Bioidentical Hormone Therapy Solutions For Women

Bio-Identical Hormone Pellets

History
Hormonal treatment options for women have evolved much in recent years. This has brought in many new forms of hormonal treatments such as Bio-Identical Hormone Pellets. Pellets have been used as a hormone delivery system in women and men since the late 1930’s. In Europe and Australia, many pharmaceutical companies produce pellets, but there is only one pharmaceutical company that commercially produces testosterone pellets in the US, Slate Pharmaceutical. There are no commercial companies that manufacture estradiol pellets. Therefore, most pellets used in the United States are manufactured from special compounding pharmacies. The ingredients (estradiol or testosterone) are U.S.P. pharmaceutical grade and are prepared from soybean and yam which are purified to be exactly like pure estradiol and testosterone. The raw materials we use at Pensacola Wellness Solutions come from PCCA (Professional Compounding Centers of America) which has been in operation since 1981. The actual pellets are prepared from a well established compounding pharmacy company in Missouri that specializes in pellet hormone therapy. This allows us to get the individual dosing and combinations that match the patient’s individual needs based on lab results.

Procedure
The insertion of pellets is a quick, simple, relatively painless procedure performed with a local anesthetic in the office setting. Taking less than 10 minutes, the area (upper outer buttock) is anesthetized and a very small incision (3-4 mm) is made to allow the insertion of the pellets through a small sterile medical instrument. The pellets are deposited in the fatty tissue below the skin. Then the skin is closed with tape. The pellets, which cannot be felt, are slowly absorbed over 4-6 months. Complications from the insertion could include minor bleeding or bruising, infection rarely, and extrusion (working its way out) of the insertion site even more rarely. After the insertion, vigorous physical activity should be avoided for 3-7 days. Early physical activity is a cause for the extrusion. Antibiotics may be prescribed for patients at risk for infection or those who have had a joint replacement.

Side Effects
The side effects of estradiol and testosterone hormone pellets are the same for any estrogen/testosterone hormone replacement therapies in general. They are outlined in the risk/benefit section.

The main areas of concern would be in women with an intact uterus who will require the addition of progesterone to avoid an abnormal buildup of the lining of the womb (endometrium). Abnormal bleeding will need to be reported and evaluated in a postmenopausal woman.

Breast surveillance is also important because estrogen stimulates the breast. Breast tenderness can be a side effect of estrogen replacement. Screening mammography and self breast exams are recommended based on age and risk factors. For the update on those recommendations, ask your physician.

Testosterone can cause any androgen (male) side effects if levels are too high, primarily affecting the skin and hair, such as increased oil production, acne, unwanted hair, and scalp hair thinning. These are all uncommon and are usually related to levels that are too high.

Testosterone and its derivatives are considered controlled substances and are classified as a Class III substance because of the potential for abuse. The history of anabolic steroid abuse centered on the careless use by body builders and professional athletes who were trying to enhance performance by increase in muscle mass. These behaviors were not limited to males. Congress enacted the Anabolic Steroid Control Act of 2004, Public Law 108-358 (118 Stat. 1661), which the President signed on October 22, 2004. The House Report (108-461) stated that the purpose of the Act is “to prevent the abuse of steroids by professional athletes. It will also address the widespread use of steroids and steroid precursors by college, high school, and even middle school students.” The House Report also noted that steroid precursors “are as dangerous to the body as those banned under the original Act.”
At Pensacola Wellness Solutions, the purpose of female hormone replacement is to restore testosterone to normal physiological levels.

Complications from the pellet insertion could include minor bleeding or bruising, infection rarely, and extrusion (working its way out) of the insertion site even more rarely. After the insertion, vigorous physical activity should be avoided for 3-7 days. Early physical activity is a cause for the extrusion. Antibiotics may be prescribed for patients at risk for infection or those who have had a joint replacement.

Oral medications
The arsenal of oral hormonal treatment options (estrogen and progesterone) for women is quite extensive. Most are familiar with Premarin and Provera, Estrace, and many other generic preparations. Pills are the most commonly prescribed designs and come in an array of doses and combinations. The end point is usually based on clinical effects/side effects. The criticisms of the oral medications are centered on the pass through the liver after absorption from the gut. This “first pass” not only alters the integrity of the hormone molecule but is thought to have adverse effects on cholesterol synthesis and blood clotting. This might explain the increased risk of heart attack and stroke that has been described in many studies. In addition, the oral medications are not bio-identical molecules although they are effective in improving symptoms of menopause.

Topical estrogen preparations deliver the hormone directly into the blood stream and eliminate the concerns of “first pass metabolism” through the liver. These preparations are bio-identical to the natural hormones and are increasing popular based on the purity of the hormones. Patches eliminate the need for daily application needing to be replaced once or twice a week based on brand. Some patches even have progesterone as a component. Compounding pharmacies are able to add testosterone to the formulas but there are no commercially available testosterone systems for women.

Vaginal delivery systems
Because the vaginal mucosa is a readily absorbable surface, estradiol creams delivered by applicators and even vaginal rings i.e. Femring and Estring are possibilities. Creams are usually applied twice a week but the rings may be left in place for up to three months. Monthly cost for creams may run $20-40 per month however the vaginal ring may cost $100-200. Injections of Hormones: Depo forms of estrogen, progestin, and even testosterone are available for intramuscular use. Most will last for 2-3 months and come in combinations based on symptoms. Women with an intact uterus are more difficult to manage with injections but it can be a convenient delivery system for women who have had a hysterectomy.