Why Experts Don’t Recommend Pellets for Menopause

Written by Giuliana Castellucci; medically reviewd by Sophia Yen.

TL;DR: Why Experts Advise Against Hormone Pellets for Menopause

• Lack of FDA Approval: Hormone pellets are compounded bioidentical hormones that are not FDA-approved, meaning they lack standardized testing for safety, efficacy, and consistency.
• Inconsistent Dosing: Without regulatory oversight, the hormone levels in pellets can vary significantly, increasing the risk of over- or under-treatment.
• Potential Side Effects: Patients may experience high hormone levels leading to side effects such as mood changes, acne, hair growth, and elevated blood pressure.
• No Proven Superiority: There is no reliable evidence that compounded pellets are more effective than FDA-approved hormone therapies.
• Expert Consensus: Organizations like the American College of Obstetricians and Gynecologists (ACOG) and The Menopause Society recommend against the routine use of compounded bioidentical hormone therapy, including pellets.

Menopause is a natural life transition that can come with significant symptoms—hot flashes, night sweats, mood changes, low libido, and sleep disruptions. Understandably, many women look for relief. Among the options marketed heavily in recent years is hormone pellet therapy, a type of compounded bioidentical hormone treatment.

But here’s the truth: despite glowing testimonials and aggressive marketing, hormone pellets are not recommended by leading medical authorities—including the American College of Obstetricians and Gynecologists (ACOG) and The Menopause Society (formerly NAMS).

What Are Hormone Pellets?

Hormone pellets are small, compounded cylinders—typically made of estrogen or testosterone—that are implanted under the skin, usually near the hip or buttock. Once inserted, the pellets release hormones continuously over 3 to 6 months.

They’re “bioidentical,” meaning they contain hormones chemically similar to what the body naturally produces. But it’s important to distinguish between FDA-approved bioidentical hormone therapy and compounded hormone pellets, which are not FDA approved.

American College of Obstetricians and Gynecologists (ACOG) Stance: “Not Recommended”

In its November 2023 Clinical Consensus, ACOG firmly states that compounded bioidentical menopausal hormone therapy—including pellets—should not be routinely prescribed. Key concerns include:

• Lack of FDA oversight: Compounded hormones like pellets are not subject to any testing for safety, efficacy, or consistency by the FDA vs. FDA-approved bioidentical medications such as the estradiol patch, spray, vaginal ring, gel are FDA tested.
• Inconsistent dosing: Without regulation, hormone levels in pellets can vary significantly, increasing the risk of over- or under-treatment.
• Poor safety profile: Some patients experience high hormone levels, leading to troubling side effects such as mood changes, acne, hair growth, and elevated blood pressure.
• No evidence of superior benefit: Despite marketing claims, there’s no reliable evidence that compounded pellets are more effective than standard treatments.
• Once implanted, you can’t take them out. If the dosage is too high, once placed, you cannot take out the pellets. You have to wait for them to dissolve/be absorbed.

ACOG emphasizes “ Compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved formulations exist. Clinicians should counsel patients that FDA-approved menopausal hormone therapies are recommended for the management of menopausal symptoms over compounded bioidentical menopausal hormone therapy.”

The Menopause Society’s Guidance

The Menopause Society, a leading authority in midlife women’s health, echoes ACOG’s warnings.

In its 2022 Hormone Therapy Position Statement, the Menopause Society supports the use of hormone therapy for managing menopause symptoms, but strongly discourages the use of compounded products, especially pellets, due to:

• Risks of supraphysiologic dosing
• Lack of rigorous clinical testing
• Unpredictable absorption rates
• Increased risk of endometrial hyperplasia or cancer (especially when progesterone is not adequately prescribed with estrogen)

Simply put: hormone pellets are a gamble—and not an evidence-based, medically supported one and there are FDA approved and tested options that are bioidentical.

Safer Alternatives to pellets: What Experts Do Recommend

If you’re looking for relief from menopause symptoms, don’t worry—there are safe, effective, bioidentical, and FDA tested options available. These include:

1. FDA-Approved Menopause Hormone Therapy

• Pills: Estradiol or estradiol/progestin combinations, taken daily.
• Bioidentical estrogen Patches: Offer a steady hormone release through the skin.
• Bioidentical estrogen Topical gels and sprays: Absorbed through the skin, often preferred for those avoiding oral medications.

Bioidentical estrogen Vaginal rings, creams, or tablets: Especially effective for vaginal dryness and urinary symptoms.

These treatments have been rigorously tested by the FDA for safety, dosing consistency, and efficacy.

2. Non-Hormonal Options

• SSRIs or SNRIs (like paroxetine or venlafaxine) can help with hot flashes and mood swings.
• Gabapentin and clonidine may also reduce vasomotor symptoms.

What Pandia Health Recommends

At Pandia Health, we support evidence-based, FDA-approved, and personalized hormonal care.

Here’s why we don’t recommend hormone pellets:

• They are not FDA approved
• They pose a higher risk of side effects
• They cannot be removed once implanted
• They go against the guidance of trusted and respected national health organizations (ACOG and the Menopause Society)

Our menopause care is backed by licensed physicians trained in hormonal health—including those certified by the Menopause Society—and we tailor treatments based on your unique biology, lifestyle, and preferences. No guesswork. Just safe, effective care. Learn more here.

Final Thoughts

Hormone pellets might sound convenient, but they come with serious risks and lack the support of top medical organizations. When it comes to your health, it’s worth choosing a path grounded in evidence, safety, and transparency.

If you’re struggling with menopause symptoms, speak with a doctor trained in evidence-based hormone therapy. And if you’re considering pellets—press pause, ask questions, and explore safer options first.

Disclaimer: This article is for informational purposes only and does not substitute professional medical advice. Always consult with a healthcare provider for personalized medical guidance.