Hormone therapy for women

You are tired in a way sleep does not fix, you cannot find words you have used your whole life, and the weight around your middle will not move. Somewhere along the way, someone told you this was normal for your age. It is not normal, and you are not imagining it.

Baseline labs drawn in houseFollow up at 6 weeks, 6 months, then annuallyLabs paid directly, price given firstJacksonville office

A woman in her forties laughing, hand at her shoulder

In short

The honest version, before the detail

Everything below expands on these points, with sources.

01Changed sleep, mood, energy, cycle or libido can be hormonal, but thyroid disease, anaemia, sleep apnoea, depression and medication effects produce the same picture.
02You can be in perimenopause with normal labs. Hormone levels move across the cycle, so one blood test is a snapshot, not an answer.
03Nothing is prescribed at a first appointment. We take a history, draw baseline labs in house, and interpret both together.
04Hormone therapy is the most effective treatment currently available for menopausal hot flushes and night sweats, according to ACOG.
05Pellets are our preferred method. They are the most consistent delivery system, releasing hormone steadily for months with no daily routine.

What this may address

Symptoms people come in with

Fatigue, insomnia, night sweats and hot flashes, brain fog and loss of concentration, anxiety, depression and irritability, migraine headaches, joint pain, weight gain, hair loss, feeling hot or cold all the time, urinary frequency, incontinence or leakage, reduced libido, vaginal dryness and cycle changes.

These symptoms are real, and they are also non-specific. Thyroid disease, anaemia, sleep apnoea, depression, medication side effects and perimenopause can each produce a similar picture. That is why the evaluation comes first and why a symptom list on its own is not a diagnosis.

We do not treat a lab value in isolation, and we do not treat a symptom list without testing. Both together, interpreted alongside your history, are what a plan is built from.

What is happening

Perimenopause starts earlier than people think

The average age of menopause is about 51. Symptoms can start as much as ten years before your last period, while you are still having regular cycles.

In those years estrogen does not simply run down. It rises and falls, and ovulation gets less predictable, which changes how much progesterone you make. That swing is why you can feel wrecked one week and fine the next, and why a single blood test on a random day can look reassuring.

Menopause itself is one year with no period and no other cause. It is a whole body transition, not just the end of your cycle.

So we do not chase one number. We look at your symptoms, your cycle history and the right labs together, because that is what actually tells us where you are.

How evaluation works here

What actually happens

Consultation

A full history: symptoms and when they started, cycle history, medical and family history, current medications and supplements, and your goals.

Baseline labs

Drawn in house. Lab work is not billed to insurance, but we can provide a superbill, and you get the price before anything is drawn.

Interpretation together

We go through what the results do and do not show, and which of the possible explanations they support.

Your plan

We go through delivery methods, monitoring and cost, and agree a plan together.

Monitoring

For pellet therapy the practice protocol is follow up labs at six weeks, again at six months, then annually. Creams and other topical hormones are monitored too. The schedule is agreed before you start.

Delivery methods

There is more than one way to take hormone therapy

Which is appropriate depends on your history, your preferences and what you are treating. No method is right for everyone.

Pellets

Our preferred method. A small pellet placed just under the skin releases hormone steadily, giving the most consistent levels with no daily routine. For women it typically lasts three to four months.

Patches, gels and creams

Applied to the skin and absorbed. The dose can be adjusted day to day, which some people prefer when starting out.

Oral and other routes

Some hormones are taken by mouth. Route affects how a medicine is processed by the body and therefore affects the risk profile, which is part of the discussion.

How we choose

Route matters more than most people are told

Estrogen through the skin, as a patch, gel or pellet, goes into the bloodstream without passing through the liver first. Compared with a tablet, that means less effect on the clotting factors the liver makes and on triglycerides. It is a good option for many patients, though no route suits everyone.

If you still have your uterus and you are taking estrogen, you also need progesterone to protect the lining of the uterus. We usually use oral micronized progesterone, because progesterone creams may not give reliable protection. Taken in the evening it can also help sleep. In some people it causes drowsiness or mood changes, so the plan is yours, not a template.

Testosterone is part of female biology too. Women make it, and it has roles in sexual function, muscle and bone. The strongest evidence for treating women is low sexual desire that bothers them after menopause, and there is no FDA approved testosterone product made for women in the United States, so dosing and monitoring have to be careful.

Compare

Delivery methods side by side

Hormone therapy delivery methods compared
Method	Typical duration	Daily routine	Worth knowing
Pellet	About 3 to 4 months for women, 5 to 6 for men	None	The most consistent delivery, with steady hormone levels between visits
Patch	Changed on a set schedule	Change on schedule	Absorbed through the skin, dose can be adjusted
Gel or cream	Applied daily	Daily	Easy to adjust, needs care about transfer to others
Oral	Taken daily	Daily	Route changes how the body processes the hormone, which changes the risk profile

No method is right for everyone. Which is appropriate depends on what is being treated, your history and your preferences.

Before you book

Benefits, risks, alternatives and candidacy

This appears before the booking button on purpose. You should be able to decide with the risks in front of you.

What it may do

For menopausal symptoms such as hot flushes and night sweats, hormone therapy is the most effective treatment currently available, according to ACOG.
Sleep, mood and quality of life may improve where those symptoms are genuinely hormone driven.
Some people notice a difference within days to weeks; others take longer, and some do not respond.

Risks and side effects

Hormone therapy carries risks that depend on your age, the type of hormone, the route, the dose and your personal and family history. We go through these with you individually.
With pellets, the dose is set for the months between visits, so it cannot be turned down quickly. That is why follow up labs are scheduled rather than optional. Bruising, soreness, bleeding, scarring, infection or a pellet working its way out can happen.
Possible effects vary by hormone and can include unexpected bleeding, breast tenderness, mood changes, acne or hair changes. These are managed by adjusting your dose.
Pellets are compounded medicines. What that means is explained in the questions below.

Alternatives, including doing nothing

Other forms of hormone therapy, including patches, gels, creams, oral and vaginal options.
Non-hormonal prescription options for hot flashes and for mood.
Treating a different underlying cause, such as thyroid disease, anaemia, a sleep disorder or a medication side effect.
Sleep, exercise, alcohol and stress changes, which support whatever treatment you choose.
Choosing to wait and monitor, which we will support.

Who may not be a candidate

This is not appropriate for everyone. Certain cancers, a history of blood clots or stroke, liver disease, unexplained vaginal bleeding, and pregnancy are among the situations that change or exclude this option. A full history is taken specifically to identify these.

Questions

Answered before you ask

How often would I need pellets?

In this practice, duration typically runs about three to four months for women and five to six months for men. It varies with metabolism, activity level and stressors on the body, which is one reason follow up labs are scheduled rather than optional.

When would I know whether it is working?

It is gradual, not a light switch. In our practice about three out of four patients report some symptom relief by their six week follow up. Hot flashes and night sweats can start to ease within about three or four days for some people. After testosterone, the level in your body starts rising within about 7 to 10 days, though how you feel takes longer. Some patients need two or three rounds, and occasionally up to a year, before symptoms are fully settled. These are our observations across our own patients, not a promise about you.

Will testosterone make me look or sound masculine?

That is the question almost everyone asks and almost nobody asks out loud. Dosed and monitored for a woman, the goal is to restore your own balance. In Elizabeth's clinical experience with more than 5,000 patients, she has not seen women become masculinized when they were dosed appropriately. Mild acne or changes in facial or body hair can happen and are usually about dose and individual sensitivity. Menopause itself also shifts the balance between estrogen and androgens, which can affect hair. Tell us about any new hair, skin or voice change so we can look at the dose and at other causes.

Will hormone therapy make me lose weight?

Hormone therapy is not a weight loss medicine. It can help with the symptoms that make eating, sleeping and training harder, and it is often one part of a bigger plan. Anyone who tells you it melts fat is overselling it.

My labs came back normal but I still feel unwell. What then?

We don't treat to normal, we treat to optimal. Reference ranges are population averages, so we look at your results alongside how you actually feel, and treat to the level where your symptoms are managed.

Are pellets FDA approved?

Pellets are compounded medicines. Ours come from an outsourcing facility registered with the FDA under section 503B, which must follow federal manufacturing standards and is inspected by the FDA. Compounded medicines are not FDA approved as finished products. If an FDA approved option suits you better, we will offer it and go through the choice with you.

Do you take insurance for the labs?

No. Labs are drawn in house and are not billed to insurance, though we can provide a superbill. Pellets and compounded medications are not covered by insurance. You get the price before anything is drawn.

Can I stop?

Yes. Patches, gels and creams can be stopped or adjusted day to day. A pellet releases steadily until it is used up, typically over a few months, so stopping simply means not renewing at your next visit.

Sources

Where this information comes from

Primary sources only: regulator publications, specialty society patient guidance and manufacturer information. Not marketing pages.

Written by

Elizabeth G. Bagan, APRN

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2026-09-24

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Next step

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We will review your symptoms and history and tell you whether further evaluation is worthwhile. No treatment is prescribed at a first consultation.

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