● Signs of bruising, swelling, discomfort and tenderness can be common
● Symptoms may begin to appear or disappear
● Examples: fluid retention, headaches, acne, facial hair growth, hair loss, breast tenderness, breast sensitivities, vaginal or uterine bleeding or spotting.
● These symptoms can persist, and if they do, patients are expected to speak to their provider and discuss other options available

● Convenience of not having to do something daily or monthly
● Consistent delivery (vs. creams, injections)
● Helps relieve symptoms associated with perimenopause, menopause and andropause
● Ex. It can help with symptoms of hot flashes, night sweats, sexual dysfunction fatigue, insomnia, vaginal dryness, vaginal atrophy, etc.

● Before the therapy is initiated, the skin is cleansed and the pellet insertion site is located on the right or left hip.
● The site is labeled and then injected with a local anesthetic.
● Once the area is numb, a scalpel is used to cut the skin to allow a space to insert a trocar device.
● The trochar is first inserted and positioned and then the pellets are inserted inside the trochar and placed inside the body. The trochar is removed and the pellets remain inside the body. The incision is closed via medical tape or sterile strips and gauze is used to cleanse the area. Tegaderm is also placed over the tape to ensure the area is protected and cover the incision site.
● Post pellet instructions include avoiding working out, sitting in water (hot tubs, pools or bathtubs) for 72 hours post pellet therapy.
● This procedure can be repeated as many as 4 times per year (every 3 months) depending on lab work and symptom improvement.
● The pellets typically last in the body between 2.5-6 months and dissolve under the skin.
● The procedure takes 5-10 minutes to complete. The procedure is usually painless.
● Patients are recommended to have labs prior to each pellet insertion, and required biannually (2 times per year; at least 6 months apart).
● Patients are to contact the office if they experience any signs of infection.

I have read and understand all of the above consent. I understand that along with the benefits of any medical treatment or therapies, there are both risks and potential complications to treatment, as well as not being treated. Those risks and potential complications have been explained to me. I have not been promised or guaranteed any specific benefit from the administration of these therapies and no warranty or guarantee has been made regarding the results of treatment. I agree to proceed with treatment and to comply with recommended dosages.

I have been given the opportunity to ask any questions about hormone replacement therapy, potential complications, required testing, and costs and have had them answered to my satisfaction. I fully understand what I am signing and hereby request and consent to treatment using hormone replacement therapy.

●  I acknowledge that there are no guarantees or assurances made with respect to the benefit of hormone replacement therapy prescribed for me.

● I acknowledge that there are certain potential risks involved in hormone replacement therapy that may require referral to a specialist for further evaluation and treatment.

● I agree to report any adverse reaction or problems that might be related to my hormone therapy to my provider at NES.

● I understand that I will be in charge of administering the hormones and supplements prescribed to me. I will conform and comply with the recommended doses and methods of administration.

● I understand that initial blood and/or urine or saliva tests will be performed to establish my baseline hormone levels. I agree to comply with requests for ongoing testing to assure proper monitoring of my hormone levels.

●  I have been informed that insurance companies will not pay for hormone replacement therapy and certain laboratory testing. I therefore agree to pay for all services including laboratory and pharmacy charges myself.

●  I agree to maintain the recommended interval testing.

I have read and understand all of the above consent. I understand that along with the benefits of any medical treatment or therapies, there are both risks and potential complications to treatment, as well as not being treated. Those risks and potential complications have been explained to me. I have not been promised or guaranteed any specific benefit from the administration of these therapies and no warranty or guarantee has been made regarding the results of treatment. I agree to proceed with treatment and to comply with recommended dosages.

I have been given the opportunity to ask any questions about hormone replacement therapy, potential complications, required testing, and costs and have had them answered to my satisfaction. I fully understand what I am signing and hereby request and consent to treatment using hormone replacement therapy.