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Background: In recent years, compounded bioidentical hormone therapy (CBHT) has emerged as a popular alternative to manufactured, FDA approved hormone therapy (HT)-despite concerns within the medical community and the availability of new FDA approved "bioidentical" products. This study aims to characterize the motivations for using CBHT in a U.S. sample of ordinary midlife women. Methods: We analyze data collected from 21 current and former users of CBHT who participated in a larger qualitative study of menopausal decision-making among U.S. women. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed thematically using an iterative inductive and deductive process. Results: Although women's individual motivations varied, two overarching themes emerged: "push motivations" that drove women away from conventional HT and from alternative therapies, and "pull motivations" that attracted women to CBHT. Push motivations focused on (1) fear and uncertainty about the safety of conventional HT, (2) an aversion to conjugated estrogens in particular, and (3) and overarching distrust of a medical system perceived as dismissive of their concerns and overly reliant on pharmaceuticals. Participants also voiced dissatisfaction with the effectiveness of herbal and soy supplements. Participants were attracted to CBHT because they perceive it to be (1) effective in managing menopausal symptoms, (2) safer than conventional HT, (3) tailored to their individual bodies and needs, and (4) accompanied by enhanced clinical care and attention. Conclusions: This study finds that women draw upon a range of "push" and "pull" motivations in their decision to use CBHT. Importantly, we find that women are not only seeking alternatives to conventional pharmaceuticals, but alternatives to conventional care where their menopausal experience is solicited, their treatment goals are heard, and they are engaged as agents in managing their own menopause. The significance of this finding goes beyond understanding why women choose CBHT. Women making menopause treatment decisions of all kinds would benefit from greater shared decision-making in the clinical context in which they are explicitly invited to share their experiences, priorities, and preferences. This would also provide an opportunity for clinicians to discuss the pros and cons of conventional HT, CBHT, and other approaches to managing menopause.

Made available in DSpace on 2014-12-17T14:16:30Z (GMT). No. of bitstreams: 1 TherezaMMP_DISSERT.pdf: 3247575 bytes, checksum: b56626eecb3cf571b5b30d6c0ab92d04 (MD5) Previous issue date: 2013-03-22 / Bioidentical hormones are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body. It is believed that the use of hormones may be safer and more effective than the non-bioidentical hormones, because binding to receptors in the organism would be similar to the endogenous hormone. Bioidentical estrogens have been used in menopausal women, as an alternative to traditional hormone replacement therapy. Thermal data of these hormones are scarce in literature. Thermal analysis comprises a group of techniques that allows evaluating the physical-chemistry properties of a drug, while the drug is subjected to a controlled temperature programming. The thermal techniques are used in pharmaceutical studies for characterization of drugs, purity determination, polymorphism identification, compatibility and evaluation of stability. This study aims to characterize the bioidentical hormones estradiol and estriol through thermal techniques TG/DTG, DTA, DSC, DSC-photovisual. By the TG curves analysis was possible to calculated kinetic parameters for the samples. The kinetic data showed that there is good correlation in the different models used. For both estradiol and estriol, was found zero order reaction, which enabled the construction of the vapor pressure curves. Data from DTA and DSC curves of melting point and purity are the same of literature, showed relation with DSC-photovisual results. The analysis DTA curves showed the fusion event had the best linearity for both hormones. In the evaluation of possible degradation products, the analysis of the infrared shows no degradation products in the solid state / Horm?nios bioid?nticos s?o compostos que t?m exatamente a mesma estrutura qu?mica e molecular dos horm?nios end?genos humanos. Acredita-se que a utiliza??o desses horm?nios pode ser mais segura e eficaz que os horm?nios n?o-bioid?nticos, pois a liga??o aos receptores no organismo se daria de forma semelhante aos horm?nios end?genos. Estrog?nios bioid?nticos v?m sendo utilizado, em mulheres na menopausa, como uma alternativa ? terapia de reposi??o hormonal tradicional. Dados t?rmicos desses horm?nios s?o escassos na literatura. A an?lise t?rmica ? um conjunto de t?cnicas que possibilita medir as propriedades f?sico-qu?micas de uma subst?ncia em fun??o da temperatura. As t?cnicas t?rmicas v?m sendo utilizadas na ?rea farmac?utica em diversas aplica??es, como na caracteriza??o de f?rmacos, determina??o do grau de pureza, identifica??o de polimorfismo, estudos de estabilidade e compatibilidade. Este trabalho tem como objetivo a caracteriza??o dos horm?nios bioid?nticos estradiol e estriol atrav?s das t?cnicas t?rmicas TG/DTG, DTA, DSC, DSC-fotovisual. A partir da an?lise das curvas TG, foi poss?vel calcular os par?metros cin?ticos para as amostras. Os dados cin?ticos mostraram boa correla??o entre os diferentes modelos empregados. Tanto para o estradiol como para o estriol, foi encontrada ordem zero de rea??o, o que possibilitou a constru??o das curvas de press?o de vapor. Dados das curvas DSC e DTA sobre ponto de fus?o e pureza s?o condizentes com a literatura, sendo poss?vel correlacionar estes resultados com o DSC-fotovisual. As an?lises das curvas DTA mostraram o evento de fus?o como o de melhor linearidade para os dois horm?nios. Na avalia??o dos poss?veis produtos de degrada??o, a an?lise do infravermelho mostra que n?o houve produtos de degrada??o no estado s?lido