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Compounded Medications for Treating Menopause

Menopause is a natural condition that typically occurs in women around 50 years of age. Although it is a singular condition, it causes many undesirable changes to a woman’s body, some of which can be treated using FDA-approved treatments. However, these drugs do not always meet the needs of specific patients, who may experience allergic reactions or other adverse events when taking commercially available medications. This concept is especially true for women, who endure nearly twice the rate of adverse events as men due to underrepresentation in clinical trials (1). Fortunately, compounding can tailor the administration route or dose in order to help women mitigate these risks while still providing patients with a safe and effective therapy.

Compounding pharmacies can tailor commercial menopause medications to meet a patient’s specific needs 

Although the number of commercial FDA-approved medications for treating menopausal symptoms, like hot flashes, continues to grow, these drugs may not meet the specific needs of individual women. As shown below, there are a variety of ways in which a compounding pharmacy can reformulate commercial medications, as deemed necessary by a licensed prescriber. 

Reformulation of commercial medications to remove allergens or irritants

Hormonal changes during menopause can also increase the skin’s sensitivity, making it more susceptible to irritation and allergic reactions to ingredients in commercial medications. For example, topical vaginal creams often contain parabens, fragrances, and propylene glycol that can cause dermatologic conditions like contact dermatitis (2). A compounding pharmacy can reformulate creams to remove these ingredients or formulate an ointment or gel with a base that does not induce irritation.

Reformulation to change the route of administration

When hormone replacement therapy emerged as a treatment option for menopause, the oral route was the most popular administration route. However, there has been a transition to transdermal therapies to avoid the first-pass effect and also due to evidence of a lower clotting risk (3). Transdermal administration of estrogen is recommended for women at high risk for venous thrombosis. 

Lowering the dose to minimize adverse events in women

The goal of any drug therapy is to maximize effectiveness while minimizing the risk of adverse events. Although rare, one of the risks of estrogen replacement therapy is stroke, which can potentially be mitigated by lowering the dose, especially for women with stroke risk factors (4). Compounding pharmacies create estrogen-containing formulations tailored to a patient’s needs. 

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Compounded treatments for menopause

Postmenopausal Atrophic Vaginitis 

Atrophic vaginitis or vaginal atrophy occurs when a woman’s body produces less estrogen, typically occurring after menopause and resulting in painful sexual intercourse. It affects as many as 40 percent of postmenopausal women (5)  but can be treated by a number of compounded preparations.

  • Estriol 1 mg/Progesterone 30 mg Vaginal Suppository
  • Hyaluronic Acid 5 mg/Gm Vaginal Cream
  • Dehydroepiandrosterone 13 mg Vaginal Suppository
  • Estriol 5 mg/mL Vaginal Cream
  • Acidophilus Lactobacillus Vaginal Cream

Vulvodynia

Chronic vulvar pain in women experiencing menopause has been estimated to range from 8.9 percent to 38 percent, making it a major health concern for this patient population. In some cases, post-menopausal women have reported similar rates of pain, regardless of hormone therapy, suggesting that a multi-phasic treatment may be necessary.

  • Amitriptyline HCl 2%/Baclofen 2% Vaginal Cream
  • Gabapentin 6% Vaginal Cream
  • Estriol 0.05% Vaginal Cream
  • Ketamine HCl 5%/Lidocaine HCl 5%/Diazepam 1% Vaginal Cream

Vaginal dryness

Vaginal dryness can occur in women of any age, but it is especially pronounced in post-menopausal women or after gynecological surgery. Females may take estrogen or progesterone to improve vaginal lubrication to improve pain during sex, including compounded preparation.

  • Vitamin E 200 IU vaginal suppository
  • Estriol 0.05% vaginal cream

Dermatological compounding for menopause

Although skin elasticity decreases with age, it decreases much more rapidly during postmenopause. In fact, as much as one-third of collagen is lost within the first five years of menopause. Studies have suggested that an HRT regimen that includes estrogen can help increase dermal collagen levels to premenopausal levels and may also work to prevent collagen loss during perimenopause (6). Systemic adverse events associated with HRT include venous thromboembolism and breast and endometrial cancers, which can be mitigated to some extent by using topical preparations.

Rosacea 

The decline in estrogen during menopause is also linked to rosacea, and although there is no cure for this condition, it can be treated with a variety of compounded medications.

  • Metronidazole 1%/ Niacinamide 4% Topical Gel
  • Ivermectin 1%/Niacinamide 4%/Zinc Pyrithione 0.025% Topical Cream

Postmenopausal Hyperhidrosis

Although estrogen replacement therapy is effective at treating many menopausal symptoms, it has no effect on postmenopausal hyperhidrosis (7,8). Postmenopausal hyperhidrosis typically affects the head and torso, but it may also affect other areas of the body. A small study showed that pronounced sweating may begin between 40 and 70 years of age (8) and may be treated with either systemic or topical treatment with glycopyrrolate (available as 0.5% topical pads).

Bioidentical Hormone Replacement Therapy

As mentioned before, we offer several options for hormone replacement to help manage a variety of menopausal symptoms, from perimenopause to post-menopause. The risks associated with HRT are closely related to the amount and duration of the therapy, making it important to optimize the amount of hormone exposure to maximize benefits and minimize the risk of adverse events (9). In the coming months, we’ll be digging deeper into hormone replacement therapy and vaginal/pelvic health, so stay tuned for more content!

Why Choose VLS Pharmacy and New Drug Loft?

A woman’s menopause treatment regimen should be as unique as her, but such a personalized approach may be difficult to achieve when using commercially available medications. Fortunately, compounding pharmacies like VLS Pharmacy and New Drug Loft are here to help ensure that each treatment regimen, as determined by a licensed prescriber, meets every woman’s specific needs. 

Regardless of which drug is prescribed to treat menopausal symptoms, our pharmacists will tailor the formulation to meet each individual patient’s specific needs. As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients by creating safe, individualized, and effective pharmaceutical therapies. All formulations are compounded with high-quality pharmaceutical-grade APIs sourced directly from PCCA, the leader of superior-quality APIs.

 

Please comment below with any thoughts or questions.

Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

 

References

  1. Zucker I, Prendergast BJ. Sex differences in pharmacokinetics predict adverse drug reactions in women. Biology of Sex Differences. 2020;11(1):32. doi:10.1186/s13293-020-00308-5
  2. Kingston A. The postmenopausal vulva. The Obstetric & Gynaecologis. 2009;11(4):253-259. doi:10.1576/toag.11.4.253.27528
  3. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. doi:10.1136/bmj.k4810
  4. Speroff L. Transdermal hormone therapy and the risk of stroke and venous thrombosis. Climacteric. 2010;13(5):429-432. doi:10.3109/13697137.2010.507111
  5. Bachmann GA, Nevadunsky NS. Diagnosis and Treatment of Atrophic Vaginitis. afp. 2000;61(10):3090-3096.
  6. Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 2: skin disorders. Clin Exp Dermatol. 2022;47(12):2117-2122. doi:10.1111/ced.15308
  7. Swartling C, Naver H, Cabreus P. Postmenopausal Hyperhidrosis and Vasomotor Symptoms in Menopause Should be Treated Differently – A Narrative Review. Arch Obstet Gynecol. 2021;Volume 2(Issue 3):57-63. doi:10.33696/Gynaecology.2.020
  8. Eustace K, Wilson NJ. Postmenopausal craniofacial hyperhidrosis. Clin Exp Dermatol. 2018;43(2):180-182. doi:10.1111/ced.13310
  9. Newman MS, Saltiel D, Smeaton J, Stanczyk FZ. Comparative estrogen exposure from compounded transdermal estradiol creams and Food and Drug Administration-approved transdermal estradiol gels and patches. Menopause. 2023;30(11):1098. doi:10.1097/GME.0000000000002266

 

 


 

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