Restoring Estrogen Levels: Why It Matters Which Estrogen You Replace

How much do you know about the hormones your body makes? When it comes time for hormone replacement, many women are left bewildered as to the choices and whether it makes a difference which estrogen gets replaced or what kind of therapy is employed.
Let’s just say it makes a very big difference. You cannot randomly replace any hormone or every hormone and return to the hormonal balance of earlier years.
Hormone Harmony: The Delicate Balancing Act

Your body needs hormones. And it needs them in specific amounts. These vital substances work together in regulating most major body functions ranging from heart rate, bone density and blood sugar to your immune system, metabolism, sex drive and more. Due to a very sensitive feedback system it is possible for hormone concentrations in the blood stream to remain relatively stable in precise amounts, depending on the body’s needs. This is important because your hormones must exist in physiologic levels in order to perform properly. Too much or too little of a hormone can create internal havoc.

Each Estrogen Plays a Different Role

Your body specifically needs estrogen. It’s what makes you a woman and helps keep you healthy. In pre-menopause, there are three primary estrogens: estrone (E1), estradiol (E2), and estriol (E3). Each becomes predominant at different times in a woman’s life.

Estrone is produced primarily in the ovaries and fat cells in pre-menopause. It is considered a weak estrogen. Estrone becomes the main estrogen in post-menopause after the ovaries stop working. Fat cells are the primary source of estrone at this point.
Estradiol is the key estrogen during a woman’s reproductive years. It exists in a beneficial ratio of 2:1 with estrone (E2:E1). Estradiol is considered the strongest and most important estrogen, achieving higher levels in the blood stream and providing greater estrogenic activity. In fact, there are receptor cells for estradiol throughout the body, not just in the uterus and breast.
Estriol becomes the primary estrogen during pregnancy when it is synthesized in very high amounts in the placenta. It’s almost undetectable when you’re not pregnant.

Menopause: The Great Hormone Disrupter

The production of estradiol begins to slow in your mid-thirties. Likewise, testosterone and progesterone levels drop. Sometime after age 40, hormone loss becomes so pronounced that disruptive symptoms start to appear. You may at this point suffer from mood swings, hot flashes, fatigue, anxiety, depression or other issues.

Unfortunately, this is only the tip of the iceberg. Once menopause fully arrives, your ovaries stop manufacturing these three hormones altogether, making you more susceptible to a variety of health issues. Research has shown that low serum levels of hormones are linked to a variety of maladies. For instance, low testosterone in men can lead to osteoporosis,1 type 2 diabetes,2 and cardiovascular disease.3 Low estradiol in women has likewise been associated with the risk of osteoarthritis,4 Alzheimer disease,5 and cardiovascular disease.6

Bioidentical Estradiol Replacement: The Wise Choice

Your need for physiologic hormone levels never goes away. Every hormone in your body is intricately tied to others in helping you maintain good health and well-being as you age. It makes a huge difference which estrogen gets replaced and what kind of hormones (bioidentical vs. synthetic or conjugated) are used.

Those who suggest replacing estrone or estriol or combinations of estrogens don’t understand the importance of reestablishing proper estrogen ratios. Restoring estradiol in a 2:1 relationship with estrone is paramount. It’s important to note that Premarin and other pharmaceuticals that use conjugated estrogens in oral form reverse the healthy ratio of 2:1 to an unhealthy 1:2. Likewise oral estradiol drugs such as Estrace create an incorrect ratio of 1:1, as do all estradiol patches. The only estrogen replacement therapy that reproduces the beneficial 2:1 ratio are bioidentical estradiol pellet implants, such as those used by SottoPelle®.7

Also, it is essential to use hormones that are molecularly identical to those your body once made. Bioidentical hormones, when properly administered, can actually return hormonal balance at a cellular level. You likewise need a therapy that can address other hormone deficiencies such as testosterone, progesterone and thyroid.

The SottoPelle® Method

SottoPelle’s proprietary method allows us to tailor your hormone therapy according to your unique needs. Our goal is to provide hormonal balance—something other methods or even other pellet therapies cannot deliver.

SottoPelle® employs a proprietary bioidentical pellet implant method that sends a steady, low dose of hormone directly into the blood stream. Precisely dosed hormones are delivered around-the-clock, seven days a week for up to six months. The body recognizes and can work with this type of delivery method. In fact, it is the only system that allows more hormone to be delivered when the body needs it.

You will find that our SottoPelle® method is not only more convenient and better attuned to the way your body works naturally, but it is also far more cost-effective than other hormone treatments.

SottoPelle® BHRT Pellet Experts

SottoPelle® has specialized in bioidentical hormone replacement using the pellet method longer than most. Our founder, Dr. Gino Tutera, developed the proprietary method that makes us a leader in our field. We have a long history of success when it comes to balancing hormones and helping people take control of their health. In fact, we are honored to say that, according to Ranking Arizona, an annual consumer publication by AZ Big Media, our patients have voted us Arizona’s #1 Hormone Therapy Clinic for two years in a row.

Call Us Today!

Consulting with an expert in SottoPelle’s science-based BHRT can go a long way in creating a healthier future for you. Discover what our remarkably simple, hassle-free method can do for you.

Learn more about SottoPelle® at www.sottopelletherapy.com and then give us a call at (877) 473-5538 to schedule a consultation.


1Dupree K, Dobs A. Osteopenia and Male Hypogonadism. Rev Urol. 2004; 6(Suppl 6): S30-S34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472878/
2 Al Hayek AA et al. Prevalence of low testosterone levels in men with type 2 diabetes mellitus: a cross-sectional study. J Family Community Med. 2013 Sep-Dec; 20(3): 170-186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957172/
3 Jones TH. Testosterone deficiency: a risk factor for cardiovascular disease? Trends Endocrinol Metab. 2010 Aug; 21(8): 496-503. https://www.ncbi.nlm.nih.gov/pubmed/20381374
4 Roman-Blas JA, Castaneda S, Largo R, Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis Research & Therapy. 2009 Sep; 11:241.
https://arthritis-research.biomedcentral.com/articles/10.1186/ar2791
5 Janicki SC, Schupf N. Hormonal Influences on Cognition and Risk for Alzheimer Disease. CurrNeurol Neurosci Rep. 2010 Sep; 10(5): 359-366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058507/
6 Rossi R, Grimaldi T, Origliani G, Fantini G, Coppi F, Modena MG. Menopause and cardiovascular risk. Pathphysiol Haemost Thromb. 2002 Sep-Dec; 32(5-6): 325-8. https://www.ncbi.nlm.nih.gov/pubmed/13679667
7 Thom M et al. Hormone profiles in post menopausal women after therapy with subcutaneous implants. Br J Obstet Gynaecol. 1981; 88:426-433. http://www.htcapractitioner.com/wordpress/wp-content/uploads/2015/07/Thom-81-Hormonal-profiles-in-postmenopausal-women-after-therapy-with-subcutaneous-implants.pdf

Why Natural Progesterone Is Crucial to Healthy HRT

A woman loses virtually all of her estradiol, testosterone and progesterone when menopause takes place. Her endocrine system becomes permanently imbalanced and out of sync when this happens. The best way to treat this hormonal imbalance is to replace what’s missing, which means restoring healthful levels of all three of these hormones and not just one or two. It’s especially important when estrogen is prescribed that natural progesterone also be taken.
Evidence Clearly Shows the Many Benefits of Natural Progesterone

Progesterone has many important functions in the body. One of its most vital tasks is to protect a woman’s uterus in the presence of estradiol. Research has indicated that this hormone acts as an anti-estrogenic, anti-androgenic substance and also provides anti-mineralocorticoid effects.1

What that means for HRT users is that taking natural progesterone with estradiol and testosterone:

• Helps protect against the negative effects of estrogen dominance
• Helps moderate the effects of androgens
• Helps regulate the body’s salt and water balances

In a scientific article published in 2005, researchers concluded that natural progesterone used in conjunction with HRT does not increase breast cancer risk and could even have a protective effect. On the other side they found evidence that synthetic progestins used in tandem with estrogen replacement therapy does increase the risk of breast cancer.2 Taking it a step further, two new studies published in 2015 demonstrate progesterone’s potential for breast protective effects in relation to breast cancer.3,4 Conversely, the link between unopposed estrogen and cancers of the breast, ovaries and endometrium is well established.5.6

Meanwhile, positive findings on the benefits of natural progesterone continue to mount. This important hormone can increase deep sleep,7 promote bone formation, and/or increase bone turnover.8 Another important finding indicates that progesterone has an antihypertensive effect and not a hypertensive effect as was previously thought.9

Choose Natural Progesterone

Many doctors continue to prescribe synthetic hormone replacement despite the strong evidence of serious health risks. If you are taking pharmaceutical progestins, talk to your doctor about switching you to natural progesterone. Better yet, consult with a physician who specializes in bioidentical hormone therapy—an expert who understands hormonal balance and how to achieve it safely and effectively.

SottoPelle® BHRT Experts

SottoPelle® has specialized in BHRT using the pellet method longer than most. Our founder, Dr. Gino Tutera, developed a proprietary method for diagnosing, dosing and implantation that makes us a leader in our field. We have a long history of success when it comes to balancing hormones and helping people take control of their health. In fact, we are honored to say that, according to Ranking Arizona, an annual consumer publication by AZ Big Media, our patients have voted us Arizona’s #1 Hormone Therapy Clinic in 2015.

Call Us Today!

Learn more about SottoPelle® at www.sottopelletherapy.com and then give us a call at (877) 473-5538 to schedule a consultation.


1Sitruk-Ware R, Bricaire C, De Lignieres B, Yaneva H, Mauvais-Jarvis P. Oral micronized progesterone. Bioavailability pharmacokinetics, pharmacological and therapeutic implications–a review. Contraception. 1987 Oct;36(4):373-402. http://www.ncbi.nlm.nih.gov/pubmed/3327648
2 Campagnoli C, Abbà C, Ambroggio S, Peris C. Pregnancy, progesterone and progestins in relation to breast cancer risk. J Steroid Biochem Mol Biol. 2005 Dec;97(5):441-50. Epub 2005 Oct 24. https://www.ncbi.nlm.nih.gov/pubmed/16249080?dopt=Abstract
3 Mohammed, Hisham, et al “Progesterone receptor modulates ER-a action in breast cancer,” Nature 2015; 523; 313-317. http://www.nature.com/nature/journal/v523/n7560/full/nature14583.html
4 Perks, Bea “Progesterone receptor could slow breast cancer growth,” Pharmaceutical Journal, PJ 17 Jul 2015. http://www.pharmaceutical-journal.com/news-and-analysis/news/progesterone-receptor-could-slow-breast-cancer-growth/20068984.article
5 O’Connor KA et al. Total and Unopposed Estrogen Exposure Across Stages of the Transition to Menopause. Cancer Epidemiol Biomarkers Prev. 2009 Mar; 18(3): 828–836. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675575/
6 Henderson BE, Ross RK, Pike MC, Casagrande JT. Endogenous hormones as a major factor in human cancer. Cancer Res. 1982;42:3232–3239. https://www.ncbi.nlm.nih.gov/pubmed/7046921
7 Friess E, Tagaya H, Trachsel L, Holsboer F, Rupprecht R. Progesterone-induced changes in sleep in male subjects. Am J Physiol 1997; 272:E885-E891. https://www.ncbi.nlm.nih.gov/pubmed/9176190
8 Prior JC. Progesterone as a bone-trophic hormone. Endocr Rev 1990; 11:386-398. https://www.ncbi.nlm.nih.gov/pubmed/2194787
9 Rylance PB, Brincat M, Lafferty K, De Trafford JC, Brincat S, Parsons V et al. Natural progesterone and antihypertensive action. Br Med J 1985; 290:13-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1415335/pdf/bmjcred00428-0015.pdf

Does Hormone Replacement Cause Weight Gain?

The answer is no. In fact, it is hormone deficiency not hormone replacement that causes weight gain in menopausal women. A study published in 2012 stated that it is a myth to blame HRT (especially estrogen replacement) for weight gain in menopausal women. In fact, hormone replacement can actually help women lose the fat around their waistlines.1
Hormone Deficiency’s Role in Weight Gain

Perimenopause is a time when important hormones begin to diminish. The ovaries cease to function normally and can no longer produce adequate supplies of estradiol (a woman’s most important estrogen), testosterone, or progesterone. For a time, these hormones may fluctuate wildly, but eventually production of estradiol and progesterone from the ovaries will cease, while the creation of testosterone slows to a trickle. Thyroxine, another important hormone made in the thyroid gland, can also go into decline at this time causing metabolism and fat-burning to slow down.

It is this deficiency of key hormones that begins a cascade of negative symptoms and effects, including weight gain. Many women start noticing changes due to hormone loss in their late 30s or early 40s. That’s when the waistline starts to expand, muscle mass and muscle tone begin disappearing, unwanted pounds are more difficult to lose and fat starts to emerge in undesirable areas.

At menopause, estradiol production in the ovaries finally comes to a halt. The body tries to compensate by creating more estrone (a weaker form of estrogen that is present in fat cells) to address some of the tasks of estradiol. Estrone really isn’t a good substitute because it isn’t as active as estradiol and cannot fully communicate with estradiol receptors. Also higher levels of estrone are needed to create beneficial effects.

In the absence of estradiol, belly fat cells—where estrone is generated—proliferate in order to keep up an abundant supply. Due to the amount needed for effectiveness, estrone is not considered a safe alternative when it comes to hormone replacement. Estrone has, in fact, been associated with breast cancer in women.

How HRT Can Help Restore or Maintain Your Ideal Weight

Managing your hormones is a big part of regulating your weight. There is no doubt that a woman’s body needs estradiol to function well. It also needs physiologic levels of other hormones in order to achieve hormonal balance. Balance is important because hormones are collaborative substances and often work together to achieve their tasks.

Restoring estradiol, testosterone, progesterone and thyroid hormones to healthful levels when they are deficient is a vital part of controlling metabolism. There are many interactive factors involved between these hormones and others that help determine appetite, fat storage, and weight gain. Things like sleep problems, exercise habits, the types of foods you eat, and stress levels can also greatly impact your hormones and your success.

Likewise, when seeking hormone replacement therapy, the type of hormones you use, along with the delivery method and the expertise of your physician make a big difference in the outcome.

Why SottoPelle® Is the Top Choice for BHRT in Arizona

At SottoPelle®, our expert practitioners start with proper testing and analysis of your hormone status in addition to reviewing your medical history. If you are a good fit for our proprietary method, we can begin therapy whenever you are ready. We use low dose bioidentical hormone pellet implants to help achieve the hormonal balance so important to overall health and well-being. This safe and effective method, when properly administered, is the only BHRT proven to achieve around-the-clock physiologic hormone levels for months at a time.

Our patients frequently praise the enhanced quality of life they’re experiencing with SottoPelle® BHRT. Weight loss, improved libido and sex drive, better sleep, and greater mental acuity are just a few of the benefits patients report to us.

In fact, we are honored to say that, according to Ranking Arizona, an annual consumer publication by AZ Big Media, our patients have voted us Arizona’s #1 Hormone Therapy Clinic in 2015.
Check us out at www.sottopelletherapy.com or give us a call at (877) 473-5538 to schedule a consultation. We look forward to helping you as we have so many others.


1S. R. Davis, C. Castelo-Branco, P. Chedraui, M. A. Lumsden, R. E. Nappi, D. Shah, P. Villaseca. Understanding weight gain at menopause. Climacteric, 2012; 15 (5): 419 DOI:10.3109/13697137.2012.707385

October 18 is World Menopause Day

Women’s Heart Health

World Menopause Day is a day dedicated to raising awareness of all aspects of aging in women. In conjunction with this year’s World Congress theme, the focus of World Menopause Day is to educate the public on women’s heart health issues and encourage women and their physicians to discuss the risks for developing cardiovascular disease (CVD).

Some Notable Facts about Cardiovascular Disease (CVD) in Women

Cardiovascular disease remains the leading cause of death for women in the western world. It not only costs millions of lives, but makes an enormous economic impact as well. According to a report published in Womens Health Issues in 2003, the total lifetime medical costs (i.e., sum of incremental and baseline lifetime medical costs) of treating a woman with CVD are 3.4 times greater than the costs of a woman without CVD.1 It is said to be one of the most costly diseases and creates a major economic burden on health care systems.2

As with any serious disease, detecting CVD early saves lives. In an important review of literature published in Climacteric this year, reviewers concluded that physicians need to engage in more intensive CVD risk assessment and management of women at all times, but particularly in midlife.3  (To help you in evaluating your own CVD risk, go to http://www.heartage.me/)

The Estradiol/Cardiovascular Disease Connection

CVD risk factors are affected by many things, but hormonal status is of particular concern. Women who are hormonally deficient, as they are in the years leading up to and after menopause, are at a higher risk than they were in younger years.

This greater cardiovascular risk has been scientifically linked to an increasingly short supply of estrogen (i.e. estradiol) as a woman ages. Estradiol affects almost every organ system or tissue in the body, including the blood vessels and heart. This vital hormone has been shown to play a cardio-protective role, among others. It increases HDL and lowers LDL cholesterol; increases blood flow by relaxing, smoothing and dilating blood vessels; and also absorbs free radicals in the blood stream that can damage arteries and other tissues. Thus, when estradiol diminishes during the aging process, so does cardiovascular protection.

HRT and Cardiovascular Disease

Since estradiol deficiency increases the risk for developing CVD, doesn’t it make sense to restore this hormone to beneficial levels with HRT?

Yes, it does make sense. But not every HRT method provides positive benefits to cardiovascular health. The type of hormones used, as well as the hormone delivery system employed, makes a big difference.

Two very large studies found that treatments based on pharmaceutical versions of estrogen and progesterone, such as those found in Premarin and PremPro, seriously increase the risk of heart attack, stroke and blood clots.4,5 In contrast, ample scientific evidence shows that bioidentical hormone replacement can go well beyond the usual symptom treatment to support many aspects of health and overall well-being.6 When properly administered, BHRT can make a beneficial impact on CVD risk, particularly in women ages 50 – 59 who do not already have cardiovascular disease.7 For women seeking the therapeutic effects of human hormones, BHRT using the pellet delivery method comes closest to the way the body works, delivering physiologic doses of hormone around-the-clock for months at a time.

Bioidentical Hormone Replacement Therapy Is the Healthy Choice

If you are a woman experiencing hormone deficiency, the earlier you address it with proper BHRT, the greater the health benefits. It is vitally important to seek out an expert who understands both the pellet implant method and the significance of restoring hormonal balance.

This is precisely what we have been doing at SottoPelle® for decades. Our proprietary BHRT pellet method has helped thousands of patients regain beneficial hormone levels and the quality of life they once knew. In fact, we are honored to say that according to Ranking Arizona, an annual consumer publication by AZ Big Media, our patients have voted us Arizona’s #1 Hormone Therapy Clinic in 2016.

For more information on SottoPelle®, check out our website at www.sottopelletherapy.com or give us a call at (877) 473-5538 to schedule a consultation. We would love to help you as we have so many others.


1Birnbaum H, Leong S, Kabra A. Lifetime medical costs for women: cardiovascular disease, diabetes, and stress urinary incontinence. Womens Health Issues 2003, Nov-Dec, 13(6):204-13. https://www.ncbi.nlm.nih.gov/pubmed/14675789
2 Tarride, JE, Lim M, DesMeules M, Luo W, Burke N, O’Reilly D, Bowen J, Goeree R. A review of the cost of cardiovascular disease Can J Cardiol. 2009 Jun; 25(6): e195–e202. Can J Cardiol. 2009 Jun; 25(6): e195–e202. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722492/
3 P. Collins, C. M. Webb, T. J. de Villiers, J. C. Stevenson, N. Panay & R. J. Baber (2016) Cardiovascular risk assessment in women – an update, Climacteric, 19:4, 329-336, DOI: 10.1080/13697137.2016.1198574. http://dx.doi.org/10.1080/13697137.2016.1198574
4 https://www.nhlbi.nih.gov/whi/
5 http://www.millionwomenstudy.org/dss_protocols/
6 Schwartz E, Holtorf K. Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions for the future. Prim Care Clin Office Pract 2008; 35 (4): 669–705. http://www.holtorfmed.com/pdf/04-Hormones-in-Wellness.pdf
7 Bechlioulis A, Naka KK, Papanikolaou O, Kontostolis E, Kalantaridou SN, Michalis LK. Menopause and Hormone Therapy: From Vascular Endothelial Function to Cardiovascular Disease Hellenic J Cardiol 2009; 50: 303-315.

The Link between Estradiol Deficiency and Attention Deficit Hyperactivity Disorder (ADHD)

ADHD impacts millions of women and girls and yet many go undiagnosed or misdiagnosed for most of their lives.1 It’s a disorder that manifests in childhood, but has never been easily recognized in girls. For a lot of years, ADHD was thought to be a boys’ phenomenon. Now we know better.
ADHD simply displays differently in girls. They don’t fit the stereotype of this disorder and their symptoms are more subtle. Where boys seem to be “bouncing off walls” or acting out in other ways, girls tend to turn inward and suffer from self-esteem issues, self-blame, major depressions, anxiety and eating disorders.

Girls and women are commonly misdiagnosed as bipolar or having a primary depressive disorder rather than ADHD. If they do get the appropriate diagnosis, they are generally treated with the same drugs given to young boys, which don’t address the complexities seen in females with the condition.

The Hormone Connection with ADHD
Steroid hormones are not just sex hormones. They play an important role throughout the body and especially in the brain. Estradiol in particular exerts a significant and complex impact on brain chemistry. This hormone has been shown to be neuroprotective2 and has a substantial influence on memory, cognition and brain plasticity, thus helping the brain perform better and faster. Estradiol does this by increasing vital concentrations of serotonin, dopamine, and other neurotransmitters significant to healthy brain performance.

Conversely, when hormones are fluctuating or deficient, neurotransmitters cannot be manufactured in the quantities needed for normal brain function. Evidence shows that the brains of those with ADHD are deficient in these neurotransmitters. Treatment usually involves medications that target these deficiencies by stimulating the production of serotonin and dopamine. What is often left out of that equation for girls and women is the impact fluctuating hormones have on ADHD.3

Insufficient Estradiol Levels Worsen ADHD in Women
Scientific research continues to explore the vital role estradiol plays in the brain.4,5 Several decades ago, it was noted that there was a possible link between hormones and ADHD in women (Hussey 1990). Low estradiol states—such as those occurring during a woman’s monthly cycle, post pregnancy, or during perimenopause and menopause—seem to exacerbate ADHD symptoms.6 It consistently appears that girls with ADHD experience increasingly severe problems at the onset of puberty, a time when hormone levels fluctuate between highs and lows. Women have likewise reported that the arrival of perimenopause caused their ADHD symptoms to worsen while at the same time lessening the effectiveness of their ADHD medications. Physicians frequently respond to these women by upping their stimulant medication, which does little to help.

Support for Women with ADHD
What does seem to help women with ADHD is a holistic treatment approach that combines various strategies. These can include ADHD medications; behavioral techniques—such as cognitive behavioral therapy and coaching; diet; exercise; and last, but not least, hormone replacement therapy.

HRT, especially properly administered bioidentical HRT, has been shown to ease some symptoms of ADHD for perimenopausal and menopausal women with this disorder. Restoring physiologic levels of testosterone and estradiol enables these hormones to combine efforts in the brain and increase vital serotonin and dopamine levels. This beneficial replenishing of key hormones can provide relief from depression, anxiety and other disabling symptoms related to the neurotransmitter deficiencies of ADHD.

Some Common Signs of Adult ADHD
Women are often not diagnosed with ADHD until their mid-30s or even into their 40s or 50s when hormone insufficiencies cause symptoms to worsen. If you have had at least 5 of the symptoms listed below during puberty or sometime prior to the onset of perimenopause, you may want to get tested for ADHD. And while you’re at it, contact a bioidentical hormone replacement expert who can measure your hormone levels to determine if you have hormone deficiencies that also need treatment.

1. Disorganization and forgetfulness
2. Lack of Motivation
3. Problems starting tasks
4. Tardiness
5. Anxiety
6. Depression
7. Relationship troubles
8. Extreme distractibility and/or hyper focus
9. Poor listening skills
10. Restlessness, difficulty relaxing
11. Sleep problems
12. Angry outbursts
13. Difficulty prioritizing
14. Impulsiveness


1 Quinn PO, Madhoo M. A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. Prim Care Companion CNS Disord. 2014; 16(3): PCC.13r01596. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/
2 Marin, R., Diaz, M., Alonso, R., Sanz, A., Arevalo, M. A., and Garcia-Segura, L. M. (2009). Role of estrogen receptor α in membrane-initiated signaling in neural cells: interaction with IGF-1 receptor. J. Steroid Biochem. Mol. Biol. 114, 2–7. http://www.ncbi.nlm.nih.gov/pubmed/19167493
3 Martel MM, Klump K, Nigg JT, Breedlove SM, Sisk CL. Potential Hormonal Mechanisms of Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A New Perspective. Horm Behav. 2009 Apr; 55(4): 465–479. http://www.ncbi.nlm.nih.gov/pubmed/19265696
4 Cook Ian A, Morgan Melinda L, Dunkin Jennifer J, David Steven, Witte Elise, Lufkin Robert, Abrams Michelle, Rosenberg Susan, Leuchter Andrew F. Estrogen replacement therapy is associated with less progression of subclinical structural brain disease in normal elderly women: a pilot study International journal of geriatric psychiatry, 2002; 17(7): 610-8.
5 Wise PM, Dubal DB, Wilson ME, Rau SW. Estradiol is a neuroprotective factor in in vivo and in vitro models of brain injury. J Neurocytol. 2000 May-Jun;29(5-6):401-10.
6 Quinn, PO. AD/HD in Women: Do We Have the Complete Picture? http://www.chadd.org/LinkClick.aspx?fileticket=-tHjnQjXheY%3D

Can Hormone Replacement Alleviate Migraines in Menopausal Women?

According to the Migraine Research Foundation, migraine is the 3rd most prevalent and 6th most disabling disease in the world.1 More women than men suffer from these headaches. In fact, the ratio of female to male is 3:1. It is known that a variety of triggers can lead to migraines, but the causes are not clearly understood. Even so, it is commonly accepted that both genetics and environmental influences play important roles in who is predisposed to getting migraines.
The Connection between Women’s Hormones and Migraine Headaches
Hormonal changes in women are a frequent trigger for those susceptible to migraine attacks. This happens when estrogen levels drop during the menstrual cycle and menopause, or when they fluctuate wildly as they do in perimenopause. Women have been voicing this to doctors for many years, saying their migraines coincide with their menstrual cycles and that they seem to get worse during perimenopause and menopause. Research simply wasn’t abundant enough to back them up. Science is finally catching up. A review of current literature published in 2014 found that: 1) women were more likely than men to suffer from migraines; 2) that considerable evidence supports an important role for sex hormones, and 3) that women’s migraines tended to be precipitated by drops in estrogen concentrations, and minimizing this decline may prevent these headaches.2 In fact, proper hormone treatment has been found to help reduce the incidence of migraines for women both before and during menopause.3

The Right HRT Can Reduce or Eliminate Hormone-related Migraines
Another study reported in 2009 showed that maintaining stable estrogen levels in menopausal women with a history of migraines markedly reduced the incidence of these headaches.4 In this and other studies, the use of non-oral bioidentical forms of estradiol delivery helped achieve maximum results. This was due to the ability of those methods to deliver a steady, consistent dose of hormone. It’s been found that synthetic estrogen and oral forms of the hormone can actually worsen migraines. They simply can’t produce stable, dependable hormone levels around the clock.

Estradiol Pellets Are the Best Option for Hormone Related Migraines
Even better results have been achieved using estradiol pellets,5 which provide steady, 24/7 doses of hormone for months at a time. Early research (1974) by Greenblatt demonstrated that both menstrual and postmenopausal migraine could be controlled with subcutaneous hormone pellets.6 He concluded that estrogen pellets alleviated all symptoms in the majority of his menopausal patients, and that maintenance of stable estrogen levels would control menopausal migraine.

For years, Dr. Gino Tutera, pioneer and founder of SottoPelle®, used bioidentical estradiol pellets to treat hormone deficient women of all ages who suffered from migraines. A 90 percent success rate was achieved with this approach. Estrogen levels were restored for these patients within three to seven days and their headaches were either reduced significantly or eliminated.

If you are suffering from hormone-related migraines, schedule a consultation with one of our BHRT experts today. We would love to help you. (877) 473-5538


1 https://migraineresearchfoundation.org/about-migraine/
2 Chai NC, Peterlin BL, Calhoun AH. Migraine and estrogen. Curr Opin Neurol. 2014 Jun;27(3):315-24. http://www.ncbi.nlm.nih.gov/pubmed/24792340
3 https://www.clinicalresearch.com/healthday-news/2014/06/24/migraines-may-worsen-during-menopause#sthash.3RGqmC1a.dpuf
4 MacGregor, EA. Estrogen replacement and migraine. Maturitas. 2009 May: 63 (1); 51–55
5 Lichten, EM. Migraine & Estradiol Pellets. Cepahalgia 1999;19(4):332. http://www.usdoctor.com/article5.htm
6 Greenblatt RB (ed). Menopausal Syndrome. New York: Medcom Press; 1974:102-110

Say Goodbye to Perimenopausal Hot Flashes!

Hot flashes are the most common symptom that accompanies perimenopause in women. It’s been estimated that more than 75% of perimenopausal women experience hot flashes.
What Are Hot Flashes?
Hot flashes are abrupt feelings of warmth. Your skin may suddenly flush or get red and splotchy as if you’re blushing. They are generally most intense over the upper body and face. Hot flashes can make you sweat profusely and then leave you feeling chilled. The frequency and intensity of episodes will vary from individual to individual. You may have a few or many hot flashes in a day. They usually subside within a few minutes. Not every woman will experience hot flashes, but most suffer with them for more than a year and up to four or five years.

The Physiology of Hot Flashes
The physiology of a hot flash isn’t clearly understood. It seems that, as estrogen levels decrease, the area of the brain that regulates temperature loses its ability to control body heat. Hot flashes occur when production of your most important estrogen – estradiol – slows and finally stops altogether. This disrupts the delicate hormone ratios that keep your cells, organs and systems working properly. Your body is transitioning from the stability of healthful estrogen levels to the instability of wild fluctuations and deficiency.

Are Night Sweats The Same as Hot Flashes?
They are the same phenomenon. The difference lies in when they occur. Hot flashes happen in the daytime; night sweats take place at night when you’re sleeping. Night sweats can leave you, your night wear and bedding drenched in perspiration. The sleep disruption can also be accompanied by headaches, increased heart rate and nausea. Hot flashes can likewise be the root cause behind daytime tiredness, fatigue, irritability and moodiness.

Make Them Go Away!
It takes more than lightweight clothing, sleeping with the window open and ingesting a few herbs to rid you of hot flashes and other symptoms. Since the problem is hormonal imbalance, that’s what must be addressed. The resolution lies in restoring beneficial levels of deficient hormones.

At SottoPelle®, we take the scientific approach to hormone replacement; one that’s based in years of research and observation. Our expert physicians will test your hormone levels, provide you with an accurate diagnosis, and help you decide if our unique pellet implant method is a good fit for you. Once you begin treatment and proper hormone ratios are reestablished, symptom relief can be yours.

Give us a call today and join thousands of others who tell us they’ve regained their lives – something they thought was lost forever!

6 Reasons Why Women Shouldn’t Be Afraid of Bioidentical Hormone Replacement Therapy

Conventional HRT
Physicians have been advising women to steer clear of long term conventional HRT use since 2002. This was the year when the Women’s Health Initiative (WHI) studies were abruptly halted due to the revelation of serious health risks associated with using oral equine estrogen and progestin, a synthetic form of progesterone. The studies focused on use of the pharmaceutical formulations Premarin and Prempro, both of which differ in chemical structure from the natural hormones produced in a woman’s body. Media reports, FDA and physician warnings caused millions of women to be afraid of taking any kind of HRT. It’s been estimated that up to 70% of women who were receiving hormone replacement at that time stopped taking it.1 It’s apparent that the fear of serious health risks far outweighed the symptoms, suffering and health consequences of living with hormone imbalances.

Scary Data on Synthetic Hormones

The data from the WHI was in fact pretty scary. It linked these synthetic hormone substitutes with a higher risk of cancer, heart disease, stroke and blood clots. Not long after the 2002 scare other studies also found pharmaceutical HRT increased the risk of Alzheimer’s, asthma and dementia. Likewise, new research in 2010 reported that combined estrogen-progestin therapy heightened the risk for more serious forms of breast cancer as well as a woman’s chances of dying from it or from other causes.2 The conclusion reached in each of these research studies was that the use of non-bioidentical hormones does more harm than good.

Positive Data on Bioidentical Hormone Replacement Therapy

What the public doesn’t realize is that very often studies, articles, websites and debates do not distinguish whether the hormones they are referring to are synthetic or bioidentical. So it would seem that all hormones are dangerous, when, in fact, they are not. Many doctors now agree that the cultural aversion to hormone replacement therapy has resulted in unnecessary suffering and possibly even led to 50,000 preventable deaths.3 Here are some of the reasons why women shouldn’t be afraid to use bioidentical hormone replacement:

Why Women Shouldn’t be Afraid

1. Bioidentical hormones precisely match hormones produced in the human body. This means bioidenticals can communicate with appropriate cell receptors and perform the tasks the body requires for health and well-being.
2. Bioidenticals have not been associated with the same health risks as formulations using pharmaceutical synthetics.4
3. Bioidentical hormones have been safely prescribed in North America, Europe and elsewhere since the 1930s.
4. Bioidentical research data began to appear beginning in the 1940s and revealed positive findings (based on the use of bioidentical hormone therapy in pellet form).5,6
5. A great deal of research literature supports the use of bioidentical hormone replacement therapy versus synthetic pharmaceuticals.7
6. Bioidentical pellet therapy was actually regularly employed in the U.S. from the 1940s to 1970s when pharmaceutical marketing intruded.
7. Evidence continues to mount that bioidenticals, when properly administered, can be virtually side-effect free, safer to use, and healthier in the long run than pharmaceutical versions.8

As a patient, the key to taking advantage of the many health benefits of BHRT is to seek out an expert who understands the importance of hormonal balance and knows how to achieve optimum results using the low dose pellet implant method—proven to be the safest, most effective hormone delivery system available.


1Roumie CL, Grogan EL, Falbe W, Awad J, Speroff T, Dittus RS, Elasy TA. Reducing the Prescription of Hormone Replacement Therapy after the Release of Study Results. Ann Intern Med. 2004;141:I-47. doi:10.7326/0003-4819-141-2-200407200-00005
2 Chlebowski RT, et al. for the WHI Investigators. Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in Postmenopausal Women. JAMA. 2010;304(15):1684-1692. doi:10.1001/jama.2010.1500.
3 American Journal of Public Health. July 18, 2013 http://news.yale.edu/2013/07/18/women-hysterectomies-estrogen-may-be-lifesaver-after-all
4 Schwartz E, Holtorf K. Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions for the future. Prim Care Clin Office Pract 2008; 35 (4): 669–705. http://www.holtorfmed.com/pdf/04-Hormones-in-Wellness.pdf
5 Salmon U., et al: Use of estradiol subcutaneous pellets in humans. Science 1939; 90:162.
6 Mishel D. Clinical study of estrogenic therapy with pellet implantation. Am J Obstet-Gynecol 1941; 41:1009.
7 http://www.bioidenticalhormones.org/bioidentical-hormones-research-studies/
8 Schwartz E, Holtorf K. Hormones in wellness and disease prevention: common practices, current state of the evidence, and questions for the future. Prim Care Clin Office Pract 2008; 35 (4): 669–705. http://www.holtorfmed.com/pdf/04-Hormones-in-Wellness.pdf

4 Reasons Pellet BHRT Is the Most Effective and Safest Method Available

If you’ve tried other methods of hormone replacement therapy—for instance pills, patches, creams, gels, suppositories or others—you know they can be inconvenient, messy and pose other issues. Dosing can be tricky too. Oral methods mean you have to take high doses of hormones in order to attain proper blood levels; dosing schedules can get complicated; using gels and creams can result in too much or too little hormone and so on.
Pellet implants, on the other hand, provide biologically identical hormones in a way the body recognizes and can utilize. What makes them so effective are the consistent blood levels of bioavailable hormones. Also, the dosing can be individualized to your own body’s needs. And they last longer than any other hormone replacement method.

Here are 4 Reasons Pellet BHRT Is the Most Effective and Safest Method Available:

1) Pellet BHRT has been prescribed since the 1930s
Hormone replacement using the pellet delivery method (subcutaneous implants) has been widely available for more than three-quarters of a century. In fact, beginning in the early 1940s, it became a very popular HRT treatment in the U.S. for about 30 years. Then, in the 1970s, pharmaceutical manufacturers introduced their newly developed and patented synthetic hormones. Shrewd marketing convinced the public, the medical establishment and the FDA to accept these new drugs as healthy and efficacious despite the long list of side effects, warnings and health risks. That being said, subcutaneous implants have remained accepted and commonly prescribed in Europe, Australia and other parts of the world.

2) Research supports the pellet implant hormone delivery system
Since the early 1940s, reports have appeared in a wide range of respected international journals validating the many benefits of pellet HRT. In fact, there is more supportive data on this method than any other form of hormone replacement therapy. The longevity of this science-based modality attests to the fact that, when properly managed, it is scientifically recognized as the safest and most effective method available for administering hormone replacement therapy. 1,2,3,4

3) Pellets are made from natural plant sources and are biologically identical to human hormones
The bioidentical hormones in pellets are made from either wild yam or soybeans. They are manufactured to the highest quality standards by facilities that are registered and inspected by the FDA. The hormones are formulated to precisely match human hormones. In other words, bioidenticals are able to fully communicate with receptor cells throughout the body and perform the many important tasks it requires. This isn’t the case with synthetic hormones, which can accomplish some tasks but not all. The intended imperfection of these formulations is the reason that synthetics can be patented, but also why they can cause havoc within the body and why they are required by the FDA to come with warnings about side effects and serious health risks.

4) Pellet implants use very small doses of hormone
Pellets are designed to release small amounts of hormone directly into the blood stream around the clock over a period of months (typically they last 3 to 6 months). This very closely matches the body’s own feedback system for releasing hormones and provides the steady, physiologic blood levels the body is used to.

Because pellets don’t have to pass through the gastrointestinal system or liver, smaller doses can be used to accomplish successful results. This makes pellet implants a much healthier alternative than oral methods like pills, tablets or capsules, which must be given in high doses to achieve any results at all.  Click here to learn more about SottoPelle BHRT Pellets.


  1. Salmon, U., et al. Use of estradiol subcutaneous pellets in humans. Science 1939, 90: 162.
  2. Greenblatt R. Indications for hormone pellets in the therapy of endocrine and gynaecological disorders. AM J Obstet-Synecol 1949; 57:294.
  3. Morris Notelovitz et al. Metabolic & Hormonal Effects of 25mg & 50mg, 17-¬‐B-¬‐Estadiol Implants. Obstetrics & Gynecology, Volume 70, No. 5, Nov 1987
  4. Suhonen S1, Sipinen S, Lähteenmäki P, Laine H, Rainio J, Arko H. Postmenopausal oestrogen replacement therapy with subcutaneous oestradiol implants. Maturitas. 1993 Mar;16(2):123-31.

Menopause, Hormones and Heart Health

Recent studies show that women are experiencing menopause at much earlier ages than expected. By age 40, most women are totally depleted of normal levels of estrogen and have lost nearly all their progesterone and more than half of their testosterone. The average woman can expect her periods to stop when she is just 46.
According to the American Heart Association, heart disease is the leading killer of women. Research indicates a correlation between declining estrogen levels during menopause and an increase in the risk for cardiovascular problems. Women who have gone through menopause are two to three times more likely to develop heart disease.

Estrogen is shown to support the blood vessels. Results from a 1991 study indicated that after 15 years of estrogen replacement, risk of death by cardiovascular disease was reduced by almost 50 percent and overall deaths were reduced by 40 percent.

At the same time, testosterone supports the cardiovascular system in women as well as men.

Menopause, Hormones, and Heart Health

While hormone therapy can help protect the heart health of menopausal and aging women, the key to effective treatment lies in the type of hormone and administration method.
Bio-identical hormone replacement therapy (BHRT) uses natural, plant-derived compounds that precisely match the same molecular structure as human hormones – unlike traditional hormone replacement therapy (HRT) which is synthetic, or pharmaceutical. Bioidentical hormones are better assimilated by the body without the dangerous side effects associated with synthetic type – including heart disease.

Research demonstrates that hormone pellets – about the size of a grain of rice and slipped under the skin – provide the most effective hormone delivery method since the hormone release is monitored naturally by the heart rate. When prescribed and properly administered, BHRT pellets can support heart health and offer relief for menopausal symptoms.

Numerous studies* cite the potential benefits of bioidentical estrogen and testosterone pellets to:

• Reduce harmful LDL and total cholesterol
• Increase protective HDL
• Decrease triglycerides
• Assist in retaining the ability of the coronary arteries to dilate and remain pliable

Evidence from a 2013 study by the American College of Obstetricians and Gynecologists supports the “timing hypothesis,” which shows that women in the early stages of menopause are more likely to experience additional cardiovascular benefits from HRT treatment than women who have been menopausal for 10 or more years.

Another study published in the American Journal of Medicine found that 32 percent of heart attacks and cardiac deaths were reduced in women age 60 or younger who had received bio-identical hormone treatment.

I recommend that women start checking their hormone levels with a simple blood test around ages 35-40 to correct hormonal imbalances. This can help to protect their hearts and avoid many unpleasant health problems that occur during menopause, such as thyroid disorders, osteoporosis, depression, breast cancer, brain fog and fibromyalgia. Bioidentical hormones, taken in early menopause, may actually help prevent coronary heart disease and many of these issues.

*Menopause, Susan Davis, 2000; Obstetrics & Gynecology, Notelovitz, 1987;