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25 mg oestradiol implants--the dosage of first choice for subcutaneous oestrogen replacement therapy?
E J Owen1, N C Siddle, H T McGarrigle
1Department of Obstetrics and Gynaecology, University College and Middlesex Hospitals, London, UK.
Objective:
To assess the oestrogen concentrations and symptom relief obtained with 25 mg oestradiol implants.
Design:
Open, observational study.
Subjects:
Twelve symptomatic, post-menopausal women seen in a designated menopause clinic.
Intervention:
A 25 mg oestradiol pellet was inserted subcutaneously, blood samples were obtained before implantation and at regular intervals (2-4 weeks) until symptoms refused as hypoestrogenaemia developed.
Main Outcome Measures:
Change in symptom score following implant treatment. Concentrations of oestrogens and their metabolites before and during low dose subcutaneous oestradiol therapy.
Results:
Ten of the 12 women had excellent symptom relief, associated with oestradiol concentrations in the follicular range for between 28 and 35 weeks. The ratio of circulating oestrogen metabolites remained physiological, despite the oestradiol concentrations being substantially higher on treatment.
Conclusions:
We suggest that 25 mg pellets should be used as the initial dose for subcutaneous oestrogen treatment, and a combination of return of symptoms and weeks since insertion used to judge the timing of reimplantation.