This article is Part I of a four-part educational series covering several commonly prescribed compounded BHRT medications. Stay tuned for the next installment: DHEA.
How Compounded Estradiol May Support Hormone Balance in BHRT
Bioidentical Hormone Replacement Therapy (BHRT) is an area of growing interest for women and healthcare professionals seeking individualized approaches to hormone health.
This five-part blog series by Health Dimensions Clinical Pharmacy explores key hormones commonly included in BHRT protocols. In Part 1, we focus on estradiol, a form of estrogen often compounded into various formats, including estradiol cream.
Compounded Estradiol Formulations
At Health Dimensions Clinical Pharmacy, we prepare customized estradiol formulations — such as estradiol cream, capsules, troches, and more — based on prescriber specifications. We create these compounded options in response to individual needs as assessed by a licensed healthcare provider.
What Is Estradiol?
Estradiol (E2) is one of the three primary estrogens in the body, alongside estrone (E1) and estriol (E3). It is generally the predominant estrogen during the reproductive years.
Estradiol may be considered by healthcare providers when addressing hormone-related changes that can occur during perimenopause, menopause, or after surgical procedures. While each patient’s experience is unique, estradiol is one hormone that may be included in a BHRT plan if clinically appropriate.
Some of the most commonly reported menopausal symptoms that compounded estradiol may help alleviate include:
Estradiol and Vasomotor Symptom Relief
Hot flashes and night sweats are hallmark complaints during menopause, often disrupting sleep and daily functioning. Estradiol has been shown to significantly reduce the frequency and severity of these episodes.
Related study:
Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial.
Demonstrated that low-dose estradiol spray significantly reduces vasomotor symptoms in postmenopausal women, reinforcing the therapeutic viability of compounded estradiol formulations for individualized hormone replacement therapy.
Vaginal and Urinary Symptoms
Vaginal dryness, vulvovaginal atrophy, painful intercourse (dyspareunia), and recurrent urinary discomfort or infections are often the result of estrogen depletion in local tissues. Topical or systemic estradiol may help restore moisture, elasticity, and tissue health.
Related study:
Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet
The study found that low-dose estradiol delivered via vaginal ring or tablet significantly improved vaginal tissue health, reducing symptoms like dryness and irritation in postmenopausal women. These results support the use of local estradiol therapy for genitourinary symptoms of menopause with minimal systemic absorption.
Skin and Musculoskeletal Changes
Estrogen plays a role in collagen production and bone density. Compounded estradiol may help slow skin thinning and contribute to the prevention of osteoporosis, especially when prescribed as part of a broader hormone therapy strategy.
Related study:
Endogenous hormones and the risk of hip and vertebral fractures among older women
Women with serum estradiol levels below 5 pg/mL had nearly double the risk of hip and vertebral fractures compared to those with higher levels, strongly supporting the role of estradiol in maintaining bone strength and preventing fractures.
Estradiol and Cardiovascular Health
Estradiol may be prescribed to support cardiovascular health in menopausal women by potentially improving cholesterol profiles, enhancing vascular function, and reducing arterial stiffness—especially when initiated early in menopause. Transdermal estradiol is often preferred for this purpose due to its favorable safety profile and reduced impact on clotting risk.
Related study:
Estrogen and cardiovascular disease: is timing everything?
Initiation of estradiol therapy within 6 years of menopause significantly slowed the progression of carotid artery intima-media thickness, indicating cardiovascular protective effects when started early in the menopausal transition.
Estradiol and Mood/Cognitive Function
Many women experience mood swings, sleep disturbances, decreased libido, and difficulty concentrating. Estradiol may support mood stability, improve sleep quality, and enhance cognitive clarity during this transition.
Related study:
Hormone therapy and cognitive function
Initiating estradiol-based HRT near menopause onset may preserve memory and executive function, while delayed therapy appears less beneficial. Women starting HRT within 5 years of menopause showed better verbal memory performance.
Estradiol and Overall Health Outcomes
Estradiol’s broad impact on multiple body systems—from bone density to metabolic and cardiovascular function—highlights its value as a foundational therapy for promoting long-term health and quality of life in appropriately selected menopausal women.
Related study:
Hormone-replacement therapy: current thinking
Estradiol-based hormone therapy is associated with a 30–40% reduction in all-cause mortality and lower incidence of osteoporosis, diabetes, and coronary artery disease when initiated in healthy women under age 60 or within 10 years of menopause.
Why Choose Compounded Estradiol?
The advantage of compounded estradiol lies in its ability to be formulated in specific doses and delivery forms—such as topical creams, capsules, or troches—tailored to each patient’s unique needs and medical profile. This level of personalization can be especially beneficial for women who have not found relief with standardized commercial options or who are sensitive to additives or dosing inconsistencies.
Routes of Estradiol Delivery
Compounded estradiol cream is commonly prescribed along with other dosage forms to provide options for individuals with specific requirements, as determined by their healthcare provider. Common compounded forms include:
- Transdermal estradiol cream
- Topical gels
- Oral capsules
- Sublingual troches
- Vaginal creams or suppositories
- Injectables
The way estradiol is delivered may influence how it is absorbed and utilized in the body. Healthcare providers consider various factors — such as symptom presentation, patient preferences, medical history, and lab results — when determining the most appropriate method. At Health Dimensions Clinical Pharmacy, we offer multiple delivery options for compounded estradiol, including the following:
1. Estradiol Cream and Gels
Transdermal estradiol cream and gels are applied to the skin, allowing the hormone to be absorbed directly into the bloodstream. This route may be preferred by providers when aiming to bypass the liver’s first-pass metabolism. Individuals seeking steady hormone levels may also consider it when they live with sensitivities to oral medications. Application sites typically include areas with thinner skin, such as the inner arms or thighs, as directed by the prescriber.
2. Estradiol Oral Capsules
Compounded oral estradiol capsules are taken through the mouth and absorbed through the digestive system. This method involves metabolism by the liver and may be suitable when systemic hormone levels are part of the therapy plan. Providers may recommend oral capsules for individuals who are comfortable with traditional pill formats and for whom liver metabolism is not a concern.
3. Estradiol Sublingual Troches
Sublingual troches are small, dissolvable compounds placed under the tongue. They allow estradiol to be absorbed directly through the oral mucosa into the bloodstream, potentially bypassing the digestive system. Some healthcare providers may find this method potentially useful for patients seeking rapid absorption or those who have difficulty swallowing pills.
4. Estradiol Vaginal Suppositories or Creams
Vaginal estradiol cream or suppositories may be suggested when localized support is appropriate. These products are inserted directly into the vaginal area and are typically used in situations where symptoms are concentrated in that region. This route focuses on local absorption and may result in lower systemic hormone levels, depending on formulation and frequency.
Each delivery method has specific characteristics related to absorption, metabolism, convenience, and patient comfort. Providers often start with a route that best aligns with the individual’s goals, medical history, and lifestyle. Adjustments can be made as needed based on response and clinical monitoring.
These preparations allow prescribers to tailor therapies to potentially better suit individual preferences, tolerability, or absorption considerations.
Customization Through Pharmacy Compounding
Compounded estradiol cream and other formulations offer flexibility in adjusting dosages over time. Providers may initiate therapy with a specific strength and modify it based on clinical evaluations, including patient feedback and lab results.
Health Dimensions Clinical Pharmacy provides:
- Custom strengths of estradiol cream and other forms
- Multiple dosage options to fit clinical goals
- Collaboration with providers to support evolving therapy plans
All compounded medications are prepared in our Farmington Hills compounding lab under strict quality standards, shipping directly to patients.
Additional Compounded Hormone Options
- Bi-estrogen and tri-estrogen blends
- Progesterone
- Testosterone
- DHEA
- Thyroid hormone combinations
- Other supportive compounds as prescribed
This BHRT blog article series will cover additional hormones in more detail. Stay tuned for our next installment of our BHRT series: Exploring DHEA (dehydroepiandrosterone), a hormone that plays a crucial role in the production of essential hormones like testosterone and estrogen.
HDRx: Serving Patients and Providers in MI and Beyond
Health Dimensions Clinical Pharmacy is located in Farmington Hills, MI, and is licensed to ship prescription medications to the following states, with a valid healthcare provider’s prescription:
- Michigan (MI)
- Ohio (OH)
- Indiana (IN)
- Illinois (IL)
- Wisconsin (WI)
- Minnesota (MN)
- Florida (FL)
We support both patients and providers by offering:
- Clinical pharmacist consultations
- Online Prescriber Portal
- Custom BHRT protocols for clinics
- Patient-friendly refill reminders and instructions
- Reliable delivery options
Ask Us About Compounded Estradiol Cream and More BHRT
Estradiol may play a role in supporting hormone balance when included in a BHRT plan developed by a licensed healthcare provider. The flexibility of compounded formulations allows for individualized approaches based on provider direction and patient feedback.
To learn more about compounded estradiol or to discuss BHRT options, healthcare providers and patients can contact Health Dimensions Clinical Pharmacy for additional information or collaboration.
References:
Buster, J. E., Koltun, W. D., Pascual, M. L. G., Day, W. W., & Peterson, C. (2008). Low-dose estradiol spray to treat vasomotor symptoms: a randomized controlled trial. Obstetrics & Gynecology, 111(6), 1343-1351. Link
Cummings, S. R., Browner, W. S., Bauer, D., Stone, K., Ensrud, K., Jamal, S., & Ettinger, B. (1998). Endogenous hormones and the risk of hip and vertebral fractures among older women. New England Journal of Medicine, 339(11), 733-738. Link
Ettinger, B., Pressman, A., Sklarin, P., Bauer, D. C., Cauley, J. A., & Cummings, S. R. (1998). Associations between low levels of serum estradiol, bone density, and fractures among elderly women: the study of osteoporotic fractures. The Journal of Clinical Endocrinology & Metabolism, 83(7), 2239-2243. Link
Giordano, S., Hage, F. G., Xing, D., Chen, Y. F., Allon, S., Chen, C. J., & Oparil, S. (2015). Estrogen and cardiovascular disease: is timing everything?. The American journal of the medical sciences, 350(1), 27. Link
Geraci, A., Calvani, R., Ferri, E., Marzetti, E., Arosio, B., & Cesari, M. (2021). Sarcopenia and menopause: the role of estradiol. Frontiers in endocrinology, 12, 682012. Link
Hodis, H. N., Mack, W. J., Henderson, V. W., Shoupe, D., Budoff, M. J., Hwang-Levine, J., … & Azen, S. P. (2016). Vascular effects of early versus late postmenopausal treatment with estradiol. New England Journal of Medicine, 374(13), 1221-1231. Link
