Health News

WAYS OF ADMINISTRATING HRT: IMPLANTS

Another HRT option (oestrogen with or without testosterone – which may be suggested for boosting your libido) is insertion under the skin of pellets containing one or more hormones. The pellet is usually placed in the fat of the lower abdomen, buttock or upper thigh, and a replacement is inserted every three to twelve months, depending on the dose required. This small and simple surgical procedure is performed in the doctor’s rooms or at a menopause clinic.

The amount of hormone absorbed from the implant varies according to how long it has been there, its position (for example, more hormone is absorbed if the implant is in the upper arm of a swimmer than if it is placed in a buttock), its depth under the skin (the deeper the implant, the greater the absorption), physical activity levels (exercise increases blood flow) and the presence of inflammation or scar tissue around the implant.

Women who find implants useful include those who for one reason or another cannot tolerate oestrogen in pill or patch form, and those needing large doses of oestrogen. These advantages may offset a common problem with implants, which is that the dose of hormone entering the body is initially high and reduces with time.

For example Natalie, a young woman who had an artificial menopause following cancer treatment, required relatively large amounts of oestrogen to alleviate recurring bouts of severe hot flushes. She found the implant both more convenient and more effective than pills, although she experienced sore breasts for some weeks after the implant was inserted (a higher than average hormone dose was entering her body), and a return of flushes as the time for a replacement implant approached (the hormone dose released by the implant had dropped significantly).

Many doctors believe that oestrogen implants should not be used as first-line HRT in women who have a uterus. This is because implants deliver substantially higher levels of oestrogen than other HRT formulations (at least part of the time) and, while helping women to feel wonderful, these levels can greatly increase the risk of severe, uncontrollable bleeding and possible hysterectomy. According to Dr John Eden from the University of New South Wales, some women on oestrogen implants feel a euphoria similar to that experienced by men on anabolic steroids. ‘But women pay a price if they have a uterus; they run the risk of heavy, uncontrollable periods.’ In the case of Margo, a patient with fibroids who had an implant inserted, the bleeding was so heavy that hysterectomy was the only option. ‘You rarely see this with other therapies, because the oestrogen levels are relatively low’, Dr Eden says. ‘Women with fibroids may get irregular bleeds, but you don’t see the activation and growth that you may get with an implant.’

It is extremely important that any woman with an intact uterus who is using an oestrogen implant realises the necessity of teaming progestogen with it for one to three years after the last implant is inserted. Implants continue to release small amounts of oestrogen for a very long time after their ‘use by’ date. It is unwise to discontinue the progestogen until two to three months after withdrawal bleeds have stopped.

An advantage of implants is their convenience, with no need to remember a daily pill or twice-weekly patch.

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