Night sweats that wake you at 3 a.m., a short fuse you don’t recognize, a fog that settles in by mid-afternoon. For many women, perimenopause doesn’t arrive as one dramatic change but as a slow pile-up of symptoms that are easy to blame on stress, work or “just getting older.” Hormone pellet therapy is one of the options women ask about most once they suspect hormones are part of the picture. This guide walks through what the process looks like at GaliDerm Aesthetics in Royal Palm Beach, step by step, so you know what to expect before you book.
Why Symptoms Start Before Your Periods Stop
Perimenopause is the transition leading up to menopause, and it often begins in a woman’s forties, sometimes earlier. During these years, estrogen and progesterone don’t decline in a neat, straight line. They rise and fall unevenly, which is one reason symptoms can come and go from month to month. Testosterone, which women produce in smaller amounts, also declines with age and plays a part in energy, libido and muscle tone.
Menopause itself is confirmed after twelve consecutive months without a period. Some symptoms ease after that point; others, like vaginal dryness and sleep changes, can continue. Common signs that bring women in for a hormone evaluation include:
- Hot flashes or night sweats
- Trouble falling or staying asleep
- Fatigue that doesn’t improve with rest
- Brain fog or trouble focusing
- Mood swings, irritability or more stress than usual
- Low libido or vaginal dryness
- Stubborn weight gain around the midsection
- Thinning hair or changes in skin
None of these symptoms on its own proves a hormone imbalance, which is why the process at GaliDerm starts with a conversation and lab work rather than a prescription.
Step One: A Consultation Built Around Your Symptoms
Your first visit is a sit-down conversation with Cigdem Gali, MSPA, PA-C, an NCCPA board-certified Physician Assistant whose clinical focus includes women’s health and medical weight loss. She will ask about your symptoms, your cycle, your sleep, your personal and family health history, and any medications or supplements you take. This is also the time to talk through what you are hoping to feel differently, whether that is sleeping through the night, steadier moods or more energy at the end of the day.
Bioidentical hormone replacement therapy (BHRT) uses hormones designed to match the molecular structure of the estrogen, progesterone and testosterone your body makes on its own. Pellets are one way to deliver them, but they are not the only option, and they are not right for everyone. Certain health histories, including some hormone-sensitive conditions, may rule pellet therapy out. Your provider will be candid about that.
Step Two: Lab Work Before Any Dose Is Chosen
Blood work shows your current hormone levels and helps confirm whether BHRT makes sense for you. Because every patient’s levels are different, the results guide which hormones you need, how much, and in what form. Two women with the same hot flashes can have very different lab results, and their plans should look different too.
Once your results are back, your provider will walk you through them and recommend a plan. That plan may or may not include pellets.
Step Three: The Pellet Insertion Visit
If pellet therapy is the right fit, insertion is a quick in-office visit. Hormone pellets are tiny, custom-dosed and about the size of a grain of rice. They are placed just under the skin after the area is numbed with a local anesthetic, so most patients feel only light pressure. The insertion itself takes just a few minutes.
Most people return to their normal routine the same day. Your provider will ask you to take a short break from strenuous exercise and will give you specific aftercare instructions for the insertion site.
Once in place, pellets release a steady dose of hormones over the following months. Patients often choose them for that reason: there is nothing to remember each day, and there are none of the daily ups and downs that can come with remembering, or forgetting, a cream or a pill.
The First Weeks: What You May Notice and When
This is the part everyone wants a date for, and the honest answer is that it varies. Some patients notice better sleep and more energy within a few weeks. Other changes build more gradually. How quickly you respond depends on your starting hormone levels, your health history and how your body processes the dose.
It helps to keep simple notes in the first couple of months: how you’re sleeping, how often hot flashes happen, how your mood and energy feel. Those notes make your follow-up visit far more useful than trying to remember how you felt six weeks ago.
If your goals include how your skin looks and feels as well as how you feel, hormone care can sit alongside aesthetic treatment. Some patients pair a hormone plan with collagen-stimulating treatments to support skin firmness, while others explore the broader weight loss and wellness services offered at the practice.
Follow-Up Labs and Your Re-Insertion Schedule
Pellets release hormones gradually over several months. Rather than putting you on a fixed calendar, your provider recommends a re-insertion schedule based on your follow-up labs and how you feel. Follow-up visits are where the plan gets fine-tuned: a dose that is working well stays, and one that isn’t gets adjusted.
Hormone therapy is not limited to women. Testosterone naturally declines in men with age, and BHRT, including pellets, is available for men as well. You can read more about both on the hormone therapy page.
What Women Ask Us Before Their First Pellet Visit
Does pellet insertion hurt?
The area is numbed first, so most patients feel only light pressure. The visit takes just a few minutes, and most people go back to their day afterward, avoiding strenuous exercise for a short time as directed.
Do I need lab work even if my symptoms are obvious?
Yes. Symptoms tell part of the story, but lab work shows your actual hormone levels and helps confirm whether BHRT is appropriate. Your dose is built around those results, not around a standard amount.
What if pellets aren’t right for me?
Pellets are one delivery method, not the only one. If your health history or lab results point away from pellets, your provider will talk through other approaches that may fit better, or explain why hormone therapy may not be the right path at all.
Can I start hormone therapy during perimenopause, or do I have to wait for menopause?
You don’t have to wait for your periods to stop. Many women seek an evaluation during perimenopause because that is when symptoms first start disrupting sleep, mood and energy. Whether treatment makes sense at that stage depends on your symptoms, labs and health history.
Bring Your Symptom List to the First Visit
The most useful thing you can bring to a hormone consultation is an honest list: what you’re feeling, when it started, and what you’ve already tried. Cigdem will take it from there, starting with labs and building a plan around your results. GaliDerm Aesthetics is at 9100 Belvedere Rd in Royal Palm Beach and sees patients from West Palm Beach, Wellington and across Palm Beach County. To set up your evaluation, call the practice or send the team a message online.
Cigdem Gali, MSPA, PA-C
As one of the founders GaliDerm Aesthetics, Cigdem Gali is committed to enhancing natural appearances through aesthetic services. She is an NCCPA board-certified PA with her Masters in Medical Science, and a Master Injector specializing in Women’s Health, Aesthetics, Medical Weight Loss, and Procedural Medicine. Cigdem has a wide range of licenses and certifications, including Allergan Master Injector, Medical Weight Loss Certified, and more! Renowned for her expertise in aesthetic injections, she has trained under celebrity Master Injectors and expert Plastic Surgeons, developing a proprietary protocol for administering cosmetic injectables with precision and artistry. Cigdem is also the founder of Elite Medical Aesthetic Academy, a top aesthetic medicine training academy in Florida.
