Friday, October 30, 2015

Why is hormone pellet therapy so popular?

Hormone loss is associated with many problems including heart disease, osteoporosis, memory loss, loss of muscle mass, lack of sex drive, mood changes, weight gain and aging skin. Bioidentical hormone replacement therapy has been show to have benefits such as improving mood, energy, sleep, memory, sexual function, muscle strength and body composition.

When I started my practice in 2007, I prescribed mainly topical bio-identical hormone creams. This approach allowed me to prescribe the appropriate mixture of hormones based on a patient's individual needs, and worked well in many people - but not all patients had optimal results. Currently, my most preferred way to replace hormones has become bio-identical hormone pellet therapy.  

Hormone pellets are smaller than a grain of rice and contain a natural plant source of estrogen and/or testosterone (based on a patient's needs). They are inserted under the skin of the buttock in a simple, painless office procedure. The pellets are gradually dissolved by the body, and a small, physiologic dose of hormone is released at a steady rate into the bloodstream.  

The pellets allow rapid resolution of hormone deficiency symptoms - sometimes within 48 hours!  The convenience is very popular - the pellets are inserted approximately once every 3-4 months and result in very consistent hormone levels and relief of symptoms.

Hormone pellet implants have consistently been shown to improve many common symptoms in men and women including:

- insomnia

- fatigue
- lack of libido
- hot flashes
- palpitations
- headaches (especially premenstrual or hormonal migraines)
- irritability
- depression
- anxiety
- memory loss
- incontinence
- aches and pains
- vaginal dryness

This treatment seems "new" but in fact hormone replacement by pellet implantation has been used with great success in the United States, Europe and Australia since 1938! Pellets deliver consistent, physiologic levels of hormones and avoid the fluctuations of hormone levels seen with other methods of delivery, like the topical creams.

Hormones delivered by pellet therapy bypass the liver, do not affect clotting factors and do not increase the risk of blood clots which is a risk with estrogen pills and synthetic progestin pills.

Pellet therapy has been shown to be superior to oral and topical hormone therapy with respect to relief of menopausal symptoms. This is why they have become the most popular method of bio-identical hormone replacement in my practice - women are finding better results! 

Hormone replacement with estrogen and testosterone pellets have been shown to be better than oral and topical hormones for bone health. The pellets not only prevent bone loss but have been shown in many studies to actually increase bone density.

Pellets do not have the same risk of breast cancer as synthetic hormone replacement pills.  In fact, studies show there may be a reduction in the incidence of breast cancer with pellet therapy. In a study on breast cancer survivors, hormone pellet implantation did not increase the risk of cancer recurrence or death as does estrogen in combination with synthetic progestins.

There are many options for bio-identical hormone replacement therapy including topical creams and patches, pills, vaginal creams, sublingual lozenges and pellet therapy. A thorough discussion of the options is important for each woman. Please click here if you are interested in learning more about bioidentical hormone replacement therapy.

Yours in health

Deborah Matthew MD

Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS) Glaser R, York AE, Dimitrakakis C. Maturitas. 20011;68:355-361
Testosterone, delivered by subcutaneous pellet implant has been shown to improve hot flashes, heart discomfort, sleep problems, depressive mood, irritability, anxiety, physical fatigue, memory loss, migraine headaches, sexual problems, bladder problems (incontinence), vaginal dryness, joint and muscular discomfort in both pre-menopausal and post-menopausal patients without adverse drug events 

Moderate dosage estrogen–androgen therapy improves continuation rates in postmenopausal women: impact of the WHI reports Gambrell and Natrajan CLIMACTERIC 2006;9:224–233
Long-term studies with up to 30 years follow up, confirm the safety of testosterone therapy and absence of adverse drug events with the pellet implant.   No increase of breast cancer even after 20 years of hormone pellet therapy

Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women.  Savvas et al.  British Medical Journal 1988  Jul 30;297(6644): 331-333
Subcutaneous oestrogen is more effective than oral oestrogen in preventing osteoporosis, probably owing to the more physiological (premenopausal) serum oestradiol concentrations achieved.

Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole:  a prospective, observational study.  Glaser et al.  Maturitas 2013 Dec;76(4):342-9
Testosterone and/or testosterone+anastrozole, delivered subcutaneously as a pellet implant, reduced the incidence of breast cancer in pre and postmenopausal women.

Saturday, October 24, 2015

The libido hormone - why women need testosterone too!

Ladies are you lacking motivation?  No energy?  Losing muscle mass?  Skin looking saggy?  Lost that lovin' feeling?

You could be deficient in testosterone!

We think of testosterone as the "male" hormone, but women have testosterone too and it is really important!  Testosterone acts like our "inner strength".  It gives us competitive drive, motivation, assertiveness, self esteem, decisiveness and confidence.  If testosterone levels decline, we notice a change in how we feel.

Testosterone also affects everything to do with sex including interest, lubrication, and ability to become aroused.

I see testosterone deficiency in women starting at age 35-40,  long before menopause.  Sometimes this is due to use of birth control pills, or high stress levels, and often it is just due to the aging process - by age 40 our testosterone levels may be reduced by half.

Restoring testosterone can help with quality of sleep, energy, mood, strength and endurance, skin tone, muscle tone and shape, and can have marked improvements on sexual function.

Other things that can improve with testosterone restoration are PMS symptoms, menstrual migraines, aches and pain, hot flashes, incontinence, vaginal dryness, palpitations and bone density. Testosterone is very important in improving bone strength to prevent fractures.

There are even some reports that suggest testosterone may help to reduce the risk of breast cancer.

Testosterone is available as a topical cream, a sublingual troche (dissoved under the tongue) or as a pellet (which is implanted under the skin).  The pellets are by far the most popular in my practice and have the best symptomatic benefit.  They have been used in the United States since 1938 and have a long track record of safety and effectiveness.

The risks of testosterone replacement are mainly nuisance symptoms like excess hair growth or some pimples, as opposed to serious risks, and these problems go away if the dose is reduced or testosterone is discontinued.  Women who already have these problems are the most likely to experience these side effects.

Testosterone replacement can have a very large impact on a women's life, her marriage, her work performance, and overall wellbeing.  It has been very satisfying to be able to help women get back to feeling like themselves again.

If you would like more info about testosterone replacement and whether it may be right for you, please click here.

Yours in health

Deborah Matthew MD
  1. Reference:  Glaser R, York AE, Dimitrakakis C. Beneficial effects of testosterone therapy in women measured by the validated Menopause Rating Scale (MRS). Maturitas. 20011;68:355-361. 

Sunday, October 11, 2015

Have you heard about the new non-surgical treatment for incontinence?

Do you have incontinence?  Don't want to have surgery?  There's a new option!

Incontinence, or the leakage of urine, is very common in women, and I see women complaining of this problem every day.   In some studies, up to 50% of women suffer with incontinence!  This can be an embarrassing problem, and can also lead to hygiene issues.  Aging tissues and childbirth are two common causes of incontinence.

In the past, we did not have very good treatments.   If symptoms were reasonably mild, women could wear a pad "just in case".  If more severe, surgery could be done.  The surgical procedures available require inserting a mesh or sling (foreign materials) into the body to help support the tissues, and come with some risks.  This is not really a good option unless the symptoms are pretty severe.

Bioidentical hormone replacement therapy can also help with incontinence.  Hormones are very important to help keep tissues healthy, including the tissues of the urinary tract.  In some cases, incontinence can be greatly improved or even resolved with use of hormone replacement, and I see this regularly in my practice.

But in some women, bioidentical hormones do not completely resolve the problem.  We now have a new solution that is so exciting because it is simple and very effective.

What if I told you that you could treat your incontinence in 20 minutes, with near zero risk and no down time?  Sounds too good to be true, but a new treatment, called the O-Shot, can do just that.

The O-Shot is a medical procedure performed by specially trained doctors using Platelet Rich Plasma (PRP),  the fraction of the blood that contains growth factors.  PRP has been used to help professional athletes heal from orthopedic injuries by injecting it into joints. It has been used to help improve wound healing in surgical patients by injecting it into the incision site.  Over the past 10 years it has been used in hundreds of thousands of procedures around the world in various parts of the body with no reports of any serious complications.  Now we can use PRP to help women with incontinence.

Here's how it works.  We draw blood from your arm, and prepare the blood in a special centrifuge to extract the PRP (which contains the growth factors).  Then the PRP is injected into the vaginal wall and clitoris near the urethra.  Topical numbing cream  is used and the needle is very tiny so you feel little to no discomfort.  The growth factors stimulate stem cells in the area to regenerate tissues - including blood vessels, collagen and nerve fibers.

It takes approximately 20 minutes to draw your blood and prepare the PRP, and the injection takes approximately 5 minutes.  Once the procedure is over, you can resume regular activities with no down time. The tissue regeneration typically starts after 3 weeks and full effects will be noted in 3 months  There are no reported serious side effects, and while results will vary, initial reports indicate that most women have significant improvement if not resolution of their symptoms.  We are really excited about the results that we are achieving.  

The O-Shot has an added benefits for some women.   Many women note improvement in sexual function, including increased lubrication, sensation, and often a reduction in pain (for women who have discomfort during intercourse).

If you are interested in learning more about the O-Shot please contact us at 704-752-9346, or visit the website