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.

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