The Truth About Compounded Meds: What Women Deserve to Know

Why we need to have this conversation

Since supporting women in their perimenopause and menopause years has quickly shifted into “big business,” the conversations on social media and in the press are louder than ever, often at odds with each other, and ultimately drive fear and chaos.

Not only was the debate “is hormone therapy good or bad for you” but it also extended into who makes the product—“big pharma” vs. compounding pharmacies. The “weight loss” medication shortage further fueled this debate.

It’s hard to make informed choices when the messaging is chaotic. I wanted to step back and take a more grounded, even voice—cutting through the noise of headlines, social media, and clickbait to focus on what women actually need to know.

And while this conversation often centers around menopause, many women use compounded medications for a range of issues—from PCOS to progesterone intolerance to vulvar conditions. The stakes go well beyond hot flashes.

Millions of women are using compounded hormones—often because they haven’t found success with other options. And yet, these medications aren’t FDA-approved, don’t follow the same quality controls as FDA-approved drugs, and are almost never covered by insurance.

So why are they so common?

To answer that, we have to look at both the clinical gaps and the structural problems that drive people toward compounded medications—not just in menopause care, but in other fast-evolving areas like GLP-1 therapies.

What Is Compounding—and When Does It Make Sense?

Compounding exists to fill a real need. If a patient can’t swallow pills, needs a lower dose than what’s commercially available, or has an allergy to a dye or filler, a compounding pharmacy can make a custom version of a drug. There are scenarios where this makes a meaningful difference in care.

We saw this clearly during the national GLP-1 shortages. When drugs like Ozempic and Wegovy were unavailable, the FDA permitted compounding pharmacies to make semaglutide formulations. But that permission was temporary—tied directly to the shortage—and yet, many pharmacies continued offering versions of semaglutide even after supply stabilized.

That shift created a gray zone. Some compounds were made with salt-based versions of semaglutide (sodium or acetate), which are not the same as what the FDA originally approved. In many cases, patients were unaware of the difference. Some were unaware they were taking a compounded product at all. This was outlined in FDA public guidance (see: FDA Compounding Inspections & Recalls).

This mirrors the situation in women’s health.

The Rise of Compounded Hormones in Menopause Care

An estimated 1 to 2.5 million women in the U.S. over the age of 40 are using compounded hormones (Pinkerton JV et al., Menopause. 2015). Many say they’ve tried everything else—patches, pills, rings—and found compounded creams or pellets to be the only tolerable option. Others are told that compounding allows for more “precise” dosing or bioidentical formulations tailored to their hormone levels.

But here’s the reality:

• Compounded hormones are not FDA-approved

• There’s no standardized quality control

• The dose absorbed can vary from what was prescribed

That doesn’t mean these products never help anyone. It means we can’t assume they work the way we’re told they do—and we can’t evaluate their safety the way we do with FDA-approved drugs.

Trust, Marketing, and the Illusion of Customization

The conversation gets more complicated when we look at how compounded products are marketed. Patients are often told their hormones are “bioidentical,” a term that sounds scientific but has no clinical meaning. In fact, FDA-approved transdermal estradiol and oral progesterone are also bioidentical—and undergo rigorous testing for safety and absorption.

The difference is not in the hormone itself but in the process. Pharmaceutical products are manufactured in controlled environments, batch-tested, and traceable by lot number. If something goes wrong, it can be tracked. That’s not the case with compounded meds, where each batch is small and testing is minimal or nonexistent.

Some providers also promote hormone testing—via blood, urine, or saliva—as a way to individualize dosing. But most professional societies, including The Endocrine Society, do not recommend this practice. The testing doesn’t meaningfully correlate with symptom management, and it often creates a false sense of precision.

The Bigger Problem: A System That Leaves Patients Scrambling

If there were more FDA-approved options, better education for providers, and consistent insurance coverage for guideline-based care, perhaps fewer women would turn to compounding. But that’s not our reality.

Insurance plans don’t always cover FDA-approved hormone therapy. Many OB-GYNs, especially those treating mid-life women, are no longer in-network. Some patients are left with few options that feel accessible, affordable, or effective. So they turn to what’s available: compounded solutions, even if the evidence is shaky.

The same situation exists for GLP-1 medications. When access breaks down—whether due to shortages, cost, or demand—patients look elsewhere. And in those moments, the lines between personalized care, systemic failure, and opportunistic marketing start to blur.

On Reddit, many women echo this tension. One wrote, "My doctor warned me away from compounded hormones because the dosing can be unpredictable… I didn’t want to accidentally get too much testosterone." Another replied, "That is not true—now the compounding pharmacies use digital scales, and you can ask for the receipts." Others shared that compounded medications had been the only effective or tolerable option for them, especially after trying multiple formulations without success.

This mix of personal experience, uncertainty, and mistrust is what makes the conversation so charged—and so necessary.

So What Now?

This isn’t about telling women what to do. It’s about making sure they understand the trade-offs. Compounding can serve an important role when nothing else is available. But it should not be the default when FDA-approved options exist—or a workaround that becomes normalized simply because the system is broken.

If you’ve used compounded medications, I’d love to hear from you. What worked? What didn’t? What were you told—and what did you find out later?

Your story matters. Because the more we talk about this, the harder it becomes to ignore the gaps.

If you are interested in a deep dive on compounded hormone therapy, specifically, check out this 2024 article on Fear, misinformation, and pharmaceutical messianism in the promotion of compounded bioidentical hormone therapy.

📚 Sources

This post was informed by patient comments, Reddit threads, and medical reporting by clinicians like Dr. Jen Gunter. For further reading, see:

• 2022 Hormone Therapy Position Statement, North American Menopause Society (formerly NAMS)

• FDA actions on compounded drugs: https://www.fda.gov/drugs/human-drug-compounding/compounding-inspections-recalls-and-other-actions

• Pinkerton JV, Santoro N. Compounded bioidentical hormone therapy: identifying use trends and knowledge gaps among US women. Menopause. 2015 Sep;22(9):926-36. doi: 10.1097/GME.0000000000000420. PMID: 25692877; PMCID: PMC4547729.

• National Academies of Sciences. The Clinical Utility of Compounded Bioidentical Hormone Therapy (2020).

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