Customizing Women’s Healthcare with Compounded Medications: Part 3

by | May 3, 2023

Welcome to the final installment of our blog series on compounded medications for women’s healthcare. Throughout the past two months, we’ve explored an array of female health conditions and how compounded medications can offer a personalized approach to treatment.

Today, we’re turning our attention to menstrual health and the various ways compounding can provide unique solutions to related challenges. But that’s not all – we’ll also delve into compounding options for health concerns like shingles, nail fungus, rosacea, and weight gain.

Menstrual and Hormonal Headaches

Many women suffer from headaches that are linked to hormonal fluctuations. For example, some women experience a new onset of headaches or an increase around menarche, starting or stopping birth control, and during perimenopause. These hormonal headaches can be persistent, occurring monthly with each period.

Symptoms of menstrual migraines include throbbing pain on one side of the head, aura, sensitivity to sound, light, and smell, nausea, and vomiting. Migraines are primarily a nervous system dysfunction, with estrogen often playing a significant role in migraines during periods. Therefore, a sudden decline in estrogen before menstruation can cause migraines, which can be alleviated by using a low-dose estradiol patch or Bi-Est to even out the dropping estradiol levels. In addition, adding progesterone during the luteal phase can help balance estradiol/progesterone levels and lessen migraine pain.

Other options to consider include:

  • Biest 80/20 0.2mg – 0.4mg
  • Progesterone 50mg-100mg capsules
  • Progesterone 20mg cream

Painful Periods

When progesterone levels decline during the monthly cycle, prostaglandins increase, causing inflammation, pain sensitization, vasoconstriction, and uterine contraction.

If the patient’s progesterone is low and they are estrogen dominant, progesterone supplementation can offer relief of painful menstrual cramps by balancing the estrogen levels.
Progesterone cream can be applied to the skin on days 15-26 of the cycle. Transdermal Ibuprofen in Lipoderm can also be effective when applied to the area of cramping 2-3 times per day, as it penetrates the drug deep into the dermal layers of the skin for better efficacy.


Shingles, also known as herpes zoster, is a painful viral condition that causes a skin rash with blisters in a localized area. Tingling, itching, and pain can occur 2-4 days before the rash appears. However, resulting nerve pain, known as “post-herpatic” pain, can be expected after the initial outbreak.

Compounding offers a multi-medication approach to address shingles pain. A formula containing Gabapentin 5%, Amitriptyline 2%, Ketoprofen 5%, and Lidocaine 5% or Tetracaine 2% can provide relief for patients. However, it is essential to note that it should not be applied to active lesions.

Nail Fungus

Nail fungus is common among women and oral antifungals often have undesirable side effects. A better option is topical antifungal treatments, although these can be challenging to deliver through the nail surface.

Compounding pharmacies can offer solutions, such as incorporating penetration enhancers like DMSO, pretreatment with urea to increase nail porosity, and adjunctive agents like ibuprofen to improve antifungal effectiveness. A typical compounded treatment includes Fluconazole 3%-Ibuprofen 2%-Tea Tree Oil-1% in DMSO Nail Polish applied twice daily, and Urea 40% Nail Gel applied daily to the affected nails.


Rosacea is a skin condition that affects many women during their hormonal years, characterized by red or pink facial skin, dilated blood vessels, and small red bumps.

Various topical gels and creams are available to address the symptoms of rosacea. Metronidazole 1% + Niacinamide 4% topical gel, Azelaic Acid 15% + Metronidazole 1% topical gel, and Ivermectin 1% + Niacinamide 4% topical cream are some of the options for rosacea treatment. Apply a pea-sized amount of the chosen product daily for optimal results.

Weight Gain

Our hormones play a crucial role in regulating our weight, metabolism, blood sugar, insulin, and fat storage patterns. As we get older, changes in hormone levels can lead to a variety of imbalances, such as unexplained weight gain, that can affect our overall health and well-being.

Common reasons for hormonal weight gain:

  • High Estrogen – weight gain in hips and thighs, water retention, sluggish metabolism
  • Low Testosterone or DHEA – abdominal obesity, decreased lean muscle and increased body fat, decreased metabolic rate,
  • High Cortisol – insomnia, anxiety, sugar cravings, increased belly fat, feeling “tired but wired.”
  • Low Cortisol – low energy, chronic fatigue, low immune reserves, food and sugar cravings, poor exercise tolerance or recovery,
  • Vitamin D3 deficiency – hyperinsulinemia, increased belly fat
  • High TSH – hypothyroidism, low metabolic rate, obesity
  • High Insulin – insulin resistance, metabolic syndrome, abdominal obesity
  • High HbA1c – predictive of type 2 diabetes or pre-diabetes
  • High C-reactive protein – predictive of high inflammation in the body contributing to weight gain

Some compounding options for weight loss include Phentermine, Naltrexone, chromium, and vitamin B12.

Always More to Learn

In conclusion, compounded medications offer a personalized approach to treatment for women’s healthcare. They can provide unique solutions to menstrual-related challenges, as well as other health issues. By working with a compounding pharmacy and healthcare provider, patients can receive customized treatment that addresses their specific needs and concerns.

It’s important to note that the information provided in this blog post is part of a Master’s Level Training available to providers in the BHRT Provider Training Academy. Through this comprehensive training program, providers can learn how to effectively prescribe and manage compounded medications for their patients.

If you’re interested in learning more about compounding and how it can benefit your patients, schedule a call with our Provider Education Specialist today.

With expert instructors and a focus on practical, evidence-based training, this program is an excellent resource for healthcare providers looking to improve patient outcomes and enhance their practice.

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