Hormone Pellets vs. Injections vs. Patches, Gels and Pills: Comparing Your Options

Why delivery method matters

Once you and your clinician decide that hormone therapy makes sense, the next question is how to take it. Delivery method affects how steady hormone levels are, how easily the dose can be adjusted, safety considerations and cost. Professional societies including The Menopause Society, the Endocrine Society and ACOG have published guidance on these differences.

Patches, gels and sprays (transdermal estrogen)

Transdermal estrogen is absorbed through the skin. Many FDA-approved products contain estradiol, which is chemically identical to the estrogen your ovaries make — so they are "bioidentical" and regulated for consistent dosing. The Menopause Society's 2022 position statement notes that transdermal estrogen may carry a lower risk of blood clots than oral estrogen, based on observational data. Doses are easy to adjust and stopping is immediate.

Pills (oral estrogen and progesterone)

Oral estradiol and FDA-approved micronized progesterone are well studied, inexpensive and simple to take. Oral estrogen passes through the liver first, which affects clotting factors and triglycerides, so it may be less suitable for some women. Women who still have a uterus need a progestogen alongside estrogen to protect the uterine lining.

Injections

Some estrogen and testosterone formulations are given by injection. Injections create higher peaks shortly after dosing and lower troughs before the next dose, which some women notice as symptom swings. They require regular visits or self-injection training.

Pellets

Hormone pellets are small implants placed under the skin that release estradiol and/or testosterone steadily over several months. JennWell offers Biote® hormone pellet therapy, and many women like pellets because there is nothing to apply or take each day and hormone release is gradual rather than peaking like an injection. Insertion is a quick in-office procedure, and dosing is guided by symptoms and lab results.

Pellets are compounded rather than FDA-approved for women. ACOG's 2023 clinical consensus and a 2020 National Academies report raise concerns about compounded pellets, including that the dose cannot be lowered or removed once placed if side effects occur, and that hormone levels can rise above the normal range, and these bodies recommend FDA-approved hormone therapy for most women. Jennifer reviews this evidence with you and uses follow-up labs to monitor levels for women who choose pellets.

Compounded creams and troches

Custom-compounded hormones are made by pharmacies to a clinician's prescription. They may be appropriate when a woman needs a dose or formulation that is not commercially available, or has an allergy to an ingredient. ACOG and The Menopause Society recommend FDA-approved products when they meet the patient's needs, because compounded products are not tested for consistent strength or absorption, and saliva hormone testing to guide dosing is not recommended.

Choosing what fits you

The right method depends on your symptoms, whether you have a uterus, your personal and family history, preferences and budget. Jennifer Neilan, WHNP, reviews the evidence with you, explains each option honestly, and adjusts treatment over time based on how you feel — using the lowest effective dose to meet your goals.

Preparing for your visit

Coming prepared helps you get the most from an appointment about hormone therapy options. If you've used pellets, injections or compounded hormones before, bring the product name, dose and how you felt. Note your preferences on daily versus less frequent dosing and your budget.

JennWell Women's Health is located at 11844 Standing Stone Dr., Suite 200 in Gretna, inside Skilled Touch Health and Healing, and welcomes women from Elkhorn, West Omaha, Millard, Papillion, La Vista, Bennington, Lincoln and across Eastern Nebraska. To schedule, call (402) 800-8595 or request an appointment online. If you are unsure whether this service is right for you, a consultation is a no-pressure place to start the conversation and learn your options.