Hormone Replacement Therapy (HRT) Compounding

Menopause & Perimenopause Support

Also called perimenopause, menopause symptoms, hormone replacement therapy (HRT), bioidentical hormone therapy (BHRT)

Menopause and perimenopause bring cycle changes, hot flashes, and sleep trouble. When a provider prescribes a hormone preparation, Mixwell in Chino, CA prepares it to their exact order.

Reviewed by Linda Pungpravat, Compounding Pharmacist, RPh Mixwell Compounding Pharmacy, Chino, CA

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Signs people notice

  • Periods that come irregularly, or stop and start again
  • Hot flashes during the day
  • Night sweats that wake you up
  • Trouble falling asleep or staying asleep
  • Vaginal dryness, or discomfort during sex
  • Mood changes, irritability, or low mood
  • Trouble concentrating or remembering things
  • Heavier or longer periods during perimenopause

Clinical Overview

What are menopause and perimenopause?

Menopause is confirmed after 12 months with no menstrual period. Perimenopause is the stretch of time before that, when cycles turn irregular and hormone levels shift. Both can bring hot flashes, night sweats, and changes in sleep, mood, and vaginal comfort.

Who is more likely to have it

Everyone who menstruates reaches menopause, though the timing varies from person to person. It can arrive earlier after surgery that removes the ovaries, or after chemotherapy or radiation. Hot flashes and night sweats often begin during perimenopause, and they last an average of 7.4 years or longer [1].

Vaginal dryness and discomfort tend to appear later and often persist. Sleep loss and mood changes are common alongside them, and they affect daily life as much as the hot flashes do.

Why standard products do not always fit

Hormone products approved by the FDA come in set strengths and forms, and they suit most patients. Some patients cannot use them. A documented allergy to an ingredient in an approved product, or a need for a dosage form that is not made commercially, can leave a gap.

National reviews describe those two situations as the appropriate reasons for a prescriber to order a compounded hormone preparation rather than an approved product [2][3]. Compounded preparations are not reviewed by the FDA, and preference alone is not a reason to use one [3].

How Compounding Can Help

When an approved product does not fit and a provider prescribes a compounded preparation, a compounding pharmacy can prepare it in forms and strengths that are not made commercially.

  • Creams, capsules, troches, or vaginal suppositories, depending on what the prescriber orders
  • Strengths that are not available in a commercial product
  • Versions made without a dye, preservative, or excipient the patient reacts to
  • More than one hormone combined in a single preparation

National guidance limits compounded hormone preparations to patients with a documented allergy to an ingredient in an approved product, or a documented need for a different dosage form [2][3]. Your prescriber decides whether that applies to you.

Common Formulas Prescribers Order for This

Non-sterile oral capsules — a compoun...Estriol / Estradiol / Progesterone CapsulesTechnical details Non-sterile compounded vaginal suppos...Estriol / Progesterone Vaginal SuppositoryTechnical details Non-sterile vaginal preparation — est...Estriol Vaginal (Ellage)Technical details Non-sterile compounded oromucosal tro...Testosterone TrocheTechnical details Cream · TransdermalTestosterone Topical BHRT CreamA compounded testosterone cream, prepared in Chino, CA in the base a prescriber specifies. Testosterone is a Schedule...Technical details

Each formula is prepared only with a valid prescription. Your prescriber decides what is appropriate.

What to ask your provider

  • Is an FDA approved hormone product an option for me first?
  • Do I have an allergy or a dosing need that rules one out?
  • Would a cream, capsule, troche, or vaginal form suit me better?
  • Is saliva or urine hormone testing useful for setting my dose?
  • How will we monitor me while I use this?
  • How long should I stay on this before we reassess?
Call (909) 378-7301

Common Questions

Are compounded hormones safer than FDA approved hormones?

No. National reviews describe safety concerns with compounded hormone therapy, including limited regulation, dosing that can run high or low, and the absence of a label listing risks. Compounded preparations are not reviewed by the FDA. They exist for patients who cannot use an approved product, and that decision belongs to your prescriber.

When is a compounded hormone preparation appropriate?

National guidance points to two situations: a documented allergy to an ingredient in an FDA approved product, and a documented need for a dosage form that approved products do not offer. Preference alone is not one of them. Your provider documents the reason and writes the prescription, and Mixwell prepares it to that order.

Is saliva testing used to set hormone doses?

Saliva and urine hormone testing are considered unreliable for setting doses and are not recommended, and blood testing is rarely needed. Your provider decides what monitoring makes sense for you, based on your symptoms and history rather than on a test result alone.

References
  1. Faubion SS, Crandall CJ, Davis L, et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767 to 794. doi:10.1097/GME.0000000000002028
  2. [VERIFY VOLUME AND PAGES] American College of Obstetricians and Gynecologists. Updated guidance regarding the role of transvaginal ultrasonography in evaluating the endometrium of individuals with postmenopausal bleeding. Clinical Practice Update. Obstet Gynecol. 2026. doi:10.1097/AOG.0000000000006275
  3. National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. Washington, DC: National Academies Press; 2020. doi:10.17226/25791

Related Focus Areas

Vaginal Dryness After Menopause (GSM) SupportVaginal dryness, painful sex, and urinary symptoms after menopause are common and treatable. When a provide...Read more Men's Hormone Optimization SupportWhen a provider diagnoses low testosterone or manages hormone balance in men, Mixwell Compounding Pharmacy ...Read more

Compounded in Chino, CA. Delivered across California.

  • Chino
  • Chino Hills
  • Ontario
  • Pomona
  • Diamond Bar
  • Rancho Cucamonga
  • Eastvale
Mixwell Compounding Pharmacy 13788 Roswell Ave, Ste 158, Chino, CA 91710
(909) 378-7301

Mixwell is a state licensed, non sterile compounding pharmacy and a PCCA member, preparing each formula in a lab built to USP 795 and USP 800 standards. Compounded medications are not reviewed or approved by the FDA and are dispensed only with a valid prescription. We do not prepare sterile products or injectables. Nothing here promises a specific result, and compounded preparations are not presented as superior to commercially available products. Mixwell does not accept insurance. Call for pricing.

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