Menopause Pellets: Where They Fit—and Why They’re Not My First Choice
- Feb 8
- 3 min read
If you’ve spent any time in menopause spaces—online, at med spas, or talking with friends—you’ve probably heard about pellet therapy.
And inevitably, the question comes up:
“Dr. T, what do you think about pellets?”
The short answer is this:Pellets are an option—but they’re not where I start.
This post isn’t about shaming pellets or the women who choose them. It’s about helping you understand where pellets fit in the larger picture of menopause care, so you can make an informed decision grounded in your goals, not hype.
What are hormone pellets?
Hormone pellets are small implants placed under the skin—usually in the upper buttock or hip area—during an in-office procedure. They most commonly contain estradiol and/or testosterone and are designed to release hormones steadily over three to six months.
Pellets are often described as:
convenient (“set it and forget it”)
long-acting
customized
And for some women, they do provide meaningful symptom relief.
✨ My framework: sequencing matters
When I think about menopause hormone therapy, I don’t think in terms of right vs wrong.I think in terms of sequence.
There are many ways to deliver hormones:
patches
pills
gels or sprays
vaginal preparations
and yes—pellets
My role as a clinician is to help you choose the right option at the right time, starting with therapies that give us the most flexibility and safety as we learn how your body responds.
That’s why pellets are not my first-line approach.
✨ Top 3 takeaways on pellet therapy
1. Pellets offer choice—but not predictability
Pellets are one way to deliver hormones, and for some women they work very well.
What gives me pause is variability.
Pellets can produce hormone levels that are:
difficult to predict
harder to fine-tune
slower to adjust if something doesn’t feel right
With other options—like patches or oral medications—we can start low, increase slowly, and pivot quickly. That flexibility is especially important early in the menopausal transition, when symptoms and hormone needs are still evolving.
2. Once a pellet is placed, control is limited
This is one of the most important differences.
If you don’t tolerate a pill or patch, we stop it.
If a pellet dose is too high, we can’t remove it—we have to wait for it to wear off.
That matters most with testosterone, where higher-than-intended levels can lead to side effects like:
hair thinning or shedding
acne
irritability or feeling “amped up”
voice deepening (sometimes irreversible)
clitoral enlargement (rare, but real)
These effects are uncommon—but when they occur, the lack of reversibility can be frustrating and distressing.
3. Pellets are best considered later—not first
Pellets may make sense after:
FDA-approved options have been tried
dosing and symptom patterns are well understood
expectations are realistic
and a woman understands the tradeoffs
At that point, pellets become one tool among many, not a shortcut or a cure-all.
This is especially important because most pellets are not FDA-approved, are typically paid for out-of-pocket, and often require frequent lab testing that may or may not change management.
Why I usually start elsewhere
At Revival Women’s Health, my priorities are:
safety
flexibility
personalization
and long-term trust
That’s why I typically begin with FDA-approved hormone therapies that:
allow gradual titration
can be adjusted or stopped easily
are supported by more consistent safety data
This approach lets us learn what your body needs—before committing to a longer-acting option.
If pellets become part of the conversation later, I want that decision to come from clarity, not urgency.
When pellets can make sense
I absolutely support women who choose pellets—especially when:
they’ve had good experiences previously
other approaches haven’t met their goals
dosing is conservative and thoughtful
monitoring is appropriate
and the decision is informed, not marketing-driven
Menopause care is deeply personal. My job is not to sell a therapy—it’s to guide a process.
Questions to ask before choosing pellets
If you’re considering pellet therapy, ask your provider:
What hormones are included and at what dose?
How do you prevent hormone levels from going too high?
What side effects should prompt immediate follow-up?
If I don’t feel well, what can we adjust—and how quickly?
How are labs used to guide care (not just justify cost)?
If I have a uterus, how is my uterine lining protected?
What is the total yearly cost?
Clear answers matter.
The bottom line
Pellets aren’t wrong.
They’re just not where I start. And anyone selling them as a superior therapy is just plain wrong.
Menopause care works best when we:
begin with flexible options
respond to your symptoms
adjust thoughtfully
and escalate only when needed
There is no single “best” therapy—only the best next step.
If this post raised questions or helped clarify your thinking, that’s the goal. And if you’re navigating these decisions and want guidance rooted in nuance and respect, you don’t have to do it alone.
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