There are many health concerns that are unique to women and a standardized one-size-fits-all approach may not adequately address their specific needs. A compounding pharmacy has the ability to customize medication therapy to meet the unique needs of women. While pharmacists do not prescribe medications, they can educate patients and collaborate with providers to recommend therapies and specific dosage forms that can optimize patient compliance and outcomes.

A Decline in Estrogen

Genitourinary syndrome of menopause (GSM) occurs with decreasing estrogen levels and is a term used to cover health issues women in menopause experience. GSM is a collection of signs and symptoms associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. Vaginal atrophy, a symptom of GSM, may present as vaginal dryness, irritation, itching, burning, urgency, urinary tract infections and painful intercourse due to thinning, inflammation and dryness of the vaginal tissue. These symptoms can be very bothersome to a patient and can negatively impact quality of life.1,2

Treating vaginal atrophy can include both hormone and hormone-free options. Vaginal forms of estradiol and conjugated estrogens have been available in commercial dosage forms for years. Vaginal estriol is available in other countries, including the UK, however it is not commercially available in the United States. Estriol vaginal formulations are a popular option among patients and healthcare practitioners who collaborate with compounding pharmacies. Patients and prescribers will often request compounded vaginal preparations of estradiol or estriol in specific compounding bases for various clinical reasons.

 Innovation in Feminine Dosing

 Vaginal dosing hasn’t changed for decades but an innovative dispensing device is bringing accuracy, comfort, and ease of use to women.

The Topi-CLICK® Perl (Precise Easy Reliable Loading) device is a revolutionary metered vaginal applicator. The device provides a patient-friendly, accurate and consistent dosing of vaginal cream and gel medications. The proprietary snap-on dosing system allows patients to simply connect the applicator to the device and easily “click” out their prescribed dose of medication. The vaginal applicator has a comfortable and flexible barrel made of a clear medical grade soft-polymer. The device protects the stability of custom formulated medication with UV-blocking, BPA-free, phthalate-free plastic.

No more hassle of trying to get cream out of a tube into a hard plastic applicator with confusing measurement lines!

A recent study3 compared the Topi-CLICK® Perl Vaginal Dosing System to the more traditional vaginal dosing methods of plastic or metal ointment tubes with smooth or ribbed applicators. The study showed that the Topi-CLICK® Perl outperformed traditional methods in accuracy and precision with significantly less residual medication waste. Users found the Topi-CLICK® Perl system the easiest to use with little mess.

Commonly requested formulations that can take advantage of the Topi-CLICK® Perl dispensing device include, but are not limited to:

  • Estriol vaginal cream
  • Estradiol vaginal cream
  • DHEA vaginal gel
  • Miconazole nitrate and Lidocaine vaginal gel
  • Boric acid/EDTA vaginal gel
  • Lactic acid vaginal gel
  • Nystatin vaginal cream
  • Gowey Tincture cervical gel
  • Amitriptyline and Baclofen vaginal gel

There is a wide range of possible formulations that can be made to treat a variety of conditions unique to women. Pharmacists can further enhance medication therapies by including agents that maintain contact time between the medication and the vaginal mucosa. Medications can be formulated to be hypo-allergenic and free of undesirable fillers as well as ingredients that women might be sensitive to like gluten or soy.

Our pharmacists are more than happy to discuss with you personalized options for women’s health and determine if it is appropriate to transition your current prescription device to the Topi-CLICK® Perl.

Originally published in FloridaMD May 2020

* The formulas and/or statements listed are provided for educational purposes only. They are compounding ideas that have commonly been requested by physicians and have not been evaluated by the Food and Drug Administration. Formulas and/or material listed are not to be interpreted as a promise, guarantee or claim of therapeutic efficacy or safety. The information contained herein is not intended to replace or substitute for conventional medical care, or encourage its abandonment. Every patient is unique, and formulas should be adjusted to meet their individual needs.