Menopause and Hormone Replacement Therapy (HRT) in Women: Is there benefit?

Menopause symptoms. Climacteric, hormone replcement concept. Mature women hold hands symbolizin female genital organs. Middle aged lady flat vector illustration

If you’ve gone to your primary care or gynecology doctor and asked about hormone replacement therapy (HRT), this is likely the response you received:

“I don’t believe in hormone supplementation for women”
“There’s no data to support hormone supplementation in women”
“Our organization doesn’t advocate for hormone supplementation in women”

If you’ve told your gynecology doctor that you have a low libido and desire, it’s likely they told you:

“You should see a sex therapist”

These are the most common responses we hear from female patients who come to us to ask about HRT and hormone supplementation. In this blog, we will explain what causes low hormones, what benefits can be achieved by hormone supplementation, and the methods patients can use for hormone supplementation.

What causes low hormones in women?

Both testosterone and estrogen are important hormones for the mental and physical well-being of women. These hormones tend to decrease with age but typically undergo an abrupt decrease during menopause. Many experts say that menopause and low hormones are a normal part of aging, but that is far from the truth.

Menopause is caused by the loss of ovarian follicular function, which results in a decline in blood levels of estrogen and testosterone. This generally occurs between the ages of 45 and 55 years, but can occur early (30’s and 40’s) or as a result of an event such as the removal of a woman’s ovaries.

What changes are associated with menopause?

The symptoms can vary depending on the person and can be differentiated based on the hormone involved:

Low estrogen symptoms:

  • Hot flashes
  • Night sweats
  • Changes in or cessation of menstruation
  • Vaginal dryness or pain during intercourse
  • Difficulty sleeping and insomnia
  • Changes in mood
  • Increased risk of depression and anxiety
  • Bladder problems: difficulty urinating, increased need to urinate, bladder incontinence

Low testosterone symptoms:

  • Decreased sexual desire and libido
  • Difficulty reaching orgasm
  • Fatigue
  • Lack of concentration
  • Muscle weakness
  • Weight gain
  • Vaginal dryness
  • Thinning hair
  • Increased incidence of cardiovascular disease
  • Loss of bone mineral density
  • Cognitive decline and increased risk of cognitive disorders such as Alzheimer’s disease

What can be done about low hormones?

There are a variety of natural ways to boost both estrogen and testosterone in women, but those methods often do not restore a woman’s hormone levels to the healthy levels she had in her 20’s. Hormone replacement therapy (HRT) can take the form of vaginal rings, creams, patches, pills and bio-identical hormone pellets. We are going to focus on bio-identical hormone pellets because these are reasons why this method is superior to the other methods.

What are Bio-Identical Hormone Pellets?

These are pellets made of the same testosterone and estrogen that occur in your body, not the synthetic forms of estrogen and testosterone that are in other preparations. One of the benefits of the bio-identical form is that the synthetic forms can have side effects such as increased risk of deep vein thrombosis and pulmonary embolism with oral estrogens and allergic reaction to injectable testosterones. Another benefit of the pellets is that patients experience slow, controlled release over months rather than the daily and weekly variation that come with the other routes of administration. The resulting blood level of hormone is also much more predictable with the pellets, peaking at 4-6 weeks after pellet placing and slowly decreasing over 3-4 months.

What are the benefits of hormone supplementation in women?

There are the benefits of testosterone supplementation in women, which have been shown in numerous high quality clinical trials over the last several decades:

  • Improved libido and desire: the same effect we see in men
  • Protective against depression and anxiety: women with low testosterone had a significantly higher rate of depression and anxiety compared to women who were on testosterone supplementation
  • Protective against breast cancer: women with low testosterone had a significantly higher incidence of breast cancer compared to women who were on testosterone supplementation
  • Patients on testosterone therapy for 12 months experience a 5-8% increase in bone mineral density
  • Decreased migraines caused by low testosterone
  • Increased lean muscle mass
  • Decreased body fat
  • Decreased triglycerides, low-density lipoproteins (LDLs), and cholesterol
  • Decreased risk of cardiovascular events like heart attack: the same effect we see in men
  • Both testosterone and estrogen have a neuroprotective role against cognitive decline and cognitive disorders

These are the benefits of estrogen supplementation in women:

  • Improvement in hot flashes and night sweats
  • Improvement in insomnia
  • Decreased vaginal dryness and pain during intercourse
  • Decreased migraines caused by low estrogen
  • Improved mood and decreased irritability

What are the risks of hormone supplementation in women with Bio-Identical Hormone Pellets?

Pellet placement is an outpatient procedure that takes about 10-15 minutes. We use lidocaine to numb the area, then place small pellets in the subcutaneous fat and use steri-strips and Tegaderm to cover the wound.

There is a very small risk of site infection, although the procedure tray and pellets are sterile and we use sterile technique during placement of the pellets. In the event of a site infection, we prescribe an oral antibiotic.

There is a very small risk of pellet extrusion, which is when one of the pellets migrates out of the skin 1-2 months after placement. This is more common in men because they receive 7-12 large pellets, whereas women typically receive 1-3 small pellets.

A small percentage of women experience facial hair growth or thinning of hair on the scalp as a result of testosterone supplementation. This is temporary and when this happens, we use a lower dosage of testosterone on the subsequent pellet procedure.

Why don’t physicians advocate for hormone replacement with Bio-Identical Hormone Pellets?

The American College and Obstetricians and Gynecologists and American Association of Clinical Endocrinology both state that there is no evidence to support the safety and efficacy of compounded bioidentical hormones and do not recommend their use. It is unclear why these organizations have ignored decades of high quality clinical trial data showing the benefits of both testosterone and estrogen supplementation in women who have low hormones. Equally important, there are no reported adverse events related to hormone supplementation to health physiologic levels with either Bio-Identical testosterone or estrogen.


For women who have gone through menopause or are experiencing symptoms of low testosterone and/or estrogen, placement of Bio-Identical Hormone pellets have a number of beneficial effects on the mental and physical health of women. Menopause may be considered a normal part of aging but is not normal for healthy physiologic function. We now have a method to return a woman’s hormone levels to the healthy levels she had in her 20’s using the exact same hormones that her body naturally produces.

If you would like to learn more, you can schedule a consultation by call us at 434-260-1667 or use our Contact Us form


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