Vail health: The ins and outs of hormone replacement therapy |

Vail health: The ins and outs of hormone replacement therapy

Lindsay Warner
VAIL CO, Colorado
Special to the Daily

Hot flash! Bone density! Hormones! The changes in estrogen levels in women going through menopause have interested doctors and patients for nearly a century. Synthetic estrogen was developed in the 1920s, and by the mid-1930s it was being used to relieve menopausal symptoms. In the mid-1960s, the book “Feminine Forever” touted the use of synthetic estrogen as a way to maintain youth and femininity. The book greatly increased the demand for hormone replacement therapy. In recent years much research has been conducted to determine how hormone replacement therapy can help women and who the best candidates for the medication are. Pharmacist August Smirl, a hormone replacement therapy expert and managing pharmacist of the Edwards Pharmacy inside the Shaw Regional Cancer Center Building, answered some common questions he gets.

Vail Daily: What is bioidentical hormone replacement therapy (BHRT)?

August Smirl: Bioidentical hormone replacement therapy is using hormones that are identical to the ones in your body to replenish diminishing hormone levels.

VD: Is there a difference between synthetic and natural hormones?

AS: Yes, synthetic hormones are chemically derived whereas natural refers to hormones that are derived from plant sources. Synthetic may be a close replica having some, but not all, of the characteristics of hormones in our body.

VD: What are the uses for bioidentical hormone replacement therapy?

AS: As we age, hormone levels decrease, causing different side effects. The older one gets, the desired outcome of taking hormones may vary. For example, a menopausal woman in her 40s is probably more interested in eliminating hot flashes, mood swings, night sweats and other side effects. Whereas a more advanced woman might desire to retain stronger bones and better brain function. Men also have diminished levels of testosterone, which leads to low energy levels and loss of lean muscle mass.

VD: Why should I do bioidentical hormone replacement therapy?

AS: Bioidentical hormones alleviate symptoms of hormone imbalance. The goal is to not just replace, but to balance out hormones in the body. This is accomplished by individually tailoring meds using lab results and addressing patient symptoms.

VD: Are there options?

AS: There are commercial hormone products available as well as those prepared by a compounding pharmacy, such as the Edwards Pharmacy. Compounded hormones are custom made to fit specific individual needs including strength and dose form.

VD: How can I get hormone replacement therapy?

AS: A prescription is required for hormones so speak with your doctor or a hormone replacement therapy doctor and a pharmacist or compounding pharmacy if needed to obtain this type of treatment.

VD: Where can I learn more?

AS: Join us for the VVMC Hormone Replacement Therapy panel discussion on Wednesday at the Sonnenalp in Vail or Thursday at the Gypsum Town Municipal Building. The panel will include Dr. Heidi Archer of Body LogicMD, Colorado Mountain Medical OB/GYN physicians Rochelle Bernstein (Wednesday) and Keith Samuels (Thursday) and myself. You can also learn more by calling your pharmacy or physician to be referred to specialists and of course, read up. There have been numerous books written, as well as many talk shows on this topic.

VD: When should I stop taking hormone replacement therapy?

AS: The duration of therapy is at the patient’s digression. If you are at a point in life where the symptoms of menopause are no longer an issue, then you might consider stopping therapy.

VD: Is any hormone replacement therapy safer than another?

AS: No hormone replacement is without risks or side effects. All options must be considered before starting a specific treatment in order to reduce the risks and learn what works for each individual.

VD: What else can I do to prevent hot flashes and loss of libido due to menopause?

AS: Some women respond to homeopathic treatment, like vitamins, very well but need to be careful if hormone replacement therapy is ever added due to potential drug interactions.

VD: What can I do to protect against heart disease or osteoporosis?

AS: Hormone replacement therapy can help prevent bone loss. Additionally, taking supplements such as fish oil, flax seed and fiber among others, can help prevent heart disease.

VD: I am a woman approaching menopause, what should I do?

AS: Educate yourself. Go online, read books, seek out health care professionals who may guide you through the process.

August Smirl, registered pharmacist, is the manager of the Edwards Pharmacy, a public pharmacy located at the Shaw Regional Cancer Center. Smirl has been a pharmacist for 22 years and been a Vail Valley Medical Center employee for nine of those years. Lindsay Warner is the communications and publications manager for Vail Valley Medical Center. Email questions or comments about this article to

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