Menopausal women have many choices in hormone replacement, but estrogen and testosterone pellets seem to be stealing the show! Lets face it - patches are cumbersome, creams are messy and don't work well, and pills 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.
This office has been offering hormone pellet therapy for the last 12 years. You'll find that our pricing is reasonable and affordable.
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 trochar, 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 by a Physician or Nurse Practitioner 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.
Some insurance companies are now paying in full or in part for hormone pellets. This office accepts insurance payment if the company chooses to cover, so all you pay is your co-pay. Even if your insurance does not cover pellets, our pricing is lower than any other office in the valley. We charge $260 for a full set (2 estradiol and 1 testosterone) of pellets if you are paying for your therapy. Generally, this is comparable to what you would spend on patches or other methods of hormone replacement every 4-6 months.
Questions and Answers
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 is 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. Oral testosterone has not only been tied to an increased risk of breast cancer, but usually is not effective.
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 eliminates the hot flashes, night sweats, insomnia and vaginal dryness. Testosterone increases energy, enthusiasm, and sex drive.
Q: Why do I have to take progesterone with the pellets?
A: Unopposed estrogen stimulation of the uterine lining causes overgrowth of the lining, or hyperplasia, and potentially uterine cancer. Progesterone prevents this overgrowth in most cases. Progesterone can cause fatigue so we suggest that progesterone be taken at night. In some women it can also cause weight gain and fluid retention. If a woman has had a hysterectomy, progesterone is unnecessary.
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 mild acne. If these symptoms develop, we reduce the dose of the pellets. Rare side effects include facial hair growth, weight gain, or fluid retention.
Q: I have heard that estrogen increases my risk of breast cancer. Is this true?
A: At this time, we have no evidence that estrogen increases a woman's risk of developing breast cancer. If estrogen does stimulate breast cell growth, it appears that testosterone counteracts that process and may be protective against breast cancer development. We do know that estrogen users who do develop breast cancer appear to have a lower mortality from the disease. This may be due to earlier detection, but the research at this time is not clear. We know that the combination of oral equine estrogen and synthetic progesterone (PremPro) does increase the risk of breast cancer. Our recommendation is to stick with non-oral bioidentical estrogen and testosterone and if progesterone is necessary, use bioidentical instead of synthetic.
Q: Will the hormone pellets protect me from bone loss?
A: Yes. Estrogen therapy, especially when combined with testosterone, has been shown to maintain the mineral content and strength of bones after menopause. The consistent levels of estrogen achieved by the pellets is especially effective in preventing bone loss.
Q: Do the pellets leave me at risk for blood clots?
A: Oral estrogen, because liver metabolism is required, increases the risk of blood clots. Pellets, because they are absorbed directly into the blood stream, do not appear to increase the risk of blood clots, and consequently do not appear to increase the risk of strokes or heart attacks.
Q: How fast will I feel the effects of the hormone pellets?
A: Women often experience relief of their symptoms within a few days of pellet insertion.
Q: Won't estrogen alone increase my sex drive?
A: It appears that estrogen alone is not effective in increasing sex drive. The addition of testosterone, however, increases not only drive, but sexual enjoyment and orgasmic potential. Women who are receiving both estrogen and testosterone report more frequent sexual fantasies, desire to initiate sexual interaction, and pleasure associated with sexual activity.
Q: Will my sex drive be the same as it was when I was in my 20's?
A: Doubtful. Sex drive and sexual response has many components, and is thought to be 70% psychological. The correct combination of estrogen and testosterone may renew a woman's interest in sex and increase her ability to respond to stimulation and attain an orgasm. Many other factors are also involved. Life stress, physical illness, relationship issues and previous sexual dysfunction all affect sexual feelings and response. We all need to remember that evolutionarily, sex drive is tied to procreation. Menopausal woman are not meant to procreate, so there is an intrinsic drop in the desire for sex and the response to sexual stimulation. This can be partially reversed by hormones, but not completely.
Q: I notice that I am depressed since my periods have stopped. I wake up feeling "low" and not at all enthusiastic about the day. Will hormones help?
A: If you have not been depressed in the past, estrogen/testosterone therapy will help lift the feeling of impending doom and lack of enthusiasm that menopausal women often experience. This hormone induced increase in sense of well being has been proven in objective research studies and is also reported by our patients.
We find particularly that the combination of estrogen and testosterone helps women feel brighter and more vibrant.
Q: I have read that hormones cause heart disease. I have a strong family history of heart disease and I do not want to end up with a heart attack. Should I stay away from hormones?
A: It is unfortunate that hormone therapy is regarded as bad for the heart, because this is only true in some circumstances. Generally speaking, estrogen is protective against heart disease if started at the onset of menopause. A recent study by the Mayo Clinic looked at women who had ovaries removed in their 40's and did not receive hormone replacement. These women had a much higher incidence of heart disease and death from heart disease and neurologic disease over the next 30 years than the general population. Surprisingly, it was also found that these women had a lower chance of dying as a result of breast or uterine cancer if they developed these diseases than the control group. Your individual risk should be discussed with your Provider.
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.
Q: Can I get all of my Gynecologic care at this office, or just my pellets?
A: All of your Gynecologic needs will be addressed at this office. It is very important to have a full Gynecologic evaluation before any hormone therapy is begun. This should include a breast examination as well as a pelvic examination. We will frequently recommend that an ultrasound be performed in order to establish a baseline. If you do bleed irregularly on pellets, another ultrasound and an endometrial biopsy will be performed.
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