What it is
Compounded hormones are mixed in a pharmacy for one patient: creams, troches, or pellets placed under the skin. They skip FDA review, so no one verifies the dose in each batch or how much your body absorbs.
Pellets carry an extra problem. They often push hormone levels far above the normal range, and levels swing between insertions. Once a pellet is in, the dose cannot be adjusted, and removal is rarely practical.
The appeal is the word "bioidentical". But FDA-approved estradiol and micronized progesterone are the same molecules your ovaries made, with a verified dose in every patch and pill. That is what this practice prescribes.
What the evidence says
- Compounded hormone products are not FDA-reviewed for safety, dose accuracy, or absorption
- Dosing varies batch to batch: what the label says is not always what you get
- Pellets commonly produce hormone levels well above the normal range
- The Menopause Society advises against compounded hormones when an FDA-approved option exists
- No evidence shows compounded hormones are safer or more effective than FDA-approved ones
- FDA-approved, body-identical estradiol and progesterone already exist
How the switch works
- 1
Bring your records
Dr. Mueller reviews exactly what you take now and at what dose.
- 2
Check your levels
If you have pellets, a blood test shows where your levels sit.
- 3
Map the switch
She matches your regimen to an FDA-approved equivalent.
- 4
Time it right
Pellets are rarely removable, so the switch waits until they wear down.
- 5
Follow-up
At 8 to 12 weeks you review symptoms and fine-tune the dose.
Questions people ask
- Aren't bioidentical hormones more natural?
- "Bioidentical" just means the same molecule your ovaries made. FDA-approved estradiol and micronized progesterone are exactly that, with FDA review behind them.
- I am on pellets now. Can Dr. Mueller take over my care?
- Yes. Pellets are rarely removable, so she checks your levels, waits for them to fall, then switches you to an FDA-approved regimen.
- What is wrong with pellets?
- Doses often run far above the normal range, levels swing between insertions, and the dose cannot be adjusted once a pellet is in. The Menopause Society advises against them.
- Is compounded progesterone cream enough to protect my uterus?
- No one can say; absorption through skin is unreliable. With estrogen on board, your uterus needs a progesterone dose proven to protect it.
- Are compounded hormones ever appropriate?
- Rarely: for a documented allergy to an ingredient in every FDA-approved product. That is uncommon.