Forget about over-the-counter pills and creams to reduce hot flashes, insomnia, and other symptoms of perimenopause. Don’t bother with prescriptions for mass-produced synthetic hormones, either.

Instead, why not use chemistry-or bio-identical hormone replacement-to duplicate natural human hormones, and then concoct the right dosage for each individual woman? Pharmacists call this individualized procedure “compounding.”

Alison Johnston (’84 Pharm.) started doing just that in January 2003 in Portland, Oregon. She reports it seems to be working.

Johnston is the only pharmacist in a compounding-only pharmacy, Marquis Compounding Pharmacy in Portland. She has her own patients and writes prescription recommendations for their doctors to sign. A few of her patients believe so strongly in bio-identical hormone replacement therapy, that they have left physicians who resisted the idea and have found others who agreed to go along with it.

Unlike synthetic hormones, the chemical structure of the hormones Johnston dispenses is identical to that of the hormones made in the human body, she says.

These bio-identical hormones are derived from soybeans or yams, and then put through a chemical process to become pharmaceutical-grade hormones, she says.

In addition to treating women for perimenopause symptoms, Johnston treats men for declining testosterone. First she tries to use supplements and minerals to boost the patient’s own production of testosterone or block its conversion into estrogen, rather than immediately treating the decline with testosterone, which could further shut down the patient’s own production of the hormone.

She also spends about 10 percent of her time on pain management compounding, most of which involves making topical creams and gels.

Johnston buys all her hormones from the Professional Compounding Centers of America (PCCA) in Houston to be sure of their quality and consistency. They arrive at her pharmacy in powder form. From there, she and her pharmacy technicians make individualized doses in various forms, such as capsules, creams, gels, or drops.

She relies on a saliva test instead of a blood test to determine hormone levels in the body. Saliva testing does not require a physician’s order and is easy to do at home. It takes a lot of skill to accurately determine hormone levels in blood, Johnston says.

“You are looking at the total hormone levels, which include both free hormones and hormones that are tightly bound to other proteins,” she says. “With saliva, you are primarily looking at the levels of free hormone, which is the hormone that has the effect.”

The saliva test measures estrogen, progesterone, testosterone, DHEA, and cortisol hormones. The results are compared with the normal ranges and the patients’ symptoms. Because nutrition and exercise play a “huge” role in the effect of the hormones, Johnston talks with the patient about those factors before she writes out her recommendations and mails them to the patient’s physician to sign.

“Nine times out of 10 the physicians sign the recommendations and mail them back,” she says.

A few physicians in the Portland area are working with her now, writing prescriptions for hormones. Johnston is hoping more will start, because she can’t take on many more patients-she has about 70.

But she can fill a lot more prescriptions.