Obstetrics Gynecology

OBSTETRICS GYNECOLOGY

OBSTETRICS/GYNECOLOGY

 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 bacterias, 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.

Southern Maryland Compounding Center 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)

Progesterone injections

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, Guava blend)-Upon waking with morning sickness, 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?

We receive numerous information requests each week from women in their 30s and 40s who are suffering from vaginal dryness and a lack of sex drive. The majority of these women are not yet experiencing menopausal symptoms such as night sweats or hot flashes, but 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, she has discovered 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 roll 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 60gm

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(Viagra 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 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. However, because these medications are applied topically, the concentrations of drug that the baby is exposed to will be very low and is not harmful.

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 them 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 different physicians and nurse practitioners throughout the area that 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).

Many 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 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 feelings. Many physicians are not familiar with the “natural” approach. Education is extremely important. Our pharmacists can assist in the education process, of both you and your doctor.

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