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Certain hormone preparations (including estradiol and progesterone), have been tested by the FDA and are available commercially by prescription. Other "compounded" hormone preparations contain customized combinations of different hormones that are individually prepared by pharmacists. Although some physicians consider these compounded hormones to be safer than commercial preparations, this has not been demonstrated by scientific research. Risks may be associated with compounded hormones, which are unregulated substances, they are neither tested nor approved by the FDA. Compounded preparation methods vary from one pharmacist to another, and from one pharmacy to another, so compounds, even repeated compounds of the same prescription, may differ. Some custom-compounded preparations are not covered by insurance plans. Custom-compounded hormones may provide certain benefits, allowing individualized doses and mixtures of different hormones that are unavailable in commercial products. In contrast with FDA-approved preparations, custom-compounded HRT preparations are often not covered by health insurance—patients must pay for these out-of-pocket. Anecdotally, some women who have posted on the FORCE message board reported that they found pharmacist-compounded hormone preparations to more effectively relieve their menopausal symptoms than commercial preparations.
Some health care providers periodically use saliva tests to measure the overall level of hormones in patients who use compounded hormones. Such testing is not necessary, and in fact, it has been found to be unreliable.
One assessment of previous research that compared hormone types determined that study conclusions were compromised because the research efforts were too small or designed poorly. Study authors suggested that not enough conclusive evidence was produced to recommend bio-identical hormones over conventional hormones.
The North American Menopause Society (NAMS), a professional organization devoted to promoting women's health and quality of life through an understanding of menopause, published a position statement on compounded hormone replacement. For most women, NAMS does not recommend custom-compounded products over well-tested, government-approved products. Nor does the Society recommend saliva testing to determine hormone levels.