Are Hormone Pellets Safe for Menopause? Pros & Risks Explained

Hormone therapy (HT) is the most effective treatment for hot flashes and night sweats and also helps prevent bone loss in appropriate candidates. (PubMed) But hormone pellets—small implants that release hormones for months—are one of the most debated ways to deliver menopause hormones, largely because most pellets are custom-compounded rather than FDA-approved and can be hard to adjust once placed. (ACOG)

This guide breaks down what pellets are, what the evidence actually supports, the real risks, and when they may—or may not—be worth considering.

Medical note: This article is educational and not a substitute for personal medical advice. If you have sudden chest pain, shortness of breath, leg swelling, severe headache, or new neurologic symptoms, seek urgent care.

Quick answer: Are hormone pellets “worth it”?

For most people with menopause symptoms, pellets are usually not a first-choice option because:

• dosing may be inconsistent and hard to reverse, (ACOG)
• many pellets are compounded products without the same FDA oversight for quality, purity, and consistent dosing as approved hormone therapies, (Lippincott Journals)
• and major medical organizations caution against routine use of compounded hormone therapy when FDA-approved options exist. (PubMed)

That said, some patients still choose pellets for convenience or because they are seeking testosterone therapy—but testosterone in women has one strong evidence-based indication (hypoactive sexual desire disorder, HSDD) and still requires careful dosing and monitoring. (PMC)

What are hormone pellets?

Hormone pellets are tiny cylinders (often described as “grain of rice” size) inserted under the skin—typically near the hip or buttock—during an in-office procedure. They slowly release hormones into the bloodstream over several months.

What hormones are in pellets?

Most pellet programs use one or both of:

• Estradiol (estrogen)
• Testosterone

Some people with a uterus may also need progesterone (often given separately) to protect the uterine lining when systemic estrogen is used. (This is a general menopause-HT safety principle emphasized in major HT guidance.) (PubMed)

FDA-approved vs compounded

Most pellet therapies are custom-compounded. Compounded products are not evaluated the same way as FDA-approved drugs for consistent dose, purity, and safety labeling, and multiple medical organizations raise concerns about variability and limited evidence. (Lippincott Journals)

Why pellets are popular (and why that matters)

Patients commonly choose pellets because they want:

• Convenience (no daily pill, patch changes, or gels)
• “Steady” hormone delivery
• Testosterone therapy for libido or energy
• A “bioidentical” approach (often marketed as “natural”)

Here’s the catch: the term “bioidentical” is often used in marketing, but it does not automatically mean safer—and “custom-compounded bioidentical” therapy is exactly what major organizations caution about when regulated options exist. (PubMed)

Pros of hormone pellets for menopause

1) Convenience and adherence

For some patients, pellets can improve adherence because you don’t have to remember a daily/weekly routine.

2) Continuous delivery

Pellets provide continuous hormone exposure. Some people subjectively prefer this to fluctuating levels (though “steady” does not always mean “optimal,” especially if the dose is too high).

3) Testosterone access (in some practices)

In the U.S., there is no FDA-approved testosterone product specifically indicated for menopausal symptoms, which is why some clinicians and patients consider compounded testosterone. (Lippincott Williams & Wilkins) However, route and dosing matter a lot (more on that below).

Cons and risks of hormone pellets

This is where pellets differ most from standard menopause HT.

1) Dose can be hard to adjust—and hard to stop

With a patch or pill, clinicians can lower the dose quickly or stop treatment if side effects occur. With pellets, once inserted, you may not be able to “turn it off” easily. This is a key reason ACOG specifically advises against pellet delivery for testosterone given limited safety data and the difficulty of removal. (Lippincott Williams & Wilkins)

2) Compounding variability and limited safety evidence

NAMS notes compounded hormone therapy has safety concerns such as limited regulation/monitoring and risks of over- or under-dosing and impurities/sterility issues. (Lippincott Journals) The Endocrine Society similarly emphasizes concerns about misleading claims and supports stronger FDA oversight for compounded hormones. (Endocrine) ACOG states compounded bioidentical menopausal HT should not be prescribed routinely when FDA-approved formulations exist. (PubMed)

3) Testosterone side effects may be more likely if dosing overshoots

Testosterone can help some postmenopausal women with HSDD (low desire with distress) when used carefully at physiologic doses. (PMC) But excess androgen exposure can cause:

• acne/oily skin
• increased facial/body hair
• scalp hair thinning
• voice deepening (uncommon but potentially persistent)
• mood changes

Clinical guidelines emphasize careful patient selection, baseline labs, and monitoring when systemic testosterone is prescribed for women. (PMC)

Related Read: How to Treat High Testosterone in Women: Signs, Causes & Safe Options

4) Procedure-related risks

Because pellets require insertion, risks include:

• infection/cellulitis
• bleeding/bruising
• scarring
• pellet extrusion (pellet working its way out)

FDA communications about compounded drugs note adverse event reports where pellet extrusion and cellulitis were among events the FDA could attribute to compounded testosterone pellets (while also emphasizing limitations of adverse event reports). (U.S. Food and Drug Administration)

5) Uterine safety requires extra attention (if you have a uterus)

If systemic estrogen is used without adequate progestogen in someone with a uterus, the uterine lining can thicken, raising endometrial hyperplasia/cancer risk (a foundational menopause HT safety concept reflected in major HT guidance). (PubMed) This becomes especially important when dosing can’t be easily adjusted.

6) Cost and coverage

Pellets are often cash-pay and may not be covered by insurance, while many FDA-approved therapies are covered depending on plan/formulary.

What major medical organizations say about pellets and compounded hormones

ACOG (American College of Obstetricians and Gynecologists)

• Compounded bioidentical menopausal HT should not be prescribed routinely when FDA-approved options exist. (PubMed)
• For testosterone, ACOG recommends preparations other than pellet therapy, citing lack of safety data and inability to remove the pellet. (Lippincott Williams & Wilkins)

NAMS (The Menopause Society)

• HT is effective for vasomotor symptoms and GSM and helps prevent bone loss, but risks vary by formulation, route, and timing. (PubMed)
• NAMS highlights safety concerns around compounded therapy, including minimal regulation and possible over/under-dosing. (Lippincott Journals)

Endocrine Society

• Raises concern about misleading claims around compounded “bioidentical” hormones and supports FDA oversight/standardization. (Endocrine)

Pellets vs patches vs pills vs gels: what’s different?

(This table reflects the core differences emphasized in major guidance about compounded therapy, oversight, and pellet adjustability.) (Lippincott Journals)

Who might consider pellets (and who probably shouldn’t)

Pellets may be discussed in limited situations when:

• You understand they are often compounded and accept the tradeoffs
• You strongly prefer long-interval dosing and have struggled with adherence
• You are being managed by a clinician who will:
• document symptom goals
• use evidence-based monitoring
• avoid supraphysiologic dosing
• reassess benefit vs harm regularly

Pellets are usually a poor fit if:

• You want easy dose adjustments (common early in treatment)
• You have side effects easily triggered by hormone shifts
• You’re being offered pellets with promises of “guaranteed” weight loss, anti-aging, or disease prevention (claims not supported as general indications)
• You are being offered testosterone for broad reasons beyond the evidence-based indication (HSDD) (PMC)

If testosterone is the main reason you’re considering pellets

It’s crucial to separate marketing claims from evidence.

What testosterone can help (best supported)

• The only evidence-based indication for testosterone therapy in women is treatment of postmenopausal HSDD after a biopsychosocial assessment. (PMC)

What testosterone is not proven to reliably treat

• general fatigue
• “brain fog”
• weight loss
• “metabolism boosting”
• cardiovascular prevention
• broad “anti-aging” outcomes

Global consensus experts conclude evidence is insufficient for testosterone for other symptoms/conditions outside HSDD. (ScienceDirect)

Questions to ask before getting hormone pellets

Bring this checklist to your visit:

1. Are these pellets FDA-approved or compounded? (ACOG)
2. Exactly which hormone(s) are in the pellet—and at what dose?
3. If I have a uterus, what is the plan to protect the uterine lining? (PubMed)
4. How will we monitor symptoms and levels over time? (especially with testosterone) (PMC)
5. What happens if I have side effects—can it be removed? (Lippincott Williams & Wilkins)
6. What are the procedure risks (infection/extrusion/scarring) and how often do you see them? (U.S. Food and Drug Administration)
7. What is the total annual cost and what is covered by insurance?

Bottom line

Hormone pellets are appealing for convenience, but the biggest tradeoff is control: if the dose is too high or side effects occur, it can be difficult to rapidly adjust or stop therapy. Major medical organizations caution against routine use of compounded hormone therapy when FDA-approved options exist, and ACOG specifically recommends avoiding pellets for testosterone delivery due to limited safety data and inability to remove the pellet. (ACOG)

For most menopausal patients, FDA-approved transdermal or oral hormone therapy offers a more adjustable, better-studied path—while testosterone therapy, when appropriate, should be approached carefully and primarily for diagnosed HSDD with monitoring. (PMC)