What's the Deal with Compounding? It's Complicated... 😂
What's the Deal with Compounding? It's Complicated... 😂
And always great when we can use a Nancy Meyers film as a teaching aid!
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Fellow Empresses,
How the hell are you? I’m still in post-COVID-19 and just SO ready for Fall. You can read about it here if you need a laugh.
This week on The Empress… I’m super excited because we’re starting our highly anticipated series on compounding and how it’s NOT quite the Breaking Bad scenario certain folks would have you think.
I first learned about compounding pharmacies when we were living in Paris. Now, when you're an American GenX kid who grew up during the infamous Tylenol scare, you are totally used to every last pill and capsule being either blister-packed and/or safety-sealed as though your very life depended on it. And so, French pharmacies felt like venturing into a whole new magical, mystical Harry Potter universe with their elegant sachets of powders, tiny bottles of tinctures, and effervescent little moons dissolving in water and mystery-blended creams. And you wouldn't actually always have to see the doctor. On the phone, the doctor would hear your litany of symptoms say, “OK, just go to the pharmacy and tell them bla-bla-bla and they'll know exactly what to prepare for you. Bonne-apres-midi, Madame!” And somehow, almost every time it worked. The pharmacist knew what to do, it cost nothing, and you got better. Merci!
I'll never forget the time I came home to find my then-husband, fresh out of dental surgery, staring… at a tall glass of water with a single white waxy bullet-shaped object at the bottom of it. He was gazing at it so intently, wondering why on earth it was not dissolving.
And so, we had grown ever so delighted by these sachets of powders and tinctures, but I'll never forget the time I came home to find my then-husband, fresh out of dental surgery, staring at the dining room table at a tall glass of water with a single white waxy bullet-shaped object at the bottom of it. He was gazing at it so intently, wondering why on earth it was not dissolving. He was waiting, perplexed, with all the patience of a trusty Labrador at dinnertime. Why wasn't it bubbling and effervessing away into something drinkable? Like a Fresca? (Remember Fresca?)
And I looked over at him, in shock at what an innocent boy my husband still was, and said, “Darling, you don’t DRINK it… You stick it up your BUM! It's for pain relief in the event you can’t open your mouth.”
And so, THIS is where I believe we get compounding all confused… To the point where we literally cannot tell which end is up, how it works, or who it can really help.
So, I thought we could spend a few posts trying to understand it better from a number of different perspectives:
Compounding 101: What it is, its history, its current use cases, and current regulation.
Then, who it helps—i.e., women in peri/menopause with common comorbidities, allergies, or compromised organs.
Why it’s so confusing? All the various corporate pharmaceutical and patriarchal agendas in play, as well as research conflation that can happen by aggregating data.
And lastly, WHY you might want to seek out a doctor and a platform working toward innovating bespoke health solutions for women?
Sound fun? Well, if not, we’re going to make it fun! Because don’t you just love it when something crazy-muddled can be explained with the help of a Nancy Meyers film? Even if you consider it one of her lesser works—It’s Complicated still fits here.
But first, a little primer: Compounding 101...
While Muslim pharmacists and chemists developed advanced methods of compounding drugs, with the first drugstore opening in Baghdad in 754, the actual modern age of pharmacy compounding did not begin until the 19th century with the isolation of various compounds from coal tar. From this single natural product came the earliest antibacterial sulfa drugs—phenolic compounds made famous by Joseph Lister—think Listerine.
Today, compounding is defined as the combining, mixing, or altering of drug ingredients to create medications tailored to individual patient needs according to a clinician’s prescription. The US Pharmacopeia (USP) regulates the compounding industry, setting high-quality standards for drugs. State pharmacy boards also play a role in regulating quality compliance.
Compounded medications may offer therapeutic alternatives for patients with unique medical needs that cannot be met by mass-produced pharmaceuticals. For example, compounding can provide customized formulations to (1) create alternate dosage strengths or delivery forms, (2) omit components to which a patient has an allergy, i.e., an intolerance to peanut oil or gluten, and (3) fill gaps in cases of shortages and discontinuations of mass-produced HRT solutions that still may be useful for certain patients, but not economically viable for drug companies.
So, when we think about compounding and HRT... It’s Complicated and that is where this movie metaphor comes into play.
We're all sort of Meryl Streep in this film... a goddess wracked with self-doubt and getting mixed messages about what to do from different people, in every direction—all while our bodies are in this multi-system, total cellular transformation that is so bespoke. There is no Eileen Fisher caftan answer for all the weird-ass symptoms, which can vary so wildly from woman to woman.
And so, the traditional mass-market pharmaceutical brand HRT, or “just take some birth control pills” in this narrative is Meryl’s philandering ex-husband, Alec Baldwin. A little bit flabby from too much fast food (think synthetic ingredients). A one-size-fits-all kind of guy with the haircut that everyone would expect, he's the self-satisfied, FDA-approved middle-aged white guy solution, easy to get a prescription for, but NOT entirely satisfying for the woman, symptom-wise. Meryl still doesn’t feel right. After all, she’s been there, and done that 30 years ago.
The compounding part of the film is actually the great part and it's the scene during which Meryl hand-makes croissants with her new squeeze, Steve Martin. Steve is the “all-natural-ingredients-character” in the film. He’s genuine. And making the croissants takes all night because they have to proof them in the oven with the right temperature and the correct humidity and it's as much chemistry as it is art. They have to be folded just so and it's an intimate process. It's a getting-to-know-you blending and it's anything but a one-size-fits-all experience. You have to talk it out and work out the dough—but not too much. When finally pulled from the oven, warm, golden, and flakey, the croissants taste phenomenal, and they DO the job. They’re so much better than sex with the ex!
They connect the two people and so that's the allegory for when a compounding pharmacy can actually work for a patient because… Say that patient has a severe gluten intolerance and a peanut allergy and the FDA-approved, pharmaceutically-backed pill that would ordinarily be prescribed contains both gluten and peanut oil as binding agents—that’s NOT going to work for that patient. So, that's when you need a compounding pharmacy that can deliver the same FDA-approved ingredients but without the harmful additives. That's when you need nine years of training in the art and science of formulating medicines. Yes, it's a lot like baking, but baking is chemistry.
And just because compounding is not backed by the billion-dollar pharmaceutical lobby doesn’t make it any less valid a solution for the specific patient it serves.
But let’s also get some specialists in here to talk about this. Here is an incredibly thought-provoking, no-holds-barred conversation from leading midlife women’s journalist Ann Marie McQueen, host of hotflash inc., speaking with Scott Brunner, CEO of the Alliance for Pharmacy Compounding and Compounding Pharmacist, Jennifer Burch.
See what you think. There’s much more to discuss and more questions to dig into. In the meantime, if you have your own questions and want to connect with a physician who specializes in peri/menopausal custom care, you can reach out to the folks at Winona and they will be happy to set up a time. Just click below to start a free visit:
But we’re not done yet, so stay tuned for our next dispatch where we dig deeper into who compounding can help—relative to women in menopause with chronic conditions and how to ensure you’re getting what you need from your provider.
Until then, remember… You are wise AF! Huzzah!
Yours in Grandeur,
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I need to go watch the movie now and match it up with your great descriptions. We've got compounding pharmacies here, but I never thought to use it for HRT. I was given the non-compounded kind and when it didn't work for me, that was it. I was taken off and it was end of story for HRT. Interesting to learn more about how they tinker with HRT through compounding.
THANK YOU for writing this, and helping to demystify something that should be available everywhere! As a gluten-free, egg-free and dairy-free human I could definitely use a greater range of options for any kind of prescription. Also the scene in "It's Complicated" where Steve Martin comes over to her house to talk about the renovation always makes my husband yell, "Why the HELL does she want to redo THAT KITCHEN?"