Pellets, Patches, Sprays and Creams: All the Ways to Get Hormone Replacement Therapy

Pellets, Patches, Sprays and Creams: All the Ways to Get Hormone Replacement Therapy featured image
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Nothing will have you Googling HRT therapy faster than your first hot flash. Hormone Replacement Therapy, or HRT, can be a lifesaver for many women navigating the challenges of menopause. It helps ease those sneaky hot flashes, stabilizes wild mood swings, and can even mitigate some of the physical changes that come with the “change.” Yet with all the options available, deciding on the right path can feel daunting. While HRT offers various treatment methods, each comes with its own set of risks and benefits.

  • Christine DiEdwardo, MD is a board-certified plastic surgeon based in Duxbury, MA
  • Jessie Cheung, MD is a board-certified dermatologist based in Willowbrook, IL
  • Somi Javaid, MD is a board-certified OBGYN and founder and chief medical officer of HerMD
  • Lauren Streicher, MD is a board-certified OBGYN and medical director of community education for Midi Health

One of the biggest concerns surrounding HRT is the potential for side effects and health risks. These can range from minor irritations to more severe complications, depending on the delivery method and individual health factors. “The risks of taking hormone therapy differ for each individual,” says Cincinnati, OH OB/GYN Somi Javaid, MD. “Factors like the type, dose, duration of use, route of administration, and timing of initiation all play a role in determining safety and effectiveness.”

Types of HRT Delivery Methods

Hormone therapy can be delivered systemically, affecting the entire body, or locally, targeting specific areas. According to Dr. Javaid, systemic therapy is usually aimed at addressing broader menopausal symptoms, while local therapy targets specific issues like vaginal dryness. “Systemic therapy can be delivered orally or via transdermal patches, gels, sprays, or pellets,” she explains.

Oral tablets are the simplest method, but Dr. Javaid warns about higher risks like blood clots and vascular events associated with this form of delivery. “Transdermal patches, on the other hand, provide a consistent hormone release and are generally considered safer due to a reduced risk of clotting issues,” she notes.

Hormone gels and sprays are another option you can apply directly to the skin. These allow for more precise dosing says Dr. Javaid, but cautions, “They require careful application to avoid unintentional transference to others.” 

Implants or pellets, which are inserted under the skin, offer a steady hormone release over several months. However, Duxbury, MA plastic surgeon Christine DiEdwardo, MD points out that “Dosage adjustments with pellets can be challenging since once a pellet is placed, it cannot be easily removed.”

Pros and Cons

Each HRT delivery method has its pluses and minuses. Willowbrook, IL dermatologist Jessie Cheung, MD notes the convenience and flexibility of some: “The advantage of oral and topical therapies is that you can quickly adjust the dosing, as most are taken daily and patches are applied every few days.” However, this flexibility can come at a cost. “The disadvantage with pellets is that most pellet procedures are done every three to six months. So dosing can’t be adjusted easily. There also some soreness for a few days after,” Dr. Cheung explains.

Pellets can be convenient due to their long-lasting nature, but they do require a minor surgical procedure for insertion. “For many patients, the convenience of pellets outweighs the inconvenience of a 5-minute, in-office procedure,” says Dr. Cheung. 

However, Lauren Streicher, MD, clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine says the cons of pellets are many. “Pellets are not FDA approved and not recommended by most academic menopause experts,” she explains. “Every single professional society, including ACOG and The Menopause society has a very clear statement saying that pellets are unregulated, result in dangerously high levels of hormones and are associated with bleeding, uterine pre-cancer, cancer increased rates of hysterectomy and other side effects.”

Conversely, creams offer quick adjustments in dosage but can be messy and require daily application. “Creams can transfer to clothing or be passed to others and there’s variable absorption,” adds Dr. DiEdwardo.

“The pros of transdermal estrogen in the form of patches, creams, gels and sprays: since they are not metabolized by the liver and unlike oral estrogen, do not increase the risk of blood clots or gallbladder disease,” notes Dr. Streicher. Dr. Javaid adds that one thing to consider with patches is they might not be ideal for individuals who have adverse reactions to adhesives or those who don’t want others to know they’re using HRT.

How to Decide Which Method Is Right for You

 “The best form of HRT is one that the patient is comfortable with and compliant in using,” Dr. Cheung says. The choice is influenced by several factors, including health history, lifestyle and specific symptoms. Dr. Javaid advises considering your health history and any medications you’re currently taking. “The risks of taking hormone therapy differ for each individual, depending on type, dose, duration of use, route of administration and timing of initiation,” she adds.

Patients should also consider their daily routines and personal preferences. Dr. Cheung mentions that some patients grow weary of applying creams twice a day, while others find pellet insertion procedures uncomfortable. 

“Discuss your options with your healthcare provider to determine which method aligns best with your needs and lifestyle,” says Dr. Javaid.

Risks to Consider

There have been shown to be benefits of HRT, however there are also potential risks and contraindications to hormone therapy. “Therefore factors that are evaluated prior to HRT include underlying medial history and risk of certain diseases, like cancer, heart disease, stroke, and blood clots, age at the start of hormone therapy, type and route of administration, dosage and how long you are on the medication,” notes Dr. DiEdwardo. “A thorough medical and family history, discussion of symptoms, physical exam and extensive testing are part of the evaluation prior to initiating HRT.”

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