Should You Take Compounded Progesterone?
Five Questions to Ask First
“One of my doctors told me to get compounded progesterone. I have no idea what to do.”
-Ask Dr. Jen
*****
It’s not possible to answer a question like this directly in this format, but here, I can review the reasons to take progesterone as well as the specific issues with compounding this medication. This information should help someone decide whether their doctor is informed and providing solid advice, whether their provider is cherry-picking from low-quality data, or whether they are simply uninformed.
Also, for those who don’t want to read through and prefer the TL;DR, skip to the end, as I have summed it all up in a short infographic.
What Does Compounding Mean
Instead of a prescription for a traditional pharmaceutical made in a factory (think Big Pharma) that meets the FDA’s or other country-specific manufacturing requirements, a compounded medication is made by a compounding pharmacy. The pharmacy purchases the progesterone powder, which is the same raw powder used by the pharmaceutical company, but the product (oral capsule, topical cream or gel, or vaginal product) is made individually or in small batches. Many providers and pharmacies claim this is bespoke, and I get it, as it sounds like you are receiving a special recipe designed specifically for you. However, you are actually getting a product that is not made with the same precision and is highly likely inferior to the traditional pharmaceutical product when it comes to progesterone.
Issues with Compounded Progesterone
Progesterone is a Biopharmaceutical Classification System Class II drug, which means it is poorly soluble and highly permeable, making it hard to formulate in a way where absorption is predictable. It took years of research for scientists to figure out how to formulate oral progesterone so it could be absorbed.
A traditional pharmaceutical must show that it is absorbed and works as expected. Factories may also be inspected, although whether this will continue here in the United States under Trump is unknown. This data does not exist with compounded products.
One study that obtained thirteen oral and thirteen topical compounded progesterone