Menopause is when your periods stop permanently and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row. After menopause, your ovaries make very low levels of the hormones estrogen and progesterone. These low hormone levels can raise your risk for certain health problems. 

Menopause is a normal part of a woman's life. It is sometimes called "the change of life." Menopause does not happen all at once. As your body transitions to menopause over several years, you may have menopause symptoms and irregular periods. The average age for menopause in the United States is 52. The range for women is usually between 45 to 58. One way to tell when you might go through menopause is the age your mother went through it.

Hot flashes are often described as the sudden feeling of warmth spreading through your upper body. They are triggered by small elevations in core body temperature. Hot flashes are most commonly felt over the face, neck, and chest, while your skin may become red, or blotchy. This is most commonly caused by lowering estrogen levels due to menopause.

About 75% of all women have these periodic fluctuations in their body temperature. Hot flashes usually last for 1 to 5 minutes, with some lasting as long as an hour. The average duration of symptoms is between 5 and 10 years, with some lasting as long as 20 years. In one U.S. study, 87% of the women reported daily hot flashes and about a third of those reported more than 10 per day. Hot flashes may begin several years before menopause. African-American women reported an average of 10 years of hot flashes, the longest of any ethnicity in the study.

Based on research and patient testimonials, it usually takes 4 to 6 weeks before you will feel the initial benefits and up to 3 months to feel the full effects of HRT; however, each patient is unique and time frames may differ. It may also take your body time to get used to it. When treatment begins you may experience side effects such as breast tenderness, nausea and leg cramps. Usually these side effects will dissipate within 6 to 8 weeks.

Vaginal tissues are sensitive to estrogen, and the loss of estrogen that occurs during menopausal transition can render these tissues fragile and cause thinning, drying and inflammation. Researchers say nearly 50% of women develop symptoms related to vaginal atrophy within a few years of menopause. Although menopause is the most common cause, vaginal atrophy may result from anything that lowers estrogen production including; chemotherapy, radiation, certain medications and surgical hysterectomy. Unlike vasomotor symptoms, vaginal atrophy does not improve over time without treatment.

Signs and symptoms may include:

• Vaginal dryness

• Vaginal burning

• Vaginal discharge

• Genital itching

• Burning with urination

• Urgency with urination

• Frequent urination

• Recurrent urinary tract infections

• Urinary incontinence

• Light bleeding after intercourse

• Discomfort with intercourse

• Decreased vaginal lubrication during sexual activity

• Shortening and tightening of the vaginal canal

Vaginal dryness

Multiple studies confirm that about 27% to 60% of women report moderate to severe symptoms of vaginal dryness in association with menopause. Furthermore, the urinary tract contains estrogen receptors in the urethra and bladder, and as the loss of estrogen becomes evident, patients may experience urinary tract infections. 

Dyspareunia

Dyspareunia, painful intercourse, is one of the most common symptoms of postmenopause. According to the American College of Obstetricians and Gynecologists around 75% of women experience painful intercourse at some time.

Based on research and patient testimonials, it usually takes 2 to 3 weeks before you will feel the initial benefits of vaginal treatment; however, each patient is unique and time frames may differ. It may also take your body time to get used to it.

Female sexual dysfunction (FSD) becomes more prevalent as women age, affecting nearly 40% of women. Common symptoms associated with FSD include diminished vaginal lubrication, pain and discomfort upon intercourse, decreased sense of arousal and difficulty in achieving orgasm. Only a small percentage of women seek medical attention. 

The only way to know if your hormones are in balance is to test them. You can either have your hormone levels tested at your next office visit or order an at-home test. We recommend having the following hormone levels tested: 

• Estradiol

• Progesterone

• Total Testosterone

• Free Testosterone

• DHEA-S

• FSH

• LH

• TSH

• Free T3

• Free T4

Different Testing Methodologies

Serum Testing is a broadly accepted method for measuring hormones and other analytes that circulate in the bloodstream.

Suitable for:

• · Assessing total circulating endogenous hormone levels (free plus protein-bound)

• · Monitoring hormone replacement therapy (sublingual, patch, pellet)

• · Assessing thyroid health

• · Assessing analytes that cannot be determined in dried blood spot, e.g., ferritin

Not suitable for:

• · Monitoring topical hormone replacement therapy (underestimates tissue uptake)

Dried Blood Spot Testing is ideal for measuring hormones and other analytes such as insulin, blood lipids, Vitamin D, thyroid hormones, and elements like lead and magnesium. Blood spot testing gives results equivalent to serum but with distinct advantages over serum testing for monitoring topical and vaginal hormone supplementation.

Suitable for:

• · Assessing total circulating hormone levels (free plus protein-bound)

• · Patients with dry mouth and/or children who may have difficulty collecting saliva

• · Monitoring hormone replacement therapy (oral, sublingual, pellet)

• · Assessing thyroid health, fertility parameters, and cardiometabolic risk factors

• · Self-collection of sample at home at a time convenient to the patient and avoiding a trip to the phlebotomist

Saliva Testing identifies bioavailable hormone levels – the active quantity that's free to move into body tissue. 

Suitable for:

• · Assessing “free” (unbound to carrier proteins) hormone levels

• · Monitoring hormone replacement given orally, topically, vaginally or via pellets

• · Collecting multiple samples during a day, e.g., determining diurnal cortisol levels for adrenal stress assessment

Not suitable for:

• · Monitoring sublingual/troche hormone replacement

• · Patients with dry mouth, e.g., due to Sjögren’s Syndrome

One size doesn’t fit all and every patient is unique. Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of a patient by a pharmacist as the result of a practitioner’s prescription drug order. While compounded medications are not FDA-approved, they serve an important patient need—especially when FDA-approved medication is not available for treatment. Our formulations are made to order in small batches to ensure freshness. The specific ingredients in your compounded formula will depend on your specific concerns and goals. It should be understood that your personal healthcare practitioner will make the final decision.

Yes! All of our compounded formulations, regardless of ingredients, are eligible for Flexible Spending Accounts (FSA) and Health Saving Accounts (HSA). 

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• AskMayoExpert. Sexual dysfunction in women. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

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• Vyleesi (prescribing information). Waltham, Mass.: AMAG Pharmaceuticals, Inc.; 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/210557s000lbl.pdf. Accessed Dec. 9, 2020.

All prescription medications require a valid and complete online consultation prior to approval and final pricing is determined. All compounded medications in the U.S. are considered off-label use. Licensed healthcare practitioners have the ability to prescribe compounds for off-label treatment, if they believe that it is an appropriate course of treatment.

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Premier Pharmacy does not make any guarantees regarding the drug and medical information, and does not assume responsibility regarding the content. The drug safety and drug information contained on the website may be time sensitive and should not be utilized as a medical reference beyond the date hereof. The deficiency of a warning for prescription medications and vitamins provided on this website in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. 

If you have questions or concerns about your medications, please do not hesitate to contact us and/or your medical practitioner, including your pharmacist. Compound prescription products have not been tested or approved by the FDA for their intended use. No claims are made as to the safety, efficacy or use of this compound.