Pros and Cons of Hormone Pellets: A New Type of HRT to Ease Menopause Symptoms

Drenching hot flashes, mood swings, energy-zapping insomnia—as hormone levels plummet during menopause, the symptoms can leave you feeling pretty miserable. Hormone replacement therapy (HRT) can provide some relief by restoring estrogen and progesterone levels. HRT is typically delivered through a pill, patch or gel. But recently, there’s been renewed interest in a new type: hormone pellets. If you’re wondering what the pros and cons of hormone pellets are and if they can help relieve your menopause symptoms, here’s what you need to know.

How hormone pellet therapy works

Hormone pellet therapy is a form of HRT in which small, hormone-filled pellets are inserted under the skin through a small incision. A compounding pharmacy creates the pellets with a customized dose of hormones. The hormone pellets are then inserted into the hip, near the upper part of the buttock, where they steadily release hormones into the bloodstream as they dissolve.

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Like standard HRT, hormone pellet therapy typically includes bioidentical versions of estrogen and progesterone:

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• Estradiol, a bioidentical form of estrogen, helps to relieve common menopause symptoms caused by declining estrogen levels. This includes hot flashes, night sweats, vaginal dryness, insomnia, bone loss and urinary leaks.
• Prometrium, a synthetic form of progesterone, protects the uterine lining from the effects of estrogen. Without progesterone, estrogen can cause irregular thickening of the uterine lining that can develop into endometrial cancer.

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But there’s another, lesser-known culprit when it comes to menopause symptoms. Levels of the hormone testosterone also decline during menopause, which can wreak havoc on your sexual wellbeing. Traditional HRT for menopause typically doesn’t include testosterone, but a unique advantage of hormone pellet therapy is that it “allows the delivery of estrogen, progesterone and testosterone within the same pellet,” says G. Thomas Ruiz, MD, lead ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, CA. Restoring testosterone levels after menopause may help to boost energy, mood and sex drive in menopausal women. 

Learn more about the pros and cons of hormone pellets (and other types of HRT) in the video below:

Pros and cons of hormone pellets

When it comes to correcting menopausal hormone imbalances, you have a wide range of options. Before deciding whether hormone pellets are the best choice for you, it’s important to weigh the pros and cons. Here, we explain the benefits and potential downsides to consider.

Pros of hormone pellets

• Convenience. Instead of having to remember a pill every day or change a patch every week, hormone pellets work for two to three months (or more) at a time, providing more long-term relief from menopause symptoms.
• Customization to treat more symptoms. The hormone balance can be personalized to your needs, and the ability to add testosterone into the mix may offer more comprehensive symptom relief than other HRT options.
• Reliable relief. “Usually four to six weeks after initiating HRT, most patients feel great—and the same thing is going to apply to the pellets,” Dr. Ruiz says.

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Cons of hormone pellets

• Not FDA approved. While the FDA oversees the safety of compounding pharmacies, the medications they produce aren’t FDA-approved. Ask your doctor to recommend a reputable compounding pharmacy, and check the pharmacy’s accreditation with the Pharmacy Compounding Accreditation Board. 
• Not typically covered by insurance. For many women, this may be the biggest deterrent. “Pellets are usually not covered by health plans, so it becomes an out-of-pocket expense for the patient,” Dr. Ruiz says. According to the Endocrine Society, hormone pellets can cost more than $1,500 per year.
• Incision risks. While the incision is small, it carries the same risks as any minor surgical procedure, including infection. The incision site may also be sore for a day or two after the procedure, which Dr. Ruiz jokes can be a literal “pain in the butt.”
• Delays when adjusting dosing. For some women, HRT can cause unpleasant side effects like nausea, breast tenderness or headaches. Unfortunately, with hormone pellets, there’s no way to dial down the dose once it’s implanted. “It’s there until it wears off,” Dr. Ruiz says. “For the next pellet, you can make an adjustment and bring the dose down.”
• Potential elevated breast cancer risk. “There may be a slight increased risk of breast cancer in women on combined hormone therapy, meaning estrogen and progesterone,” Dr. Ruiz says. However, he says it’s a “category-based risk” that applies to HRT in general, not just pellets. It’s also important to note that research is mixed and still ongoing, and many find the pros of hormone pellet therapy outweigh the very small potential for an increased risk of cancer.

According to the American College of Obstetricians and Gynecologists, hormone replacement therapy typically isn’t recommended for women who have ever had breast cancer, endometrial cancer, stroke, heart attack, blood clots or liver disease.

How to get started on hormone pellet therapy

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If bothersome symptoms of menopause have been interfering with your quality of life, ask your OB-GYN if hormone replacement therapy might bring some relief. Your doctor can help you evaluate all your options, including hormone pellets.

Because hormone pellets aren’t FDA-approved and usually aren’t covered by insurance, not all doctors offer them. You can kick-start the conversation with your usual ob-gyn, but you may be referred to another doctor for the actual procedure.

You may also opt to try standard HRT first, especially if budget is a concern. “I’ll tell you what I tell my patients: if you want to try standard HRT, it’ll save you some money and it’s covered by insurance,” Dr. Ruiz says. “But if we can’t find the right combination for you with standard HRT, then we can send you to somebody who specializes in [pellet] therapy, and you can have a consultation with them.”