Pellet therapy is an effective way to replenish hormone levels in women. A tiny pellet, approximately the size of a grain of rice, is implanted under the skin. It consistently releases small doses of bioidentical hormones. When hormones are absorbed by the body rather than swallowed, they are not altered by the liver and go directly into the tissues, for what is known as the "first pass effect." Release of the hormones is controlled by your body. You absorb more during exercise or stress and less while sleeping or resting.