Menopause and Hormones

Timed-released, bioidentical estrogen and testosterone hormone pellets are becoming increasingly popular. Dr. Wilson has been offering these pellets for 15 years, and has seen their popularity increase significantly in the last 2 years. This increase seems to be due to the heightened awareness of the advantages of bioidentical hormones instead of synthetic or horse urine derived hormones.

We all have Suzanne Somers to thank for increasing the public awareness of the importance of choosing bioidentical hormone options. She has been a stalwart proponent of hormones for menopausal women, despite massive opposition to hormone use after the release of the Women's Health Initiative study a few years ago. Despite the controversy, it seems clear that hormone replacement therapy can be the difference between a happy, enjoyable, productive life and a dull, difficult existence.

What are balance hormone pellets and why are they better than hormone pills, patches or creams?

The pellets are not necessarily better than other modes of hormone replacement therapy. Pellets are, however, an excellent option for some women. A huge advantage is simple convenience. The pellets are placed by a physician under the skin of the hip and generally last for 4 months. A menopausal woman using the pellets does not have to think about taking a pill, changing a patch or applying a cream except for 3 times a year!

An enormous advantage is that both estrogen and testosterone pellets can be used together. The only other estrogen/testosterone combination available commercially is a pill, and this pill is not bioidentical and has been associated with an increased risk of breast cancer. Testosterone creams are available, and can be formulated along with estrogen (and progesterone), but blood levels in women using the creams are often not high enough to handle the symptoms of menopause.

Pellets offer excellent blood levels of both estrogen and testosterone, and the dose will be designed just for you based on blood tests and symptoms.

How are the pellets inserted?

A physician administers a local anesthetic in the skin of the hip. This anesthetic is identical to the anesthetic used in the dental office. A tiny nick is made in the skin of the hip and the pellets are placed under the skin. The nick is covered with adhesive strips that stay on for 3-4 days. A band-aid is placed over the strips in case there is a small amount of bleeding.

How do I know what dose is right for me?

We will be monitoring both your blood levels and your symptoms. As a general rule, a baseline hormonal level will be drawn in the office before your first pellets are placed. If you do not have ovaries, this is not necessary because your levels will be zero. After 6 weeks, another level will be drawn in order to see how high your levels climb. We will plan to draw a third level at about 3 months from pellet placement to see if your levels are dropping. Some women metabolize the pellets faster than others, and need another dose of pellets in 3 months. Some women maintain adequate levels for 5 months. If you feel your symptoms returning and are not scheduled for another pellet dose, we encourage you to come to the office for a blood draw. After a few pellet doses, we no longer need to draw blood so frequently because we know how fast you metabolize the pellets and we will be able to set a schedule of pellet doses just for you. Occasionally, however, we want to check blood levels to make sure that your levels are not building up too high.

How will I know if my levels are too high or too low?

If your levels are too low, you will experience menopausal symptoms such as hot flashes, insomnia and night sweats. Some women begin to feel slightly depressed and notice that their sex drive is waning. You are encouraged to come to the office for a blood draw if these symptoms occur.

Most women do not notice when their levels are too high, which is why we check levels from time to time, even after years of pellet use. Pellets can deliver a small amount of hormone to the system for up to 9 months, and we want to prevent buildup of hormone levels. If we see that your levels are getting too high, we simply delay the next dose of pellets.

What do pellets cost?

We charge $220 for a set of pellets. Office consults, visits and blood tests are generally covered by your insurance company. If you are receiving pellets 3 timer per year, this is about $13 per week. We have purposely set our prices in an affordable range in order to make this option available to more women.

Why take hormones?

To answer this question, some history is useful. As recently as 1900, the average age of death was 50. Any woman who lived longer than age 50 probably felt lucky to be alive, and was willing to suffer through the hot flashes, insomnia and other uncomfortable symptoms of menopause. Women are now living well into their 80's. This means that at LEAST 30 years of their lives are spent in the menopausal state.

No only are the hot flashes, night sweats, insomnia, vaginal dryness, and general moodiness and depression difficult to live with, but being without hormones is not necessarily the best thing for you. There is mounting evidence that hormone use, if started at the time of menopause, is beneficial for cardiovascular health, neurologic health, bone health, and optimal functioning of the immune system. Obviously, there are some women who should not take hormones, but many would benefit from them.

How do I know if I am a candidate for hormone replacement therapy?

If you are suffering from menopausal symptoms that are getting in the way of your ability to function normally and affecting your marriage and other relationships, you might consider hormone replacement. Even if you are not very symptomatic, hormones might be a consideration because of their other health benefits.

Estrogen replacement will eliminate the hot flashes, night sweats and vaginal dryness. Estrogen can lift depression and allow you to think more clearly. Every brain cell has an estrogen receptor. Estrogen is the most powerful bone-preserving agent available, more powerful than any of the other drugs available for this purpose. Estrogen seems to protect the cardiovascular system if started at the time of menopause. It also seems to keep the immune system healthy.

For example, a recent Mayo Clinic Study concluded that young women (under 45) who had their ovaries removed and did not receive adequate estrogen replacement had a 70% increased mortality risk over the next 30 years of life than the controls. This mortality was a result of cardiovascular and neurologic disease primarily, but it was also found that women who did not have adequate estrogen and developed breast cancer or uterine cancer were more likely to die of the disease!

Testosterone therapy preserves sex drive, sexual responsiveness and ability to have an orgasm. It also increases muscle and bone mass. It seems to increase enthusiasm and lift depression. Testosterone was overlooked as an essential female hormone for many years, but it is now known that testosterone in combination with estrogen are important for optimal postmenopausal health.

Many women are confused and distressed when, in their 40's, their sex drive and ability to respond and enjoy sexual interaction decreases significantly. This can cause serious problems in a relationship. The combination of estrogen and testosterone can make an enormous difference in sex drive, responsiveness, and ability to have an orgasm. The actual intensity of an orgasm is increased as well. A large percentage of women seeking out Balance hormone pellets do so in order to revitalize their sex drive, and the reports are positive.

Do I need to take progesterone?

If you have had a hysterectomy, you do not need to take progesterone. Progesterone's most important function is to protect the lining of the uterus from abnormal build-up. If you are taking estrogen without progesterone and you do have a uterus, you may thicken the lining of your uterus to the point that you begin to bleed abnormally. More importantly, this thickened lining can develop into cancer over a period of years.

Generally, a woman receiving estrogen pellets will be given a prescription of bioidentical progesterone to take orally. Other forms of bioidentical progesterone are available as well, and you will discuss this with your physician during your hormone consult. We discourage the use of synthetic progestins due to an increased risk of breast cancer.

I still have my uterus. Will I bleed if I use the pellets?

You may or may not bleed on the pellets. Generally, a woman in her 40's will tend to bleed when the uterus is stimulated by estrogen, so we use progesterone in a way that induces a period. Periods do not necessarily need to occur monthly, every other month or every third is often adequate to bleed off the uterine lining.

An older woman still needs to take progesterone, but a small daily dose of progesterone is often adequate and will avoid any bleeding. If bleeding does occur, we need to know about it so that we can make sure that no abnormal cells have developed inside the uterus.

Who should not take hormone therapy?

Generally speaking, women who have had breast cancer are not candidates for estrogen replacement therapy. There is no evidence in the literature that taking estrogen increases the risk of recurrence, but oncologists are reluctant to approve estrogen, particularly in a tumor that was estrogen receptor positive. Some women, after assessing the literature, choose to take estrogen anyway, but this is controversial. Many oncologists, however, feel comfortable using testosterone even after breast cancer.

Women who have a strong family history of blood clots should be genetically tested to see if they carry a gene that would cause them to clot more easily. If the gene is present, then estrogen is contraindicated. Of course, if you personally have had a serious blood clot, you would not be a candidate.

Your history will be thoroughly evaluated at the time of your consultation, and if you are not a candidate for hormones, your physician will let you know.

Can I get all of my gynecologic care at this office, or just my pellets?

All of your gynecologic needs will be addressed at this office. It is very important to have a full gynecologic examination, including a breast exam, before pellets are placed. We need to make sure that you have no breast masses that could be adversely affected by hormones. You will need to have a normal pap smear. We want to know that you have no uterine, ovarian or vaginal abnormalities before we start hormones. If you do bleed abnormally on the hormones, we will need to perform an ultrasound and an endometrial biopsy to be sure that there is not another reason for your bleeding that we need to address.