Pellet hormone therapy: Is it right for you?

February 22, 2019 Providence Health Team

Pellet hormone therapy provides a steady trickle of hormones over the course of several months.

Pellets are inserted underneath the skin via a small incision.

It is ideal for women who have undergone early hysterectomies or patients already on hormone treatment and want to feel even better.

If you are a woman who is feeling good on hormone replacement therapy, but would like to feel even better, then pellet hormone therapy may be right for you. Instead of injections, creams or patches, hormones are delivered in a unique way, says Elizabeth Stegmaier, ND, a naturopathic physician with Providence Women’s Care and Family Wellness in Missoula, Montana.

“Generally, pellets of estrogen and/or testosterone are placed under the skin in a roughly 3mm-4mm incision at the top of the buttocks area during a 15-minute, in-office procedure,” Dr. Stegmaier says. “Those pellets are then absorbed over the course of three to six months; the average is about four months. The pellets act like little ovaries, and women have a small trickle of hormones every day as the pellets dissolve. That’s different than a cream, troche or patch that needs to be reapplied more frequently.”

Because pellets mimic ovarian hormone function, this therapy is especially beneficial for women who have had early hysterectomies, Dr. Stegmaier says. “Women in their 30s who have had their ovaries removed need estrogen therapy, because they need to have high doses of estrogen — it’s important for bone, brain and heart health. Those patients do exceptionally well on pellet therapy.”

Pellet therapy can also work for women who are going through traditional menopausal hormone changes, too. Dr. Stegmaier notes that generally these women have already been on other types of hormone therapies and know they work. “For example, a woman may come in just after menopause, and she’s been taking small doses of estrogen and testosterone, and she’s doing great,” Dr. Stegmaier says. “There are two reasons for her to switch to pellets. The first is to see if she can feel even better, because generally what we see is that a pellet is the best delivery method. The second reason is that she is tired of applying creams and patches and wants an easier delivery system.”

Dr. Stegmaier adds that pellet therapy may not be as ideal for some women if they are highly sensitive to estrogen, because they can start spotting or bleeding. Dr. Stegmaier may adjust the therapy with an increase in progesterone or a decreased dose of estrogen, or both, but that can sometimes result in complications.

Another interesting note is that the therapy isn’t limited to women. In fact, Dr. Stegmaier treats many men for testosterone issues. Like women, men should already have tried other hormone delivery systems before embarking on pellet therapy. Pellet therapy for men is FDA-approved. Although for women it is considered “off label” use and is not FDA-approved, pellet therapy has been used for women in the United States since 1939.

If a patient opts for pellet therapy, the dosage and timing of insertions are calibrated for maximum effectiveness during the course of the first year. Because the pellets can’t be taken out once they are inserted, Dr. Stegmaier favors a conservative approach to dosing to avoid potential side effects from overly high hormone levels. This is another reason why Dr. Stegmaier recommends patients have already been on another form of hormone therapy before switching to pellets. “For instance, if someone is wearing an estrogen patch, the dose in the patch can help me determine the proper pellet dose,” she says.

In addition to ease of delivery and an improvement in how patients feel, pellet hormone therapy has other pluses. Estrogen patches, which are a common form of hormone delivery, can cause an allergic reaction triggered by the patch adhesive. With testosterone, the only ways women can get that hormone is through an injection or cream, and Dr. Stegmaier says in her experience pellets are far superior in how women feel. In some cases, pellet therapy may help alleviate postmenopausal vaginal dryness and painful intercourse, to the point that women can stop using vaginal creams. And depending on a patient’s insurance plan, it can be cheaper than other therapies.  

With pellet therapy, Dr. Stegmaier says her patients have seen improvement in practically every symptom of menopause. “The reported benefits have included fewer or no hot flashes or night sweats, mood improvements, less anxiety, increased libido and sexual response, increased ability to exercise — everything from ‘I got my life back’ to ‘I’m a new person.’”

When it comes to any kind of hormone therapy, Dr. Stegmaier takes seriously the process of having a thorough discussion of the risks and benefits with each patient. “There are risks to taking hormones, so finding a provider who can have a thoughtful conversation about this is important,” she says.

Want to talk to a primary care doctor about hormone health? Find a Providence provider near you:

Alaska

California

Montana

Oregon

Washington

Providence Health Plan

Providence Health Assurance

St. Joseph Health

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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