Hormone replacement therapy (HRT) is most often used to treat menopausal symptoms. Typical symptoms of menopause would include hot flushes, vaginal dryness, low libido, weight gain, irritability, moodiness and sleep disturbances. Women have traditionally used synthetic estrogen to treat menopausal symptoms and to help protect against osteoporosis. A second option now, lies in the use of bio-identical HRT through the use of plant-derived hormones that are biologically identical to mimic hormones naturally occurring in women.

Bio-identical HRT is however, not limited solely to the treatment of menopause and can also be used to treat or alleviate symptoms of endometriosis, Pre-Menstrual Syndrome, weight gain, low libido or fibrocystic breast disease.

A simple look at physiological functioning would reveal that no two women are exactly alike! The value of bio-identical hormone replacement therapy is that it can be adapted to fit individual body and hormone levels. Such hormones can be made in a variety of strengths and dosage forms beyond the commercially available synthetic hormones. Commonly replaced hormones include estradiol, estrone, estriol, progesterone and testosterone.

Formulations of bio-identical hormones include capsules, topical creams and gels, pessaries and sublingual troches or lozenges.

Replacement routes include:

	Creams and gels that are absorbed through the skin
	Troches (medicated lozenges available in different flavours) that are absorbed through the buccal mucosa
	Capsules of micronized hormones that are taken orally
	Vaginal pessaries

With the help of a doctor and a compounding pharmacist, a woman can start and maintain a bio-identical hormone replacement regimen that closely mimics what her body has been doing naturally for years.

In tailoring the regimen, symptoms are a simple way of gauging the adequacy of the hormone replacement therapy. Blood or salivary hormone testing ensures that the replacement therapy is not excessive and that the body is metabolizing the hormones well, so as to reduce the likelihood of side effects.

Although the aging of skin cannot be halted, it can however, be slowed. The effects of aging that are directly related to the skin are often treatable. Recent advances have identified many of the factors that cause wrinkling and loss of skin elasticity that arise with age. Such factors include exposure to the sun, cold environments, windy conditions, smoking, fatigue, stress, poor nutrition as well as environmental irritants like soaps and detergents. Prolonged exposure to these without protection is a recipe for accelerated skin aging.

While it is not possible to avoid every form of skin insult, many can be avoided or protected against regularly through the use of appropriate clothing, sunscreens and moisturizers among others. To further slow the clock, skin that has begun to age can now be rejuvenated through the use of novel biocosmetic products.

Biocosmetics combines the best of pharmaceuticals and cosmetics to create novel formulations in dermatological therapy. Pharmaceuticals including estriol, hydroquinone, vitamin A, hyaluronic acid, glycolic acid and kojic acid can be combined with traditional cosmetic ingredients like vitamins C and E, squalene and tea tree or evening primrose oil among others.

Skin types vary between individuals and the exact nature of each is as varied as the features that make each person’s face unique. A doctor’s analysis can identify oily, dry or dehydrated skin as well as locate trouble spots and areas of skin damage. The compounding pharmacist can then formulate the prescribed therapy with an appropriate cream base to suit the skin condition.

The great thing about customizing biocosmetic creams for use, is that skin irritations, rashes, redness and inflammation are all significantly reduced when compared with the use of mass-produced products. Biocosmetic creams are often used to sooth dry cracked skin, improve moisturization as well as to treat blemishes and other problem areas. Importantly, they go a long way in protecting the skin from the harmful external forces that contribute to aging.

Chronic pain can often be a formidable hurdle for patients and their treating doctors in the leap towards better health outcomes. Therapeutic options are often limited and patients can experience distress due to inadequate or inconsistent relief. The pain that results from arthritis, fibromyalgia, migraine headaches and nerve and muscle pain does not have to be a regular occurrence. The solution may very well lie in customized therapy.

Pain comes in many different forms and is experienced and described differently by different patients. Thresholds for pain may vary between patients and even for an individual patient, depending on the time of day or precipitating causes among others.

Commonly prescribed oral pain relief medication that contains NSAIDs can result in stomach irritation and other unwanted side effects. Compounding on the other hand, can provide alternate methods of delivery by combining the ingredients of traditional oral pain medications in the form of a topical gel, cream, or spray that can be applied directly to the site of the pain. A good example is treating migraine through the use of nasal sprays or flavored troches or lozenges. These dosage forms escape breakdown in the gut, providing optimal results with less gastric irritation.

A variety of medication is often prescribed to counter all the symptoms associated with a condition like fibromyalgia. This sort of polypharmacy is replaceable by the use of a single specially prepared topical gel. This formulation can combine several medications to be applied directly to the affected areas.

A one-size-fits-all cream often does not provide the appropriate strength of active ingredients to treat the condition. The result is that such creams end up being applied more frequently or used excessively, thereby increasing the potential for unwanted side effects. These problems should not have to be contended with when we have the ability to make customized formulations that achieve the standards of both efficacy and safety in single preparations for tailored use.

Children are especially suited for custom compounded prescriptions because commercially manufactured dosage forms do not often provide the best solution for them. This can be due to difficulty in swallowing the oral medication, small volumes required with some formulations or even the taste of the medication leading to non-compliance.

In collaboration with a paediatrician, a compounding pharmacist can avail a host of formulations for children in treating pain and conditions like respiratory disorders, oral thrush, head lice, nappy rash, skin disorders, cold sores or fever blisters and many more.

The child who refuses to take his or her medicine because of the taste is a definite candidate for compounded medication therapy. Dozens of flavours are available to compounding pharmacists, who can enhance both the taste and the colour of a medication while ensuring that the flavour’s pH is compatible with the medication’s properties. A child would probably enjoy taking their medication if it tastes like bubblegum or even chocolate.

Many children have a difficult time swallowing capsules or tablets, especially if they have to take more than one medication during the day. The compounding pharmacist can, at the request of the child’s paediatrician, develop and prepare medications in alternate dosage forms that facilitate compliance. These include lollipops, chewable lozenges, syrups, suspensions, ice blocks, transdermal gels and even pacifier dosages for infants.

The best part about the oral ones is that they can be administered in any number of great flavours!

Dentists especially benefit from the use of compounded medication because so many of the commercial preparations do not cater to the specific requirements of dental procedures. Such requirements can be partially met by the onsite mixing of commercial preparations. Successful therapy however, is much more assured through professional compounding to produce tailored formulations.

Compounded formulations benefit dental practitioners of all specialties. These include general dentists, endodontists, pedodontists, periodontists, oral and maxillofacial surgeons, orthodontists and prosthodontists among others.

Dental procedures that successfully employ the use of compounded medication include burning mouth syndrome, candidiasis, canker sores, cold sores, dry sockets, the gag reflex, halitosis, dental-related neuropathic pain conditions, root canal and temporomandibular joint syndrome among others. Compounded medication is also useful in treating xerostomia and even supports the cosmetic whitening of teeth without excessive enamel erosion.

Compounding can allow a dentist to incorporate analgesics, antivirals, antibiotics, topical anesthetics and sedatives in various formulations to make dry socket mixtures, root canal pastes, plaque removal solutions, plaque disclosure solutions, oral rinses, adhesives, bleaching gels and crown preparations among others.

More endearing than a great smile from a patient, is sometimes the cheerful grin of a dentist upon successful therapy. Products that facilitate dental procedures include mouthwashes, suckers, lip balms and creams, topical gels, ointments, topical anesthetics, anesthetic sprays, caustics, mucosal bandages, bleaching aids, troches and anti-inflammatory or analgesic sprays. Each of these can be formulated with specific active ingredients to support successful dental treatment that brings out the smiles!

Medication for animals, while having potential similarity with medication designed for us, often differs from ours by dosing and dosage forms. The preparation of a pet’s medication, for example, can benefit immensely from compounding!