Compound interest: Petersen shares expertise on women’s health, leads APhA–APPM Compounding SIG
When Carol Petersen, BSPharm, first joined Women’s International Pharmacy in 1993, it was just a small Madison, WI–based compounding practice concentrating on the newly developed use of oral progesterone and estradiol preparations to treat symptoms of premenstrual syndrome (PMS) and menopause.
Today, Women’s International Pharmacy is a compounding pharmacy that supplies prescriptions to both women and men in every state in the nation. Despite the company’s size and national reach, Petersen said it has retained its core commitment to the traditional compounding practice of filling one prescription at a time for the individualized needs of specific patients.
Carol Petersen, BSPharm, explains the purpose of a compounded medication to a patient and demonstrates how to measure a dose.
In addition to steroidal hormones prepared in individualized dosage forms, the pharmacy now also compounds personalized thyroid treatments as well as dispenses prescription manufactured hormone products. “Our business growth,” Petersen said, “has largely come from two sources—practitioners who determine this is something they want to use in their practice and satisfied customers who spread the word.”
To advance its educational agenda, Women’s International Pharmacy publishes an online newsletter called Stay Connected, in which it has tackled dozens of subjects related to women’s health and other medical issues, from autoimmune diseases to PMS and menopause. Petersen regularly contributes short, well-researched articles to the newsletter. “We try to make it readable for the public,” she said. “As a professional myself, I appreciate when something is clear and easy to read. It doesn’t have to be all decked out in the secret language of medicine.”
Commitment to art, science of compounding
Petersen’s long commitment to the art and science of compounding made her an ideal choice to lead the APhA Academy of Pharmacy Practice & Management’s (APhA–APPM) new Special Interest Group (SIG) for compounding pharmacists. “Carol has a long history in this area and a passion for the profession that really grabbed our attention,” said Margaret Tomecki, PharmD, FAPhA, APhA Director of Practice Development and Research.
Women’s International Pharmacy advocates for compounding. L–R: Petersen; Jim Rock of Rock & Associates; Ron Casselberry, MD, International College of Integrative Medicine President.
After a slow start, the membership ranks of the APhA–APPM Compounding SIG have been growing, and the SIG appears well on its way to making its members’ collective voice heard, with Petersen as Coordinator and Lou Diorio, BSPharm, Principal of the New Jersey–based consulting firm Health Solutions Inc., as Coordinator-elect. “We’ve had some challenges,” Diorio said, “but I think we have a good amount of momentum now. “
Petersen said she envisioned the APhA–APPM Compounding SIG “as a venue where educators, policy makers, students, hospitalists, practitioners, and students can come together and have a strong voice in the practice. ... Compounding is fundamental to the practice of pharmacy,” she said, “and I know that APhA, with 60,000 members, carries a strong voice in Washington. We are very neglectful if we don’t make sure APhA carries the message that we want.”
An APhA member since 1989, Petersen added that “APhA has made it extremely easy to share information with the eCommunities [on pharmacist.com]. We have other modalities available to us such as webinars and meetings using distance technology, which I would like to utilize. Our group can look at updating APhA policies on compounding if appropriate. We can communicate quickly on issues as they are happening and give guidance to APhA lobbying efforts.”
Loyd V. Allen Jr., PhD, Editor-in-Chief of the International Journal of Pharmaceutical Compounding, agreed. “There is a broad array of topics that can be covered in this type of forum,” he said, including “everything from clinical issues to physical–chemical issues on questions concerning the best way of preparing certain compounds.” Allen said the forum could also include “political discussions related to the regulations of the state boards of pharmacy and the FDA as well as the standards within the [U.S. Pharmacopeia] that are related to compounding.”
Diorio said that one encouraging sign for the new APhA–APPM Compounding SIG was the number of student pharmacists joining because compounding is an area of growing interest to them. “I’m so close to it on a daily basis,” he said, “that I sometimes forget that this is an exciting area. One of my core beliefs is that you need to invest in the profession and you need to invest in the new grads.”
Women’s key role in their health care
Women’s International Pharmacy founder and co-owner Wallace Simons, BSPharm, and co-owner Constance Hegerfeld together opened another location of Women’s International Pharmacy in Arizona in 1995 and also launched a veterinary pharmacy practice, Pet Health Pharmacy. Petersen has worked alongside Simons and Hegerfeld for much of her career.
Petersen believes that women today are playing a key role in advancing the practice of medicine. “They are no longer content,” she said, “to accept a paternalistic solution to their problems but want to be fully involved and fully informed about their health care. They want to hire their doctors as advisers and coaches. They have access to the wonderful resources of the Internet, but more than that they reach beyond their local coffee klatches and extend their connections throughout the country and the world.”
Compounding and women’s health
The art of compounding uniquely satisfies the demand for personalized solutions to problems in women’s health, such as the following:
- Complications in absorption of hormones may be relieved by changing dosage forms.
- Combinations of hormones may improve the ease of using the prescribed hormones.
- Flavoring may help mask bitterness in preparations, such as with progesterone lozenges.
For the first time in history, pharmacists can optimize hormone levels and watch the disappearance of deficiencies associated with aging. Pharmacists will need to understand the neural functions of hormones, as well as receptors and binding proteins, and how those functions can be optimized.
Let’s review a few situations affecting women.
Menopause is a large issue and is estimated to come with symptoms of discomfort in 80% to 90% of women in their menopausal years. While addressing estrogens, progesterone, and testosterone is helpful, we also have to bear in mind that it is not unusual for ovarian production of hormones to decline with aging. We have a built-in backup system with the adrenal glands being able to supply all the sex hormone functions through progesterone, DHEA (dehydroepiandrosterone), and hydrocortisone. Identifying hormone deficiencies of the adrenal glands and adding these hormones also may help.
Polycystic ovary syndrome (PCOS) is a disease that plagues younger women and is a huge factor in infertility. The primary cause of PCOS is insulin and glucose dysregulation, but insufficient thyroid activity may also be a factor. Estrogens and cortisol may be high or low, progesterone may be low, and/or both testosterone and DHEA may be high. Diet changes and hormone modulation may bring about great changes.
Infertility also may occur when not enough progesterone is produced during the luteal phase of the menstrual cycle. Using extra progesterone will help the fertilized egg implant and ensure that the pregnancy is maintained until the placenta begins to put out much more of the hormone.
Many hysterectomies and oophorectomies are performed each year. The reasons for these surgeries may have underlying causes in hormone imbalances and could potentially be remedied with alterations in diet and lifestyle, and by treating hormone deficiencies.
—Carol Petersen, BSPharm
How did Women’s International Pharmacy get its start?
Carol Petersen, BSPharm, described the beginnings of Women’s International Pharmacy in a written response to Pharmacy Today.
“Women’s International Pharmacy opened its doors in the late 1980s. Dr. Katarina Dalton [a pioneer in the use of hormonal therapy for women], had used injectable progesterone and large doses of progesterone in vaginal suppositories. Relying on the work published by Joel Hargrove and Wayne Maxson on the feasibility of using micronized progesterone with an edible oil in capsules to achieve measurable progesterone levels, a compounded progesterone capsule became the first offering at Women’s International Pharmacy. Using progesterone orally was considered a breakthrough at the time. But soon, Women’s International Pharmacy was offering capsules in a variety of strengths as well as suppositories, rectal solutions, and lozenges.
“Using ample amounts of progesterone that might vary in each woman could lead to remarkable results. Sometimes women might be prescribed oral capsules and/or lozenges for breakthrough symptoms. Dosing is very individualized.
“Hargrove and Maxson then published another seminal paper, adding estradiol to progesterone for menopausal symptoms. This moved us into another phase of women’s health, and prescriptions for women become more and more personalized. We added other estrogens, testosterone and pregnenolone, and the adrenal hormones DHEA and hydrocortisone to our offerings. We expanded to offering other dosage forms such as topical and vaginal creams and gels and oral drops. More and more practitioners became interested, and their patients could even receive several hormones in a single dosage form.”