Laura G Owens ~ Writer. Raw. Real. Chronically ambivalent.

(Photo credit: Renjith Krishnan’s)

Have you talked to your doctor because you think you might be in peri or full menopause?

Are you feeling off, forgetful, sweaty? Are you waking up in the middle of the night, increasingly anxious, unfocused, irritable and have little sex drive? Perhaps you’ve had a complete hysterectomy and your doctor wants you on hormone replacement therapy.

The first step is to measure your hormones. Saliva testing is preferable to serum blood tests, in some instances. 

(Click image for hormone testing kit)

Click for list of ZRT Labs hormone tests)

And, if based on your test results you decide to start hormone replacement therapy (HRT), consider bioidentical HRT over conventional, synthetic forms. It’s important to get your bioidentical hormones (BH) from a reputable pharmacy who dispenses with a prescription from your doctor. (Ask your doctor what your state requires as this varies).

Find a compounding pharmacist nearest you.

While over the counter (OTC) progesterone creams are available, I don’t recommend these because of the potential for inconsistency in the active compounds and dosing.  Dr. Lee however, the HRT guru I follow, recommends a few OTC formulas in his book.

(click image for more information)

One  of Dr. Lee’s OTC progesterone cream recommendations is Emerita. Yet, I order my progesterone and testosterone from a local compounding pharmacy. I mail or fax the pharmacy my Ob & Gyn ordered prescription and the staff fills my script through the mail upon request.

So what exactly is a compounding pharmacy?

Writes Wikipedia:

Compounding pharmacies use commercially-available bulk drugs to create new formulations which differ (in form or dosage) from those manufactured on a large scale by pharmaceutical companies.

Custom-compounded BHRT is (bioidentical hormone replacement therapy) almost wholly restricted to the United States, where pharmacy compounding is governed at the state level while the FDA has regulatory authority over the compounded product. Some internet-based compounding pharmacies understate harm and claim benefits of compounded BHRT beyond what can be proven by evidence-based medicine, and many of their claims exceed those made by other, more mainstream, BHT practitioners.

Find a compounding pharmacist nearest you.

In the United States, compounding pharmacies are licensed and regulated by their respective state like all other pharmacies. National standards have been created by Pharmacy Compounding Accreditation Board (PCAB). Compounding pharmacies were the subject of the United States Supreme Court decision Thompson v. Western States Medical Center (535 U.S. 357, 2002).

I pay a small extra fee to have my compounding pharmacy dispense my creams in a dose-monitored pump to ensure I easily apply the exact amount of progesterone and testosterone cream my doctor prescribed. (Note: Testosterone is a controlled substance and is not available over the counter).

Syringes with tick measurements on the side are often given to customers. These work fine and usually don’t cost more.

Verify your pharmacy and the pharmacist is legitimate. I won’t mention the name, but a certain pharmacy in our area was charged (okay the pharmacists were, not the local chain) for dispensing steroids in and out of state, without a prescription.

Find a compounding pharmacy nearest you.

Before I bought my prescription from the pharmacy I now use I met with the doctor on staff (a former Ob & Gyn who specialized in hormone and brain balancing) and the compounding pharmacist.

I order my bioidentical estrogen patches, Vivelle-dot (I used to use Climara but the bi-weekly Vivelle is offers a more continuous delivery of the active ingredient because you change the patch twice a week) from a Canadian Pharmacy. Because Vivelle is not a compounded substance, it IS FDA approved. I order mine from a verified Canadian pharmacy.

Will insurance cover bioidentical hormones?

Many insurance companies don’t cover compounded medications, it’s important to ask if they pay some, all or none of the cost. Some insurance plans will cover bioidentical estrogen patches (e.g. Climara, Vivelle-dot) because these biodientical estrogen patches are regulated by the FDA.

I have a health savings plan and pay out of pocket, so I price my hormones all the time.  For years I’ve found that even if my estrogen patches were covered under my insurance, it was (usually) less expensive to order them out of pocket from my Canadian pharmacy, even after including the shipping charges.

I use Smart Choice Pharmacy and have been nothing but pleased over the years. Their customer service is polite, efficient and prompt.

Hormone replacement therapy decision checklist:

1. Track symptoms for several months before and after starting HRT
2. Get tested (saliva preferable in many cases)
3. Consult with open minded doctor who understands or specializes in women’s medicine, natural hormone and mood balancing.
4. Start hormone therapy if applicable. Monitor your symptoms over time, realizing that your body may feel worse the first week or two before you feel better as you adjust ot the hormones.
5. Use bioidentical hormones, BHRT (my preference), using the least amount to achieve desired results (reduced or no symptoms).
6. Use a compounding pharmacist for your BHRT creams and compare your health insurance and pharmacy plans for bioidentical estrogen patches if applicable. Many women find they don’t need estrogen HRT, only progesterone.

Obtaining your BHRT creams from a compounding pharmacist rather than over the counter increases the likelihood that the progesterone and/or testosterone cream you use is formulated to the dosing and purity your doctor prescribed, which is critical to relieving your menopausal symptoms.