• Damir Franić, Matjaž Sever, Andrej Janež, Maja Franić-Ivanišević, and Mojca Jensterle.
• 1Outpatient Clinic Ob&Gyn, Rogaška Slatina, Slovenia; 2School of Medicine, University of Maribor, Maribor, Slovenia; 3Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia; 4Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; 5Department of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia.
• Acta Clin Croat. 2019 Mar 1; 58 (1): 167-172.

AbstractAlthough the use of commercially manufactured hormone therapy (HT) to treat menopausal symptoms has declined during the past 12 years, the use of custom compounded HT seems to have increased. A 39-year-old woman with refractory anemia sustained premature ovarian insufficiency following allogeneic stem cell transplantation. After systemic biologic treatment (azacitidine) and corticosteroid therapy, besides extreme climacteric symptoms (Green Climacteric Scale, 59) and impaired quality of life, she also had elevated liver enzymes. Therefore, she was not a candidate for oral HT. Treatment was started with 17-beta estradiol patch 0.5 mg (Climara) together with micronized progesterone intravaginally, 2x100 mg (Utrogestan) for 3 months. She was not satisfied, so the custom compound HT started with 17-beta estradiol 0.5 mg gel 2x/day and micronized progesterone in liposomal gel 100 mg/daily. She was much better but she complained of low libido, decreased sex drive and emotional instability, so 1% testosterone gel was added. Now she was completely satisfied, Green Climacteric Scale was 8 and liver enzymes were normal. In conclusion, custom compound HT has the possibility of tailoring and adjusting therapy to the individual need, which has been the everlasting goal in menopause medicine and should be a good option for special clinical cases.

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