Bioidentical Hormone Replacement Therapy

Surya Medicine offers personalized bioidentical hormone replacement therapy. Bioidentical hormones are structurally identical to the hormones that your body makes, which enables them to work in the body in exactly the same way that your natural hormones work. They are used to resolve menopausal symptoms such as hot flashes, mood swings, foggy brain and decreased concentration, low libido, poor sleep, weight gain, and decreased muscle tone. They are protective to bone, brain, and cardiovascular health as we age.

To begin, lab work is obtained to determine your body’s unique hormone levels. Based on the results, a combination of hormones, targeted to your body’s specific needs, is made in the form of a cream, pellet, or capsule. Dr Miletich believes that through the skin (transdermal) or under the skin (subdermal) applications are best because they bypass the “first pass effect of the liver.”

In the beginning of your therapy, you will need frequent testing to check that each hormone component is in proper balance. With continued use, less frequent testing is required.

Pellet Therapy

Pellet Therapy involves hormone implants (the size of a grain of rice) being placed under the skin that consistently release small physiologic doses of bioidentical hormones.  Hormone pellets have been used since the 1930s.  Their popularity diminished in the 1950s and 1960s with the growth of the US pharmaceutical industry and the availability of the synthetic oral hormones called Premarin and Provera.  These are the two hormones that were used in the Women’s Health Initiative (WHI) study in the early 2000s that linked certain forms of hormone replacement therapy with an increased risk of blood clots, stroke, and breast cancer. We have learned a lot since the WHI study was completed and now know that the structure (bioidentical versus synthetic hormones) and route of application of hormones makes a difference in the risks and benefits of hormone replacement therapy.  Fortunately, pellet therapy never went away and has been well studied for safety and efficacy.


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Advantages of pellet therapy:

  • Hormones are absorbed directly into the bloodstream, avoiding the “first pass effect” in the liver.

  • They typically last 3-4 months

  • They allow for the continuous availability of the hormones

  • Your body controls the release of the hormone.  During stress and exercise, you absorb more.  At rest, you absorb less.

  • There is no need to apply creams daily

  • Great for increasing bone density