Bioidentical Hormones-Daily Applications or Pellets?


There are few more challenging times of life in which women’s hormones change than menopause. Although PMS, pregnancy, and peri-menopause can be difficult, menopause is often described as the switch when women no longer feel like themselves. Drastic changes in the endocrine system can cause hormone levels to drop precipitously, which causes very significant symptoms for many women. Hot flashes, night sweats, insomnia, fatigue, anxiety, depression, achy joints, vaginal dryness, and low libido to name but a few of these symptoms. These days there are multiple options for choosing how to manage and decrease these symptoms, with bio-identical hormones being a top choice for women due to the desire to use hormones that mimic the body’s own natural hormones. But with more and more choices, it becomes confusing to choose which bio-identical hormone delivery method is best. Choices include oral capsules, lozenges, topical creams and gels, vaginal suppositories and newer on the market, hormone pellets.

As Naturopathic Doctors, we would like women to feel healthy and happy, free from embarrassing hot flashes and night sweats. A good night’s rest and energy to do what you want to do the next day is a basic human need. Aging doesn’t have to come with achy, stiff joints and it doesn’t have to mean a loss of sex life due to vaginal dryness, painful intercourse, and a lack of desire for one’s partner. We would like women to make a good informed decision about which hormone delivery method to use that comes with the least amount of side effects.

There Is No One-Size-Fits-All Method

When it comes to bio-identical hormone replacement therapy, there is no one-size fits all way to deliver the hormones but through years of clinical experience and prescribing hormones, I have had the chance to follow hundreds of women on bio-identical hormones and find that for most, using hormones through a daily application method versus pellets seems to work the best with the least side effects. Daily methods include applying a topical cream or gel, inserting a vaginal suppository, ingesting an oral capsule, or dissolving a lozenge under the tongue every day. Pellets are surgically injected under the skin and are left in for months at a time until they dissolve.

We Can Change Quickly According To Your Body’s Response

The first advantage to the daily method is that we are able to make changes quickly if something doesn’t feel right. If we need to go up or down in dosage, it can often be done via a simple change through the pharmacy and under the direction of your doctor and it can happen within a few days. With pellets, once the pellet is injected, there is nothing that can be done to change the dosage if something doesn’t feel right except surgically take out the pellet or wait a few months for the hormones to dissolve in the body.

We Can Combine Estradiol And Estriol

Another benefit of using daily estrogens is that they are usually made with a combination of estradiol and estriol, often called bi-est. Estriol is considered a protective form of estrogen when it comes to estrogen dependent cancers. Unfortunately, pellets only contain estradiol.

Easier To Monitor And Manage Testosterone Levels

One of the things I see in practice all the time with women who are using testosterone pellets is significantly high levels of testosterone when tested. These high levels cause acne, hair loss, and irritability unfortunately. With daily testosterone application, the ability to reduce dosages can happen quickly if any of these symptoms occur and the likelihood that these symptoms appear with daily use, has in my experience been few and far between.

As I mentioned in the beginning, there is no one-size-fits-all delivery method for bio-identical hormones, thus lies some of the beauty in bio-identical hormones because we can really tailor it to the individual, so for some people, the pellets work well for them. But as a Naturopathic Doctor who has prescribed bio-identical hormones for years, my preference lies in a daily delivery method including capsules, lozenges, topical creams/gels, and vaginal suppositories so that women can get the best types of estrogens, have the ability to make relatively quick changes if needed, and have the least amount of side effects.

To Get Started

To get started on a personalized regimen of bio-identical hormones through a daily delivery method, the doctors at Walnut Creek Naturopathic provide a thorough assessment of symptoms, go through a full health history, and order testing so that we can individualize the prescriptions for the person correctly. If you would like to try bio-identical hormones, call our office at 925-939-0300

Dr. Jamie Berner, Licensed Naturopathic Doctor