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    Experiencing a hormone imbalance can be difficult and frustrating. Hormone replacement therapy can help target unwanted symptoms. However, some treatment methods, like hormone pellets, may not deliver the results you need. In fact, they may even make the situation worse.

    Hormone pellets are made up of a mix of hormones, which may or may not be the right dosage you need. The uncertainty of dosage could mean your symptoms don’t change, or even add new side effects to what you are already experiencing. Plus, since you only receive hormone pellets every three months, you may have to endure these symptoms for weeks before trying a new compound mix.

    We can help you find a safe, effective hormone replacement therapy treatment that will give you relief from your symptoms while keeping your health a priority. Book an appointment today to talk about your options. 

    Hormone Pellets Pose a Greater Risk Than You Realize

    A common method of HRT is hormone pellets, which are tiny, rice-sized capsules containing a mix of hormones. These capsules are inserted under the skin through a surgical incision and slowly dissolve over the next 90 days, releasing the hormones into your body. 

    While the method may seem straightforward, it’s important for you to be aware that hormone pellets may actually pose a greater risk to your health than other forms of HRT. A recent study published in the Journal of the North American Menopause Society observed that women who used hormone pellets were much more likely to experience side effects like mood swings, anxiety, hair pattern change, acne, and weight gain. 

    You should consult with an experienced healthcare provider and carefully weigh the risks of hormone pellets before deciding on the best course of treatment for you.

    Pellets Contain Unregulated Compounds of Hormones

    Woman doing yoga after choosing HRT over hormone pellets

    Hormone pellets are made of a mix of hormones in varying doses, which means it’s very difficult to find the right amount for your body that will actually help improve your symptoms..

    Hormone pellets contain a mix, or compound, of various hormones. The risk of a compounded hormone means that there are now multiple sources for adverse drug effects, making it difficult to identify which element in the compound was responsible for the reaction. 

    Hormone pellets are prepared by compounding pharmacies. These types of pharmacies are not the same as a pharmacy you would find in Walgreens or CVS. All drugs sold in these pharmacies must be approved and regulated by the FDA. 

    However, compounded drugs are not FDA-approved and have not been evaluated by the FDA for safety, effectiveness, or quality. This means that the mix of hormones you are putting in your body hasn’t had to go through a rigorous review process. Sadly, there have been hundreds of cases of infection and dozens of death caused over the years by contaminated or poorly compounded drugs.

    Compound Amounts May be Based on Inaccurate Testing

    The main selling point for hormone pellets is that they have a custom compound of hormones specific to your body’s individual needs. They claim that it will provide the proper amount of hormones you need to rebalance your levels. The problem is, most of these “custom formulas” are based on a saliva test that you completed. 

    In recent years, many clinics have begun using saliva tests to check hormone levels, as it’s an easier and less costly procedure for them. However, a saliva test can’t be trusted when it comes to accurately determining hormone levels. Experts at the North American Menopause Society say that saliva tests have not yet been proven to be accurate or reliable. A blood test is still the best option for checking your hormone levels. Blood testing is an established, reliable process for measuring the amount of hormones in your body.

    Every Woman’s Body Handles Medication Differently

    Determining your required hormone dosage requires a precise calculation. For hormone pellets, this includes incorporating a calculation of your absorption and titration rates. 

    Absorption is the way the hormones are absorbed from the pellet into your bloodstream. Many factors can affect your absorption rate, such as slow metabolism, poor sleep, high blood pressure, or stomach conditions. Titration is the process of adjusting the dose to find the ideal amount that maximizes benefits and minimizes adverse effects. Your titration starting point requires a close examination of multiple factors including your age, weight, immune system, allergies, existing health conditions, current medications, and general biochemistry.

    What makes this a serious challenge is that absorption and titration are not a one-size-fits-all equation. Everyone’s body handles medication differently, making it nearly impossible to correctly calculate your dosage for each hormone.  Add the concept of mixing multiple hormones into one pellet—a mix based on an unproven test—and the complexity escalates quickly. 

    Unfortunately, this means finding the right balance of hormones for you is almost impossible. With no way to test how individual mixes of hormones affects you, there is a high possibility that you will not receive the correct amounts of hormones. Too little, and your hormonal symptoms may remain unchanged. Too much, and you may experience new side effects on top of everything else.

    One of the most significant issues with hormone pellets is their 90-day window, the length of time it takes for your body to completely absorb the pellets. If your dosage isn’t correct and you are suffering from ongoing symptoms or side effects, you have to wait three months before trying a new compound mixture. Consequently, achieving hormone balance with pellets can require months of trial and error.

    Your Hormone Levels Fluctuate for Three Months After Treatment

    After being treated with hormone pellets, you can expect fluctuations in your hormone levels over the next three months. Pellets release hormones gradually over time. This will cause initial spikes in hormone levels at the beginning, followed by a slow decline as the pellets are depleted. By the time you get to the end of the 90 days, your hormone levels may even drop below your baseline level. 

    This fluctuation can cause unpredictable symptom swings. You may find yourself feeling great one day and struggling with symptoms the next. After actively pursuing treatment to feel better, you may find yourself feeling even more frustrated than before you started.

    Surgical Incisions Required for Hormone Pellets Could Develop Problems

    One potential risk factor to note with hormone pellets is the surgical incision required. The incision is about 5 to 7 mm wide and 8 to 10 mm deep, and is usually made on your upper hip or lower abdomen. The provider performing the incision uses a sharp blade to cut thoroughly through your subcuticular tissue so there is no resistance for the implant device, called a trocar. The incision must reach your subcutaneous fat layer under your skin in order to deposit the pellets in the correct area. If the pellets are deposited too close to the skin, it will cause increased discomfort for you. The trocar is then inserted approximately 4 cm into the fat layer and releases the pellets. The incision is then held closed with skin tape.

    After the procedure, you will have limitations on your activities in order to prevent reopening the incision or exposing it to infection. You should not immerse the incision site in water such as hot tubs, bathtubs, or swimming pools for five days. It is recommended to avoid movement such as squats, deep bending, cycling, or other heavy exercise for at least three days. 

    The incision site may be swollen for around three days after the procedure. It can be uncomfortable for up to ten days, and can take up to two weeks to fully heal. However, other health conditions and some types of medications, such as blood thinners and antibiotics, mean that it could take much longer to fully heal. During this time, you would need to continuously monitor and clean the incision to prevent an infection from developing, which would then require further treatment to manage before it gets worse. 

    Going through an invasive surgical incision procedure, healing process, and risk of infection every three months is a serious downside to hormone pellets. Fortunately, there are other hormone replacement therapy methods that are much less intimidating. 

    Bioidentical Hormone Injections are Safe and Effective

    Hormonal imbalances can be a hindrance to living a healthy, active life. Our bioidentical hormone injections are an effective option to treat your imbalance. These hormones are natural, not synthetic. Your body adapts to them more easily because it reads them as being the same as the hormones you naturally produce.

    With injections, it is easier to regulate and measure the precise amount of hormones you are receiving. And since they are injected directly into your bloodstream, your body is better able to absorb these hormones quickly and effectively. With our expertise in HRT, we can help restore balance to your body and get you back to feeling like your best self.

    Hormone Replacement Solutions for You from HerKare

    We take a personalized approach to treatment, ensuring that each patient receives a tailored plan that meets their unique needs. Our team recognizes the complexity of hormone imbalance and can help find the optimal treatment for you. If you have been struggling with the uncomfortable symptoms of hormonal imbalance, contact us now to schedule an appointment.


    It is with heavy hearts that we announce that Dr. Sridevi Panchamukhi will be discontinuing her affiliation with HerKare. Dr. Panchamoukhi’s last day with HerKare was Monday, March 27, 2023. As a patient you may obtain copies of your medical records or arrange transfer of your medical records to another physician. HerKare Physician Group, PLLC will continue to maintain your medical records. You may reach out to to obtain copies of your records. We wish Dr. Panchamoukhi the very best.