The Pros and Cons of HRT Implants

Oestrogen

Small pellets of oestrogen, inserted into the fat under the skin, last for about six months. This simple pro­cedure can be done at your local surgery or in the hospital outpatient department. You are given an injection of a local anaesthetic to numb the skin before a small cut is made, usually in the lower abdomen. After the implant is inserted the wound is closed with a stitch or piece of tape. If you have a stitch, your doctor will remove it about five days later. If Steristrips were used, gently peel them off yourself after five days and cover the wound with a sticking plaster until it has fully healed. Try not to do anything too strenuous immediately after an implant insertion, because occasion­ally they fall out.

Testosterone

Testosterone is the male hormone but the ovary also produces small amounts. The precise role of tes­tosterone in women remains unclear but a few doctors recommend the addition of testosterone implants for women with sexual problems. There is some evidence that testosterone increases interest in sex, although some authorities dispute this. Oes­trogen replacement alone will restore poor libido caused by oestrogen deficiency but the option of additional testosterone is available for those who favour it.

Advantages of implants: The advantage of implants is that you do not have to remember to use HRT. They dissolve slowly and provide stable levels of the hormone with minimal fluctuations. The pellet fully dissolves after five to six months, when it needs replacing. Implants produce the highest levels of oestrogen, although these usually still remain within the normal premeno­pausal range. This has the potential advantage of stimulating a greater increase in bone density than other forms of HRT.

Disadvantages of implants: The main disadvantage is that, if this method does not suit you, it is virtually impossible to remove the pellet once implanted.

An occasional problem is that the implants last increasingly shorter periods of time after each insertion so that, for some women, menopausal symptoms return two or three months after the last implant. When oestrogen levels are measured, they are very high and it seems that these women have developed some immunity to the effects of the implant. The only way to treat this is to reduce the dose of the implant gradually and restore normal levels of oestrogen.

Women needing progestogens will have to take regular courses, as with other regimens. If you stop using implants, you should still continue progestogens until there is no bleeding. This can be up to two years or more after the last implant because implants continue to stimulate the lining of the womb long after their effects on menopausal symptoms have ceased.