Obstetrics / Gynecology

OB/GYN is an area in which custom compounding has always been able to benefit the
practitioner and patient greatly. We compound several formulas that contain antibiotics,
friendly bacteria, etc. All of these can be compounded in almost any base: i.e., creams,
gels, or ointments.
Tinidazole (for bacteria and fungus)
Metronidazole –suspension/capsules
An estimated 75% of all women are likely to develop vaginal yeast infections sometime
during their lives, and about half of these women probably will experience recurrent
episodes. Studies have shown that there is a simple and effective source of relief from
this troublesome infection–
Boric Acid Suppositories.
Usually caused by the yeast Candida albicans, yeast infections typically are treated with
oral antifungal medications (e.g., fluconazole) or topical antifungal medications (e.g.,
miconazole and clotrimazole). Boric acid suppositories inserted into the vagina also
have been used for yeast infections. In one study of 92 women with chronic yeast
vaginitis that had failed to respond to treatment with over-the- counter or prescription
antifungal medicines, 98% of the women found relief by using boric acid capsules
vaginally, twice per day for two-to- four weeks.
Nystatin cream pre-loaded syringes
Friendly Bacteria suppositories, gels, or creams

Fertility Compounding:
Progesterone is a reproductive hormone that is often administered to patients during
infertility treatment. Insufficient levels of progesterone may result in miscarriage. Early in
pregnancy, progesterone is manufactured by the corpus luteum (a small cyst-like
structure that forms in the ovary after ovulation). After about 9-10 weeks, the placenta
should be producing enough progesterone to support the pregnancy. Low progesterone
that causes miscarriage is theorized to be from inadequate production from the corpus
luteum. Many fertility treatment protocols have patients supplement with progesterone
suppositories as an “insurance policy” to make certain that there is enough
progesterone available to maintain a successful pregnancy.

Estradiol (E2) is a natural type of estrogen. It stimulates the rebuilding and thickening of
the uterine lining after menstruation and helps cells in the fallopian tubes, uterus and
vagina divide and mature. It also helps to dilate blood vessels to carry more oxygen to
the uterus.

PharmacyMax Labs compounds vaginal suppositories containing progesterone and
estradiol (E2) in a variety of strengths and combinations. Our suppositories contain only
natural (bio-identical) progesterone and estradiol. Both of these hormones are derived
from plant sources and are indistinguishable from what a woman’s body produces
naturally.

Fertility Formulations:
Progesterone Vaginal Suppository
Progesterone vaginal gel in various strengths
Estradiol Vaginal Suppository
Progesterone/Estradiol combo suppository (All available in customized strengths)

Pregnancy Nausea/Vomiting:
Doxylamine succinate10mg/Pyridoxine 10mg capsules
Doxylamine succinate 20mg/Pyridoxine 20mg SR capsules (addition of methocel makes
it SR)
Doxyamine succinate 10mg/Pyridoxine 50mg capsules
Doxylamine succinate 20mg/Pyridoxine 100mg SR capsules
Ginger Root Capsules-available in 250mg & 500mg strengths
Ginger 200mg Sorbitol Lollipop(choice of flavors: Apple, lemon/marshmallow)-Upon
waking with morning sickness, the patient can lick lollipop until symptoms go away.

Nighttime Leg Cramps:
Guaifenesin 10% in speed gel-Applied directly to skin at place of discomfort with roll-on
applicator. Results are almost immediate.

Libido:
Women – Could Your Sex Drive use a Tune-Up?
Every woman likes to think of those days when making love was exciting. Our
pharmacists have been queried by women seeking advice on reigniting the sparks with
their partners. Our staff, along with your personal physician, can assist in bringing
those pleasures back. Women, even in the 30s and 40s , contact us daily with
concerns associated with the suffering from vaginal dryness and a lack of sex drive.
Although the majority of these women are not yet experiencing menopausal symptoms
such as night sweats or hot flashes, their libido is low and vaginal dryness is causing
painful intercourse.
Underlying medical conditions, certain medications, or emotional issues may cause a
decrease in libido and sexual response. However, assuming that all of those potential
contributory factors have been ruled out, we have had great success working with
physicians and recommending a compounded vaginal cream containing a low-dose of
natural (100% bio-identical) testosterone.
Testosterone for Women? Suzanne Somers recently wrote a book called “The Sexy
Years.” She claims that by using bio-identical hormone replacement, including the use
of bio-identical testosterone has helped her discover her fountain of youth. She credits
natural testosterone with revitalizing her sex life and helping her feel twenty years
younger.
Testosterone was discovered decades ago, but only recently have doctors begun to
understand its role in women. Women produce about 5-10% as much testosterone as
men. Testosterone plays an important role in maintaining sexual desire, energy level,
sense of well-being, as well as the strength and integrity of skin, muscle, and bone.
There is a gradual drop in testosterone production in women beginning at age 30.
Women who have had their ovaries removed have lower levels of testosterone. Stress
may also play a role in decreased levels. All women should first ask their doctor to order
a test of their ‘free testosterone’ level to determine if replacement is something to
consider. Saliva testing is another convenient and non-invasive way to determine if a
woman has low testosterone or an underlying hormonal imbalance.
If a woman is also experiencing significant vaginal dryness or vaginal thinning, we may
recommend adding a low-dose of Estriol (E3) to the testosterone cream recipe. What is
Estriol? Estriol (E3) is one of the three primary estrogens found in a woman’s body. The
other two are Estrone (E1) and Estradiol (E2). One of the significant advantages of
Estriol (E3) is that it does not induce endometrial and breast tissue proliferation to the
extent that estradiol does. Estriol is estimated to be 80 times less potent than estradiol
on endometrial tissue response, and up to 1000 times less potent than estradiol on
breast tissue response. Estriol has a higher affinity for the estrogen receptors that are
most responsible for maintaining good vaginal health, and it is the only estrogen that
has been shown to reverse vaginal atrophy without necessarily causing systemic
effects. Note: Patients that are not currently using progesterone should have 5 mg of
natural Progesterone added to the cream formulation to balance the unopposed Estriol
(this holds true even for women who are post-hysterectomy).

Libido/Vaginal Dryness Formulation:
Testosterone 0.1%/Estriol 0.05% Vaginal Foam
Testosterone 2%/Estradiol.625mg/gram vaginal cream
(Progesterone can be added to these formulations)
Libido/Sexual Enhancement Formulations
Testosterone 10 mg/0.1 mL Sublingual Drops
Scream Cream Formula#1- Aminophylline 3%/L-Arginine 6% Cream 30gm
Scream Cream Formula #2- Aminophylline 3%/L-Arginine 6%/Ergoloid
0.05%/Pentoxyfilline 5%/Isosorbide dinitrate 0.26% Cream 30gm
(The L-Arginine can be taken out if patient has genital herpes)
Sildenafil 1% Cream 20 grams

Breast Feeding solutions:
We are compounding the nipple ointment popularized by Dr Jack Newman. This special
lactation ointment contains equal parts of nystatin, clotrimazole, mupirocin, &
betamethasone ointments.
Nystatin: (nye-STA- tin). Topical nystatin is used to treat fungus infections of the skin.
Clotrimazole: (kloe-TRIM- a-zole) is used topically to treat fungal infections such as
Candida albicans.
Mupirocin: (myoo-PEER- oh-sin) is used to treat bacterial infections caused by
Staphylococcus and Streptococcus. Cracked nipples may be infected with bacteria.
Mupirocin kills the bacteria or helps prevent their growth.
Betamethasone valerate: Is a topical corticosteroid used to help relieve redness,
swelling, itching, and discomfort associated with nipple soreness.
Instructions for use: For cracked and painful nipples, apply a thin film to the nipple and
areola after each feeding. Massage gently into skin. Do not over apply. It is not a
problem if the baby goes back to feeding right away. Once your nipples have healed,
use the ointment periodically to prevent the problem from reoccurring.
Safe to for Use while Breast-Feeding. This ointment formulation has been used by
many women across the US and Canada and has been found to be safe and effective
and not harmful to babies. When taken orally, many medicines pass into breast milk in
small amounts. Since these medications are applied topically, the concentration of the
drug will be very low and is not harmful to the baby.
Precautions: Do not get medication in the eyes. Always keep medicine out of reach of
children.
Storage: Store at controlled room temperature and protect from extreme temperatures
and sunlight. Keep medicine in the original container. Discard all medications that have
expired.
Side effects: There are no expected side effects with this medication combination. If you
are allergic to any of the components of the ointment, you may develop a skin rash. If
your skin condition worsens or you develop hives, blistering, burning, itching, stinging,
swelling, redness, peeling, or any other bothersome effects, stop using the ointment and
consult with your physician or lactation specialist.
This ointment requires a valid prescription from your physician, nurse practitioner, nurse
midwife, or physician assistant.

Bio-Identical Hormone Replacement Therapy:
Our Pharmacy Compounds Natural Hormones to meet each individual patient’s needs.
We work with several physicians and nurse practitioners throughout the area that who
are trained and very knowledgeable concerning hormone replacement therapy.
Natural HRT for Women
During various stages of a woman’s life, her body may need hormone supplements to
assist in a particular transition from one stage of life into another. Menopause is one of
the most common stages where women undergo HRT. However, natural HRT can help
counter negative side effects associated with PMS, endometriosis, birth control, peri-
menopause, menopause and various other conditions.

Benefits of Natural Hormone Replacement Therapy:
May prevent osteoporosis and restore bone strength.
Reduced hot flashes and reduced vaginal dryness.
Better maintenance of muscle mass and strength.
May improve cholesterol levels.
Improved sleep and better mood, concentration and memory.
May prevent senility and Alzheimer’s disease.
Improved libido (sex drive).
Fewer unwanted side effect than with synthetic hormones.
Can minimize symptoms of menopause.

HRT Literature:
There are also several books available on natural hormone replacement therapy.
Natural Hormone Replacement, Jonathan V. Wright, M.D.
What your Doctor my not tell you about Menopause, John Lee, M.D.
Natural Woman, Natural Menopause, Marcus Laux, N.D. & Christine Conrad
The Hormone of Desire, Susan Rako, M.D.
Woman’s Bodies, Woman’s Wisdom, Christine Northrup, M.D.
Guide to Natural Hormone Replacement, Julian Whitaker, M.D.

DHEA:
More prolific than any other hormone produced by the adrenal glands.
Restoring DHEA to youthful levels may help boost testosterone levels.
Some DHEA is metabolized into testosterone and estrogens (amount is patient-
specific), but unmetabolized DHEA has independent effects that may reduce the risk of
heart disease and cancer. These effects also may lead to weight loss.
Converts to Androstenedion and Testosterone
Estrogen – (Estradiol)
Natural estrogens are synthesized from soybeans.
Promotion and growth of specific cells in the body.
Responsible for development of most secondary sexual characteristics of the female.
Slows bone loss…estrogens do not assist in the formation of new bones.
Components of Human Estrogen:
Estrone (10-20% of circulating estrogens) = E1
Implicated in hormone-medicated cancers.
Estradiol (10-20% of circulating estrogens) = E2
Estriol (60-80% of circulating estrogens) = E3
Thought to be anti-carcinogenic; most protective estrogen ever tested against breast
cancer.

Symptoms of Low Estrogen:
Hot Flashes
Night Sweats
Shortness of Breath
Palpitations
Sleep Disorders
Dry Hair/Hair Loss
Vaginal Dryness
Mood Swings
Anxiety
Headaches
Short-term memory loss
Depression
Frequent Urinary Tract Infections

More about Estrogen:
Pregnenolone
Pregnenolone – Functions
Pregnenolone is a natural hormone made from cholesterol in the body and is a
precursor for the production of ALL the human steroid hormones, including DHEA,
Progesterone, Estrogens, Testosterone, Cortisone, Cortisol and Aldosterone.
Since it is not a steroid hormone, just a precursor, it is extremely safe and has very few
side effects.
Pregnenolone has a balancing ability to adjust other hormone levels as needed by the
body.
Pregnenolone can help improve memory, reduce allergies and arthritic inflammation,
improve mood and energy and can act as a detoxicant.
The body’s own production is reduced with aging, stress, depression, hypothyroidism
and toxin exposure.

Progesterone:
Natural progesterone is synthesized from the wild yam or soybeans.
Counteracts estrogen’s tendency to induce excess growth in the endometrial lining of
the uterus.
Builds new bone tissue leading to increased bone mass and density.
Assists in raising HDL-cholesterol levels (if combined with estrogen therapy.)
Synthetic progesterone has an overall negative effect on HDL-cholesterol levels.

Symptoms of Low Progesterone:
Headaches
Low sex drive
Anxiety
Moodiness
Swollen Breasts
Depression
Fuzzy Thinking
Irritability
Food Cravings
PMS Symptoms
Water Retention

Testosterone:
Natural testosterone (when replacing inadequate testosterone levels) can:
Improve mental alertness and mood.
Make bones stronger (increase calcium retention)
Revive a lagging sex life.
Improve hot flashes that have not responded to estrogen alone.
Improve breast tenderness.

Menopause:
Women should not have to dread menopause. There are many natural alternatives that
are extremely helpful in alleviating problems associated with hormonal changes during
menopause. Menopause is the most common stage when women recieve receive
Natural Hormone Replacement Therapy. The process should involve natural hormones,
not patented hormones because patented hormones usually have artificial additives that
can often influence the desired results.
If you are approaching menopause, and are considering hormone replacement, we
recommend that you talk to us or your pharmacist and health care provider about your
concerns. Many physicians are not familiar with the “natural” approach. Education is
extremely important. Our pharmacists can assist in the educational process for both you
and your doctor.

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