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Short answer: start by asking for FDA‑approved (traditional) HRT first — it’s standardized, regulated, and has better safety/quality data. Consider compounded “bioidentical” HRT (BHRT) only if you and a knowledgeable clinician decide you need a custom dose or formulation that approved products don’t provide — and if you do, use an accredited compounding pharmacy and a specialist who understands the limits and risks.
Why, in plain terms
- Traditional (FDA‑approved) HRT: products (estradiol, micronized progesterone) are manufactured and tested for quality and studied for benefits/risks. Dosing and monitoring are standardized and usually covered by insurance.
- Compounded BHRT: often promoted as “natural” and customized, but compounded hormones are not reviewed by the FDA for safety or efficacy, can have variable potency, and have limited long‑term outcome data. They can be appropriate when a specific dose/route isn’t commercially available, but require extra caution.
Specific products and services to ask about (and why)
- Estradiol patches: Climara, Vivelle‑Dot — steady transdermal delivery; transdermal estrogen is commonly used and in many studies linked to a lower risk of blood clots than oral estrogen.
- Oral estradiol: Estrace — a standard, FDA‑approved oral estradiol option.
- Vaginal estrogen for local symptoms: Estring (vaginal ring) or vaginal creams/tablets — effective for vaginal dryness/urgency without high systemic exposure.
- Micronized progesterone: Prometrium — an FDA‑approved “body‑identical” progesterone option often preferred over synthetic progestins for some women.
- Testosterone for women: there are effectively no widely used FDA‑approved testosterone products for postmenopausal women in the U.S.; some clinicians prescribe off‑label low doses or use compounded testosterone. Approach cautiously and discuss risks/monitoring.
If you are considering BHRT (compounded)
- Compounding pharmacies to consider: Wedgewood Pharmacy is a large, well‑known compounding pharmacy used by many BHRT prescribers. Only use pharmacies that are PCAB accredited (or meet USP compounding standards) and that provide Certificates of Analysis (COA) and batch testing.
- Pellet therapy providers: BioTE (pellets) is a well‑known commercial program offering subdermal pellets; note pellets are controversial — they’re convenient but harder to titrate and have less robust safety/outcomes data.
Where to go / who to see
- Start with a clinician experienced in menopause care: a gynecologist, an endocrinologist, or a primary care doctor trained in menopause. Look for clinicians who are certified or have training from the North American Menopause Society (NAMS) or who advertise menopause/HRT expertise.
- Telemedicine/menopause clinics that offer expert consultations and prescriptions: Gennev (menopause telehealth), Maven Clinic (women’s/men’s health telemedicine with practitioners who may manage HRT). These can be convenient for follow‑up and symptom management.
- If you choose compounded BHRT, ask your prescriber which compounding pharmacy they use and verify the pharmacy’s accreditation and testing procedures before filling.
Questions to ask your clinician and pharmacy
- “Are there FDA‑approved options that would meet my needs before considering compounded BHRT?”
- “What are the benefits and risks for my health history (blood clots, breast cancer risk, cardiac risk)?”
- “If you’re prescribing compounded hormones, which compounding pharmacy do you use, is it PCAB‑accredited, and can I see batch testing/COAs?”
- “How will you monitor me (symptoms, labs, follow‑up schedule) and what will trigger dose changes or stopping therapy?”
Bottom line Ask your clinician first about FDA‑approved HRT (patches, oral estradiol, vaginal options, and micronized progesterone like Prometrium). If an approved option isn’t suitable and you want a “bioidentical” compounded formulation, use an experienced menopause clinician and an accredited compounding pharmacy (e.g., Wedgewood or another PCAB‑accredited pharmacy), and get clear informed consent and monitoring. If you’d like, tell me your age, symptoms, and any relevant medical history and I can suggest specific questions to bring to your appointment.