Choosing a Dosage Form for Compounded BHRT

Choosing a Dosage Form

for Compounded Bioidentical Hormone Replacement Therapy

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

row of doorsOne of the truly wonderful things about using compounded bioidentical hormone therapy is the opportunity to choose from a wide array of dosage forms. A “dosage form” is the manner used to deliver a medication into the body, such as capsules, creams, lozenges, gels, suppositories, and drops. Women’s International Pharmacy offers many choices of dosage forms in order to help meet each individual’s specific needs.

Oral Dosage Forms

Capsules are convenient to use. They are quick and easy to take, and multiple hormones can be combined into one capsule, allowing for increased individualization and ease of use. Women’s International Pharmacy pioneered compounding hormones mixed with an edible oil inside a capsule. These oil-based capsules were based on original research with progesterone done by Drs. Hargrove and Maxon. They demonstrated that micronization, or reducing the particle size of the hormone powders, and mixing the powders in oil inside the capsule allowed for good absorption of hormones like progesterone.

Sex and adrenal hormones mixed with oil are absorbed into the body from the intestinal tract and transported via chylomicrons (particles that transport fats throughout the body) through the lymphatic system. This allows the hormones to avoid extensive destruction by the liver on their first pass through the body, and may increase the amount of drug available for use by the body. Some criticize using capsules with hormones orally, citing that the hormones are broken down by stomach acids. This is true of hormones that are protein-based, but not those that are related to cholesterol like most sex and adrenal hormones.

Progesterone taken orally in a capsule may cause drowsiness for some individuals. This occurs when progesterone is broken down by the body into other substances called metabolites. Some of these metabolites may have a sedative effect for some. Practitioners may deliberately prescribe progesterone at bedtime for patients having trouble falling asleep hoping the patient experiences the drowsy effect.

Capsules might not be a first choice for individuals who have problems with their digestive tract. However, because the hormones are dispersed in oil inside the capsule, a practitioner may direct their patients to open the capsule and use the hormones and oil directly on the skin.

Transdermal Dosage Forms

Hormones may be applied to the skin in creams, gels, ointments, lotions, sprays, and drops. Patches are also available commercially from drug manufacturers. Most transdermal dosage forms allow for multiple hormones to be combined together for ease of application. Transdermal dosage forms also allow the flexibility to use varying amounts of the medication to adjust the dose based on a practitioner’s directions.

The skin usually acts as a barrier that prevents substances from entering the body, but cholesterol-based hormones can travel through hair follicles and make it past the outer skin layer into the blood and tissues. A common misconception when dosing hormones transdermally is that the amount of hormone applied is the amount absorbed. It has been estimated that only 10-80% of the hormone applied in a cream is actually absorbed. With such a large range, it is easy to see why doses may vary for individual patients. Additionally, absorption through the skin may be compromised for people who have impaired blood flow to the skin, such as those diagnosed with hypothyroidism, or low thyroid function.

It can also make a difference where on the skin the hormones are applied. Hormones can easily get through hair follicles but very hairy areas could interfere with the dosage form coming into contact with the skin. The part of the body where the hormones are applied may have a higher temporary level of hormones available to the hormone receptors in that area. This can be important if treating a specific area such as the eyes or vaginal area.

When using transdermal dosage forms, it is important to take steps to ensure the hormones aren’t transferred to other individuals through direct (touch) or indirect (laundry, door handles, bedding) contact. Wash hands with soap and water after applying the medication and avoid person-to-person and person-to-pet contact with application sites.

Sublingual Dosage Forms

Sublingual dosage forms are placed under the tongue or between the cheek and gum to allow the hormones to be absorbed through the tissue of the mouth into the body. However, part of the dose should be considered to be an oral dose as it would be very difficult not to swallow any of the dose.

Sublingual use tends to raise the blood levels of the hormones quickly and to a higher level than the hormones delivered in oral capsules. Sometimes these enhanced levels are useful. Sublingual estradiol is sometimes used to rapidly relieve headaches triggered by low estrogen levels, and lozenges have been used 4-8 times daily to mimic the surges in testosterone that young men naturally experience throughout the day.

Lozenges and drops are examples of sublingual dosage forms. Lozenges are prepared by placing hormones in a tablet like form that dissolves easily in the mouth. Drops are made by suspending or dissolving the hormone powder in an edible oil or other liquid. Drops can be used under the tongue or on the skin. It is important to shake the drops vigorously before use so the hormones are evenly distributed.

The drop dosage form is ideal for very sensitive patients because the hormones can be suspended in an edible oil with no other ingredients added. One can determine if the hormone itself is presenting an issue or if it is the presence of other ingredients. Taste can be an issue when using sublingual dosage forms; however, compounding pharmacies can help by adding flavors and/or sweeteners if desired.

Vaginal or Rectal Dosage Forms

Hormones may be inserted vaginally or rectally in suppositories, capsules, creams and gels. The vaginal and rectal routes can be used to distribute the hormones throughout the entire body, but may also be used when a direct effect is desired at the site of application. For example, the rectal route may be used to relieve hemorrhoid symptoms and the vaginal route may be used to relieve symptoms of vaginal atrophy and dryness.


For many people, any one of the dosage forms described above will work well, and the deciding factor is purely preference. Others—whether due to sensitivities, absorption issues, or something else—may need to try a number of dosage forms before finding the one that works best for them. Women’s International Pharmacy is here to help patients and practitioners sort through the options and make the best choice for each individual.

  • Arafat ES, et al. Sedative and hypnotic effects of oral administration of micronized progesterone may be mediated through its metabolites. Am J Obstet Gynecol. 1988 Nov;159(5):1203-9.
  • Maxson WS, Hargrove JT. Bioavailability of oral micronized progesterone. Fertil Steril. 1985 Nov;44(5):622-6.
  • Järvinen A, et al. Steady-state pharmacokinetics of oestradiol gel in post-menopausal women: effects of application area and washing. Br J Obstet Gynaecol. 1997 Nov;104 Suppl 16:14-8.
  • Hargrove JT, Maxson WS, Wentz AC. Absorption of oral progesterone is influenced by vehicle and particle size. Am J Obstet Gynecol. 1989 Oct;161:948-51.
  • McCormick K. Hormone Testing. Women’s International Pharmacy.
Choosing a Dosage Form for Compounded BHRT 2017-12-12T15:31:40+00:00

Medication Disposal Tips

Medication Disposal Tips

Written by Kathy Lynch, PharmD– Women’s International Pharmacy


April is the time of year when our thoughts turn to spring. Earth Day was first celebrated on April 22, 1970. Forty-five years later, it continues to be a time when we focus our attention on the earth and the protection of our environment, including our groundwater. Waste water treatment plants are not effective in keeping medications from polluting our water system.

Drug disposal options expanded last fall when the US Congress amended the Controlled Substances Act of 2010. People who have unused or expired controlled substances, as well as other oral or topical medications, and OTCs including vitamins, may now return them to their local pharmacy, clinic, or any other agency that has a medication disposal program in place. The Drug Enforcement Administration (DEA) also changed the rules so that people may mail-in unwanted medications to collectors that destroy the drugs by incineration which is the disposal method of choice. The DEA used to sponsor national medication take-back events twice a year but is now shifting that responsibility to local communities.

If an individual’s current pharmacy does not have a drug disposal program, call your local police department or go to their website. You can also search for local community programs by using the terms “medication drop boxes,” “medication disposal,” or “safe community programs.” If there isn’t a program near you, follow government guidelines for medication disposal (FDA Regulations and USEPA)

Women’s International Pharmacy jars, topiclicks, vials, lids, dropper bottles, and droppers are recycle number 5. Tubes are number 41. Please follow your service area’s guidelines when recycling medication containers. Keep in mind Women’s International Pharmacy does not accept medicines for disposal and suggests you follow the federal guidelines.

Medication Disposal Tips 2017-12-15T11:20:41+00:00

Compounded Thyroid Medication Options

Compounded Thyroid Medication Options

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


People with low thyroid function often turn to compounders in their search for additive-free thyroid medications. Many are sensitive to the fillers and binders used in the manufacturing of compressed thyroid tablet formulations. Patients with autoimmune thyroid problems, for example, may respond better to corn-free thyroid preparations. Others with lactose intolerance will want thyroid medications that are lactose-free.

Women’s International Pharmacy has been compounding thyroid capsules in a variety of oils for years. We are able to compound liothyronine (T3) and levothyroxine (T4) as separate compounds, or in combination with each other. These bioidentical thyroid hormones are synthesized in the laboratory from a non-animal source. They contain T3, T4, or both, compounded with a small amount of oil (usually olive) and encapsulated in gelatin capsules, with vegetarian or dye-free options.

We also compound desiccated porcine thyroid capsules in much the same manner. Desiccated porcine thyroid powder (lactose-free) contains a fixed ratio of T3 to T4. Each powder lot comes with a certificate of analysis for the concentration of T3 and T4.

All compounded medications require a prescription from a licensed medical practitioner. If you are interested in compounded thyroid hormone capsules, feel free to call and speak with one of our many knowledgeable pharmacists.

Compounded Thyroid Medication Options 2017-12-08T15:17:34+00:00