US Pharm. 2015;40(9):1.Lately, health news reports are replete with stories touting the benefits of hormone-related health therapies to treat everything from infertility to obesity to cancer. In the February issue of the International Journal of Cancer, for example, a study describes a hormone called irisin, released from muscles after strenuous exercise, that might help to treat or prevent breast cancer. The discovery might derive from the findings that women who exercise are reported to have a 30% to 40% lower risk for breast cancer or to have enhanced survival if they already have the disease.
In this issue’s continuing education article, the authors describe a variety of hormones, both natural and synthetic, for treating infertility. While often effective, the medication regimens involving hormone therapies to help women become pregnant are somewhat complex, and the intricacy inherent in this therapy highlights the vital role that the pharmacist can play in the health continuum.
The first-line therapy against infertility due to ovarian dysfunction, clomiphene citrate (CC), illustrates this challenge. A selective estrogen receptor modulator that induces ovulation, CC is recommended to be dosed at 50 mg daily, usually beginning on Day 3 to 5 of a patient’s menstrual cycle and continuing for 5 days. If ovulation does not occur, 100 mg daily is given for a second cycle and repeated two additional times. If ovulation occurs but does not result in pregnancy, CC can be administered for a maximum of six courses.
Some infertility therapies necessitate subcutaneous injection, and here too pharmacists can contribute by instructing women in the correct administration. Examples of follicle-stimulating hormones delivered via hypodermic needle include menotropins, urofollitropin, and follitropin alfa and follitropin beta.
As with many medications, hormone therapies for treating infertility carry the risk of adverse events—yet another opportunity for the pharmacist to counsel patients. The list of potential adverse drug reactions cited in the CE article is lengthy: ovarian enlargement; ovarian hyperstimulation syndrome; abdominal and breast discomfort; visual disturbance; headache; multifetal gestation and multifetal births; hot flashes; vaginal hemorrhage; injection-site reactions; and fatigue.
The clinical insight offered by pharmacists, as highlighted in a feature article about hormone replacement therapy (HRT) in this issue, is also valuable to patients currently undergoing this therapy. Given to treat the symptoms of postmenopause—primarily decreased sexual function and vasomotor symptoms—available in many treatment forms. As in infertility treatments, pharmacists can offer therapy-optimization suggestions and patient counseling. Pharmacists are well positioned to access the woman’s health profile and communicate the benefits and risks of initiating or curtailing treatment; they can also offer options for symptom control.
Women electing to take HRT to relieve hot-flash symptoms often hope it will also help alleviate their menopause-related memory and thinking problems, but a recent study reports this might not be the case. Oral hormone therapy, however, was linked to mood benefits, research found. “Hormone therapy is not a panacea, as it was once portrayed to be,” said study researcher Carey Gleason, PhD, an associate professor at the University of Wisconsin School of Medicine and Public Health. “On the other hand, it is not a poison.”
As cited in this issue’s feature article covering HRT, pharmacists are working more closely with healthcare providers and taking on a larger role in therapy selection. This collaboration is opening the doors to a growing subspecialty—compounded hormone products. Furthermore, as one of the most trusted healthcare professionals, pharmacists often receive detailed information from female patients about their vasomotor symptoms during therapy. Prior to visiting her physician for a follow-up appointment, for example, the patient might convey a new symptom to her pharmacist during a refill pickup.
As medical science advances, so too must the ability of pharmacists to participate as integral members of the healthcare continuum. Hormone therapy is an excellent fit for their skill set.
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