Answering Women’s Questions: Custom-Compounded Hormone Therapy

Q: I heard some people on TV talking about something called “custom-compounded” hormone therapy for hot flashes and other problems that women have after menopause. What is custom-compounded hormone therapy?

A: When people talk about custom-compounded hormone therapy, they are talking about the use of personalized, made-to-order hormone treatments. These hormone treatments are prepared by special pharmacies, which are called “Compounding Pharmacies.”

Custom-Compounded hormone therapy can be made in many different doses and forms, such as gels, lotions, tablets, and suppositories. The amount of hormone in these made-to-order products and the type of product (that is, whether it is a cream or a gel or some other type) are based on prescription from a doctor.

Q: Are the hormones used in custom-compounded hormone therapy more natural that the hormones used in other hormone therapy products? If so, do women get fewer side effects an better results with custom-compounded hormones compared with other hormone therapy products?

A: The hormones most commonly used in custom-compounded hormone therapy have the exact same chemical structure as the hormones that are found naturally in a woman’s body. For this reason, they are called “bioidentical” hormones.

The bioidentical hormones used in custom-compounded hormone therapy include 3 different types of estrogens: Estrone, estradoil and estroil and, if needed, progesterone. Sometimes, testosterone and a hormone called dehydroepiandrosterone (DHEA) are also used in custom hormone products. These bioidentical hormones are made in labs, just as many other hormones and drugs are. In fact, several hormone therapy products made by large drug companies use bioidentical hormones such as estradoil and progesterone.

Although some people claim that women will have fewer side effects and better results with bioidenical hormones, there have been no well-desgined studies to test these claims. Thus, women thinking about using custom-compounded hormone therapy should be given the same information about benefits and side effects as women using the hormone therapy products that are available from drug companies.

Women should also be aware that, unlike drugs sold in the United States, custom-compounded drugs are almost never tested for quality, purity, or potency by any government agency.

Q: In terms of breast cancer, heart disease, and other possible health risks, is it safer to use custom-compounded hormone therapy than to use the hormone products that are sold by big drug companies?

A: No, there is no proof that custom-compounded hormones are safer than other hormone products used to treat hot flashes and other menopausal symptoms. Until doctors and researchers show otherwise, women should not be led to believe that the risks of using custom-compounded hormone therapy are lower than the risks of using other hormone therapy products on the market.

Q: My friend tried custom-compounded hormone therapy. She said the pharmacy measured the hormones in her saliva to figure out how much hormone she needed to take. That sounds like a good idea. Does it work?

A: There is no good evidence that measuring hormone levels in saliva is helpful in figuring out which hormones to take or how much the dose should be. On the contrary, studies have shown that hormone levels in saliva can change a lot over the course of a single day and these chaning levels not connected in any consistent way to what is happening in a woman’s body.