Compounding for Vaginal Conditions

APRIL 01, 2006
Shannon W. Fields, BA, CPhT

Many women experience vaginal problems of some type at various points in their life. For some women, these problems tend to occur almost chronically and may be resistant to a number of treatments. Other women begin to experience problems, such as vaginal dryness, more frequently as they approach menopause and the hormonal changes that accompany it. When traditional treatments fail, compounding pharmacies can be a valuable resource for patients suffering from vaginal conditions, such as recurrent yeast infections and chronic vaginal dryness.

Yeast infections (or genital candidiasis) can occur at any age, and 3 of every 4 women will experience a yeast infection at some point in their lifetime. Approximately 5% of women suffer from recurrent or chronic yeast infections. These infections may be more common after a round of antibiotics, because this type of therapy may disturb the normal balance of vaginal flora, allowing an overgrowth of yeast. Some women may be slightly more prone to yeast infection during or closely following a pregnancy or while taking oral contraceptives, due to the high levels of estrogen present in the system. Women with diabetes also appear slightly more prone to yeast infections.1

For those who suffer from recurrent yeast infections, it is not unusual for an infection to become resistant to the commonly used antifungal treatments available by prescription or over the counter. In such cases, a compounding pharmacist may be of help with certain therapies, which can both treat the infection and prevent the recurrence of candidiasis.

For example, boric acid vaginal capsules (generally 250-600 mg) or suppositories may be used on a once- or twice-daily basis for 7 to 14 days to treat the condition. They also can be used as maintenance therapy, with a smaller or less frequent dose.2,3 Another compounded treatment for an active yeast infection, which can be used in conjunction with boric acid vaginal therapy, is topical Peri-Wash, containing boric acid, menthol, and phenol. It is used to soothe the symptoms of itching and burning that often are present. These 2 treatments represent just a sampling of compounded options available to treat vaginal yeast infections.

A frequent complaint of many women is vaginal dryness and discomfort, which is particularly common in women nearing menopausal age or in transitional periods, such as following the birth of a child. The decrease in estrogen levels can lead to thinning of the vaginal tissues. This condition may cause painful intercourse and can be difficult to treat. With so many new warnings about hormone replacement therapies in the last couple of years, many women are hesitant about using synthetic hormones to treat symptoms such as vaginal dryness. More and more women are exploring natural or bioidentical hormone replacement to treat these and other symptoms, because these hormones are not as strong as many of their synthetic counterparts. Additionally, because they are natural to the human body, many experts feel that they pose a lower risk of cancer than do synthetic hormones.4

Compounding pharmacies can prepare vaginal creams using bioidentical hormones that may clear up chronic vaginal dryness and restore elasticity. A common preparation for treating this specific condition is a vaginal cream containing estriol, which, for these purposes, is often prescribed in a 0.5% to 1% dose. Estriol is a weak bioidentical estrogen that is produced in particularly high amounts during pregnancy. In topical form, it has a pronounced local effect on the estrogen receptors in vaginal tissue. Some experts also feel that estriol vaginal creams can improve the symptoms of incontinence and the frequent urinary tract infections that are common as a woman approaches menopause.4,5

For women who have not had success with more traditional therapies, a compounding pharmacy may be the key to restoring vaginal health. Conditions such as recurrent yeast infection and vaginal dryness may be effectively relieved with compounded treatments, such as the examples mentioned above. It is important to remember that compounding enables a physician to tailor treatment specifically to the needs of the individual patient, with more options than commercial medicine allows.

Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.

For More Information

The International Journal of Pharmaceutical Compounding (IJPC) is a bimonthly scientific and professional journal emphasizing high-quality pharmaceutical compounding. The journal covers topics relevant and necessary to empower pharmacists to meet the needs of today's patients. For more information, or to subscribe to IJPC, visit, or call 888-588-4572.

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