Estrogen creams are prescribed to relieve a number of menopausal conditions in women such as hot flashes, vaginal dryness, burning, itching of the vaginal area, and urgency or irritation with urination. It is important to look at the many other symptoms of estrogen deficiency and why it is important to consider replacing low estrogen as women age. The benefit of estrogen replacement goes beyond the management of the symptoms of menopause. Estrogen is extremely important for memory loss, heart health, bone health, growth, and repair of body tissue. Other symptoms of menopause, like loss of sexual interest and arthritic conditions, dramatically get better when the estrogen hormone is replenished.
Estrogen has over 400 functions in a woman’s body ranging from stimulating the production of an enzyme in the brain (choline acetyltransferase) that prevents Alzheimer’s disease to increasing metabolic rate, prevention of muscle loss to improving sleep.
ORAL ESTROGEN- Estrogen tablets can be prescribed to relieve estrogen deficiency symptoms but they have bad side effects like headaches and breast tenderness. More importantly, when estrogens are taken by mouth they can increase blood pressure, triglycerides, elevated liver enzymes, decrease growth hormones, increase carbohydrates craving, and can cause gallstones. Hence at Towne Lake Family Pharmacy, we encourage physicians to prescribe estrogen replacement treatment in the form of creams to be either applied topically or vaginally.
COMMERCIALLY AVAILABLE ESTROGEN- Topical estrogens are available as commercially available creams or they can be compounded. The commercial creams are typically pricey and most insurance plans do not cover them. The two most commonly prescribed commercially available products on the market are Estrace and Premarin vaginal creams and their cost run anywhere between $380- $580. Even when insurance covers these creams, they are classified as “non-preferred” branded products and therefore they carry higher copayments.
COMPOUNDED TOPICAL ESTROGEN CREAMS- At Towne Lake Family Pharmacy we make compounded transdermal/topical/vaginal creams as an alternative to the pricey, commercially available products at a more affordable price. Where indicated, we also compound estrogen cream using the form of estrogen called estriol. Estriol has a better attachment to the receptors in vaginal tissue. Estriol is also believed to be a much safer form of estrogen with a lower risk of cancer. Because Estriol has a long half-life it stays in the vaginal tissue longer, and it can be conveniently dosed every other day. Depending on the hormonal needs of each woman other hormones like DHEA, testosterone or progesterone can be added to estriol or estradiol.
NON-HORMONAL VAGINAL CREAMS- For various reasons, some patients with a high cancer risk cannot use hormones, and for those patients, we can compound non-hormonal vaginal creams to address issues of dryness by using a hormone-free alternative like vitamin E acetate or Sodium Hyaluronate.
Contact us at Towne Lake Family Pharmacy with any questions on hormone replacement therapy.
References:
Smith Pam, M.D., MPH., A Comprehensive Look at Hormones and the Effects of Hormones Replacement Chapter 41
Alexander GM, Swerdloff RS, Wang C, Davidson T, McDonald V, Steiner B, Hines M. Androgen-behavior correlations in hypogonadal men and eugonadal men. II. Cognitive abilities. Horm Behav. 1998;33:85- 94.
English KM, Mandour O, Steeds RP, Diver MJ, Jones TH, Channer KS. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J. 2000;21:890- 894.
Petti DB. Clinical practice. Combination estrogen-progestin oral contraceptives. N. Engl J Med 2003;
Soules MR. Development of a staging system for the menopause transition: a work in progress. Menopause 2005;12:117-120
Leiblum S. Bachmann G, Kemmann E. Colburn D, Swartman L. Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones. JAMA 1983;249:2195-2198