In my practice, approximately 20% of the time I will recommend compounded hormones as part of the regimen for my patients when we lack a choice among the FDA-approved bioidentical hormones. I prescribe hormones separately, rather than mixing everything together, which allows for a greater individualization of care, a concept advised in the new NAMS guidelines. I should note that physicians commonly add progesterone to topical (across the skin) hormone therapy. The dominant thinking among experts today is that this practice does not provide sufficient protection of the uterus from cancer, due to inadequate absorption of topical progesterone.
The route of administration of hormone therapy for women can vary for both bioidentical and non-bioidentical forms. These include oral, vaginal, topical, and subcutaneous or deep injection. There is a strong rationale for avoiding oral estrogen. It is absorbed by passing through the liver, causing production of some proteins with negative health consequences. These include proteins that contribute to blood clots in the legs and elsewhere (thrombosis) and C - reactive protein, which is associated with increased cardiovascular risk, especially in women.