Hormone replacement therapy (HRT) is an effective treatment for hormonal imbalance, particularly among women. However, even though 80% of women going through menopause experience symptoms, studies show only a small portion of them use HRT for relief. Men can also take advantage of HRT, including hormone pellet therapy. HRT is a simple, highly effective way to restore hormone balance without taking pills, receiving injections, or using creams, gels, vaginal rings, or patches.
This article will explore the pros and cons of hormone pellets to understand if this treatment is right for your patients. While HRT provides exceptional results for many, the treatment isn’t right for everyone.
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Understanding Hormone Pellet Therapy
Hormone pellets are small, tic-tac-sized materials made up of various hormones, including combinations of estrogen, testosterone, progesterone, pregnenolone, dehydroepiandrosterone (DHEA), or others. The hormones present in pellets mimic natural hormones present in the human body, as they have virtually the same composition.
However, bioidentical hormones present in pellets are often sourced from plants.
Pros of Hormone Pellets
Hormone pellets offer numerous benefits for patient health, including:
Steady Hormone Levels
Hormone pellets provide a consistent release of hormones that help increase low levels of estrogen, testosterone, or other hormones. These bioidentical hormones restore the body's natural hormone release patterns.
Pellet therapy can reduce the following symptoms of hormonal imbalance, offering the following benefits:
- Faster metabolism
- Easier weight loss
- Reduced body fat
- Increased muscle mass and strength
- Less vaginal dryness in women
- Reduced erectile dysfunction (ED) in men
- Higher libido
- Fewer night sweats
- Reduced hot flashes
- Less pain with intercourse
- Better sleep quality
- More energy
- Fewer mood swings
- Less depression
- Reduced confusion or brain fog
- Thicker hair
Unlike many other methods of hormone replacement therapy (HRT), hormone pellets allow patients to avoid peaks and troughs (fluctuating hormone levels) and experience steady hormone release without the often unpleasant symptoms linked to hormonal imbalance.
Convenience and Adherence
Bioidentical hormone pellets offer convenience for patients, as they require just a few applications each year to achieve long-lasting balance. This convenient perk can improve adherence, as patients don’t have to remember to take a pill daily, receive frequent injections, or apply a hormone patch or creams each week.
Personalized Dosages
A one-size-fits-all all isn’t the approach used for hormone pellet therapy. This form of hormone replacement allows for personalized dosing tailored to each patient’s individualized needs based on the results of a thorough hormone evaluation and their goals.
Cons of Hormone Pellets
While the pros of hormone pellets are numerous, potential drawbacks include:
Invasive Procedure
The pellet insertion process is more invasive than many other HRT methods, requiring a minor surgical procedure.
A provider must make a tiny incision in a patient’s upper buttocks or hips. They first numb the area, insert the hormone pellets, and close the incision using medical tape. While pellet insertion is a minor procedure, it's more invasive than taking a pill or receiving a patch or shot.
Difficulty in Adjusting Dosage
Because hormone pellets are designed to last for several months, adjusting hormone doses quickly can be challenging. Adjustments made to pellet hormone therapy require a new incision and pellet insertion.
Healthcare providers must monitor patients closely, providing a low dosage for a short period and rechecking hormone levels frequently until achieving just the right dose.
Potential Side Effects and Complications
Potential side effects or complications associated with hormone pellet therapy in some people include:
- Infection at the injection site
- Pellet extrusion (spontaneous expulsion of a pellet from its insertion site)
- Problems related to incorrect dosing (weight gain, fatigue, mood changes, etc.)
- Increased risk of blood clots, stroke, gallbladder disease, and breast cancer
- Weight changes
- Fatigue
- Acne
- Blurred vision
- Headaches
- Increased facial hair
- Cramping
- Spotting
- Breast tenderness
- Mood swings
- Bloating
- Menstruation changes
- Skin discoloration
- Itchiness or redness at the incision site
While the United States Food and Drug Administration (FDA) has approved some bioidentical hormones for optimal safety and effectiveness, the FDA hasn’t approved compounded bioidentical hormones because not enough is known about the long-term side effects or safety.
Comparing Hormone Pellets to Other HRT Methods
Other forms of HRT are often as effective as hormone pellet therapy, which is why it’s important to weigh the pros and cons of hormone pellets before determining which HRT treatment is best for each patient.
- Hormone pellet therapy: requires pellet insertion (minor procedure) every few months
- Pills: requires daily (or as instructed) use; must remember to take pills as directed
- Patches: worn on the skin; must replace hormone patches weekly or twice a week
- Creams, sprays, or gels: must remember to apply to the skin daily or several times weekly
- Injections: must attend an office visit every few weeks or self-inject hormones at home
- Vaginal rings: worn in the vagina and replaced every 90 days
Hormone pellets are typically more convenient with higher adherence rates compared with other forms of HRT. Studies show that almost 60% of patients instructed to take hormone pills missed at least some of their doses.
Who is a Good Candidate for Hormone Pellet Therapy?
Good candidates for hormone pellet therapy include individuals with low levels of estrogen, testosterone, progesterone, or other hormones who experience unpleasant symptoms associated with hormonal imbalance.
Additionally, candidates must be willing to attend doctor’s appointments every few months to monitor hormone levels and remove or replace hormone pellets as needed.
Patients who don’t want to worry about taking a pill, wearing a vaginal ring, applying a patch or cream regularly, or receiving injections every few weeks often find hormone pellet therapy a welcome, more convenient option with high success rates.
Considerations Before Choosing Hormone Pellet Therapy
Before deciding on hormone pellet therapy it’s important to discuss a patient’s medical history, lifestyle, and preference for treatment frequency to determine which HRT method best fits their needs and expectations.
Frequently Asked Questions (FAQ)
Use the following FAQs to address common patient concerns before suggesting hormone pellet therapy:
Will I gain weight on hormone pellets?
It depends. Some people do gain weight after beginning hormone pellet therapy, while others lose weight.
Studies show that hormone therapy reduces abdominal obesity and insulin resistance in perimenopausal women.
Researchers found that testosterone therapy in men increases lean body mass, which could increase overall body weight since muscles weigh more than fat.
Weight fluctuations may also occur during an adjustment period while a practitioner finds just the right dosage needed for proper balance.
However, if hormone imbalance has contributed to unwanted weight gain, pellet therapy can help individuals move toward a healthier weight.
Are hormone pellets better than pills?
Hormone pellets and pills are both effective ways to improve hormone balance and reduce negative symptoms associated with fluctuating hormones. However, some patients have difficulty remembering to take pills regularly, which reduces the effectiveness of this treatment.
Women who desire birth control may choose pills or other hormonal birth control methods instead of pellets, as pellet therapy doesn’t protect sexually active women against unwanted pregnancies.
Hormonal birth control can prevent pregnancy while minimizing unpleasant symptoms in perimenopausal women experiencing heavy menstrual bleeding, menstrual pain or irregularities, acne, low bone density, or vasomotor symptoms (night sweats, hot flashes, heart palpitations, etc.).
Who is not a candidate for hormone pellets?
Hormone therapy may not be safe for patients with a history of or risk factors linked to heart disease, breast cancer, stroke, or blood clotting disorders. Other contraindications could include history of uterine cancer, chronic liver disease or dysfunction, or migraines with auras.
Providers should establish the most appropriate treatment plan based on a patient’s medical history, risk factors, lifestyle, preferences, and goals.
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Key Takeaways
As with most forms of medical interventions, the pros and cons of hormone pellets exist. Discuss the risks and benefits of this treatment with patients and evaluate whether it's right for them based on their medical history, symptoms, lifestyle, and treatment preferences.
With the right composition and dosage, pellet therapy can greatly improve a patient’s quality of life and overall well-being.
Lab Tests in This Article
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References
A guide to birth control in your 40s and 50s. (2023, May 10). Cleveland Clinic. https://health.clevelandclinic.org/birth-control-during-perimenopause
Ahmed Albaradei , S., Ramzand, A., Madi, E., Hossam , E., Abdelhamid, R., & Abdelrahman, A. (2022, April). Assessment of compliance with hormonal therapy in early breast cancer patients with positive hormone receptor phenotype: A single institution study. National Library of Medicine . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9073292/
Bioidentical hormones: Therapy, uses, safety & side effects. (2022, April 15). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/15660-bioidentical-hormones
Chaunt, L. A. (2023, April 13). Using functional nutrition to address hormone imbalances. Rupa Health. https://www.rupahealth.com/post/using-functional-nutrition-to-address-hormone-imbalances
Cho, M. K. (2018). Use of combined oral contraceptives in perimenopausal women. Chonnam Medical Journal, 54(3), 153. https://doi.org/10.4068/cmj.2018.54.3.153
Christie, J. (2023a, January 6). A functional medicine approach to obesity and weight management. Rupa Health. https://www.rupahealth.com/post/an-integrative-approach-to-obesity
Christie, J. (2023b, January 26). 5 lab test can that help diagnose the root cause of chronic bloating. Rupa Health. https://www.rupahealth.com/post/5-lab-test-that-help-diagnose-the-root-cause-of-chronic-bloating
Christie, J. (2023c, January 31). How to add bioidentical hormone replacement therapy to your integrative medicine clinic. Rupa Health. https://www.rupahealth.com/post/how-to-add-bioidentical-hormone-replacement-therapy-to-your-integrative-medicine-clinic
Cleveland Clinic. (2022, April 4). Hormonal imbalance: Causes, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22673-hormonal-imbalance
Cleveland Clinic. (2023, July 5). Birth control pill: Types, side effects & effectiveness. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/3977-birth-control-the-pill
Cloyd, J. (2023a, March 29). 10 differential diagnosis for fatigue: Testing & integrative treatment recommendations. Rupa Health. https://www.rupahealth.com/post/10-differential-diagnosis-for-fatigue
Cloyd, J. (2023b, June 19). A functional medicine post stroke protocol: Testing, therapeutic diet, and integrative therapy options. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-post-stroke-protocol-testing-supplements-and-integrative-therapy-options
Cloyd, J. (2023c, June 28). Complementary and integrative medicine options for patients with liver disease: Comprehensive lab testing, nutrition, and supplement suggestions. Rupa Health. https://www.rupahealth.com/post/a-functional-and-integrative-medicine-approach-to-treating-liver-disease-comprehensive-testing-nutrition-and-treatment-options
Cloyd, J. (2023d, September 4). A root cause medicine protocol for patients with hot flashes: Testing, therapeutic diet, and supportive supplements. Rupa Health. https://www.rupahealth.com/post/a-root-cause-medicine-protocol-for-patients-with-hot-flashes-testing-therapeutic-diet-and-supportive-supplements
Cloyd, J. (2023e, October 9). Rhythms of the heart: Demystifying common types of heart arrhythmia. Rupa Health. https://www.rupahealth.com/post/rhythms-of-the-heart-demystifying-common-types-of-heart-arrhythmia
Cloyd, J. (2024, March 15). 4 decisive signs you need hormone replacement therapy. Rupa Health. https://www.rupahealth.com/post/signs-you-need-hormone-replacement-therapy
Coleman, E. (2024, March 21). Guide to hormone headache: Definition, causes & treatments. Rupa Health. https://www.rupahealth.com/post/guide-to-hormone-headache-definition-causes-treatments
Conner, V. (2022a, August 2). Nutrition and lifestyle tips to help reduce hot flashes. Rupa Health. https://www.rupahealth.com/post/natural-treatments-for-menopause
Conner, V. (2022b, September 21). 3 lifestyle choices that increase your risk of gallbladder disease. Rupa Health. https://www.rupahealth.com/post/gallbladder-disease-causes-risk-factors-and-treatments
DePorto, T. (2023, January 11). Why people in blue zones experience longer lifespans. Rupa Health. https://www.rupahealth.com/post/blue-zones-longevity-whats-their-secret
Easthope, A. (2022, April 26). 11 common causes of low male testosterone (and how to fix them). Rupa Health. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-low-male-testosterone-hypogonadism
Estradiol transdermal patch: MedlinePlus drug information. (2022, March 15). Medlineplus.gov. https://medlineplus.gov/druginfo/meds/a605042.html
Estradiol vaginal ring (estrogen replacement therapy). (2024). Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/20396-estradiol-vaginal-ring-estrogen-replacement-therapy
Garrison, K. (2024, March 12). 8 supplements that balance hormones to look out for. Rupa Health. https://www.rupahealth.com/post/supplements-to-balance-hormones
Harper-Harrison, G., & Shanahan, M. M. (2023, February 20). Hormone replacement therapy. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493191/
Henry, E. (2022a, January 4). How to reverse weight gain and slowed metabolism. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-slow-metabolism-middle-age
Henry, E. (2022b, February 4). Studies show these 2 diets reduce migraine severity and frequency. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-migraines
Khakham, C. (2023a, April 6). Understanding your risk of cardiovascular disease with functional medicine labs. Rupa Health. https://www.rupahealth.com/post/understanding-your-risk-of-cardiovascular-disease-with-functional-medicine-labs
Khakham, C. (2023b, May 8). An integrative and functional medicine approach to blood clotting disorders. Rupa Health. https://www.rupahealth.com/post/an-integrative-and-functional-medicine-approach-to-blood-clotting-disorders
Kresge, K. (2023, February 21). An integrative medicine approach to depression. Rupa Health. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-depression
LoBisco, S. (2022a, September 1). 8 ways to reduce anger associated with perimenopause. Rupa Health. https://www.rupahealth.com/post/why-does-perimenopause-rage-happen
LoBisco, S. (2022b, November 16). 7 natural treatments for low progesterone. Rupa Health. https://www.rupahealth.com/post/progesterone-imbalance-signs-treatments
Maholy, N. (2023a, March 2). A functional medicine protocol for dysmenorrhea. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-protocol-for-dysmenorrhea
Maholy, N. (2023b, April 19). Functional medicine protocol for treatment of acne. Rupa Health. https://www.rupahealth.com/post/functional-medicine-protocol-for-treatment-of-acne
Malani, S. (2023, May 2). Complementary and integrative testing, therapies, and treatment and recovery of breast cancer. Rupa Health. https://www.rupahealth.com/post/complementary-integrative-therapies-for-treatment-and-recovery-of-breast-cancer
Mood swings: When are they a problem? (2024, February 6). Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/mood-swings
Newson, L. R. (2016). Best practice for HRT: Unpicking the evidence. British Journal of General Practice, 66(653), 597–598. https://doi.org/10.3399/bjgp16X687097
Preston, J. (2022, September 26). Benefits and risks of the top 5 most common prescriptive birth control methods. Rupa Health. https://www.rupahealth.com/post/benefits-and-risks-of-the-top-5-most-common-prescriptive-birth-control-methods
Ranjan, P., Chopra, S., Sharma, K. Aparna., Malhotra, A., Vikram, NavalK., & Kumari, A. (2019). Weight management module for perimenopausal women: A practical guide for gynecologists. Journal of Mid-Life Health, 10(4), 165. https://doi.org/10.4103/jmh.jmh_155_19
Storer, T. W., Basaria, S., Traustadottir, T., Harman, S. M., Pencina, K., Li, Z., Travison, T. G., Miciek, R., Tsitouras, P., Hally, K., Huang, G., & Bhasin, S. (2016). Effects of testosterone supplementation for 3-years on muscle performance and physical function in older men. The Journal of Clinical Endocrinology & Metabolism, 102(2), jc.2016-2771. https://doi.org/10.1210/jc.2016-2771
Sweetnich, J. (2023, February 24). The importance of testing DHEA levels. Rupa Health. https://www.rupahealth.com/post/evidence-based-health-benefits-of-dhea
Weinberg, J. (2022, March 31). How to tell if you have an estrogen imbalance. Www.rupahealth.com. https://www.rupahealth.com/post/a-functional-medicine-approach-to-estrogen-imbalance
Yoshimura, H. (2023, July 5). Implementing bioidentical hormone therapy in practice with specialty lab testing. Rupa Health. https://www.rupahealth.com/post/biodentical-hormone-therapy-protocol-and-testing
