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Special Report: Natural Hormone Replacement Therapy
                                    What you need to know

                                                                   • Compounded prescription
                                                                     medications tailored to your
                                                                     individual needs by our pharmacy,
                                                                     Madison Pharmacy Associates.
                                                                  At Women’s Health America, we                  • Madison Pharmacy Associates
                                                                  recognize and respect each woman’s               Compounding Pharmacy
                                                                  individuality. We know that no one             • Restore Clinical Services
                                                                  else will experience hormonal changes          • Madison BioDiagnostics Lab
                                                                  in exactly the same way as you. Your
                                                                  hormonal profile is as unique as your
                                                                  fingerprint.
                               Marla Ahlgrimm, R.Ph.                                                            Our unique story began in Madison,
                                Founder and CEO                   We also understand that no one else           Wisconsin in the late 1970s when
                              Women’s Health America              knows your body as well as you. We            we worked with one woman who suffered
                                                                  began listening to women long before the      severely every month with symptoms
                     Dear Friend,                                 term “women’s health” was even coined.        later defined as PMS. At that time, there
                                                                  That shared history and experience—           was no diagnosis and the only treatment
                     By contacting Women’s Health America,        listening to what women tell us they want     options for her symptoms in the U.S.
                     Inc., you have taken a very important        and need—forms the foundation of all our      were tranquilizers, antidepressants, or a
                     first step toward learning more about        products and services.                        hysterectomy.
                     improving your health with customized,                                                     As pharmacists, we worked with her
                     individualized care We are proud to          Our professional staff includes specialists
                                                                                                                physician, did extensive research, and
                     provide the latest information on:           in natural HRT—including nurses               compounded a progesterone therapy for
                                                                  and pharmacists. With over 20 years           her. She was the first woman in the U.S.
                     • Natural Hormone Replacement                experience in natural HRT, we have
                       Therapy (HRT) and what distinguishes                                                     to use natural progesterone therapy to
                                                                  been working in this area longer than         manage PMS.
                       “natural” hormones from other types        any group in the U.S. We take pride in
                       of hormones.                               serving women’s unique needs, working         PMS soon became a household word,
                     • PMS, perimenopause and                     with their healthcare providers, and          and news of our work began to spread to
                       menopause— prescription and                offering a full range of hormone options.     thousands of women across the U.S. In
                       non-prescription plans for symptom         It will be our pleasure to work with you      1982, we founded the first pharmacy in
                       management.                                and your provider.                            America to specialize in women’s health,
                     • State-of-the-art hormone level             Please call us at 800-558-7046, or find us    As time has passed and women’s needs
                       measurements you can do at                                                               changed, we have continued to evolve with
                                                                  online at www.womenshealth.com
                       home.                                                                                    our patients. Today, we are Women’s Health
                     • Our own specially formulated                                                             America, Inc., a dynamic international
                                                                  To your health,                               organization dedicated to meeting women’s
                       prescription and over-the-counter
                                                                                                                complex and unique health needs.
INSIDE                 products.

Bioidentical
Hormone
Solutions for PMS
pages 2, 3
                        Defining the Terms:                        same as the hormones produced by
                                                                                                                                        CH3
                                                                   your body. These chemical differences
                        Bioidentical and natural                   can mean synthetic hormones interact                                 C     O
Perimenopause:                                                     differently with your body, producing
A Positive Change       What’s the difference between
                         bioidentical, natural and synthetic       substantially different effects.
page 4
                          hormones? The difference is in the       For example, let’s look at the difference
                                                                                                                                        CH3
                           chemical structure.                     between the synthetic progestins                 O
Menopause                                                                                                           PROGESTERONE                   O

                           A natural hormone has a chemical        and natural progesterone. Synthetic                                  C     O
and Beyond                                                         progestins like Provera®, are similar to                                   O    C       CH3

page 5                     structure that is identical to the
                            hormones naturally produced by         the progesterone your body produces,
                             the body. Natural hormones            but the subtle chemical differences can
The Restore®                                                       significantly influence the hormones
Program                       are also referred to as                                                               O

                              “bioidentical” hormones              action and effects in the body. Synthetic
                                                                                                                              CH3
page 6                                                             progestins can cause irritability, nausea,
                               because they are biologically                                                        MEDROXYPROGESTERONE ACETATE

                               identical to your own.              depression, and water retention in               (PROVERA)


WHA Self-Care Plan                                                 some women. Natural progesterone is
                                A "synthetic" hormone, on          identical to the hormone made in the           Different chemical structures: bioidentical
page 7                          the other hand, has a structure    body, and many women find it easier            progesterone (top) and medroxyprogesterone
                                similar to, but not exactly the    to tolerate.                                          acetate, a synthetic (bottom).

                                                           Women’s Health America, Inc. 800-558-7046 www.womenshealth.com
Which Hormones Do I Need, and How Much?
                                                    Estrogen. A category of               Progesterone (P). The word         Testosterone (T).
                                                    hormones that includes estrone        means “for gestation.”             A male hormone, also
                                                    (E1), estradiol (E2), and estriol                                        produced in women
                Every woman is unique               (E3).                                  • Necessary for fertility and
                                                                                             maintaining pregnancy           in substantially smaller
                and as such there is no set                                                                                  amounts
                combination or dosage of            Protects against:                      • Has a calming effect
                bioidentical hormones that           • Osteoporosis                        • Enhances mood                    • Builds and promotes
                works for every woman.               • Heart disease                       • Regulates fluid balance            muscle tone
                Generally, a natural                 • Alzheimer’s disease                 • Increases energy and sex
                                                     • Colon cancer                                                           • Increases energy
                hormone replacement                                                          drive
                therapy (HRT) regimen will           • Urinary incontinence                                                   • Decreases fatigue
                                                     • Tooth loss/decay                    • Stabilizes blood sugar,
                include:                                                                                                      • Increases sex drive
                                                                                             thyroid function, and
                • A form of estrogen                Enhances:                                mineral balance                  • Enhances well being
                • A form of progesterone             • Sleep                               • Relieves perimenopausal          • Strengthens bone
                • And, if needed,                    • Mood                                  and menopausal symptoms
                  testosterone.                      • Mental sharpness/memory             • Decreases risk of
                                                     • Digestion                             endometrial cancer
                                                     • Sex drive                           • May help protect against
                Let’s review the key                                                                                           Source: The HRT Solution by
                                                     • Skin tone                             breast cancer, fibrocystic
                hormones, and what they                                                                                        Marla Ahlgrimm, R.Ph. and
                                                     • Key brain chemicals like              breasts, and osteoporosis
                do in the body.                                                                                                John Kells. Avery, 1999.
                                                       serotonin and endorphins




         Bioidentical Hormone Solutions For Premenstrual Syndrome (PMS)
              PMS is a hormonal disorder                      Charting Hints                                 Managing PMS
              characterized by:                                                                              The first step toward taking charge of
                                                               • Keep the record daily. Writing down
               • A regularly recurring group of                  your symptoms every day will make           your PMS symptoms is a self-care plan
                 symptoms which occur from two                   your record most accurate. Set aside        that includes a healthy diet, regular,
                 to 14 days before your menstrual                a specific time each day if you need        moderate exercise, stress reduction, and
                 period, usually disappearing after the          to—you’ll need only a minute or two.        a nutritional supplement. How to get
                 period begins.                                                                              started? See The Women’s Health America
                                                              • After you’ve charted your symptoms for       Self-Care Plan on page 7.
               • This is followed by a symptom-free              two to three cycles, it’s time to discuss
                 time in each monthly cycle.                     your findings with your healthcare          Some women find that self-care isn’t
              These regularly recurring symptoms and             provider.                                   enough to manage PMS. Bioidentical
              their timing in the menstrual cycle typify       • Continue charting after you begin a         progesterone therapy is an option in
              PMS.                                               self-care or prescription treatment         those cases.
                                                                 plan. Charting is the best way for you      Your healthcare provider can prescribe
              Do You Suffer From PMS?
                                                                 and your healthcare provider to judge       bioidentical progesterone. Usually it is
              There is no laboratory test to diagnose            how well the treatment is working.
              PMS and symptoms are as individual as                                                          taken during the second half of the
              the woman suffering from them.                                                                 menstrual cycle, from ovulation until
                                                              What Causes PMS?                               your period begins.
              You can find out if you have PMS by             As of yet, no universally agreed upon
              taking the quick symptom survey on              cause of PMS has been identified. Some         The Hormone
              page 3. While more than 150 symptoms            suggested causes include:                      How does progesterone work? When
              have been associated with PMS, we have                                                         produced by your ovaries, progesterone
                                                               • Vitamin-mineral deficiency                  prepares the uterine lining for a fertilized
              narrowed the list to the most common.
              Add up your score to determine which             • Nutritional factors                         egg. Progesterone means “for gestation”
              action steps would be best for you.              • Hypoglycemia (low blood sugar)              and is the hormone of pregnancy. If
                                                               • Progesterone deficiency                     fertilization and implantation do not
              Charting Your Symptoms                                                                         occur, your progesterone level falls and
              An even better way to determine if you           • Fluid retention
                                                                                                             your period begins.
               have PMS, and assess your symptoms,             • Excess prolactin (a pituitary hormone)
               is to keep a daily record of exactly            • Stress                                      Your progesterone level fluctuates in a
                when symptoms occur, for two (2) to                                                          monthly pattern. During the first half
                 three (3) consecutive cycles. Daily                                                         of your cycle, from day 1 of your period
                  Symptom Records are available from                                                         to ovulation approximately 14 days
                  Women’s Health America.                                                                    later, your progesterone level is low.

                                                                                                                                     (Continued on Page 3)

Page 2
                                              Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
PMS Symptoms
                                                           Severity
                                           None     Mild     Moderate      Severe
                                            0        1          2            3
     Anxiety
     Irritability
     Crying for no reason
     Craving carbohydrates, alcohol, sweets
     Mood swings
     Depression
     Breast tenderness
                                                                                               ProCycle® PMS and ProCycle® Gold
     Headaches or migraines                                                                    nutritional supplements are available from
     Fatigue/lack of energy                                                                    Women’s Health America. Order online at:
     Bloating/weight gain                                                                      www.womenshealth.com/shop/catalog/
     Difficulty concentrating
     Sleep disturbances
     Acne or oily skin                                                                     PMS Action Steps
     Lack of libido                                                                                                           Total Score
     Urinary incontinence                                                                                              1-14      15-30 31+
                                   TOTAL                                                    ProCycle® PMS
                                                                                            Nutritional Supplements                       
                                                                                            Diet & Exercise                               
After ovulation, your progesterone level   Synthetic progestins, found in oral
rises. Progesterone is produced by the     contraceptives and frequently prescribed         Non-prescription
ovaries during the second half of the      for menopausal women, can suppress               Progesterone Cream                      
menstrual cycle. If you become pregnant,   ovulation and lower your body’s output of
the placenta takes over the output of      the natural hormone. Synthetic                     -or-
progesterone, producing high levels        progestins often intensify, rather than
after Week 9 or 10 of pregnancy. High      relieve, PMS symptoms.
                                                                                            Prescription Progesterone                      
progesterone levels may be one reason                                                       Saliva Hormone Level
                                           Bioidentical progesterone and
some women feel especially good while
                                           synthetic progestins cannot be used              Testing; Urine NTx                             
pregnant.
                                           interchangeably. They have different
The Medication                             chemical structures and very different
The hormone progesterone is prescribed     effects in the body. If your healthcare       Add up your total number of points on the chart
to supplement a woman’s production of      provider prescribes progesterone, be sure     on the top left, then take the suggested action
the hormone. Bioidentical progesterone     to ask for a prescription for the             steps in the chart above.
is identical to what your body produces.   bioidentical form.


Bioidentical Progesterone Therapy and PMS Management
Progesterone Prescription Options             important for symptom management              or rectally, contain progesterone in
                                              and to avoid drowsiness, menstrual            a wax base. They provide consistent,
Points To Remember                            irregularity, or breakthrough bleeding.       even absorption. When used vaginally,
 • Progesterone replacement therapy                                                         some women report leakage, and
                                           2. Micronized Oral Capsule: 25-100
   must be individualized for each                                                          when used rectally, some report bowel
                                              mg. Capsules are absorbed and
   patient.                                                                                 stimulation.
                                              metabolized more quickly and may
 • For women who are menstruating,            cause drowsiness or a woozy, light-        5. aplía™ a Metered Transmucosal
   typical recommended dosing is two          headed feeling.                               Applicator. Can contain one or
   times per day, days 14-28, based on a                                                    multiple combinations of hormones
                                           3. Rapid Act Sublingual Tablet: 25-100
   28-day cycle.                                                                            for precise, and sanitary application
                                              mg. Tablet is pleasantly orange-flavored
 • For women no longer menstruating or        and dissolves under the tongue in less        directly to the labia or vaginal opening.
   post-hysterectomy, dosing is daily.        than one minute for rapid absorption.         Clean, convenient, precise.
Progesterone therapy: Commonly             3. Cream or Gel: 15-30 mg/gm.
prescribed dosage forms                       Deliver continuous, consistent             What to Expect
1. Even Release Oral Tablet: 200 mg,          absorption. May not be as effective        Some women feel immediate relief
   300 mg, 400 mg. Contains                   as even-release tablets for symptom        (within hours) from PMS symptoms of
   progesterone in an even-release            management.                                irritability and anxiety and in two to
   tablet. This form produces consistent   4. Suppository: 25-400 mg. Progesterone       three menstrual cycles, they feel like
   progesterone blood levels, which is        suppositories, used vaginally              their bodies have adjusted.
                                                                                                            (Continued on Page 4)
                                                                                                                                                Page 3
           Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
Most women tolerate bioidentical              progesterone, their manufacturers added
                                                             progesterone therapy very well.               progesterone USP to them. The amount
                                                             Occasionally, your monthly period may         of progesterone in these creams can range
                                                             be delayed. If your period is more than       from none at all to as high as 10%.
                                                             a day or two late, discuss it with your
                                                             healthcare provider—your dosage may           There are two preferable options to wild
                                                             need to be adjusted. You may experience       yam cream:
                                                             flushing (a brief feeling of warmth) when      • Have your healthcare provider write
                                                             taking progesterone. This is normal,             a prescription for a cream containing
                                                             because progesterone raises body                 micronized progesterone. You will
                                                             temperature about a degree.                      know exactly how much progesterone
                                                                                                              you’re getting. Many insurance
                                                             What About Wild Yam Cream?                       plans will reimburse for prescription
                                                             Many wild yam creams contain little              progesterone creams.
                                                             or no progesterone. Wild yam doesn’t           • Women’s Health America’s
             Non-prescription progesterone cream is          contain progesterone, and your body
             available from Women’s Health America.                                                           bioidentical progesterone cream
                                                             doesn’t convert wild yam extract into            contains 960 mg in a 2-ounce tube,
             Order online at: www.womenshealth.              progesterone. If these creams contain            and is available without a prescription
             com/shop/catalog/                                                                                at www.womenshealth.com/shop/
                                                                                                              catalog/
         Perimenopause: A Positive Change
            Defining Perimenopause                           is the place to start for mid-life health:    healthy decades ahead.
            Perimenopause refers to the years                nutrition, exercise, relaxation, and
                                                             nutritional supplements. The Women’s          When Self-Care Isn’t Enough
            surrounding a woman’s last
            menstrual period. Between ages 35                Health America Self-Care Plan on page 7 has   Nearly two-thirds of women find
            and 50, a woman may experience                   a lifestyle plan you can really use.          that self-care is enough to manage
            physical and emotional changes,                                                                hormonal symptoms. For some,
                                                             Some women combine self-care plans            however, self-care isn’t enough to
            although perimenopausal symptoms                 and natural hormone replacement therapy
            vary in every woman.                                                                           alleviate uncomfortable symptoms,
                                                             (HRT) during perimenopause to feel vital,     or to provide long-term benefit to
            Managing Perimenopausal Symptoms                 energetic, and mentally sharp. Getting        the heart, bones, and brain. In those
            Perimenopause is more than symptom               the care you need during perimenopause        cases Women’s Health America offers
            management—it’s about staying healthy            ensures a smoother transition into            customized prescription options.
            from head to toe after age 35. Self-care         menopause and lays the groundwork for



               Perimenopause                                           Perimenopausal                                       Severity
               Action Steps                  Total Score               Symptoms                             None     Mild     Moderate      Severe
                                             1-14      15+                                                   0        1          2            3
             ProCycle® PMS & Gold                                      Fatigue/lack of energy
             Nutritional Supplements                                 Anxiety
                                                                       Irritability
             Diet/Exercise                                           Depression
             Non-prescription                                          Breast tenderness
             Progesterone Cream                                        Headaches or migraines
             with or without
                                               
                                                                       Mood swings
             Phytoestrogens                                            Water retention or bloating
             Prescription HRT                                         Vaginal dryness
             Saliva Hormone Level                                      Memory loss or changes
             Testing; Urine NTx                                      Hot flashes
                                                                       Sleep disturbances
                                                                       Increased facial hair
               Add up your total number of points on the               Acne or oily skin
               chart on the right, then take the suggested
                    action steps in the chart above.                   Lack of libido
                                                                       Urinary incontinence
                                                                       Risk of heart disease
                                                                       Risk of osteoporosis
                                                                                               TOTAL


Page 4
                                            Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
Bioidentical Hormone Solutions for Perimenopause
Your perimenopausal transition is               Prescription Options During                      progesterone slows down, and
unique—no other woman’s experience              Perimenopause                                    the ratio between progesterone
will be the same. That’s why a natural          Your body and psyche go through a                and estrogen is out of balance.
hormone replacement therapy (HRT)               dynamic process as you transition from         • A bioidentical form of estrogen such
program needs to be tailored to your            perimenopause to menopause and                   as estriol. Used vaginally, estriol is
individual hormone levels, lifestyle,           beyond. Some women start using one               especially helpful for vaginal dryness
medical history, and preferences.               hormone to manage perimenopausal                 and urinary incontinence. Taken orally,
Which Hormones To Take During                   symptoms and add other hormones as               estriol may help manage hot flashes.
Perimenopause, and How Much?                    their bodies continue to change. Women’s         Women sometimes ask about estradiol
                                                Health America will work with you and            during perimenopause. Typically,
These factors help determine which
                                                your healthcare provider to determine            estradiol is not prescribed to women
hormones you need, and how much:
                                                what’s right for you.                            who are still menstruating.
 • The symptoms you want to manage.                                                            • Bioidentical testosterone. Enhancing
                                                During perimenopause, your natural
 • Your hormone levels (see page 6, the         hormone replacement therapy program              libido is just one of the benefits of
   Restore® Program).                           may include one or more of these                 using bioidentical testosterone.
 • Your risk factors for heart disease and      hormones:                                        This hormone also increases energy,
   bone loss.                                                                                    builds muscle tone, and increases
                                                 • Bioidentical progesterone. Some               bone strength.
 • Your medical history.                           symptoms occur when production of                                             Restore BIOBALANCE
                                                                                                                                 ProCycle® Gold
                                                                                                                                 nutritional supplements
Menopause and Beyond                                                                                                             help alleviate:
                                                                                                                                   • hot flashes & night sweats
                                                                                                                                   • insomnia
                                                                                                                                   • irritability & fatigue
Menopause, technically, is a woman’s last       mood, memory, and productivity, and by                                             • energy & mood
menstrual period. The average age for a         uncomfortable physical symptoms.                                                   • mental sharpness
woman to reach menopause is 51 and                                                                                               Order online at:
a woman is considered postmenopausal            Use the list below to check any
                                                                                                                                 www.womenshealth.com/
when she has not had a period for 12            symptoms you are experiencing.                                                   shop/catalog/
consecutive months.                              • Anxiety/irritability
                                                 • Fatigue/lack of energy            Menopause: Healthy Steps
More than one-third of your life is ahead        • Depression
of you after you reach menopause. It’s           • Hot flashes                       1.ProCycle® Gold nutritional supplement. Taken daily,
exciting to contemplate how you want             • Breast tenderness                    this special formula provides significant relief from
to spend those years! Where to start? If         • Headaches or migraines               menopausal symptoms.
you haven’t already adopted a self-care          • Lack of libido                    2. Diet and exercise. See The Women’s Health America
program, see The Women’s Health America          • Vaginal dryness                      Self-Care Plan on page 7.
Self-Care Plan on page 7. You’ll find            • Sleep disturbances
nutrition, relaxation, and exercise tips that                                        3. Prescription hormone replacement therapy. Talk with
                                                 • Memory loss or changes
you can adapt to suit your lifestyle.                                                   your healthcare provider about your symptoms and
                                                 • Acne or oily skin
                                                                                        your natural hormone replacement therapy options.
Menopausal Symptoms                              • Increased facial hair
                                                                                        We are here to help work with your healthcare
Every woman’s transition into menopause          • Water retention or bloating
                                                                                        provider!
is different. Some women have few                • Urinary incontinence
symptoms, and only very mild ones.               • Risk of heart disease             4. Saliva hormone level testing and urine NTx bone
Other women find the quality of their            • Risk of osteoporosis                 density testing are both available from Women’s
lives significantly affected by changes in                                              Health America and frequently covered by many
                                                                                        insurance plans.

Bioidentical Hormone Solutions for Menopause
No “one-size-fits-all” hormone regimen          Prescription Options for Menopause               acts as a reservoir for continuous
works for all women. Our PCAB                   Your bioidentical hormone therapy                hormone delivery.
accredited pharmacy, Madison Pharmacy           program may include:                          • Micronized progesterone, see page 3.
Associates, can compound a prescription         • Biest (oral oil capsules or transdermal     • aplía™ metered applicator. Contains
for bioidentical hormones tailored to your        cream). A combination of 20%                  one or more combinations of hormones
individual needs.                                 bioidentical estradiol and 80%                for precise, and sanitary transmucosal
Today, scientists and researchers                 bioidentical estriol, this ratio offers       application directly to the labia or
understand that women produce, absorb,            maximum therapy benefits. Taken once          vaginal opening. Clean and convenient.
and metabolize hormones differently.              daily, in the morning.                      • Testosterone (oral oil capsules, cream,
Your individual hormone levels,                 • Estriol (vaginal cream or suppository).        or transdermal patch). Bioidentical
preferences, lifestyle, risk factors, and the     Bioidentical estriol, used vaginally,          testosterone is often prescribed to
symptoms you most want to manage, all             can relieve vaginal dryness and urinary        manage low libido, low energy, and
must be evaluated in the formulation of           incontinence. Typically used 2-3 times         fatigue. It is taken in the morning to
your hormone prescription (see Restore®           per week at bedtime.                           mimic the body’s natural pattern. Oral
page 6).                                        • Estradiol Patch. The transdermal patch         dosing is preferred for low libido.
                                                                                                                                                                  Page 5
           Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT                 (Continued on Page 6)
Bone loss, or osteoporosis, results
                                                                                                               from a combination of factors:
                 Staying Healthy After Menopause           estrogen’s protective effect on the body.           • Decline in calcium absorption.
                Healthy Heart, Strong Bones                                                                    • Less Vitamin D in the body.
                                                           The Women’s Health Initiative raised
              Heart disease rates increase in women        questions about hormone therapy’s                   • Drop in estrogen, progesterone, and
              after menopause. Why? Estrogen levels fall   protective effect against heart disease in            testosterone after menopause.
              during perimenopause, even when              older women. Other studies have shown               Here’s how to protect your bones:
              a woman is still menstruating. As a          that estrogen may have a protective effect
                                                           against heart disease in younger women.             • Enjoy regular weight-bearing
              woman approaches menopause, estrogen
                                                           In one landmark trial, the Postmenopausal             exercise for 15 to 20 minutes, four times
              production declines and she begins to
                                                           Estrogen and Progestin Interventions                  a week (see page 7 for examples).
              lose its
              protective effects on her heart and bones.   (PEPI) trial, a form of estrogen combined           • Take 1000 mg of calcium citrate and
                                                           with natural, micronized progesterone                 600 mg of magnesium as well as 2 mg
              Estrogen Protects the Heart by:              provided the best cardiovascular                      of boron daily; ProCycle® Gold contains
               • Increasing beneficial HDL                 protection of all the combined hormone                the right amount of each.
                 (“good cholesterol”).                     regimens tested.                                    • Take Ostivone twice daily. When taken
               • Decreasing levels of harmful LDL                                                                together, Ostivone and calcium result
                 (“bad cholesterol”).                      Preventing Osteoporosis                               in significantly greater bone mineral
                                                           Along with its protective effect on the               density than taking calcium by itself.
               • Keeping smooth inner lining of
                                                           heart, estrogen helps keep bones strong.
                 coronary arteries elastic.                                                                    • Take 800 IU of Vitamin D daily.
                                                           Bones are made up of living cells that
               • Preventing arteries from constricting.    continuously grow (remodel) and dissolve            • Talk with your healthcare provider
                                                           (resorb) throughout our lives. Estrogen,              about regularly measuring your rate of
              Continuing Estrogen’s Protective Effect
                                                           progesterone, and testosterone work                   bone loss with the simple NTx urine test
              “I exercise and eat right—my heart and                                                              (see page 6).
              bones are fine,” some women tell us after    together to form and protect bone.
              discussing natural hormone replacement       Estrogen helps absorb calcium from the           These products can be ordered
              therapy (HRT) with their healthcare          intestinal tract, helps deposit calcium into     on-line at www.womenshealth.com/shop/
              providers. In many cases, that’s true,       bone, and helps prevent bone from being          catalog/.
              however, we still recommend they             broken down in the remodeling process.
              consider natural hormone replacement         Progesterone and testosterone stimulate          If you are interested in reading more
              therapy as a means of extending              cells that build bone.                           about studies on hormone therapy, see the
                                                                                                            “Resources” section on page 8.

         When Self-Care Isn’t Enough: Restore ®
                                                                 to hormones in a way that is               receptor cells in your body and carry
                                                                 as unique as your fingerprint.             out the functions they are designed
                                                                 Our pharmacists use pure,                  to perform. Only 2% - 5% of the
                                                                 pharmaceutical-grade chemicals             hormones circulating in your body are
                                                                 to hand-prepare each prescription.         “free.” The rest are bound to proteins,
                                                                 These bioidentical hormones                and unavailable to stimulate cells.
                                                                 (derived from soy) are                     A blood test usually measures “total”
                                                                 biologically identical to the              hormones. Total hormones include free
                                                                 hormones your body produces.               and bound hormones in one number.
                                                              3. Ongoing case management:                   A total hormone measurement in blood
              Q: What is Restore®?                               Our pharmacists and nursing                does not tell you or your healthcare
                                                                 staff will assist your healthcare          provider what percentage of your
              A: Restore® is a customized hormone                                                           hormones is actually available to
                 measuring and monitoring program,               provider in evaluating your needs
                                                                 and adjusting your care plan and           stimulate your cells.
                 exclusively available from Women’s
                 Health America. Restore® has 3 (three)          hormone prescription to attain           Q: How do I get started in the Restore®
                 components:                                     the best outcomes.                          program?
                                                           Q: Why use the Restore® program                A: Just follow these simple steps:
                1. Testing: Analytical measurement of         from Women’s Health America?
                   saliva to determine hormone                                                              1. You need a prescription for
                   levels as well as of urine to measure   A: Because Restore includes saliva                  Restore® from your healthcare
                   rate of bone breakdown.                    and urine testing, interpretation by             provider. She or he can complete the
                                                              specially-trained professionals,                 Restore® Enrollment Form and fax it
                2. Individualized Prescriptions:              individualized prescription
                   Customized bioidentical hormone                                                             to Women’s Health America.
                                                              compounding, and ongoing case
                   prescriptions from our PCAB                management—all in one program.                2. We mail your Restore® home
                   Accredited pharmacy, Madison                                                                testing kit to you with complete
                   Pharmacy Associates. Your               Q: What is the difference between                   instructions for collecting saliva
                   individualized prescription will be        saliva and serum (blood) testing?                and urine samples.
                   based on your test results and the      A: Saliva measures “free” hormones. Free
                   fact that your body produces,                                                            3. You send your samples back to the
                                                              hormones are bioavailable to stimulate           lab for testing.
                   metabolizes, absorbs, and responds
                                                                                                                                      (Continued on Page 8)
Page 6
                                            Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
The Women’s Health America Self-Care Plan
Many women can manage hormonal symptoms            STEP 2: GET PHYSICAL!                               ProCycle® Gold is ideal for women who can’t take
with self-care—a healthy diet, regular exercise,                                                       estrogen for health reasons or prefer to manage
                                                   Moderate outdoor exercise is great for overall
stress management, and nutritional supple-                                                             their menopausal symptoms by combining diet and
                                                   fitness and helps reduce stress. There are other
ments like ProCycle® PMS and ProCycle® Gold.                                                           exercise.
                                                   benefits as well:
Taking great care of yourself doesn’t have to        • Raises HDL (“good cholesterol”)                 Each ProCycle® Gold tablet consists of a blend
                                                     • Reduces triglycerides (fats) in the blood       of vitamins, including Vitamins A, B1, B2, B6, B12a,
be complicated, overly time-consuming, or
                                                                                                       C, E, D3, beta carotene, folic acid, niacinamide,
expensive. You can get started with these            • Builds strong bones                             biotin, and pantothenic acid. Minerals in ProCycle®
simple measures today. Whether you are               • Increases heart and lung capacity               Gold include calcium citrate, magnesium, iodine,
experiencing PMS or the transition from              • Causes the release of endorphins, nature’s      copper, zinc, manganese, potassium, selenium, and
perimenopause to menopause and beyond,                   mood elevators                                chromium.
you’ll be surprised at how quickly you’ll see        • Increases oxygen and blood flow to              ProCycle® PMS and ProCycle® Gold contain no
results—fewer symptoms, more energy, and               muscles, reducing tension                       animal products, sugars, starch, corn, dairy, wheat
renewed mental clarity.                              • Reduces fluid retention                         or yeast products, fish oil, kelp, artificial colors,
STEP 1: YOUR HEALTHY DIET                                                                              flavors, or preservatives.
                                                   How Much, How Often?
Eat Early and Eat Often                            Research shows even a moderate amount of exer-      STEP 4: STRESS MANAGEMENT
Make healthy changes in your diet. Instead of      cise provides relief from PMS symptoms. As little
                                                                                                       The hectic pace of women’s lives can make it dif-
“three squares,” try eating three small meals      as 1 hour and 10 minutes per week of aerobics
                                                                                                       ficult to find time to relax. It’s important to set a
and three snacks daily. Frequent small meals       (that’s only 10 minutes a day), 50 minutes a week
                                                                                                       regular time to slow down. Relaxation lets you tap
keep your blood sugar stable and avoid energy      of running, or 1 hour and 20 minutes a week of
                                                                                                       into your own personal mind-body connection, by
highs and lows. As you plan your meals and         swimming relieved symptoms, according to one
                                                                                                       activating an inborn physiological response.
snacks, include a mix of these “staples.”          study. A brisk 20- to 30-minute walk three times
                                                   a week is a favorite exercise routine among many    Are you a person who says, “I don’t know how to
 • Whole grains and legumes (beans)                women who contact Women’s Health America.           relax!”? No problem. Your body knows how— this
 • Lean sources of protein—                                                                            ability is always there, waiting for you to learn how
                                                   And, because walking is a weight-bearing form
   most women do not eat enough protein                                                                to use it. For most women, relaxation isn’t just one
                                                   of exercise, it has the added benefit of building
 • Raw and leafy vegetables                                                                            thing—it’s a balance of social, physical, creative,
                                                   strong bones. Other forms of weight-bearing
 • Foods with soy protein (soy nuts,                                                                   and spiritual activities.
                                                   exercise include: dancing, tennis, certain yoga
   soy milk, or tofu)                              poses, running, and weight training.                Make a point of doing things that help you feel
 • Fish with Omega-3 fatty acids                                                                       relaxed on a regular basis. Spend time with family
                                                   The quantity and type of exercise are less impor-
   (tuna, mackerel, herring, sardines, salmon,                                                         and friends, read, or watch something humorous.
                                                   tant than the commitment to exercise regularly.
   shellfish)                                                                                          Enjoy a creative outlet like cooking, sewing, music,
                                                   To feel well consistently, you need about 20
                                                                                                       art, or writing. Pray, meditate, or practicing deep
Foods to Eat                                       minutes of exercise three or four times a week.
                                                                                                       breathing. Simplify where you can and look at
 • Lean meat, fish                                 STEP 3: THE RIGHT NUTRITIONAL                       relaxation not as a rare luxury, but as something
 • Low-fat milk, cheese, and yogurt                SUPPLEMENTS FOR YOU                                 you need to stay healthy.
 • Whole grain bread, cereal, and pasta                                                                Remember, if you experience physical symptoms
                                                   ProCycle® PMS
 • Legumes (lentils and beans)                     Specially developed for women with PMS,             or illness, don’t assume they’re “just stress.” Always
 • Green, leafy vegetables                         ProCycle® PMS is a therapeutic nutritional          have a health care provider check them out, to
 • Fresh fruit (moderate amounts—it’s high in      supplement containing a balanced combina-           eliminate possible physiological causes.
   sugar—best with small amounts of protein        tion of B vitamins, magnesium, and calcium.
                                                   ProCycle® PMS contains a beneficial 2-to-1
                                                                                                       STEP 5: EDUCATE YOURSELF
   or complex carbohydrates. Example: 1/2
   apple with 1 small handful of almonds)          ratio of magnesium to calcium. This ratio is        Take time to learn about your body and options for
 • Plain popcorn                                   important to help regulate muscle relaxation,       healthy living and healthy aging.
 • Unsalted pretzels                               blood sugar, and to promote sound sleep. Also,      The HRT Solution by Marla Ahlgrimm, R.Ph. and John
                                                   magnesium may have a role in reducing the           Kells. Avery, 1999.
Foods to Avoid                                     risk of heart attack, stroke, and hypertension,
                                                                                                       Self Help for Premenstrual Syndrome by Michelle
 • Salty lunch meat, sausage, bacon                and in preventing migraine in pregnant women.       Harrison M.D., and Marla Ahlgrimm, R.Ph. Random
 • High-fat cheeses such as brie                   ProCycle® Gold                                      House, 1998.
 • White bread, cake, cookies                      ProCycle® Gold is a complex vitamin and             The Power of Perimenopause by Stephanie Bender. Three
 • Jam, honey, molasses                            mineral supplement designed exclusively             Rivers, 1998.
 • High-salt snacks like potato chips              for women during their menopausal years.            Better Bones, Better Body by Susan E. Brown, Ph.D.
                                                   It contains a precise ratio of Vitamin E,           NTC, Contemporary Publishing, 2000.
 • Caffeinated drinks, coffee, tea, soda
                                                   B vitamins, magnesium, calcium, zinc, and           Menopause Without Medicine by Linda Ojeda, Ph.D.
 • Alcohol                                         boron. The calcium in ProCycle® Gold comes          Hunter House, 2000.
                                                   from calcium citrate, which is easily absorbed.




                                                                                                                                                          Page 7
      Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
(Continued from Page 6)                                                                      We wrote the book on
                 4. A Women’s Health America case                  from the support of our certified             hormone therapy
                    manager individually evaluates your            and specialized staff who are highly
                    lab results and then sends the results         trained in natural HRT.                        “The HRT Solution should be the bible of hormone replacment for any woman who is
                                                                                                                  on hormones or considering taking them. Any other approach isn’t good enough.”




                                                                                                                  The
                                                                                                                                             – Christiane Northru, M.D., author of T HE WISDOM OF MENOPAUSE
                                                                                                                                               and WOMEN’S BODIES, WOMEN’s WISDOM




                    and their considerations for your
                                                                3. Follow-up Testing: Follow-up
                    prescriptions and care plan to your
                    healthcare provider.                           measurement after you begin natural            HRT                                                                     End the
                                                                                                                                                                                      confusion about
                                                                                                                                                                                         Hormone
                                                                                                                                                                                       Replacement
                                                                                                                                                                                                              by
                                                                                                                                                                                                              Marla Ahlgrimm, R.Ph.
                                                                                                                  Solution
                                                                                                                                                                                         Therapy




                                                                   hormone replacement therapy takes                                                                                                          and
                 5. You follow up with your healthcare             the guesswork out of tailoring your            NEWLY REVISED WITH ALL THE LATEST INFORMATION
                                                                                                                                                                                                              John M. Kells, with
                    provider to discuss the Restore®               prescription to your specific needs.              A comprehensive, personalized program
                                                                                                                   of natural hormone replacement to relieve
                                                                                                                                                                                                              Christine Macgenn
                                                                                                                                                                                                              Rodgerson
                                                                                                                  menopauseal symptoms and restore vitality,

                    program’s results and considerations           This careful dosage adjustment                              sexuality, and health...for life




                    and to get started on natural                  avoids side effects. As long as you            Marla Ahlgrimm, R.Ph., and John M. Kells
                                                                                                                  with Christine Macgenn Rodgerson



                    hormone replacement therapy (HRT)              maintain your HRT prescriptions
                    if needed.                                     through Madison Pharmacy
                                                                   Associates, there is no charge for            “The HRT Solution should be the bible of
              Q: Will insurance cover the Restore®                 scheduled follow-up testing.                  hormone replacement for any woman who
                 program?
                                                                                                                 is on hormones or considering taking them.
                                                                4. Restore® tests are convenient,                Any other approach just isn't good enough."
              A: More and more insurance plans,                    painless, and noninvasive (no
                 including Medicare Part B, cover the              needles).
                                                                                                                                                                   - Christiane Northrup, M.D,
                                                                                                                                                     author of The Wisdom of Menopause and
                 testing. We require advance payment,                                                                                                     Women's Bodies, Women's Wisdom
                 and provide you with information            Resources
                 to submit to your insurance plan for
                                                             The HRT Solution. M Ahlgrimm and JM Kells.          Everything you and your healthcare provider
                 reimbursement.
                                                               New York: Avery Publishing, 1999.                 need to know about why synthetic hormone
              Q: What are the Restore® program                                                                   therapy has not worked for many women—
                 benefits?                                   Effects of estrogen or estrogen/progestin           and why natural hormone therapy does—is
                                                                regimens on heart disease risk factors in        right here. Marla Ahlgrimm explains the
                 1. Testing: Baseline saliva testing            postmenopausal women: The PEPI Trial. JAMA       differences in clear, concise terms illustrated
                    determines which hormones you               273: 199-208, 1995.                              with real-life stories from patients.
                    need and how much.
                                                             Effect of estrogen during menopause on risk and     The HRT Solution introduces a new approach
                   This baseline hormone information,           age at onset of Alzheimer’s disease. M Tang et   to hormone therapy that is as natural
                   with the results of the bone                 al., Lancet, 348:429-32, 1996.                   and as individual as you. Testing to assess
                   breakdown urine test (NTx test), gives                                                        and monitor hormone levels is combined
                   you and your healthcare provider a        More reasons than ever for HRT. TL Bush et al.,     with customized, low-dose therapy using
                   more precise view of your health,           Patient Care Nov. 15, 1993, pp. 103-132.          bioidentical hormones, identical to those your
                   and allows you to make informed                                                               body naturally produces.
                   decisions about natural HRT.              Estriol, the forgotten estrogen? AH Follingstad,
                                                                JAMA 239: 29-30, 1978.                           This book can be purchased from
                 2. Specialist Support: You and your                                                             Women’s Health America for $14.95 plus
                    healthcare provider will benefit                                                             shipping and handling.

                                                                                                                                                                             Order by phone at

                                    Healthcare as                                                                                                                     800.558.7046

                                  individual as you!
                                                                                                                                                                                                  or online at
                                                                                                                     www.womenshealth.com




      P.O. Box 259690
   Madison, WI 53725-9690

RETURN SERVICE REQUESTED




                                                                                                                                                                                                                                 REV 11-2009
                                                                                                                                                                                                                            Ref #: SRMINS_02

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Special Report: Natural Hormone Therapy - What You Need To Know

  • 1. Special Report: Natural Hormone Replacement Therapy What you need to know • Compounded prescription medications tailored to your individual needs by our pharmacy, Madison Pharmacy Associates. At Women’s Health America, we • Madison Pharmacy Associates recognize and respect each woman’s Compounding Pharmacy individuality. We know that no one • Restore Clinical Services else will experience hormonal changes • Madison BioDiagnostics Lab in exactly the same way as you. Your hormonal profile is as unique as your fingerprint. Marla Ahlgrimm, R.Ph. Our unique story began in Madison, Founder and CEO We also understand that no one else Wisconsin in the late 1970s when Women’s Health America knows your body as well as you. We we worked with one woman who suffered began listening to women long before the severely every month with symptoms Dear Friend, term “women’s health” was even coined. later defined as PMS. At that time, there That shared history and experience— was no diagnosis and the only treatment By contacting Women’s Health America, listening to what women tell us they want options for her symptoms in the U.S. Inc., you have taken a very important and need—forms the foundation of all our were tranquilizers, antidepressants, or a first step toward learning more about products and services. hysterectomy. improving your health with customized, As pharmacists, we worked with her individualized care We are proud to Our professional staff includes specialists physician, did extensive research, and provide the latest information on: in natural HRT—including nurses compounded a progesterone therapy for and pharmacists. With over 20 years her. She was the first woman in the U.S. • Natural Hormone Replacement experience in natural HRT, we have Therapy (HRT) and what distinguishes to use natural progesterone therapy to been working in this area longer than manage PMS. “natural” hormones from other types any group in the U.S. We take pride in of hormones. serving women’s unique needs, working PMS soon became a household word, • PMS, perimenopause and with their healthcare providers, and and news of our work began to spread to menopause— prescription and offering a full range of hormone options. thousands of women across the U.S. In non-prescription plans for symptom It will be our pleasure to work with you 1982, we founded the first pharmacy in management. and your provider. America to specialize in women’s health, • State-of-the-art hormone level Please call us at 800-558-7046, or find us As time has passed and women’s needs measurements you can do at changed, we have continued to evolve with online at www.womenshealth.com home. our patients. Today, we are Women’s Health • Our own specially formulated America, Inc., a dynamic international To your health, organization dedicated to meeting women’s prescription and over-the-counter complex and unique health needs. INSIDE products. Bioidentical Hormone Solutions for PMS pages 2, 3 Defining the Terms: same as the hormones produced by CH3 your body. These chemical differences Bioidentical and natural can mean synthetic hormones interact C O Perimenopause: differently with your body, producing A Positive Change What’s the difference between bioidentical, natural and synthetic substantially different effects. page 4 hormones? The difference is in the For example, let’s look at the difference CH3 chemical structure. between the synthetic progestins O Menopause PROGESTERONE O A natural hormone has a chemical and natural progesterone. Synthetic C O and Beyond progestins like Provera®, are similar to O C CH3 page 5 structure that is identical to the hormones naturally produced by the progesterone your body produces, the body. Natural hormones but the subtle chemical differences can The Restore® significantly influence the hormones Program are also referred to as O “bioidentical” hormones action and effects in the body. Synthetic CH3 page 6 progestins can cause irritability, nausea, because they are biologically MEDROXYPROGESTERONE ACETATE identical to your own. depression, and water retention in (PROVERA) WHA Self-Care Plan some women. Natural progesterone is A "synthetic" hormone, on identical to the hormone made in the Different chemical structures: bioidentical page 7 the other hand, has a structure body, and many women find it easier progesterone (top) and medroxyprogesterone similar to, but not exactly the to tolerate. acetate, a synthetic (bottom). Women’s Health America, Inc. 800-558-7046 www.womenshealth.com
  • 2. Which Hormones Do I Need, and How Much? Estrogen. A category of Progesterone (P). The word Testosterone (T). hormones that includes estrone means “for gestation.” A male hormone, also (E1), estradiol (E2), and estriol produced in women Every woman is unique (E3). • Necessary for fertility and maintaining pregnancy in substantially smaller and as such there is no set amounts combination or dosage of Protects against: • Has a calming effect bioidentical hormones that • Osteoporosis • Enhances mood • Builds and promotes works for every woman. • Heart disease • Regulates fluid balance muscle tone Generally, a natural • Alzheimer’s disease • Increases energy and sex • Colon cancer • Increases energy hormone replacement drive therapy (HRT) regimen will • Urinary incontinence • Decreases fatigue • Tooth loss/decay • Stabilizes blood sugar, include: • Increases sex drive thyroid function, and • A form of estrogen Enhances: mineral balance • Enhances well being • A form of progesterone • Sleep • Relieves perimenopausal • Strengthens bone • And, if needed, • Mood and menopausal symptoms testosterone. • Mental sharpness/memory • Decreases risk of • Digestion endometrial cancer • Sex drive • May help protect against Let’s review the key Source: The HRT Solution by • Skin tone breast cancer, fibrocystic hormones, and what they Marla Ahlgrimm, R.Ph. and • Key brain chemicals like breasts, and osteoporosis do in the body. John Kells. Avery, 1999. serotonin and endorphins Bioidentical Hormone Solutions For Premenstrual Syndrome (PMS) PMS is a hormonal disorder Charting Hints Managing PMS characterized by: The first step toward taking charge of • Keep the record daily. Writing down • A regularly recurring group of your symptoms every day will make your PMS symptoms is a self-care plan symptoms which occur from two your record most accurate. Set aside that includes a healthy diet, regular, to 14 days before your menstrual a specific time each day if you need moderate exercise, stress reduction, and period, usually disappearing after the to—you’ll need only a minute or two. a nutritional supplement. How to get period begins. started? See The Women’s Health America • After you’ve charted your symptoms for Self-Care Plan on page 7. • This is followed by a symptom-free two to three cycles, it’s time to discuss time in each monthly cycle. your findings with your healthcare Some women find that self-care isn’t These regularly recurring symptoms and provider. enough to manage PMS. Bioidentical their timing in the menstrual cycle typify • Continue charting after you begin a progesterone therapy is an option in PMS. self-care or prescription treatment those cases. plan. Charting is the best way for you Your healthcare provider can prescribe Do You Suffer From PMS? and your healthcare provider to judge bioidentical progesterone. Usually it is There is no laboratory test to diagnose how well the treatment is working. PMS and symptoms are as individual as taken during the second half of the the woman suffering from them. menstrual cycle, from ovulation until What Causes PMS? your period begins. You can find out if you have PMS by As of yet, no universally agreed upon taking the quick symptom survey on cause of PMS has been identified. Some The Hormone page 3. While more than 150 symptoms suggested causes include: How does progesterone work? When have been associated with PMS, we have produced by your ovaries, progesterone • Vitamin-mineral deficiency prepares the uterine lining for a fertilized narrowed the list to the most common. Add up your score to determine which • Nutritional factors egg. Progesterone means “for gestation” action steps would be best for you. • Hypoglycemia (low blood sugar) and is the hormone of pregnancy. If • Progesterone deficiency fertilization and implantation do not Charting Your Symptoms occur, your progesterone level falls and An even better way to determine if you • Fluid retention your period begins. have PMS, and assess your symptoms, • Excess prolactin (a pituitary hormone) is to keep a daily record of exactly • Stress Your progesterone level fluctuates in a when symptoms occur, for two (2) to monthly pattern. During the first half three (3) consecutive cycles. Daily of your cycle, from day 1 of your period Symptom Records are available from to ovulation approximately 14 days Women’s Health America. later, your progesterone level is low. (Continued on Page 3) Page 2 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
  • 3. PMS Symptoms Severity None Mild Moderate Severe 0 1 2 3 Anxiety Irritability Crying for no reason Craving carbohydrates, alcohol, sweets Mood swings Depression Breast tenderness ProCycle® PMS and ProCycle® Gold Headaches or migraines nutritional supplements are available from Fatigue/lack of energy Women’s Health America. Order online at: Bloating/weight gain www.womenshealth.com/shop/catalog/ Difficulty concentrating Sleep disturbances Acne or oily skin PMS Action Steps Lack of libido Total Score Urinary incontinence 1-14 15-30 31+ TOTAL ProCycle® PMS Nutritional Supplements    Diet & Exercise    After ovulation, your progesterone level Synthetic progestins, found in oral rises. Progesterone is produced by the contraceptives and frequently prescribed Non-prescription ovaries during the second half of the for menopausal women, can suppress Progesterone Cream  menstrual cycle. If you become pregnant, ovulation and lower your body’s output of the placenta takes over the output of the natural hormone. Synthetic -or- progesterone, producing high levels progestins often intensify, rather than after Week 9 or 10 of pregnancy. High relieve, PMS symptoms. Prescription Progesterone   progesterone levels may be one reason Saliva Hormone Level Bioidentical progesterone and some women feel especially good while synthetic progestins cannot be used Testing; Urine NTx   pregnant. interchangeably. They have different The Medication chemical structures and very different The hormone progesterone is prescribed effects in the body. If your healthcare Add up your total number of points on the chart to supplement a woman’s production of provider prescribes progesterone, be sure on the top left, then take the suggested action the hormone. Bioidentical progesterone to ask for a prescription for the steps in the chart above. is identical to what your body produces. bioidentical form. Bioidentical Progesterone Therapy and PMS Management Progesterone Prescription Options important for symptom management or rectally, contain progesterone in and to avoid drowsiness, menstrual a wax base. They provide consistent, Points To Remember irregularity, or breakthrough bleeding. even absorption. When used vaginally, • Progesterone replacement therapy some women report leakage, and 2. Micronized Oral Capsule: 25-100 must be individualized for each when used rectally, some report bowel mg. Capsules are absorbed and patient. stimulation. metabolized more quickly and may • For women who are menstruating, cause drowsiness or a woozy, light- 5. aplía™ a Metered Transmucosal typical recommended dosing is two headed feeling. Applicator. Can contain one or times per day, days 14-28, based on a multiple combinations of hormones 3. Rapid Act Sublingual Tablet: 25-100 28-day cycle. for precise, and sanitary application mg. Tablet is pleasantly orange-flavored • For women no longer menstruating or and dissolves under the tongue in less directly to the labia or vaginal opening. post-hysterectomy, dosing is daily. than one minute for rapid absorption. Clean, convenient, precise. Progesterone therapy: Commonly 3. Cream or Gel: 15-30 mg/gm. prescribed dosage forms Deliver continuous, consistent What to Expect 1. Even Release Oral Tablet: 200 mg, absorption. May not be as effective Some women feel immediate relief 300 mg, 400 mg. Contains as even-release tablets for symptom (within hours) from PMS symptoms of progesterone in an even-release management. irritability and anxiety and in two to tablet. This form produces consistent 4. Suppository: 25-400 mg. Progesterone three menstrual cycles, they feel like progesterone blood levels, which is suppositories, used vaginally their bodies have adjusted. (Continued on Page 4) Page 3 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
  • 4. Most women tolerate bioidentical progesterone, their manufacturers added progesterone therapy very well. progesterone USP to them. The amount Occasionally, your monthly period may of progesterone in these creams can range be delayed. If your period is more than from none at all to as high as 10%. a day or two late, discuss it with your healthcare provider—your dosage may There are two preferable options to wild need to be adjusted. You may experience yam cream: flushing (a brief feeling of warmth) when • Have your healthcare provider write taking progesterone. This is normal, a prescription for a cream containing because progesterone raises body micronized progesterone. You will temperature about a degree. know exactly how much progesterone you’re getting. Many insurance What About Wild Yam Cream? plans will reimburse for prescription Many wild yam creams contain little progesterone creams. or no progesterone. Wild yam doesn’t • Women’s Health America’s Non-prescription progesterone cream is contain progesterone, and your body available from Women’s Health America. bioidentical progesterone cream doesn’t convert wild yam extract into contains 960 mg in a 2-ounce tube, Order online at: www.womenshealth. progesterone. If these creams contain and is available without a prescription com/shop/catalog/ at www.womenshealth.com/shop/ catalog/ Perimenopause: A Positive Change Defining Perimenopause is the place to start for mid-life health: healthy decades ahead. Perimenopause refers to the years nutrition, exercise, relaxation, and nutritional supplements. The Women’s When Self-Care Isn’t Enough surrounding a woman’s last menstrual period. Between ages 35 Health America Self-Care Plan on page 7 has Nearly two-thirds of women find and 50, a woman may experience a lifestyle plan you can really use. that self-care is enough to manage physical and emotional changes, hormonal symptoms. For some, Some women combine self-care plans however, self-care isn’t enough to although perimenopausal symptoms and natural hormone replacement therapy vary in every woman. alleviate uncomfortable symptoms, (HRT) during perimenopause to feel vital, or to provide long-term benefit to Managing Perimenopausal Symptoms energetic, and mentally sharp. Getting the heart, bones, and brain. In those Perimenopause is more than symptom the care you need during perimenopause cases Women’s Health America offers management—it’s about staying healthy ensures a smoother transition into customized prescription options. from head to toe after age 35. Self-care menopause and lays the groundwork for Perimenopause Perimenopausal Severity Action Steps Total Score Symptoms None Mild Moderate Severe 1-14 15+ 0 1 2 3 ProCycle® PMS & Gold Fatigue/lack of energy Nutritional Supplements   Anxiety Irritability Diet/Exercise   Depression Non-prescription Breast tenderness Progesterone Cream Headaches or migraines with or without  Mood swings Phytoestrogens Water retention or bloating Prescription HRT  Vaginal dryness Saliva Hormone Level Memory loss or changes Testing; Urine NTx   Hot flashes Sleep disturbances Increased facial hair Add up your total number of points on the Acne or oily skin chart on the right, then take the suggested action steps in the chart above. Lack of libido Urinary incontinence Risk of heart disease Risk of osteoporosis TOTAL Page 4 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
  • 5. Bioidentical Hormone Solutions for Perimenopause Your perimenopausal transition is Prescription Options During progesterone slows down, and unique—no other woman’s experience Perimenopause the ratio between progesterone will be the same. That’s why a natural Your body and psyche go through a and estrogen is out of balance. hormone replacement therapy (HRT) dynamic process as you transition from • A bioidentical form of estrogen such program needs to be tailored to your perimenopause to menopause and as estriol. Used vaginally, estriol is individual hormone levels, lifestyle, beyond. Some women start using one especially helpful for vaginal dryness medical history, and preferences. hormone to manage perimenopausal and urinary incontinence. Taken orally, Which Hormones To Take During symptoms and add other hormones as estriol may help manage hot flashes. Perimenopause, and How Much? their bodies continue to change. Women’s Women sometimes ask about estradiol Health America will work with you and during perimenopause. Typically, These factors help determine which your healthcare provider to determine estradiol is not prescribed to women hormones you need, and how much: what’s right for you. who are still menstruating. • The symptoms you want to manage. • Bioidentical testosterone. Enhancing During perimenopause, your natural • Your hormone levels (see page 6, the hormone replacement therapy program libido is just one of the benefits of Restore® Program). may include one or more of these using bioidentical testosterone. • Your risk factors for heart disease and hormones: This hormone also increases energy, bone loss. builds muscle tone, and increases • Bioidentical progesterone. Some bone strength. • Your medical history. symptoms occur when production of Restore BIOBALANCE ProCycle® Gold nutritional supplements Menopause and Beyond help alleviate: • hot flashes & night sweats • insomnia • irritability & fatigue Menopause, technically, is a woman’s last mood, memory, and productivity, and by • energy & mood menstrual period. The average age for a uncomfortable physical symptoms. • mental sharpness woman to reach menopause is 51 and Order online at: a woman is considered postmenopausal Use the list below to check any www.womenshealth.com/ when she has not had a period for 12 symptoms you are experiencing. shop/catalog/ consecutive months. • Anxiety/irritability • Fatigue/lack of energy Menopause: Healthy Steps More than one-third of your life is ahead • Depression of you after you reach menopause. It’s • Hot flashes 1.ProCycle® Gold nutritional supplement. Taken daily, exciting to contemplate how you want • Breast tenderness this special formula provides significant relief from to spend those years! Where to start? If • Headaches or migraines menopausal symptoms. you haven’t already adopted a self-care • Lack of libido 2. Diet and exercise. See The Women’s Health America program, see The Women’s Health America • Vaginal dryness Self-Care Plan on page 7. Self-Care Plan on page 7. You’ll find • Sleep disturbances nutrition, relaxation, and exercise tips that 3. Prescription hormone replacement therapy. Talk with • Memory loss or changes you can adapt to suit your lifestyle. your healthcare provider about your symptoms and • Acne or oily skin your natural hormone replacement therapy options. Menopausal Symptoms • Increased facial hair We are here to help work with your healthcare Every woman’s transition into menopause • Water retention or bloating provider! is different. Some women have few • Urinary incontinence symptoms, and only very mild ones. • Risk of heart disease 4. Saliva hormone level testing and urine NTx bone Other women find the quality of their • Risk of osteoporosis density testing are both available from Women’s lives significantly affected by changes in Health America and frequently covered by many insurance plans. Bioidentical Hormone Solutions for Menopause No “one-size-fits-all” hormone regimen Prescription Options for Menopause acts as a reservoir for continuous works for all women. Our PCAB Your bioidentical hormone therapy hormone delivery. accredited pharmacy, Madison Pharmacy program may include: • Micronized progesterone, see page 3. Associates, can compound a prescription • Biest (oral oil capsules or transdermal • aplía™ metered applicator. Contains for bioidentical hormones tailored to your cream). A combination of 20% one or more combinations of hormones individual needs. bioidentical estradiol and 80% for precise, and sanitary transmucosal Today, scientists and researchers bioidentical estriol, this ratio offers application directly to the labia or understand that women produce, absorb, maximum therapy benefits. Taken once vaginal opening. Clean and convenient. and metabolize hormones differently. daily, in the morning. • Testosterone (oral oil capsules, cream, Your individual hormone levels, • Estriol (vaginal cream or suppository). or transdermal patch). Bioidentical preferences, lifestyle, risk factors, and the Bioidentical estriol, used vaginally, testosterone is often prescribed to symptoms you most want to manage, all can relieve vaginal dryness and urinary manage low libido, low energy, and must be evaluated in the formulation of incontinence. Typically used 2-3 times fatigue. It is taken in the morning to your hormone prescription (see Restore® per week at bedtime. mimic the body’s natural pattern. Oral page 6). • Estradiol Patch. The transdermal patch dosing is preferred for low libido. Page 5 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT (Continued on Page 6)
  • 6. Bone loss, or osteoporosis, results from a combination of factors: Staying Healthy After Menopause estrogen’s protective effect on the body. • Decline in calcium absorption. Healthy Heart, Strong Bones • Less Vitamin D in the body. The Women’s Health Initiative raised Heart disease rates increase in women questions about hormone therapy’s • Drop in estrogen, progesterone, and after menopause. Why? Estrogen levels fall protective effect against heart disease in testosterone after menopause. during perimenopause, even when older women. Other studies have shown Here’s how to protect your bones: a woman is still menstruating. As a that estrogen may have a protective effect against heart disease in younger women. • Enjoy regular weight-bearing woman approaches menopause, estrogen In one landmark trial, the Postmenopausal exercise for 15 to 20 minutes, four times production declines and she begins to Estrogen and Progestin Interventions a week (see page 7 for examples). lose its protective effects on her heart and bones. (PEPI) trial, a form of estrogen combined • Take 1000 mg of calcium citrate and with natural, micronized progesterone 600 mg of magnesium as well as 2 mg Estrogen Protects the Heart by: provided the best cardiovascular of boron daily; ProCycle® Gold contains • Increasing beneficial HDL protection of all the combined hormone the right amount of each. (“good cholesterol”). regimens tested. • Take Ostivone twice daily. When taken • Decreasing levels of harmful LDL together, Ostivone and calcium result (“bad cholesterol”). Preventing Osteoporosis in significantly greater bone mineral Along with its protective effect on the density than taking calcium by itself. • Keeping smooth inner lining of heart, estrogen helps keep bones strong. coronary arteries elastic. • Take 800 IU of Vitamin D daily. Bones are made up of living cells that • Preventing arteries from constricting. continuously grow (remodel) and dissolve • Talk with your healthcare provider (resorb) throughout our lives. Estrogen, about regularly measuring your rate of Continuing Estrogen’s Protective Effect progesterone, and testosterone work bone loss with the simple NTx urine test “I exercise and eat right—my heart and (see page 6). bones are fine,” some women tell us after together to form and protect bone. discussing natural hormone replacement Estrogen helps absorb calcium from the These products can be ordered therapy (HRT) with their healthcare intestinal tract, helps deposit calcium into on-line at www.womenshealth.com/shop/ providers. In many cases, that’s true, bone, and helps prevent bone from being catalog/. however, we still recommend they broken down in the remodeling process. consider natural hormone replacement Progesterone and testosterone stimulate If you are interested in reading more therapy as a means of extending cells that build bone. about studies on hormone therapy, see the “Resources” section on page 8. When Self-Care Isn’t Enough: Restore ® to hormones in a way that is receptor cells in your body and carry as unique as your fingerprint. out the functions they are designed Our pharmacists use pure, to perform. Only 2% - 5% of the pharmaceutical-grade chemicals hormones circulating in your body are to hand-prepare each prescription. “free.” The rest are bound to proteins, These bioidentical hormones and unavailable to stimulate cells. (derived from soy) are A blood test usually measures “total” biologically identical to the hormones. Total hormones include free hormones your body produces. and bound hormones in one number. 3. Ongoing case management: A total hormone measurement in blood Q: What is Restore®? Our pharmacists and nursing does not tell you or your healthcare staff will assist your healthcare provider what percentage of your A: Restore® is a customized hormone hormones is actually available to measuring and monitoring program, provider in evaluating your needs and adjusting your care plan and stimulate your cells. exclusively available from Women’s Health America. Restore® has 3 (three) hormone prescription to attain Q: How do I get started in the Restore® components: the best outcomes. program? Q: Why use the Restore® program A: Just follow these simple steps: 1. Testing: Analytical measurement of from Women’s Health America? saliva to determine hormone 1. You need a prescription for levels as well as of urine to measure A: Because Restore includes saliva Restore® from your healthcare rate of bone breakdown. and urine testing, interpretation by provider. She or he can complete the specially-trained professionals, Restore® Enrollment Form and fax it 2. Individualized Prescriptions: individualized prescription Customized bioidentical hormone to Women’s Health America. compounding, and ongoing case prescriptions from our PCAB management—all in one program. 2. We mail your Restore® home Accredited pharmacy, Madison testing kit to you with complete Pharmacy Associates. Your Q: What is the difference between instructions for collecting saliva individualized prescription will be saliva and serum (blood) testing? and urine samples. based on your test results and the A: Saliva measures “free” hormones. Free fact that your body produces, 3. You send your samples back to the hormones are bioavailable to stimulate lab for testing. metabolizes, absorbs, and responds (Continued on Page 8) Page 6 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
  • 7. The Women’s Health America Self-Care Plan Many women can manage hormonal symptoms STEP 2: GET PHYSICAL! ProCycle® Gold is ideal for women who can’t take with self-care—a healthy diet, regular exercise, estrogen for health reasons or prefer to manage Moderate outdoor exercise is great for overall stress management, and nutritional supple- their menopausal symptoms by combining diet and fitness and helps reduce stress. There are other ments like ProCycle® PMS and ProCycle® Gold. exercise. benefits as well: Taking great care of yourself doesn’t have to • Raises HDL (“good cholesterol”) Each ProCycle® Gold tablet consists of a blend • Reduces triglycerides (fats) in the blood of vitamins, including Vitamins A, B1, B2, B6, B12a, be complicated, overly time-consuming, or C, E, D3, beta carotene, folic acid, niacinamide, expensive. You can get started with these • Builds strong bones biotin, and pantothenic acid. Minerals in ProCycle® simple measures today. Whether you are • Increases heart and lung capacity Gold include calcium citrate, magnesium, iodine, experiencing PMS or the transition from • Causes the release of endorphins, nature’s copper, zinc, manganese, potassium, selenium, and perimenopause to menopause and beyond, mood elevators chromium. you’ll be surprised at how quickly you’ll see • Increases oxygen and blood flow to ProCycle® PMS and ProCycle® Gold contain no results—fewer symptoms, more energy, and muscles, reducing tension animal products, sugars, starch, corn, dairy, wheat renewed mental clarity. • Reduces fluid retention or yeast products, fish oil, kelp, artificial colors, STEP 1: YOUR HEALTHY DIET flavors, or preservatives. How Much, How Often? Eat Early and Eat Often Research shows even a moderate amount of exer- STEP 4: STRESS MANAGEMENT Make healthy changes in your diet. Instead of cise provides relief from PMS symptoms. As little The hectic pace of women’s lives can make it dif- “three squares,” try eating three small meals as 1 hour and 10 minutes per week of aerobics ficult to find time to relax. It’s important to set a and three snacks daily. Frequent small meals (that’s only 10 minutes a day), 50 minutes a week regular time to slow down. Relaxation lets you tap keep your blood sugar stable and avoid energy of running, or 1 hour and 20 minutes a week of into your own personal mind-body connection, by highs and lows. As you plan your meals and swimming relieved symptoms, according to one activating an inborn physiological response. snacks, include a mix of these “staples.” study. A brisk 20- to 30-minute walk three times a week is a favorite exercise routine among many Are you a person who says, “I don’t know how to • Whole grains and legumes (beans) women who contact Women’s Health America. relax!”? No problem. Your body knows how— this • Lean sources of protein— ability is always there, waiting for you to learn how And, because walking is a weight-bearing form most women do not eat enough protein to use it. For most women, relaxation isn’t just one of exercise, it has the added benefit of building • Raw and leafy vegetables thing—it’s a balance of social, physical, creative, strong bones. Other forms of weight-bearing • Foods with soy protein (soy nuts, and spiritual activities. exercise include: dancing, tennis, certain yoga soy milk, or tofu) poses, running, and weight training. Make a point of doing things that help you feel • Fish with Omega-3 fatty acids relaxed on a regular basis. Spend time with family The quantity and type of exercise are less impor- (tuna, mackerel, herring, sardines, salmon, and friends, read, or watch something humorous. tant than the commitment to exercise regularly. shellfish) Enjoy a creative outlet like cooking, sewing, music, To feel well consistently, you need about 20 art, or writing. Pray, meditate, or practicing deep Foods to Eat minutes of exercise three or four times a week. breathing. Simplify where you can and look at • Lean meat, fish STEP 3: THE RIGHT NUTRITIONAL relaxation not as a rare luxury, but as something • Low-fat milk, cheese, and yogurt SUPPLEMENTS FOR YOU you need to stay healthy. • Whole grain bread, cereal, and pasta Remember, if you experience physical symptoms ProCycle® PMS • Legumes (lentils and beans) Specially developed for women with PMS, or illness, don’t assume they’re “just stress.” Always • Green, leafy vegetables ProCycle® PMS is a therapeutic nutritional have a health care provider check them out, to • Fresh fruit (moderate amounts—it’s high in supplement containing a balanced combina- eliminate possible physiological causes. sugar—best with small amounts of protein tion of B vitamins, magnesium, and calcium. ProCycle® PMS contains a beneficial 2-to-1 STEP 5: EDUCATE YOURSELF or complex carbohydrates. Example: 1/2 apple with 1 small handful of almonds) ratio of magnesium to calcium. This ratio is Take time to learn about your body and options for • Plain popcorn important to help regulate muscle relaxation, healthy living and healthy aging. • Unsalted pretzels blood sugar, and to promote sound sleep. Also, The HRT Solution by Marla Ahlgrimm, R.Ph. and John magnesium may have a role in reducing the Kells. Avery, 1999. Foods to Avoid risk of heart attack, stroke, and hypertension, Self Help for Premenstrual Syndrome by Michelle • Salty lunch meat, sausage, bacon and in preventing migraine in pregnant women. Harrison M.D., and Marla Ahlgrimm, R.Ph. Random • High-fat cheeses such as brie ProCycle® Gold House, 1998. • White bread, cake, cookies ProCycle® Gold is a complex vitamin and The Power of Perimenopause by Stephanie Bender. Three • Jam, honey, molasses mineral supplement designed exclusively Rivers, 1998. • High-salt snacks like potato chips for women during their menopausal years. Better Bones, Better Body by Susan E. Brown, Ph.D. It contains a precise ratio of Vitamin E, NTC, Contemporary Publishing, 2000. • Caffeinated drinks, coffee, tea, soda B vitamins, magnesium, calcium, zinc, and Menopause Without Medicine by Linda Ojeda, Ph.D. • Alcohol boron. The calcium in ProCycle® Gold comes Hunter House, 2000. from calcium citrate, which is easily absorbed. Page 7 Women’s Health America, Inc. 800-558-7046 www.womenshealth.com — Learn more about HRT
  • 8. (Continued from Page 6) We wrote the book on 4. A Women’s Health America case from the support of our certified hormone therapy manager individually evaluates your and specialized staff who are highly lab results and then sends the results trained in natural HRT. “The HRT Solution should be the bible of hormone replacment for any woman who is on hormones or considering taking them. Any other approach isn’t good enough.” The – Christiane Northru, M.D., author of T HE WISDOM OF MENOPAUSE and WOMEN’S BODIES, WOMEN’s WISDOM and their considerations for your 3. Follow-up Testing: Follow-up prescriptions and care plan to your healthcare provider. measurement after you begin natural HRT End the confusion about Hormone Replacement by Marla Ahlgrimm, R.Ph. Solution Therapy hormone replacement therapy takes and 5. You follow up with your healthcare the guesswork out of tailoring your NEWLY REVISED WITH ALL THE LATEST INFORMATION John M. Kells, with provider to discuss the Restore® prescription to your specific needs. A comprehensive, personalized program of natural hormone replacement to relieve Christine Macgenn Rodgerson menopauseal symptoms and restore vitality, program’s results and considerations This careful dosage adjustment sexuality, and health...for life and to get started on natural avoids side effects. As long as you Marla Ahlgrimm, R.Ph., and John M. Kells with Christine Macgenn Rodgerson hormone replacement therapy (HRT) maintain your HRT prescriptions if needed. through Madison Pharmacy Associates, there is no charge for “The HRT Solution should be the bible of Q: Will insurance cover the Restore® scheduled follow-up testing. hormone replacement for any woman who program? is on hormones or considering taking them. 4. Restore® tests are convenient, Any other approach just isn't good enough." A: More and more insurance plans, painless, and noninvasive (no including Medicare Part B, cover the needles). - Christiane Northrup, M.D, author of The Wisdom of Menopause and testing. We require advance payment, Women's Bodies, Women's Wisdom and provide you with information Resources to submit to your insurance plan for The HRT Solution. M Ahlgrimm and JM Kells. Everything you and your healthcare provider reimbursement. New York: Avery Publishing, 1999. need to know about why synthetic hormone Q: What are the Restore® program therapy has not worked for many women— benefits? Effects of estrogen or estrogen/progestin and why natural hormone therapy does—is regimens on heart disease risk factors in right here. Marla Ahlgrimm explains the 1. Testing: Baseline saliva testing postmenopausal women: The PEPI Trial. JAMA differences in clear, concise terms illustrated determines which hormones you 273: 199-208, 1995. with real-life stories from patients. need and how much. Effect of estrogen during menopause on risk and The HRT Solution introduces a new approach This baseline hormone information, age at onset of Alzheimer’s disease. M Tang et to hormone therapy that is as natural with the results of the bone al., Lancet, 348:429-32, 1996. and as individual as you. Testing to assess breakdown urine test (NTx test), gives and monitor hormone levels is combined you and your healthcare provider a More reasons than ever for HRT. TL Bush et al., with customized, low-dose therapy using more precise view of your health, Patient Care Nov. 15, 1993, pp. 103-132. bioidentical hormones, identical to those your and allows you to make informed body naturally produces. decisions about natural HRT. Estriol, the forgotten estrogen? AH Follingstad, JAMA 239: 29-30, 1978. This book can be purchased from 2. Specialist Support: You and your Women’s Health America for $14.95 plus healthcare provider will benefit shipping and handling. Order by phone at Healthcare as 800.558.7046 individual as you! or online at www.womenshealth.com P.O. Box 259690 Madison, WI 53725-9690 RETURN SERVICE REQUESTED REV 11-2009 Ref #: SRMINS_02