Skip to main content
Opening late October in 13 states. Get early accessPrescribed only if it’s right for youDiscreet shipping in plain packaging
Get early access

Custom Hormone Therapy

Hormone therapy, built around you. It starts with a detailed look at your symptoms, cycle and health history, with bloodwork if your provider asks for it. Your provider then prescribes only what you need, whether that’s estradiol, progesterone, DHEA or a combination, and adjusts your plan as you go.

  • A full evaluation of your symptoms, cycle and history
  • Only the hormones you need, in strengths set for you
  • Check-ins and dose changes as you go

Personalized plan · from $99/mo. Prices are preliminary.

How it works

  1. Answer the evaluation: how your symptoms have been over the past few weeks, your periods, your health and family history, and every medicine and supplement you take.
  2. Get bloodwork if your provider asks for it: a morning draw, usually fasting. If you still have periods, it’s timed to about day 21 of your cycle.
  3. Your provider reviews everything with you and prescribes only what you need. A licensed pharmacy compounds each medicine for you and ships it.
  4. Use each medicine as its label directs, and check in so your provider can adjust your plan.
What’s in it
Estradiol, progesterone, DHEA, or a combination; your provider decides
Forms
Estradiol as a compounded cream or an FDA-approved generic patch or tablet; progesterone usually as FDA-approved capsules at bedtime; DHEA as a compounded vaginal cream
Labs
If your provider asks: a morning blood test before you start or to fine-tune your plan
Who it’s for
Women in perimenopause or menopause, including after surgery that removed the ovaries, whose symptoms bother them

Only what you need.

  • Estradiol (If you need it): Your body’s main estrogen before menopause. Estrogen is the most effective treatment for hot flashes and night sweats, and it helps vaginal dryness too. A compounded cream you rub into your skin, or an FDA-approved generic patch or tablet.
  • Progesterone (With estrogen, if you have a uterus): Protects the lining of your uterus when you take estrogen. The evidence for that is for FDA-approved progesterone capsules, so that’s usually what your provider prescribes, with a compounded oil-free capsule if you can’t take them. On its own at bedtime, it may help night sweats and sleep, an off-label use.
  • DHEA (If your provider recommends it): A hormone your body turns into estrogen and testosterone. As a vaginal cream it’s used for dryness and painful sex after menopause. Evidence for DHEA taken by mouth is limited.

What the research does and doesn’t show

Estradiol: in 24 trials with 3,329 women, estrogen pills cut hot flashes by about 75% compared with placebo and made them milder. In a large UK study, estrogen through the skin, as FDA-approved patches and gels, wasn’t linked to blood clots, unlike pills. In lab records of 1,062 women, compounded estradiol creams gave lower estradiol levels than FDA-approved gels and patches at similar doses.

Progesterone: taken by mouth with estrogen, micronized progesterone, the kind in FDA-approved capsules, kept the lining of the uterus from overgrowing in a 3-year trial, and those capsules are approved for that use. No study shows that compounded progesterone, in any form, protects the lining, and progesterone creams haven’t been shown to either. On its own at bedtime, an off-label use, progesterone eased hot flashes and night sweats more than a placebo in a 12-week trial of 133 women early after menopause; in a 3-month trial of 189 women in perimenopause it didn’t clearly reduce them, though women taking it reported fewer night sweats and better sleep.

DHEA: used in the vagina, it’s FDA-approved, as prasterone inserts, for moderate to severe pain with sex after menopause. In two 12-week trials of 716 women, it eased that pain more than a placebo, by a modest amount. Taken by mouth, DHEA had at most a small effect on sexual function in studies, unclear effects on hot flashes, and made acne more likely.

What it doesn’t show: no trial has tested the compounded estradiol cream, DHEA vaginal cream or progesterone capsule, alone or together. The DHEA results come from FDA-approved inserts.

So estradiol is the most effective treatment for hot flashes, FDA-approved progesterone capsules protect the uterus when estradiol is used, and vaginal DHEA can ease painful sex. How much a compounded cream delivers varies, which is why your provider checks in and adjusts.

Studies: MacLennan et al., Cochrane Database Syst Rev 2004 (24 trials, 3,329 women; 75% fewer hot flushes vs placebo; PMID 15495039); Vinogradova et al., BMJ 2019 (transdermal estrogen and blood clots, adjusted odds ratio 0.93; oral 1.58; PMID 30626577); Newman et al., Menopause 2023 (1,062 women using estradiol patches, gels or compounded creams; PMID 37847876); Writing Group for the PEPI Trial, JAMA 1996 (estrogen with cyclic micronized progesterone vs estrogen alone, 3 years; PMID 8569016); Prometrium prescribing information (prevention of endometrial hyperplasia); The Menopause Society 2022 and National Academies 2020 (no evidence that compounded progesterone protects the endometrium); Hitchcock and Prior, Menopause 2012 (133 healthy women 1 to 10 years after menopause, oral micronized progesterone 300 mg vs placebo, 12 weeks; PMID 22453200); Prior et al., Sci Rep 2023 (189 perimenopausal women, oral micronized progesterone 300 mg vs placebo, 3 months; PMID 37277418); Intrarosa prescribing information (approved 2016 for moderate to severe dyspareunia due to menopause); Hayes and Birch, Am Fam Physician 2019 (two 12-week trials, 716 women; 0.36 to 0.40 points more improvement than placebo); Scheffers et al., Cochrane Database Syst Rev 2015 (28 trials, 1,273 women; sexual function SMD 0.31; acne odds ratio 3.77; PMID 25879093); Davis et al., Global Consensus Position Statement on testosterone therapy for women, J Clin Endocrinol Metab 2019 (systemic DHEA not recommended for low desire); The Menopause Society 2022 hormone therapy position statement (PMID 35797481).

What to expect

First weeks
Your evaluation is reviewed, with bloodwork if your provider wants it, and your plan is prescribed and shipped.
Weeks 4–12
Hot flashes and night sweats often ease once the dose is right. Breast tenderness, spotting or bloating can happen early and usually settle. Compounded hormones haven’t been tested in trials.
Ongoing
Your provider checks in after about 3 months, then at least once a year, to adjust your plan and review whether you still need each part of it.

Important safety information

Before you start

Your provider reviews your health history, medicines and allergies before prescribing, and prescribes only if it’s right for you. Tell your care team about any side effect, and get emergency care for chest pain, trouble breathing, or swelling of the face, lips or throat.

Side effects, and when to get help

Estradiol cream: breast tenderness, spotting or irregular bleeding, headache, bloating, nausea and skin irritation where it’s applied. Progesterone capsules: drowsiness or dizziness, which is why they’re taken at bedtime, and sometimes bloating, breast tenderness or mood changes. DHEA vaginal cream: vaginal discharge, and sometimes changes on a Pap test. DHEA can be turned into testosterone in the body, so tell your provider about new acne or hair growth. Less common but serious, with estrogen: blood clots, stroke, heart attack, gallbladder disease, higher blood pressure and breast cancer, and, with a uterus and no progesterone, cancer of the uterine lining. Call your provider about unexpected vaginal bleeding or a new breast lump. Get care right away for chest pain, a painful or swollen leg, sudden shortness of breath, a sudden severe headache, changes in vision or speech, weakness or numbness on one side, or swelling of the face, lips or tongue.

Rules that keep it safe

If you have a uterus and use estradiol, take the progesterone your provider prescribes, on the days they set: estrogen alone can cause cancer of the uterine lining. That’s usually FDA-approved progesterone capsules, the only form shown to protect the lining; compounded progesterone and progesterone creams, including store-bought ones, haven’t been shown to. Take progesterone at bedtime, and don’t drive if it makes you drowsy. Tell your provider if you’re allergic to peanuts: FDA-approved progesterone capsules are made with peanut oil, so your provider may prescribe a compounded capsule made without oil instead. After applying estradiol cream, let the skin dry, wash your hands and cover the area with clothing: children, partners and pets can absorb estrogen from treated skin. Don’t use any of these if you’re pregnant, trying to get pregnant or breastfeeding, and don’t rely on them as birth control. Tell your provider before surgery or a long stretch of bed rest, as estradiol may need to stop 4 to 6 weeks before. Keep up with mammograms, cervical screening and blood pressure checks, and report any unexpected bleeding.

Is it FDA-approved?

Not all of it. The estradiol cream and the DHEA vaginal cream are compounded: prepared by a licensed pharmacy for you, and not reviewed by the FDA for safety, effectiveness or quality. The progesterone is usually FDA-approved micronized progesterone capsules. If you can’t take those, for example with a peanut allergy, it’s a compounded capsule made without oil, which isn’t FDA-approved either. FDA-approved versions of the other hormones exist too: estradiol patches, gels and sprays, a capsule that combines estradiol and progesterone, and DHEA vaginal inserts (prasterone). Your provider will go over them with you. ‘Bioidentical’ means a hormone has the same chemical structure as one your body makes; those FDA-approved products are bioidentical too. ACOG and The Menopause Society recommend FDA-approved hormone therapy over compounded for most people, the Endocrine Society has raised similar concerns, and a 2020 National Academies report advised using compounded hormones mainly for an allergy to an ingredient in an approved product or a form that isn’t available. In November 2025 the FDA began removing most boxed warnings from the labels of FDA-approved menopause hormone therapy, and it approved the first revised labels in February 2026. For estrogen used on its own throughout the body, it kept one: in someone with a uterus, estrogen without a progestogen raises the risk of cancer of the uterine lining. Those changes concern FDA-approved products’ labels; compounded medicines have no FDA label.

About Custom Hormone Therapy

Why is it called custom?

Because no two plans are the same. Some women need estradiol, progesterone and DHEA; others need only one or two. Your provider chooses what goes in your plan, the form and the strength from your evaluation, and changes it as you go.

What does “bioidentical” mean?

That a hormone has the same chemical structure as one your body makes. Estradiol, progesterone and DHEA are all bioidentical, and so are many FDA-approved products, such as estradiol patches and gels and progesterone capsules. There’s no good evidence that compounded bioidentical hormones are safer or work better than FDA-approved hormone therapy, and your provider can go over both.

Do I need bloodwork?

Not always. Hormone therapy for menopause is mostly guided by your symptoms, but your provider may ask for a blood test before you start or to fine-tune your plan, such as estradiol, progesterone, testosterone, SHBG and DHEA-S. It’s drawn in the morning, usually fasting; if you still have periods, at about day 21 of your cycle.

Do I need progesterone?

Yes, if you take estrogen and still have your uterus. Estrogen on its own can thicken the uterine lining and raise the risk of endometrial cancer. FDA-approved progesterone capsules taken by mouth were shown to protect against that; no study has shown the same for compounded progesterone, and creams haven’t been shown to work. So your provider will usually prescribe the FDA-approved capsules, with a compounded oil-free capsule if you can’t take them, for example with a peanut allergy. After a hysterectomy you usually don’t need it.

What are the risks?

Estrogen therapy can raise the risk of blood clots and stroke and, with long-term use, some cancers. How much depends on your age, how long it’s been since menopause, your health history and your dose. DHEA can cause acne or unwanted hair growth. Your provider reviews these before prescribing and checks in regularly. In 2025 the FDA began removing most boxed warnings from FDA-approved menopause hormone therapy, keeping the endometrial cancer warning for estrogen used without a progestogen.

Is it FDA-approved?

Not all of it. The estradiol cream and the DHEA vaginal cream are compounded: prepared for you by a licensed pharmacy and not reviewed by the FDA for safety, effectiveness or quality. Progesterone is usually FDA-approved capsules, and your estradiol can be an FDA-approved generic patch or tablet instead of the cream. Your provider goes over the options with you.

More hormone therapy treatments · All treatments