Hey, what are pellets for hormones? Do I need them?

What are pellets for hormones- woman physician having telehealth conference

What are pellets for hormones? They’re one way to take hormone replacement therapy (HRT). Find out all the pros and cons of using them and what other options exist.

What are pellets for hormones?

What are pellets for hormones- physician holding clipboard talking with patient

About 44% of postmenopausal women report trying HRT. However, as HRT becomes more mainstream, many women ask how it can help with their insomnia and other symptoms. One way to deliver HRT is through a hormone pellet. Hormone pellets have a longer history than most people realize. In fact, their use actually dates back to the 1930s. However, they were reserved for women who underwent total hysterectomies.

As small as a grain of rice, hormone pellets time-release small, stable doses of bioidentical hormones to your body. They continue to do this until they dissolve. (This usually takes 4–6 months for women.) Bioidentical hormones have an identical chemical structure to your natural hormones and are made from plants.

How are hormone pellets placed in my body?

Woman physician sitting at desk discussing hormone pellets

Pellet procedures get described as simple and quick, and they are. But do expect a few instructions from your provider beforehand and after. For example, you may need to avoid blood thinners for a week before your procedure.

Usually, pellets get placed in fatty areas of the body, like the low belly, hip, or upper bottom. A nurse will numb your skin at the insertion site, so you don’t feel pain. A small tool called a trocar helps your physician insert the pellet. There’s no real downtime needed after your appointment. However, your physician may ask you to avoid intense physical activity and swimming for 3–4 days.

Are pellets the only way to replace hormones?

What are pellets for hormones- illustration of woman physician holding up RX script

If you need HRT, you aren’t locked into pellets. Tablets, creams, gels, patches, pellets, troches, injections, and/or vaginal pessaries may be options depending on what hormones you’re replacing. Some women say researching HRT becomes overwhelming because all of the different methods available. But a good discussion with your provider helps. They can go over factors that narrow it down: lifestyle, if you have children in your home, what you’re comfortable with, and also your budget.

What are the pros of using pellets for hormone replacement?

What are pellets for hormones- woman sitting on couch in dress clothes with living room behind her

There are benefits to hormone pellets. Some women choose pellets over other forms of HRT because they’re convenient. Once inserted, you can forget about them for 4–5 months. You’ll get a constant release of a tiny, very precise amount of hormones directly into your bloodstream. Unlike pills, pellets mean these hormones also bypass your liver and gastrointestinal system, both of which can alter how much hormones you’re actually getting.

Are there cons of using pellets for hormone replacement?

Pellets are undeniably convenient. But they’re not for everyone. In our opinion, the cons of pellets often outweigh the positives. For starters, pellets do require a minor procedure. A small number of women may experience discomfort around the insertion site.

Pellets don’t let dosages be tweaked

Perhaps the biggest drawback to pellets, though, is this: once inserted, they’re hard to get back out. It can be done. But it requires another procedure. So, why would you ever want or need to take a pellet out? Hormone test results may be a good indicator of about how much hormone replacement therapy you need. But there’s actually a science and an art to prescribing HRT. Often, a fair amount of trial and error occur to find out precisely what works for you. Your optimal hormone levels and what makes you feel best aren’t necessarily identical to what dosages your labs may be saying you need.

With a pellet, your dosage is set for 4–5 months. (And, in some women, even longer.) It can’t be tweaked or altered. If that dosage is even slightly too high? Imagine side effects like weight gain, mood swings, libido changes, heavy or absent periods, headaches, fatigue, and aggression. On the flip side, if your dose is too low? You may still have the unwanted symptoms that drove you to seek HRT in the first place. In these cases, there’s no way to switch your dosage unless your pellet is surgically removed or dissolves in a few months. However, other methods of HRT allow your dose to be changed right away. Knowing that can be done simply and easily is important (and a relief!).

The added danger of high doses of testosterone

Pellets generally are made of estradiol (a form of estrogen) and testosterone and sometimes, progesterone. All hormone replacement dosing needs to be handled extremely carefully. Yes, because of side effects but also because of long-term risks as well—such as changes to cholesterol and more. Nowhere is this more important than in pellets, where therapy is difficult to readily change or discontinue. Your provider should understand this. They need to know estrogen generally shouldn’t be given without progesterone. They also need to understand that testosterone can convert into estrogen. While you want enough estrogen to feel well, too much estrogen (even the “good” kind!) corresponds to menstrual issues, acne, constipation, low libido, and increased cancer risk.

What’s the verdict on pellets for hormones?

Physician with glasses examining patient

What’s best for one woman isn’t always right for another. When considering HRT, it’s extremely important to connect with your primary care physician. Discuss the different options being presented to you. How you take your HRT should be a conversation as individualized to your age, lifestyle, needs, symptoms, and preferences as your dosing.