Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1990 Feb 17;300(6722):436–438. doi: 10.1136/bmj.300.6722.436

Prolonged endometrial stimulation associated with oestradiol implants.

K F Gangar 1, D Fraser 1, M I Whitehead 1, M P Cust 1
PMCID: PMC1662234  PMID: 2107895

Abstract

OBJECTIVE--To provide information on endometrial stimulation after discontinuation of treatment with oestradiol implants. DESIGN--Long term follow up of withdrawal bleeding patterns in women taking progestogens cyclically every month after oestradiol implant treatment was ended. SETTING--Specialist menopause clinic. SUBJECTS--10 Postmenopausal patients (at least 12 months' amenorrhoea after the last spontaneous period) who were treated with oestradiol implants for typical symptoms of oestrogen deficiency. The oestradiol dose was 50 mg, reimplantation occurring roughly every six months. Patients subsequently either needed to discontinue the hormone treatment for medical reasons or expressed a desire to stop treatment. MAIN OUTCOME MEASURE--Duration of endometrial stimulation--defined as the presence of withdrawal bleeding in response to progestogen given cyclically--after insertion of the last oestradiol implant. RESULTS--Four patients eventually stopped bleeding, their mean duration of bleeding being 35 months (range 27-43 months). One patient required hysterectomy 26 months after the last implantation because of persistent irregular bleeding despite treatment with high doses of progestogen. Three patients bled for 22, 30, and 36 months and then restarted oestrogen treatment because symptoms returned. The last two patients subsequently continued to bleed 12 and 21 months after the last implantation. CONCLUSIONS--The duration of endometrial stimulation after implantation can be prolonged, up to 43 months. Insertion of oestradiol implants can carry a long term commitment to the cyclical administration of progestogen and regular withdrawal bleeding if endometrial hyperplasia and carcinoma are to be avoided.

Full text

PDF
436

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Gangar K., Cust M., Whitehead M. I. Symptoms of oestrogen deficiency associated with supraphysiological plasma oestradiol concentrations in women with oestradiol implants. BMJ. 1989 Sep 2;299(6699):601–602. doi: 10.1136/bmj.299.6699.601-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Magos A. L., Brewster E., Singh R., O'Dowd T., Brincat M., Studd J. W. The effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome. Br J Obstet Gynaecol. 1986 Dec;93(12):1290–1296. doi: 10.1111/j.1471-0528.1986.tb07868.x. [DOI] [PubMed] [Google Scholar]
  3. Padwick M. L., Endacott J., Whitehead M. I. Efficacy, acceptability, and metabolic effects of transdermal estradiol in the management of postmenopausal women. Am J Obstet Gynecol. 1985 Aug 15;152(8):1085–1091. doi: 10.1016/0002-9378(85)90567-8. [DOI] [PubMed] [Google Scholar]
  4. Paganini-Hill A., Ross R. K., Henderson B. E. Endometrial cancer and patterns of use of oestrogen replacement therapy: a cohort study. Br J Cancer. 1989 Mar;59(3):445–447. doi: 10.1038/bjc.1989.91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Paterson M. E., Wade-Evans T., Sturdee D. W., Thom M. H., Studd J. W. Endometrial disease after treatment with oestrogens and progestogens in the climacteric. Br Med J. 1980 Mar 22;280(6217):822–824. doi: 10.1136/bmj.280.6217.822. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Persson I., Adami H. O., Bergkvist L., Lindgren A., Pettersson B., Hoover R., Schairer C. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. BMJ. 1989 Jan 21;298(6667):147–151. doi: 10.1136/bmj.298.6667.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Savvas M., Studd J. W., Fogelman I., Dooley M., Montgomery J., Murby B. Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women. BMJ. 1988 Jul 30;297(6644):331–333. doi: 10.1136/bmj.297.6644.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Thom M. H., Collins W. P., Studd J. W. Hormonal profiles in postmenopausal women after therapy with subcutaneous implants. Br J Obstet Gynaecol. 1981 Apr;88(4):426–433. doi: 10.1111/j.1471-0528.1981.tb01008.x. [DOI] [PubMed] [Google Scholar]
  9. Whitehead M. I., Padwick M. L., Endacott J., Pryse-Davies J. Endometrial responses to transdermal estradiol in postmenopausal women. Am J Obstet Gynecol. 1985 Aug 15;152(8):1079–1084. doi: 10.1016/0002-9378(85)90566-6. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES