Hormone Pellets vs Creams vs Injections for Women

Once a woman has decided to look into hormone therapy, the next question is almost always how she wants to take it. Pellets, creams and injections all deliver hormone. They just do it in very different ways, and that difference is what people actually want explained when they sit down across from me.

There is no single right answer here. The method that suits you comes out of your lab work, what your days look like and how much you want to think about it. Here is how I walk through the three options with patients at our St. Matthews office, before anyone decides anything.

Key takeaways

Pellets are placed under the skin in a short office visit and release hormone steadily for several months, so there is nothing to keep track of day to day.
Creams and gels are applied at home every day, which gives flexibility, but they only work if they are used consistently and kept from transferring to other people.
Injections are given on a set schedule rather than daily, so levels rise after each one and drift back down before the next.
The right method comes from your labs, your symptoms and your routine together, not from the method itself being better.
At our St. Matthews office, bioidentical pellets are the foundation for most patients, and injections are available when they fit someone better.

Medically reviewed by Jessica Zink, APRN, FNP-C, Family Nurse Practitioner. Reviewed October 28, 2026.

What are the three ways women usually take hormone therapy?

Direct answer Women most often take hormone therapy as pellets placed under the skin during an office visit, as a cream or gel applied at home, or as an injection given on a set schedule. All three can deliver bioidentical hormone. They differ in how steady your level stays and in how much you have to do.

The hormone itself is not the whole story. What changes between these three is the delivery: how it gets into you, how evenly it arrives and who is responsible for making that happen.

Pellets and injections are both handled through the clinic. Creams and gels put the routine in your hands at home. Some women want that control. Others have told me they are tired of one more thing to remember in the morning, and that is a legitimate reason to choose differently. I bring all three up at the free consultation, because a patient who understands why we chose a method tends to stay with it and tell me honestly how she feels on it.

How do hormone pellets work?

Direct answer A pellet is a small, rice sized dose of bioidentical hormone from an accredited compounding pharmacy, placed just under the skin at the upper hip during a short office visit. The spot is numbed first. The pellet then releases hormone steadily over several months, with no daily routine to keep up.

The visit itself is quick. We numb the area, make a tiny opening, place the pellets and put a small bandage over it. You drive yourself home and go on with your day. We ask you to skip soaking baths and hard workouts for a short stretch while the site heals, and we tell you exactly how long when you are here.

What patients like about pellets is the evenness. No pill, nothing to apply, no counting days.

What patients should know is that a pellet cannot be stopped mid stream. Once it is placed, it works until it is used up. That is one reason we draw labs first and go through your history carefully rather than starting anyone on a hunch. The whole process, visit by visit, is on our how it works page.

What about creams and gels?

Direct answer Creams and gels are topical forms of hormone therapy applied to the skin at home, usually daily. They are flexible and easy to stop, but absorption varies from person to person, they depend on applying them the same way every day, and they can transfer to other people through skin contact.

Topicals have a real place. They are easy to start and easy to stop, and for a woman still deciding how she feels about hormone therapy at all, that reversibility matters.

The drawbacks are practical. How much hormone gets through the skin differs between people, and on the same person it can differ with where it is applied. If application slips for a few days, the level follows. Anything on your skin can also move to a partner, a child or a pet who touches that area, so topicals carry handling rules you have to respect every day.

I will say plainly that topical hormone therapy is not what we build our plans around here. If it is what you want to pursue, I will tell you that at the consultation rather than quietly steering you somewhere else.

Are injections a good fit for women?

Direct answer Injections are used more often for testosterone therapy in men, but they are an option for some women. They are given on a set schedule rather than daily, so your level is highest soon after an injection and lower before the next one. Some women feel that rise and fall.

The pattern is the main thing to understand. An injection puts a dose in at once, and your body works through it until the next one. For some people that is perfectly comfortable. For others, the stretch just before the next visit is when the old symptoms start to come back, which is exactly what they were trying to get away from.

Injections also mean a recurring appointment. That suits some schedules and frustrates others, and it is worth being honest with yourself about it at the start rather than six weeks in. Whether they make sense for you is a conversation about your labs and your history, not something I can settle from a blog post.

How do I choose between them?

Direct answer We choose from three things together: what your hormone panel shows, which symptoms are affecting you most, and what your routine can realistically hold. Your medical history, including a hysterectomy or any surgery involving your ovaries, shapes the decision as well.

Labs come first. We draw your hormone panel right here in the office, often at that same first visit, and results come back in a few days. I call you and we go through them together in plain language. If your numbers do not support hormone therapy, I tell you that, and we talk about what else might explain how you feel.

Then symptoms. A woman waking at three in the morning every night and a woman who has no interest in intimacy anymore are not necessarily in the same place, even with similar numbers on paper.

Then your life. Do you want to handle something daily, or do you want it handled and off your mind? Can you get to the office regularly? Is there a small child in the house who climbs on you? These are not small questions. They are the difference between a plan that works and a plan that quietly stops happening.

If you want to see how that first conversation goes before you book one, I wrote out the whole visit in what to expect at a hormone consultation.

What do you use at your St. Matthews office?

Direct answer For most of our patients, women and men, bioidentical hormone pellets from an accredited compounding pharmacy are the foundation. Injections are available when they suit a patient better. Both are decided at your free consultation after we have your lab results, never before.

We lean on pellets because of the steadiness and because they take the daily routine out of the equation, which is what most of the women in our chairs are asking for. That is a preference built on what works for our patients, not a rule I apply to everyone who walks in. If your labs, your history or your own preference point another way, we talk about it. I would rather have a patient on a plan she actually believes in than one she agreed to in the room and abandoned at home.

You can read more about what we do for women on our hormone therapy for women page, and the clinic wide overview lives on the hormone therapy hub.

What happens after you start?

Direct answer We recheck your levels after the first round and before each round that follows, so the next decision is based on where you actually are rather than where you started. Most patients settle into a few visits a year, and you can call between them.

This part matters more than the method you picked. Your numbers move, your life changes, and the plan should follow both.

Many patients tell us they sleep better and feel more even in the first few weeks, and that energy, focus and libido often follow over the first couple of months. Everyone is different, and hormone therapy is not right for everyone. If your history points another way, I say so.

If something feels off between visits, call. I would far rather hear about it in week three than at your recheck.

Questions we hear

Can I switch methods later if the first one is not working for me?

Yes. Plenty of patients start one way and change course after we see how they feel and what the recheck shows. That is a normal part of this, not a failure. Bring it up at your recheck or call the office and we will talk about it.

Do I need lab work before starting, no matter which method I choose?

Yes. We draw your hormone panel in the office, usually at your free consultation, and we go over the results together before anything begins. We do not put people on hormones their labs do not support.

Is bioidentical hormone therapy the same as natural hormone therapy?

People use the words interchangeably, but bioidentical has a specific meaning: the hormone has the same molecular structure as the one your body makes. Ours is compounded by an accredited pharmacy, and I am happy to go through it properly at your visit.

Can I start hormone therapy if I have had a hysterectomy?

Many of our patients have. Your surgical history changes what we look at and what we consider, so bring any records you have, especially if your ovaries were removed. We will go through it at the consultation.

If you are weighing these options and want a real answer for your situation, that is a thirty minute conversation with me and no charge. Book your free consultation or call (502) 749-6565, and we will find a time that works. More common questions are answered on our FAQ page.