Manufactured or compounded hormone replacement therapy?

Jennifer, a family care doctor in Mt. Pleasant, South Carolina, struggled with menopause discomfort for 15 years. She slept poorly, felt lethargic, complained of brain fog and low libido and, said bluntly, “My mood wasn't that great.”

Nothing – from traditional hormone replacement tablets to hormone therapy injections – seemed to alleviate the symptoms. Finally, under the guidance of her personal physician, she found relief, thanks to a local compounding pharmacy able to produce a customized hormone dosage form to meet her needs.

 “This therapy has so improved the quality of my daily life and work, I cannot imagine life without it,” said Jennifer, now 59.

Physicians began prescribing hormone replacement therapy in the 1960s. The therapies have changed and evolved over the last 60+ years, but the concept of supplementing women’s hormones when they decline remains constant. Bio-identical hormone replacement is available by prescription as either commercially available manufactured products or as compounded medication by a pharmacist. The aim of either therapy chosen by the prescriber is hormone balance for the patient.

Why would prescribers choose compounded hormones over commercially available hormones? A qualitative study of menopausal decision-making indicates many women today are seeking “patient-centered” health care and are demanding shared decision-making with clinicians.

One such patient, Jean S., said, “I have been using compounded hormone replacement for just over a year. In partnership with my primary care physician and my compounding pharmacist, we have been able to tailor my therapy to my needs. We can make minor adjustments based on how my body responds. I am not forced to take pre-determined pill dosages that may not meet my needs.”

Compounded hormones may be highly debated, but many women are choosing this option with their prescribers. A national population-weighted survey determined that 35 percent of U.S. women using hormone therapy are using compounded hormones.

Another recent study evaluated the motivation for women requesting compounded hormones over conventional therapy. Even though the study was small, the data demonstrated that “many women chose CBHT [compounded hormones] because they want a different kind of clinical experience, in which their experiences of menopause are validated and they are listened to, where their treatment objectives are solicited and prioritized, and where they are invited to play an active role in determining their treatment.”

The individualized experience provided by compounded hormones stems from the customization of not only the strength of the hormones to improve health and overall well-being, but also in the delivery system options. Plus, the ability to combine hormones through compounding is another benefit. Physicians and pharmacists work together with the patient to balance the patient’s hormone levels.

Laurie Steelsmith, a naturopathic physician in Honolulu, said she’s been prescribing compounded hormones to her patients for 27 years, chiefly because it’s rooted in finding personalized and flexible treatments, instead of the one-size-fits-all limitations of some commercial drugs.“Many of my patients do not tolerate synthetic hormones or do not tolerate the inert ingredients in most FDA-approved hormone creams,” she said. “I have to adjust doses of hormones I prescribe on a regular basis, and conventional hormone therapies do not allow me the same flexibility that using compounded bioidentical hormones do.”

Learn more about compounded hormones, stories of patients helped by this approach, and the potential threat to this vital therapy on compounding.com.