Female BHRT Reference
BHRT General Information

Effects of estradiol with micronized progesterone or medroxyprogesterone acetate on risk markers for breast cancer in postmenopausal monkeys.
These findings suggest that oral micronized progesterone has a more favorable effect on risk biomarkers for postmenopausal breast cancer than medroxyprogesterone acetate.

A Comprehensive Review of the Saftey and Efficacy of Bioidentical Hormones for the Management of Menopause and Related Health Risks.

A Perspective on HRT for Women:
 Picking up the Pieces After the Women's Health Initiative Trial - Part 1

Author(s):Gillson, George R., Zava, David T
This article is the first of a two-part series discussing hormone replacement therapy. These articles discuss important concepts about the less-than-optimal results achieved so far with conventional hormone replacement therapy, consider the possibility that some types of hormone replacement therapy are safer than others and discuss reasons why they are safer. They are intended to supply clinicians with additional information as a basis for decisions about bioidentical estrogen and progesterone replacement now that the standard of care is in question. Specifically, Part 1 focuses on differences between bioidentical and conventional hormone replacement therapy (fundamental principles, compliance, estrogens [composition of metabolites, oral estrogen replacement therapy and transdermal estrogen] and estriol [composition of metabolites, bio-availability of metabolites, oral estriol, vaginal estriol and bio-accumulation]). The authors conclude that, although controlled trials have not been conducted with Tri-Est and Bi-Est (oral form or skin cream), these may be less likely to cause harm over the long term. Each practitioner must consider the evidence about whether to prescribe bioidentical or conventional hormone replacement therapy and weigh the benefits against possible risks, since there is no longer any clear standard of care.

A Perspectiuve on HRT for Women:
Picking Up the Pieces for Women After the Women's Health Initiative Trial - Part 2

Author(s):Gillson, George R.; Zava, David T.
This second part of a two-part series focuses on a discussion of progesterone and progestins differentiating the two in terms of synergy between estradiol and progesterone, balance between estrone and estrogen sulfate within tumor cells, protection of the uterine linings and impact on cardiovascular function; and bioidentical progesterones (oral and topical). Sidebars provide examples of studies showing adverse effects of medroxyprogesterone acetate on cardiovascular health, progesterone’s beneficial effects on cardiovascular function, results with bio-identical progesterone, results with topical progesterone and a protocol for combined hormone replacement therapy using progesterone skin cream. The authors conclude that physicians should not turn their backs on patients suffering from hormonal deficiencies in the absence of large clinical trials with bio-identical hormones since the literature suggests estradiol and estriol would be good estrogens to use and transdermal delivery of hormones is advantageous over oral delivery. With oral delivery, doctors should rethink dosing and consider impact on other relevant parameters. It appears that certain progestins should be avoided in favor of bioidentical progesterone, and saliva testing can allow monitoring of hormone levels. With good follow-up, clinical judgment and laboratory backup, there is enough information about hormone replacement to offer bio-identical hormone replacement therapy as a viable option.
Hargrove JT, Eisenberg E.
Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone.
Hargrove JT, Maxson WS, Wentz AC, Burnett LS.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.

Hormone replacement therapy: the benefits in tailoring the regimen and dose.
Gambacciani M, Genazzani AR.
Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynecology Piero Fioretti, University of Pisa, Via Roma 67, 56100 Pisa, Italy. margamba@tin.it

Am J Respir Crit Care Med. 1995 Oct;152(4 Pt 1):1183-8.
Menopause, Postmenopausal Estrogen Preparations, and the Risk of Adult-Onset Asthma

A Prospective Cohort Study
Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts; and the Departments of Epidemiology and Nutrition, Harvard School
of Public Health, Boston, Massachusetts

Postmenopausal hormone therapy and asthma onset in the E3N cohort.
Romieu I, Fabre A, Fournier A, Kauffmann F, Varraso R, Mesrine S, Leynaert B, Clavel-Chapelon F. Source National Instituto of Public Health, Cuernavaca, Mexico 2INSERM, ER120/Université Paris-Sud, Faculté de Médicine, IFR69/Institut Gustave Roussy, Villejuif, France. iromieu@correo.insp.mx

Arch Intern Med. 2004 Feb 23;164(4):379-86.
Prospective study of postmenopausal hormone use and newly diagnosed asthma and chronic obstructive pulmonary disease.

Barr RG, Wentowski CC, Grodstein F, Somers SC, Stampfer MJ, Schwartz J, Speizer FE, Camargo CA Jr.
Department of Medicine, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachesetts, USA.


Estriol Summation Statement
Bruce Biundo, RPh, PCCA Pharmacy Consultant, Jennifer Rollins, PharmD Candidate 2008,
Carrie Shuman, PharmD Candidate 2008

The effects of oral estriol on the endometrium in postmenopausal women.
Granberg S, Eurenius K, Lindgren R, Wilhelmsson L.
Department of Obstetrics and Gynecology, Central Hospital, Elverum, Norway. seth.granberg@telia.com

Effect of oral estriol on urogenital symptoms, vaginal cytology, and plasma hormone level in postmenopausal women.
Manonai J, Theppisai U.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Endocrinological and clinical investigations in post-menopausal women following administration of vaginal cream containing oestriol.
Haspels AA, Luisi M, Kicovic PM.

Effects of protracted administration of estriol on the lower genito urinary tract in postmenopausal women.
Iosif CS.

Department of Obstetrics and Gynecology, University of Lund, Sweden

Safety and efficacy of oestriol for symptoms of natural or surgically induced menopause.
Takahashi K, Okada M, Ozaki T, Kurioka H, Manabe A, Kanasaki H, Miyazaki K.
Department of Obstetrics and Gynecology, Shimane Medical University, 89-1, Enya-cho, Izumo 693-8501, Japan.

Biology and receptor interactions of estriol and estriol derivatives in vitro and in vivo.
Katzenellenbogen BS.

Estriol production and metabolism in normal women.
Longcope C.

Comparative effect of estriol and equine conjugated estrogens on the uterus and the vagina.
Phillips A, Hahn DW, McGuire JL.

Short term oral estriol treatment restores normal premenopausal vaginal flora to elderly women.
Yoshimura T, Okamura H.

Treatment of climacteric urogenital disorders with an estriol-containing ointment
[Article in Hungarian]
Koloszar S, Kovacs L.
Szent-Gyorgyi Albert Orvostudomanyi Egyetem, Szuleszeti es Nogyogyaszati Klinika, Szeged.

Plasma estriol and its conjugates following oral and vaginal administration of estriol to postmenopausal women: correlations with gonadotropin levels.
Schiff I, Tulchinsky D, Ryan KJ, Kadner S, Levitz M.

A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections.
Raz R, Stamm WE.
Infectious Disease Unit, Central Emek Hospital, Afula, Israel.