesterone, and possibly several other types of hormones. The most appropriate lab work will be determined by you physician.

Estrogen does have a tendency to change the sugar tolerance in diabetic patients. It could create a slight hyperglycemic state so it is necessary for diabetic patients on estrogen replacement to monitor their blood sugar regularly.

Talk to your doctor if you are taking anticoagulants (coumadin/warfarin). Estrogens increase the ability of blood to clot and may alter the effects of the anticoagulants. Estrogen also decreases active thyroid in the body. If you are taking thyroid replacement you may need to have the dose reevaluated after starting estrogen.

The risk for blood clots while on estrogen therapy is highest in the first year of therapy. Estrogen tends to promote coagulation of the blood. It is important to discuss your risk factors for blood clots with your physician.

There are 3 main types of estrogen in the female body: estriol (E1), estradiol (E2), and estrone (E3). Certain prescription estrogen formulations include different amounts of estrogen and different types of estrogen (E1, E2 or E3). In addition, some estrogen formulations are considered synthetic while others are bio-identical. In addition to the different types of estrogen in each formulation it is important to consider different drug delivery routes: oral, transdermal patch, cream, suppository, or troches. Depending upon the patient, different delivery routes may be more suitable for that individual. On the other hand, certain delivery routes may be preferable but not effective.

If the estrogen therapy is used in conjunction with progestins or natural progesterone then the risk of endometrial cancer is very low. Without progesterone, estrogen causes endometrial cells to keep dividing and growing, which increases the risk for cancer. However, progestins or progesterone diminish this effect dramatically.

All compounded hormones are derived for either soy or yam. The process involves extracting precursor molecules from the plant then converting into a human hormones via a laboratory process. Soy or yams do not contain human hormones, so eating lots of these types of foods will not naturally boost your hormone levels nor can the body convert soy or yam into any type of human hormone.

Most insurance companies view compounded hormones as non-formulary products. This means that certain products may have a high co-pay or may not be covered. Call you insurance company to discuss reimbursement polices for compounded hormones. The staff at Clark Professional Pharmacy works with a verity of different insurance companies and can fill out claim forms for a speedy reimbursement.

There are several types of physicians that are familiar with the principles of bio-identical hormone therapy. Call the pharmacy for recommendations in your area.

Since compounded hormone therapy is very specific to each patient it is not possible to for each prescribed product to be evaluated by the FDA. All compounding pharmacies must follow good compounding practices in accordance with state law.