Why Hormone Structure Matters

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The structure of hormones plays a crucial role in their function. For hormone therapy to be truly effective, the replacement hormone must precisely match the body’s naturally produced hormones. There are significant differences between hormones that are natural to humans and those that are synthetic or derived from animals.

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Pharmaceutical companies often modify natural hormones by adding side chains, allowing them to patent the synthetic versions. However, bioidentical hormones—including estrogens, progesterone, testosterone, dehydroepiandrosterone (DHEA), and natural thyroid hormones—are chemically identical to those our bodies produce.

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Our compounding pharmacists collaborate with patients and healthcare providers to create customized hormone therapy tailored to each individual’s needs, ensuring the right strength and dosage form. Before starting hormone therapy, a thorough review of a patient’s medical and family history is essential. Since every woman responds uniquely to treatment, close monitoring and adjustments help achieve the best outcome.

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The Benefits of Compounded Bioidentical Hormone Therapy (cBHT)

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Interest in alternative hormone therapy options surged after the results of the Women’s Health Initiative (WHI) trials were published in 2002. Since then, the number of prescriptions for compounded hormones has significantly increased.

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Compounded medications are custom-prepared to meet an individual’s unique needs when commercially available products fall short. Estrogens, progesterone, and testosterone have been used internationally since the 1940s in both manufactured and compounded forms. Millions of women rely on bioidentical hormones to manage menopause, fertility concerns, and other hormonal imbalances, while men also benefit from testosterone therapy.

Even though numerous commercially available hormone-containing products have been extensively tested for safety and efficacy, many patients still require individualized compounded preparations. Compounded bioidentical hormones offer:

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• Customizable dosing and dosage forms

• Flexible routes of administration

• The ability to minimize side effects while achieving optimal benefits

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Patients often turn to compounded hormones after experiencing inadequate results with standard medications. Personalized treatments can lead to better compliance and improved outcomes.

Rethinking Hormone Replacement Therapy (HRT)

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The North American Menopause Society (NAMS) released its 2017 Hormone Therapy Position Statement endorsed by over 50 medical organizations. The statement emphasizes that:

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• Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (hot flashes and night sweats) and the genitourinary syndrome of menopause (GSM).

• HT can help prevent bone loss and fractures.

• Risks vary depending on factors such as type, dose, duration, administration route, and timing of initiation.

• For women under 60 or within 10 years of menopause onset, the benefit-risk ratio is favorable for treating bothersome symptoms and preventing osteoporosis.

• For women over 60 or more than 10-20 years post-menopause, the risks of coronary heart disease, stroke, venous thromboembolism, and dementia increase.

• Longer treatment durations should be carefully evaluated based on individual needs, with shared decision-making between patients and providers.

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The Impact of Estrogen Avoidance

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Following the WHI study, widespread fear led to a decline in hormone therapy use. However, later research challenged those initial concerns. A 2013 study found that avoiding estrogen therapy may have contributed to premature deaths among hysterectomized women aged 50-59. Lead researcher Dr. Philip Sarrel emphasized the importance of informed discussions between women and their healthcare providers regarding hormone therapy benefits.

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Further, a 2017 follow-up study tracking over 27,000 postmenopausal women found that estrogen plus progestin (median 5.6 years) or estrogen alone (median 7.2 years) was not associated with an increased risk of all-cause, cardiovascular, or cancer mortality over 18 years.

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Clinical Takeaways from NAMS’ Hormone Therapy Position Statement

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Medscape’s Arefa Cassoobhoy, MD, MPH, interviewed Dr. JoAnn Manson, lead author of the WHI, to summarize key insights:

• Younger women (under 60 or within 10 years of menopause) have lower risks of heart disease, stroke, deep vein thrombosis (DVT), and breast cancer related to HT.

• Women with frequent hot flashes and night sweats experience a more favorable benefit-risk ratio from HT.

• Transdermal hormone therapy (patches, creams, gels) avoids first-pass liver metabolism, reducing clotting risks compared to oral HT.

• Genitourinary symptoms worsen over time and can significantly impact quality of life. Low-dose vaginal estrogen is the most effective treatment, with no evidence of increased risk for heart disease, stroke, DVT, dementia, or breast cancer.

• Women with early menopause (either premature ovarian insufficiency or early surgical menopause) face increased risks for heart disease, cognitive decline, and osteoporosis—making them ideal candidates for HT.

• Starting HT later in life, especially in women with diabetes, requires caution due to a higher risk of cognitive decline.

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Why Patients Choose Compounded Medications

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Compounded medications provide solutions for:

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• Allergies or intolerances to commercial products.

• Adverse reactions to commercial preparations (e.g., allergic reactions to adhesive patches).

• Non-standard dosing needs, allowing for precise adjustments.

• Alternative dosage forms, such as creams or lozenges, to bypass liver metabolism.

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At our compounding pharmacy, patient safety is our top priority. We adhere to strict regulations and use only pure ingredients sourced from FDA-inspected facilities.