157. Hormone Pellet Therapy for Menopause: The Advantages That Critics Ignore

Ten hours of exercise a week, a clean gluten-free diet, and the scale went up ten pounds. That's what finally drove me to pellet therapy in 2018, and I haven't looked back since. But before I tell you that story, I need to deal with the question I know you're about to ask: can insurance cover this? Almost certainly not, and I want you to understand exactly why. I bill for it anyway, and I'll walk you through what that actually costs my practice, how long we wait to get paid, and what Medicare has done recently to make things even more difficult. If you've ever been annoyed at a bill for a pellet, this is the part nobody explains. In this episode you'll learn… Why hormone pellet therapy is almost never covered by insurance.

A respected gynecologist says the O-shot has no biological basis. I think she's wrong, and I can tell you exactly why. Dr. Jen Gunter has written twice that the O-shot is untested and built on a sketchy past. Both articles are linked below, and I'd encourage you to read them. Her central claim is that there's no damaged tissue down there to heal, so there's nothing for platelet rich plasma to do. I can name three circumstances that damage those exact tissues, and almost every woman listening has lived through at least one. Where I don't disagree with her is the missing research. So I'll explain why these studies are so hard to run, what the few that exist actually found, and the one group of women I usually talk out of this procedure entirely. In this episode you'll learn… Why critics argue there's no damaged tissue down there to repair.

There's an injection that improves orgasms and urinary leaking at the same time, and almost no woman has heard of it. The O-shot involves no estrogen and no hormones. It's made from your own blood, drawn from your arm, and spun down before it goes anywhere. The needle is the same one we use for Botox. It was designed around sexual function, and it delivers on that. But something else kept happening to the women who had it done, something nobody was aiming for, and that's become one of the main reasons I've come to recommend it. In this episode you'll learn… What the O-shot injects and where the two injections go.

Every vaginal estrogen product treats the inside. Only one of them treats the outside. Last week, I made the case that vaginal estrogen does not stay where you put it. This week, I go through what is actually available, and what each option can and cannot do for you. We cover the creams, the inserts, the ring, and the one FDA approved product that contains no estrogen at all. One of these treats something none of the others can touch, which is why I keep prescribing it despite the mess. I also get into compounded formulations and read the ingredient list on a common estradiol cream so you can hear what you are really putting in your body. In this episode you'll learn… Which three vaginal estrogen options carry FDA approval in the United States.

Women have been told for decades that vaginal estrogen stays where you put it, which means no progesterone and nothing to monitor. I do not believe that is true, and this week I lay out why. We start with what genitourinary syndrome of menopause, or GSM, actually looks like, including the urinary half of it that almost nobody connects back to hormones. Then I make my case for what happens to the estrogen after it leaves the vaginal tissue, and what two safeguards I think every woman using it should have. I also share an ultrasound finding that changed how I think about yearly screening, in a patient who was not using hormones at all. In this episode you'll learn… What separates local hormone therapy from whole body hormone therapy.