Spokane pharmacist Edie Ward describes herself as an advocate for the women she talks to daily about hormone replacement therapy. Almost three years ago, she decided to beef up that role by becoming a certified menopause practitioner.

Ward admits that today she's far from the typical behind-the-counter pharmacist in a white coat, instead spending most of her time in patient consultations regarding hormone-related health issues, inside Riverpoint Pharmacy, at 528 E. Spokane Falls Blvd. She consulted with about 300 new patients last year for hormone-related health concerns and saw about the same number of people in 2010.

"Every woman is different and needs something different," Ward says. Her $75 consultations can last up to an hour and involve patients completing a detailed health information survey.

Ward says some women reach menopause symptom free, while others will have many symptoms that affect health—from migraines and weight gain to frequent hot flashes interrupting sleep—because of lower levels of hormones estrogen and progesterone.

"I never make a blanket statement that every woman needs hormone replacement," Ward says, adding that she makes her recommendation based on talking to a patient, reviewing health and lab information, and working in conjunction with a woman's physician.

Ward is a proponent of what are called"bioidentical" hormones for replacement therapy rather than commonly used synthetic or animal-derived versions, if hormone replacement therapy is warranted. She says the bioidentical hormones, which use wild yams as an original source, are produced by chemically converting the yam into both progesterone and estradiol, the most potent estrogen in humans. Bioidenticals also are described as having the same molecular structure as a human hormone.

Riverpoint Pharmacy is a specialty pharmaceutical compounding operation that, among other services, can mix raw ingredients to make physician-prescribed pharmaceutics that aren't available over the counter commercially. Those include vitamin supplements and different strengths of bioidentical hormones than what's available commercially. The company also makes topically administered versions of pharmaceuticals, such as use of gels or patches.

"There's an art to figuring out what women need for hormone therapy," Ward says. "Even though commercial bioidenticals are available at pharmacies, they come in very specific strengths, and if you need something that is custom made, or in a strength not available, or in the right administration, then we provide that service."

She adds, "As a pharmacist, I don't have any prescriptive authority. I work exclusively with the individual woman's health care provider. I'm an advocate. After an extensive review, I make a recommendation for therapy, if therapy is warranted."

Menopause typically occurs in women ages 45 to 55, when menstruation eventually stops and a woman's body goes through changes that end her ability to become pregnant. Specifically, a woman's ovaries stop making eggs and produce less estrogen and progesterone. Changes in those hormone levels can cause mood swings, weight gain, hot flashes, vaginal dryness, loss of sex drive, sleep problems, and migraines, among other symptoms, Ward says.

During the past decade, the medical community has engaged in considerable debate about hormone replacement therapy for relief of menopausal symptoms—and the potential benefits and risks. Today, many physicians will prescribe at least low doses of hormone replacement depending on a woman's health history and symptoms.

Ward, in gaining her certification in May 2009 from the North American Menopause Society, says she passed a board examination mainly taken by physicians such as obstetrician-gynecologists, seeking an additional credential. Although she had gone to several seminars on women's health, she thought the certification would help her work with female patients and build rapport with physicians.

"I'd get the question over and over from doctors, 'How do you know what's best for my patient?', even though I'd gone to several seminars and training in women's health, and yet I didn't have the credentials to back it up," Ward says.

Today, she says she gets referrals from different types of doctors, including family physicians, internists, and ob-gyns. She also receives word-of-mouth recommendations.

She says, "We'll have someone come in who's noticed a friend has lost weight, is sleeping through the night, and say, 'I want whatever she's using.' Then you go, 'Well, it's not the same for everyone.' That's where the art comes in. It's knowing the dosage they need, the route of administration, or using a specific treatment in a way that gives them the greatest benefit."

She also says the lab tests she requests are important because a woman might be having other health problems unrelated to menopause. She gives an example that a woman's fatigue might be because of thyroid issues.

"We also have a lab panel we ask for, and many physicians don't understand why, but many symptoms can overlap, such as fatigue," she says. "There are different things that can cause fatigue symptoms, sometimes hormonal. It helps us make better recommendations."

Ward has worked at Riverpoint Pharmacy since 2005 and received her pharmacy degree from Washington State University in 1992. She also does consultations with men regarding hormone-related issues, and with younger women who may be experiencing a hormonal imbalance or symptoms in the years leading up to menopause.

"I do find more and more women have done their homework and have read and studied menopause before they come in," she says. "I also have women who have unfortunately done very poorly and have been sick for a long time and had no idea why. They're so surprised how hormones have affected their health and their lives."

Ward is the only employee at Riverpoint who sees patients for hormone-replacement therapy consultations, although she says the pharmacy's co-owner, Cathy Hudek, is also a certified menopause practitioner. Hudek now focuses on the business's daily operations.

Ward says Riverpoint Pharmacy is among three pharmacies in the state—and the only one in Eastern Washington—accredited through the Pharmacy Compounding Accreditation Board. To attain the accreditation, Riverpoint has implemented quality control procedures, including independent lab testing and in-house product checks.

The North American Menopause Society, a nonprofit group of health professionals, says that some confusion still surrounds bioidentical hormone therapy. It offers some caution that custom-compounded recipes haven't been tested to prove that the active ingredients are absorbed appropriately or provide predictable levels.

In 2002, a major Women's Health Initiative health study found hormone-replacement therapy could raise the risk of heart disease, stroke, and breast cancer. However, more recent analysis of that study shows most of the heart disease ill effects were in women in their 60s and 70s, who made up the bulk of the study and on average were 12 years past menopause when they began taking hormones, a Wall Street Journal article reported. The September 2011 article also said more recent analysis found that the risk of breast cancer was small and varied.

"There's so much misinformation about hormones," Ward says. "Unfortunately, the majority of studies done on hormones have not used bioidentical hormones in their studies." When asked why, she says that naturally occurring hormones aren't patentable, and that the process to make bio-identicals also wasn't patented, so it isn't a potentially profitable research topic.

She contends, however, that when hormone replacement therapy is recommended, use of human-identical hormones is better than use of synthetics or animal-derived versions. At the same time, Ward is hesitant to call bioidenticals "natural hormones" because they are chemically synthesized.

"There is nothing natural to what they do to a yam to turn it into an estradiol," she adds. Ward sometimes recommends commercially sold bioidenticals, if they're more affordable for the woman.

Since the average lifespan of a woman who hasn't had any major health issues by age 50 is projected to be over 100, Ward says she sees hormone replacement therapy as a significant consideration, if the lack of hormones potentially is going to affect their quality of life for over half of their lives.