Route of administration
The medications used in menopausal HRT are available in numerous different formulations for use by a variety of different routes of administration:
Oral administration – tablets, capsules
Transdermal administration – patches, gels, creams
Vaginal administration – tablets, creams, suppositories, rings
Intramuscular or subcutaneous injection – solutions in vials or ampoules
Subcutaneous implant – surgically-inserted pellets placed into fat tissue
Less commonly sublingual, buccal, intranasal, and rectal administration, as well as intrauterine devicesMore recently developed forms of drug delivery are alleged to have increased local effect lower dosing, fewer side effects, and constant rather than cyclical serum hormone levels. Transdermal and vaginal estrogen, in particular, avoid first pass metabolism through the liver. This in turn prevents an increase in clotting factors and accumulation of anti-estrogenic metabolites, resulting in fewer adverse side effects, particularly with regard to cardiovascular disease and stroke.Injectable forms of estradiol are no longer recommended in menopausal hormone therapy due to the availability of other formulations. Bioidentical hormone therapy
Bioidentical hormone therapy (BHT) is the usage of hormones that are chemically identical to those produced in the body. Although proponents of BHT claim advantages over non-bioidentical or conventional hormone therapy, the FDA does not recognize the term bioidentical hormone, stating there is no scientific evidence that these hormones are identical to their naturally occurring counterparts. There are, however, FDA approved products containing hormones classified as bioidentical.Bioidentical hormones can be used in either pharmaceutical or compounded preparations, with the latter generally not recommended by regulatory bodies due to their lack of standardization and regulatory oversight.
Martin Fugate and Elizabeth Smith, who had married and settled near Hazard, Kentucky in around 1800, were both carriers of the recessive methemoglobinemia (met-H) gene, as was a nearby clan with whom the Fugates descendants intermarried. As a result, many descendants of the Fugates were born with met-H.

Blue Men of Lurgan
The "blue men of Lurgan" were a pair of Lurgan men suffering from what was described as "familial idiopathic methaemoglobinaemia" who were treated by Dr. James Deeny in 1942. Deeny, who would later become the Chief Medical Officer of the Republic of Ireland, prescribed a course of ascorbic acid and sodium bicarbonate. In case one, by the eighth day of treatments, there was a marked change in appearance, and by the twelfth day of treatment, the patients complexion was normal. In case two, the patients complexion reached normality over a month-long duration of treatment. See also
Carbon monoxide poisoning
Hemoglobinemia

References


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