Posts Tagged 'women’s health'

An Interview with Peter Koshland, PharmD, and Sonia Rafeh, Outreach Director at Koshland Pharm

Pharmacist Peter

Check out Dr. Richard Shames’ recent interview with pharmacist Peter Koshland and Outreach Director Sonia Rafeh of Koshland Pharm about how compounded medications can make a difference in your health and healing. They also cover current topics such as the “me too” movement and how it’s relevant to women’s health.


Recent Trial (KEEPS) Shows Benefits of Hormone Therapy in Newly Menopausal Women

The researchers who conducted the KEEPS trial (Kronos Early Estrogen Prevention Study) presented initial findings to the North American Menopause Society on October 3, 2012, summarized in the statement:

“Estrogen/progesterone treatment started soon after menopause appears safe and relieves many of the symptoms menopausal women face as well as improving mood and markers of cardiovascular risk.”  (KEEPS press release, “Hormone Therapy Has Many Favorable Effects in Newly Menopausal Women,”10-3-12)

This four year, randomized, double-blinded, placebo-controlled clinical trial (the gold standard in clinical trials) compared oral vs. transdermal estrogen in conjunction with cyclic progesterone.  The participants were healthy women aged 42-58 who started therapy within three years of the onset of menopause.  The oral estrogen used was conjugated equine estrogen (Premarin), and the transdermal estrogen was a bioidentical, estradiol patch (Climara).

The researchers are still analyzing the data, but have so far concluded that “The results provide reassurance for women who are recently menopausal and taking HT for short-term treatment of menopausal symptoms.  KEEPS also highlights the need for individualized decision making about hormone therapy, given that oral conjugated equine estrogen and transdermal estradiol  have different profiles of effects and different women have different symptom profiles and priorities for treatment”  (KEEPS press release, “Hormone Therapy Has Many Favorable Effects in Newly Menopausal Women,” 10-3-12).  The different profiles of effects include an association with the use of oral conjugated equine estrogen with an increase in HDL (“good”) cholesterol, a decrease in LDL (“bad”) cholesterol, and an increase in triglyceride levels (a lipid fraction that is of uncertain significance), and an association between the use of bioidentical transdermal estradiol with with improved insulin sensitivity (lower insulin resistance).  For more information, see:

These initial findings support our understanding of existing studies that estrogen therapy, started close towards the beginning of menopause, can be an effective treatment of menopausal symptoms without  posing a risk to cardiovascular health.


Online Women’s Health Support Group, September 10-October 20

One of our favorite practitioners, Naturopathic Doctor Amy Day, is about to start a 6 week online wellness support group for busy moms.  This is a great resource for any mom out there who wants or needs to reduce stress, increase energy, or lose weight naturally.

In her introduction, Dr. Day addresses prospective group members:

“Dear Fellow Mom,

I know how stress and fatigue can get in the way of being the healthy mom that you want to be.

You feel so exhausted that it’s hard to even do the basics, let alone take care of your own health! You get behind at work because it’s so hard to focus. You are frustrated about the belly fat that just won’t go away. It seems like you spend half of your time with your kids yelling at them because you are so impatient and irritable. Your relationships suffer from lack of attention, and your friends wonder if you’ve fallen off the face of the earth.

If you want to restore your balance and rejuvenate your body, then keep reading…”

I highly recommend taking time to take care of yourself by using resources such as Dr. Day’s online wellness support group.  Be well!


Spring Newsletter from Koshland Pharm

Check out Koshland Pharm’s Spring 2012 newsletter, Prescriptions for Health.

This newsletter includes an article about a Bay Area medical doctor who incorporates exercise physiology into his practice, tips for evaluating quality in a compounding pharmacy, updates from Koshland Pharm’s staff (pictured above), and examples of how compounding pharmacies can help during drug shortages.

We hope you enjoy it!  ~Peter

Health Tips from Koshland Pharm

Koshland Pharm has launched its first health-related, quarterly newsletter, Prescriptions for Health.

This first newsletter includes articles about a Bay Area Naturopathic Doctor who supports women in regaining their energy, tips for preventing the transference of hormone creams, and some highlights from a recent practitioner summit about bioidentical hormone replacement therapy.

You can click on the newsletter to the left to check out the articles.  I welcome your feedback!  ~Peter

Pharmaceutical Ads – Reinforcing Stereotypes?

woman ad1I came across this article about how the pharmaceutical industy reinforces or even creates stereotypes about women.  I was struck by this quote from the article:

‘In every society,’ writes Ivan Illich, ‘medicine, like law and religion, defines what is normal, proper or desirable. Medicine has the authority to label one man’s (or woman’s) complaint a legitimate illness, to declare a second man (or woman) sick though s/he themselves do not complain, and to refuse a third social recognition of his/her pain.’

Here are some ads from the past pulled from this article plus a few more:

Premarin ad












Premarin ad2








Premarin ad3











woman ad1










woman ad2












woman ad3
















Live well!

Should Hormone Replacement Therapy Be Used to Prevent Disease?

1557274926_a7c2569175_bIn my former post comparing bioidentical hormone replacement therapy (BHRT) to conventional hormone replacement therapy (HRT), I recieved an excellent question asking why we don’t strive to prevent disease with these therapies.  This is a very important topic and one all women should be aware of when they are evaluating claims from doctors, pharmacies, etc., about the benefits of hormone replacement.

First, a little history.  When I graduated from the UCSF School of Pharmacy a  decade or so ago, we were taught that all women of menopausal age should be put on conventional hormone replacement irregardless of whether they had symptoms or not.  The rationale for this was that the hormones would provide lots of long term benefits to the woman including decreased risk of heart attacks, increased bone density, prevention of Alzheimer’s disease, and many others.  Then came the results of the Women’s Health Initiative in 2002.

I’ve mentioned the Women’s Health Initiative (WHI) before, but to recap, this was a large multi-center clinical trial administered by the National Institutes of Health, which, for its primary study, compared the popular non-bioidentical, hormone replacement drug Prempro with placebo in over 16,000 women.  In 2002, the trial was halted because the women were doing far worse with the Prempro than the placebo.  They had higher incidences of heart attack, stroke, blod clots, Alzheimer’s disease, and breast cancer.  The bottom line was that our rationale for giving hormone replacement up until that point was totally wrong.  It is important to note that there were several good studies that showed these same results in the 1980’s and the 1990’s that were basically ignored by the medical establishment and the mainstream press.  The WHI was such a well designed study with such a large number of women, the results could no longer be ignored.

So, first of all, we understand that conventional hormone replacement therapy (HRT) with Prempro or other synthetic or equine derived hormones should not be used to prevent disease.  It is pretty clear that this treatment causes disease.

So what about bioidentical hormones?  It is well established by numerous trials that when dosed correctly, with proper customization for a particular patient, the key bioidentical hormones (estrogens, progesterone, testosterone) are safe.  This makes sense since we are giving hormones that the body recognizes, knows how to metabolize and are recognized by the cells that use them.  Also, if we give doses that are equivalent to those normally produced by the body, we are not overwhelming it with super-human levels that could cause unexpected symptoms.

However, when it comes to preventing disease, with the possible exception of osteoporosis, there just isn’t enough good, solid clinical data to support those claims.  There is preliminary data and physiological findings that indicate that progesterone and estriol may prevent breast cancer.  There is also preliminary data to support that balancing estrogen dominance with bioidentical progesterone could prevent heart attacks and strokes.  But there isn’t enough of this data to be able to make these claims with confidence and since breast cancer, heart attacks, and strokes are very serious things, we don’t want to use inference and guesswork when we make any medical claims.

Therefore, the primary focus of hormone replacement therapy should be to treat menopausal symptoms.  This is no small thing.  Menopausal symptoms can have a devastating effect on one’s quality of life and I believe there is no reason to suffer when there is a good treatment available such as bioidentical hormones.  We just can’t say with confidence that this treatment will prevent disease or prolong life.  Hopefully, some day we will be able to make those claims as new research helps inform our decisions.  Until then, let’s live well in the here and now and really, isn’t that what it’s all about anyway?

I welcome any comments or questions.  If you want to look at a list of menopausal symptoms click on the following link –

Thank you and live well!

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