Data supports that hormone replacement therapy with pellet implants is the most effective and the most bio-identical method to deliver hormones in both men and women. Implants, placed under the skin, consistently release small, physiologic doses of hormones providing optimal therapy.
Questions About Hormone Therapy
Pellets are compounded using biologically identical hormones (most often estradiol and testosterone). The hormones are pressed or fused into very small solid cylinders. These pellets are usually smaller than a grain of rice. In the United States, the majority of pellets are made by compounding pharmacists and delivered in sterile glass vials. There is no other ‘method of hormone delivery’ that is as convenient for the patient as the implants. Pellets have been used in both men and women since the late 1930′s. There is more data to support the use of pellets than any other method of delivery of hormones.
Pellets deliver consistent, healthy levels of hormones for 3-5 months. They avoid the fluctuations, or ups and downs, of hormone levels seen with every other method of delivery. Estrogen delivered by subcutaneous pellets maintains the normal ratio of estradiol to estrone. This is important for optimal health and disease prevention. Pellets do not increase the risk of blood clots like synthetic hormone replacement therapy. In studies, when compared to conventional hormone replacement therapy, pellets have been shown to be superior for relief of menopausal symptoms, maintenance of bone density, restoration of sleep patterns, and improvement in libido, sexual response and performance. Properly balanced hormones in men and women delivered by pellet implants have been shown to increase energy, relieve depression, increase sense of well-being, relieve anxiety and improve memory and focus, as well as increase in muscle tone and bone density. The benefits of properly balanced hormones help with vaginal dryness, incontinence, urinary urgency and frequency. Testosterone, delivered by pellet implant, increases lean body mass (muscle strength, bone density) and decreases fat mass. Bioidentical hormone therapy helps to prevent chronic illnesses such as heart disease, diabetes, Alzheimers and osteoporosis. Even patients who have failed other types of hormone therapy have a very high success rate with pellets.
The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets are usually inserted in the lateral upper buttocks area through a small incision, which is then taped closed. The experience of the health care professional matters a great deal, not only in placing the pellets, but also in determining the correct dosage of hormones to be used.
Complications from the insertion of pellets include; minor bleeding or bruising, discoloration of the skin, infection, and the possible extrusion of the pellet. Other than slight bruising, or discoloration of the skin, these complications are very rare. Testosterone may cause a slight increase in facial hair in some women. After the insertion of the implants, vigorous physical activity is avoided for 3-4 days because this may cause the pellet to shift.
You may wonder why you haven’t heard of pellets. Pellets are not patented and have not been marketed in the United States. They are frequently used in Europe and Australia where pharmaceutical companies produce pellets. Most of the research on pellets is out of Europe and Australia. Pellets were frequently used in the United States from about 1940 through the late 70′s. Then pharmaceutical companies and physicians started marketing synthetic estrogens which took focus away from pellet therapy. Since bio-identical pellets are natural they cannot be patented; therefore, pharmaceutical companies do not market them.
What if my primary care physician or my gynecologist says that there is ‘no data’ to support the use of Bioidentical Hormone Pellet Implants?
He or she is wrong. There is a big difference between ‘no data’ and not having read the data. It is much easier for busy practitioners to dismiss the patient than it is to question their beliefs and do the research. It’s about a patient making an informed choice. After pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, co-ordination and physical performance. They may see an improvement in skin tone and hair texture. Concentration and memory may improve as will overall physical and sexual health. There is data to support the ‘long term’ safety of hormones delivered by pellet implants.
Do Bioidentical Hormone Pellet Implants have the same danger of breast cancer as other forms of hormone replacement therapy?
Pellets do not carry with them the same risk of breast cancer as high doses of oral synthetic estrogens that do not maintain the correct estrogen ratio or hormone metabolites. Nor do they increase the risk of breast cancer like the synthetic, chemical progestins used in the Women’s Health Initiative Trial. Data supports that balanced, bio-identical hormones are breast protective.
When a patient first starts on hormone therapy there may be mild, temporary breast tenderness, which resolves on its own. Hormone receptors may be very sensitive and take time to adjust. There may be a temporary water weight gain, which will also resolve on its own. In women who have not had a hysterectomy, there is a risk of bleeding.
Some patients begin to ‘feel better’ within 24-48 hours while others may take a few weeks to notice a difference. Diet and lifestyle, along with hormone balance are critical for optimal health.
The pellets usually last between 3 and 5 months. The pellets do not need to be removed. They completely dissolve on their own.
Progesterone keeps us healthy and makes us feel better, therefore, natural progesterone (not synthetic) is recommended for all women. In addition to its role in reproduction progesterone also keeps the menstrual cycle regular and normal, and balances estrogen’s potential negative effects on the body. Progesterone also plays a role in protecting the uterus from developing cancer, increases HDL or “good cholesterol”, improves the break down of fat into energy, and cuts the bodies craving for carbohydrates and sweets. In fact, progesterone deficiency is commonly a cause of PMS symptoms and painful lumpy breasts. Additionally, progesterone is a natural anti-depressant, aids thyroid function and keeps blood sugar levels normal.
Comprehensive blood work and evaluation will be done before therapy begins. This will include a FSH, estradiol, testosterone, progesterone, CBC and thyroid hormone levels. PSA levels will also be drawn for men. Levels will be monitored during hormone therapy and reevaluated prior to insertion of the next set of pellets. Women are advised to continue their monthly self-breast exam and obtain a mammogram and/or pap smear.