title: Prolonged endometrial stimulation associated with oestradiol implants.
abstract: OBJECTIVE
  To provide information on endometrial stimulation after discontinuation of treatment with oestradiol implants.
  
  
  METHODS
  Long term follow up of withdrawal bleeding patterns in women taking progestogens cyclically every month after oestradiol implant treatment was ended.
  
  
  METHODS
  Specialist menopause clinic.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Academic Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry, London.
authors.forename: K F
authors.initials: KF
authors.lastname: Gangar
authors.forename: D
authors.initials: D
authors.lastname: Fraser
authors.forename: M I
authors.initials: MI
authors.lastname: Whitehead
authors.forename: M P
authors.initials: MP
authors.lastname: Cust
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004343:Drug Implants; D004717:Endometrium / Q000187:drug effects*; D004958:Estradiol / Q000009:adverse effects / Q000097:blood / Q000494:pharmacology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause / Q000097:blood / Q000187:drug effects; D008875:Middle Aged; D013268:Stimulation, Chemical; D013997:Time Factors; D014592:Uterine Hemorrhage / Q000139:chemically induced
chemical_list: D004343:Drug Implants; D004958:Estradiol