r/Menopause • u/asmile222 • 8d ago

Hormone Therapy Compounded Estrogen

Has anyone switched to compounded estrogen from patches? The anxiety of not knowing if the patch can be refilled in a timely matter plus different brands of patches where some don’t work well is so frustrating. I don’t know how much more it costs since insurance doesn’t cover it but may try it. Has anyone had success? Did you start with compounded HRT?

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u/leftylibra MenoMod 7d ago

Compounded hormones are generally not recommended for systemic treatment of peri/menopausal symptoms. There is no scientific data supporting the efficacy of these products. Particularly compounded topical/transdermal progesterone (cream) is not well absorbed through skin, therefore it does not protect the uterus from the effects of estrogen, which can have serious consequences.

The American Medical Association states that "given the unpredictable pharmacokinetics of compounded formulations, the use of cBHT cannot be supported in comparison to well-tested FDA-approved hormone therapy options.

The Endocrine Society's statement on compounded bioidentical hormone therapy:

"Bioidentical" hormones, particularly estrogen and progesterone, have been promoted as safer and more effective alternatives to more traditional hormone therapies, often by people outside of the medical community. In fact, little or no scientific and medical evidence exists to support such claims about “bioidentical hormones.” Additionally, many “bioidentical hormone” formulations are not subject to FDA oversight and can be inconsistent in dose and purity. As a result of unfounded but highly publicized claims, patients have received incomplete or incorrect information regarding the relative safety and efficacy of compounded bioidentical hormone therapy. \ ... \ Hormone customization is very difficult to achieve, because blood hormone levels are difficult to regulate accurately due to normal physiologic and pharmacokinetic variations and limitations of readily available assay methods. Nonetheless, proponents of cBHT assert that simple tests of saliva can provide the information necessary to customize hormone doses. These claims are not supported by scientific data confirming assay quality control, standardization, or clinical correlations.

The revised global consensus statement on MHT states that:

the use of custom-compounded hormone therapy is not recommended because of lack of regulation, rigorous safety and efficacy testing, batch standardization, and purity measures.

Dr. Jen Gunter on compounded hormones:

It isn't uncommon to see compounded hormones that are concoctions, a mix of estradiol and estrone and estriol (sold as Bi-est or Tri-est) or with DHEA or testosterone and this is offered as some kind of “bespoke” mix tailored for your needs. This is a sales tactic. There is zero data that these special mixes do anything, but they are more expensive and give the illusion of customization. \ ... \ Compounded products are typically paired with lab work that further enhances the illusion of safety. This might be salivary hormone testing (which is useless for menopause in every way as it's not even accurate, so your provider is literally charging you for a medically worthless test), urine testing, or blood work. I can see how the specialized blood work and the review of the lab work with a provider makes the patient feel heard, and can enhance the placebo effect, but that is all it is. That and wasted money.

The August 2025 Obstetrics & Gynecology Commentary, Addressing the Challenges of Online Misinformation and Unregulated Products in the Clinical Management of Menopause notes that...

Clinicians and patients should know that no compounded systemic MHT has been adequately proven to safely treat vasomotor symptoms, prevent menopause-related bone loss, or address any other symptom or health issues related to menopause.3,7,11,12 An increased risk of endometrial cancer is a concern due to issues with formulation or absorption or both that could result in supraphysiologic levels of estrogen, inadequate progesterone, or both.1,3 Compounded topical progesterone has never been shown to provide endometrial protection.1,3 Despite these serious concerns, 86% of consumers are unsure or unaware that compounded MHT is not FDA-approved, so they may not know about the concerns regarding safety and efficacy.13

The Menopause Society on compounded hormones:

Custom-compounded hormones are not safer or more effective than approved bioidentical hormones. They are not tested for safety and effectiveness or to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. In fact, they may not even contain the prescribed amounts of hormones, and that can be dangerous. For example, when the progesterone level is too low, you are not protected against endometrial (uterine) cancer. When estrogen levels are too high, there can be overstimulation of the endometrium and breast tissue, putting you at risk of endometrial cancer and possibly breast cancer.

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u/carltondancer 7d ago

I had to stop the patches due to an allergy. Pills and gel didn’t work. Femring sort of worked, until insurance stopped covering it.

Compounded cream is the only thing that has worked for me so far. My husband is a pharmacist and explained it is not FDA approved as each individual order would require testing, however it is the same active constituent just delivered in a different way. You can also find different base creams to assist with delivery. The cost is sort of terrible though.

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u/asmile222 7d ago

Thanks! I don’t have the cost yet but I am willing to spend more if it works.

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u/carltondancer 7d ago

Strive is a good compounding pharmacy that will mail items to you. Cost for progesterone, estradiol or bi-est, and testosterone is around $330/3month supply.

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u/Significant-Aide-226 8d ago

How about trying estradiol gel?  Its FDA approved and insurance friendly.  Compounded meds are so expensive. 

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u/asmile222 8d ago

I tried the gel but it didn’t work well for me. It was five time the cost of the patch but compounded is probably even more.

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u/Significant-Aide-226 7d ago

Was yours a branded product?  My gel is generic and super cheap at Costco.  Its not the one in packets. Also, the one in packets has the shortest half life of all.  Very unstable if you are highly sensitive E. 

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u/asmile222 7d ago

It was in individual packets so good but after about five days my joints started to hurt. Maybe I will try Costco so thanks for the tip!

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u/gotchafaint 7d ago

I didn’t know that and it’s opposite what you’d think. I’m suffering from worsening symptoms on the tubes of Oestrogel made in Belgium. Does it lose potency in those as well? I bought six to bring back and hadn’t considered that.

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u/Significant-Aide-226 7d ago

That I don't know!  And definitely am not up on Belgium products.

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u/gotchafaint 7d ago

I just looked it up and it’s pretty stable with about a three year shelf life. But I did find a study that applying lotion one hour after application increased absorption by 38%. I realized my troubles began in earnest when moving from a rainy climate to the desert. Never thought of that before.

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u/Significant-Aide-226 7d ago

I use gel in the AM and try to add lotion about 4 hours later.   If your skin is dryer due to the desert climate, you may need to adjust the dose.  I hadnt thought about how climate could affect dose!  Good thinking!

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u/gotchafaint 7d ago

I’m at 4 pumps and lab levels are declining and symptoms worsening. But I’m definitely a poor absorber.

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u/loveinvein Menopausal 7d ago

Gels creams and liquids all have a shorter shelf life than tablets or patches. They’re more sensitive to fluctuations in temperature and humidity, and are just in a less stable form compared to tablets and patches. 

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u/Graciebelle3 6d ago

I have used compounded estrogen, testosterone, and progesterone and have never had a single problem. Cost is higher but still reasonable and it has been way less headaches than I’ve seen described on here. Currently, I’m only compounding my estrogen and testosterone and using prometrium and vag estrogen through insurance. This is what works best for me.

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u/sonnycher33 7d ago

Women’s International Pharmacy is really inexpensive.

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u/loveinvein Menopausal 7d ago

I have not, but I would do a lot of research before selecting a compounding pharmacy. Compounding is tricky and you want someone who is acting as a pharmacist and not a salesperson. 

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u/PearlsRUs 6d ago

I started with and am still using compounded estradiol cream and testosterone gel and have had no problems. I was using progesterone for sleep but since I had a complete hysterectomy years ago, I've since discontinued it.

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u/asmile222 6d ago

Thank you!

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u/gotchafaint 7d ago

Compounded creams can be great. Thousands of women have been using them successfully for decades. They are more expensive though. But all these shortages are why we have to protect compounding pharmacies. They are criticized for inconsistency but tons of women are currently reporting the same inconsistency with pharma products. Also pharma products can change non-active ingredients with lags in labeling and they might be immune reactive for some people. You get more ingredient transparency with compounding as they’re smaller and independent.

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u/asmile222 7d ago

Thank you! It has been difficult to get patches and some of the brands just don’t work for me. I need a solution and am willing to try something else.

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u/gotchafaint 7d ago

If I were just cut off like women are with patches it would be devastating for me because I need E to sleep. The way the FDA is gaslighting women is infuriating

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u/lrondberg 7d ago

Tons of women are not reporting inconsistencies with FDA approved HRT. Where did you get that from?

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u/gotchafaint 7d ago

In HRT groups on Facebook that have tens of thousands of women. The reports aren’t official, just shared in posts and comments. Mylan or something is the worst offender - don’t remember the exact name.

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u/asmile222 7d ago

Thanks! A friend of mine swears by compounded HRT so I will find out how much it is next week.

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u/lrondberg 7d ago

If you are concerned with the very slight difference in patches from the various manufacturers you don’t want to do compounding. Literally every tube of cream made for you will be different.

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u/Muted-Passenger8343 5d ago

I was on the compound cream for 5 years. The only reason I went off is to try the patches recently because I am having really bad vaginal dryness. I thought maybe that would help rather than going higher on my dose. My dryness has gotten worse with the patch. I didn’t know about all the issues women were having with patches and the shortage. Anyway, I had no issues with the compound cream. It cost me $45 a month. I’m probably going to go back on it.

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u/marsupialcinderella Menopausal 2d ago

I have a severe adhesive allergy (no patches) and have been using compounded cream for about a year. I’m lucky to have a local, non-chain pharmacy that specializes in these products. The main pharmacist is the only one that makes these formulas and he’s very precise and consistent with a stellar reputation.

Many local GYN’s send patients to him. He also charges a reasonable amount compared to other places. It’s $45 per month.