Menopausal women have many choices in hormone replacement, but estrogen and testosterone pellets seem to be stealing the show! Let’s face it – patches are cumbersome, daily regimens are hard to remember, and pills can create swings in blood hormone levels on a daily basis.
If you are suffering with hot flashes, night sweats, insomnia, vaginal dryness, lack of sex drive, fatigue, aches and pains, poor memory and concentration, moodiness or depression, you are a candidate for hormone replacement. You have many options, but for the woman who wants to feel truly young again, pellets are the most popular choice.
Estradiol and testosterone pellets are inserted in the fat layer under the skin of the hip and release hormone slowly over time, maintaining constant and reliable blood levels. The hormone levels gradually rise, peak at 3-4 weeks, and then gradually fall over the following few months.
In the natural pre-menopausal state, ovaries make 3 types of estrogen as well as testosterone and progesterone. These hormones are maintained in a balance. Hormone pellet therapy is better able to mimic pre-menopausal physiologic levels of estradiol and estrone, 2 of the 3 types of estrogen that are produced by the ovaries. Pellet therapy also offers the option of adding testosterone, which is produced by the ovaries along with estrogen before menopause.
Women who receive hormone pellets find that they feel normal again, many after suffering for years with difficult menopausal symptoms. These women report no more hot flashes or night sweats. They regain their ability to sleep through the night peacefully and wake up feeling refreshed with a general feeling of well-being. Women who receive both estradiol and testosterone pellets also report a renewed sex drive, ability to enjoy sex and experience orgasms for the first time in years.
In our experience, no other method of hormone replacement attains the same consistent blood levels and actual positive results.
Insertion is easy, quick, and relatively painless. A small area on the hip is sterilized and local anesthetic is injected just under the skin. A tiny nick is made in the skin and, using a trocar, the hormone pellets, which are the size of rice grains, are inserted under the skin. The tiny incision is closed with adhesive strips and covered with a band-aid.
Women with an intact uterus will need to also take progesterone pills or cream to protect the uterine lining from overstimulation by estrogen. In this office we prefer bioidentical progesterone to synthetic. Bioidentical oral progesterone is available commercially as Prometrium or can be compounded at a compounding pharmacy. Progesterone cream is available over the counter or can be compounded. We generally try to avoid any uterine bleeding by giving the progesterone daily, but this is not always successful. If irregular bleeding occurs on the continuous therapy we alter our regimen to a 10 day a month pulse of progesterone, which causes a predictable monthly bleed.
Women receiving hormone pellets will be asked to return for blood levels in a few months. The results of these blood levels will be evaluated, and a recommendation will be made for timing and dosage of the next pellets. We base our decisions about dosage and timing on symptoms as well. Some women feel better with higher levels of hormones than others. All of these factors are taken into account when tailoring a hormone pellet regimen to an individual woman.
If you begin to experience hot flashes, night sweats, moodiness or inability to sleep before you are scheduled to come in for a blood hormone level, please move your appointment up. You may need your pellets sooner than anticipated.
Q: What is wrong with just taking estrogen pills? It is so simple to take a pill once a day.
A: Many things. The issue of greatest concern is that oral hormones pass through the liver in the process of metabolism and a result of this liver pass, the liver increases the production of clotting factors. This may be why increased risks of stroke and heart attack are reported in women taking oral hormones. Estrogen alone does not impart the same sense of well-being and/or increased energy level that a combination of estrogen and testosterone produces.
Q: Will the estrogen patch give me hormone levels comparable to the pellets?
A: No. Blood estradiol levels on the patch are lower than they are on the pellets. The other disadvantage of the patch is that it only contains estradiol or estradiol and synthetic progesterone. The pellets offer a combination of estradiol and testosterone, which are complimentary to one another. Estrogen can eliminate the hot flashes, night sweats, insomnia and vaginal dryness. Testosterone may increase energy, enthusiasm, and sex drive.
Q: How often do I need to have the pellets inserted?
A: Most women maintain their hormone levels for 4 months after a set of pellets is inserted. We find that pellets need to be inserted more often in the beginning of pellet therapy and less often after a few insertions. Some women do not need pellets more than every 6 months or so, and some need pellets every 3 months. Timing of pellet insertions is an individual matter.
Q: What are the side effects of hormone pellets?
A: Most women feel great on the pellets and have no side effects. Those women who do experience side effects most commonly report breast tenderness, which is a result of estrogen stimulation of the breast tissue. Testosterone can cause oily skin or mild acne. If these symptoms develop, we reduce the dose of the pellets. I generally start with a moderate dose, and increase as needed, giving the body time to adjust over time. Rare side effects include facial hair growth, weight gain, weight loss, nausea, pain at insertion site, or extrusion of pellets.
Q: Who should not take hormones?
A: Generally speaking, women who have a personal history of breast cancer are not candidates for hormone replacement therapy. There is no evidence in the literature that estrogen increases the risk of recurrence of breast cancer, but Oncologists are reluctant to approve estrogen therapy in a woman who has had breast cancer, particularly if the tumor was estrogen receptor positive. Many Oncologists, however, are comfortable with testosterone.
Women who have a strong family history of blood clots should be genetically tested to see if they carry a gene that would cause their blood to clot easily. If this gene is present, then estrogen is contraindicated. Of course, if you have personally had a blood clot, you are not a candidate for estrogen therapy.
Your Provider will evaluate your personal and family history at the time of your consultation and determine if you are a candidate for hormone therapy.
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