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HRT implants

Published by Bupa's health information team, May 2009.

This factsheet is for people who are planning to have hormone replacement therapy (HRT) implants, or who would like information about them.

During the menopause, oestrogen levels naturally start to decrease. This reduction in oestrogen causes the symptoms normally associated with the menopause. HRT implants are small pellets that are inserted under the skin to increase oestrogen levels.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About HRT

Hormone replacement therapy (HRT) is a treatment used to reduce the symptoms of the menopause. The aim is to top-up or restore your body's supply of hormones.

Your ovaries make oestrogen and progesterone as part of the menstrual cycle. Low oestrogen levels cause the unpleasant symptoms of menopause such as hot flushes, night sweats, headaches, vaginal dryness and urinary infections. Low oestrogen levels can also affect the bones, causing them to break more easily (a condition called osteoporosis).

If you're going through the menopause and have not had a hysterectomy (an operation to remove the womb), you will need to take a combination of oestrogen and progesterone. Taking oestrogen alone increases the risk of developing endometrial cancer (cancer of the womb lining). This is because oestrogen stimulates the production of the womb lining, which can lead to endometrial cancer. When it is combined with progesterone, this hormone produces a shedding of the lining of the womb, or a period, which decreases the risk of endometrial cancer. This is called combined HRT.

If you've had a hysterectomy, you are at no risk of endometrial cancer and can take oestrogen on its own.

HRT can be taken in several different ways. For example, it can be taken as a tablet, a skin patch or in a gel form. Oestrogen-only HRT is also available as an implant. However, combined HRT is not available as an implant. Because of this, if you have an HRT implant but have not had a hysterectomy, you will need to take progestogens as well. These can be taken orally or through an implant or mirena coil.

What is an HRT implant?

An HRT implant is a small pellet containing oestrogen. It is placed under the skin of the abdomen, buttock or thigh. The implant slowly dissolves, causing oestrogen to be absorbed into the bloodstream. It lasts for between two and 12 months, depending on the strength of the implant. After this time, the implant has to be replaced.

Using an implant is more convenient than skin patches, gel or tablets, as you don't need to remember to use them every day. Some women also don't like taking tablets, have a reaction to skin patches or worry that they aren't using the gel correctly.

However, implants do have some disadvantages. These are listed below.

  • Occasionally, the more implants you have, the shorter the effect lasts. This can mean that symptoms eventually return two to three months after having the HRT implant.
  • If you find that the implant doesn't suit you, it's nearly impossible to remove.
  • If you're taking a progestogen alongside your implant, you will need to carry on taking it after stopping implants until any bleeding stops. Sometimes, this can take up to two years.

What are the alternatives?

HRT can be taken in a number of different ways. Oestrogen comes as a tablet, patch, gel, pessary (a small tablet that is inserted into the vagina) or as a vaginal ring. Progestogen comes as a tablet, mirena coil, vaginal gel or pessary, or is sometimes combined with oestrogen in a patch. Your GP may recommend that you try another form of HRT before having an implant.

Preparing for your procedure

There are no special preparations you need to make before your appointment and you can eat and drink normally before you arrive.

The HRT implant is normally done as a day case and under local anaesthesia. This means you will be awake but the area will feel numb and you will feel no pain.

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

When you have an HRT pellet implanted, it is normally done in a consulting room by your doctor. Because HRT can affect breast tissue, your doctor may examine your breasts to ensure there are no abnormalities before he or she inserts an HRT implant.

The implant is placed under the skin and in the fat of the abdomen, buttock or thigh. Your skin will be cleaned and you will be given a local anaesthetic injection to numb the area. This may sting a little. After this has taken effect, a small 3 to 5mm cut is made in your skin. The implant is put into place and the cut is closed using an adhesive strip or a stitch. The procedure usually takes five minutes to complete.

What to expect afterwards

After a local anaesthetic it may take several hours before the feeling comes back to the area where your implant is. Take special care not to bump or knock the area.

You can go home when you feel comfortable to do so. This treatment should not affect your driving. You will be able to travel alone.

Your nurse will give you some advice about caring for your healing wound before you go home. If you have a stitch, you will be given an appointment within five days for it to be removed.

You shouldn't get the dressing too wet or do any strenuous exercise for 24 hours to help the wound heal.

Recovering from an HRT implant procedure

The effects of a local anaesthetic last a couple of hours. You may feel some discomfort when these effects start to wear off. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

It can take a few weeks for the hormone to take effect and for your symptoms to improve. It's normal to get your implant replaced every six months. When you get it replaced, you will have your hormone levels checked first. You may need to have HRT for a few years to help with menopausal symptoms. Ask your doctor for more advice.

What are the risks?

Inserting an HRT implant is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure. H3 Side-effects These are the unwanted but mostly temporary effects of a successful procedure. Not everyone has side-effects.

Oestrogen HRT can cause some side-effects, including:

  • breast tenderness
  • leg cramps
  • headaches
  • nausea
  • fluid retention - this is when fluid builds up in your tissue, which can cause some swelling

HRT has no effect on weight gain. Most side-effects resolve within a couple of months.

There is a slightly increased risk of having a stroke and of developing breast or ovarian cancer or blood clots with HRT use. The risks are small, but you must discuss them with your doctor before starting any treatment. You should review your treatment with your doctor every year.

It's also important for women on HRT to have regular mammograms and be breast aware. If you are worried about any changes to your breasts, you should contact your doctor straight away.

Complications

This is when problems occur during or after the procedure. Most women are not affected.

You may experience bruising at the implant site. In very rare cases, the site can become infected. Very occasionally, you may feel a thickening below the skin. This is caused by scar tissue forming where implants have been placed.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Related topics

Further information

Sources

  • Menopause. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 9 December 2008
  • Hormone Replacement Therapy (HRT). Womens Health London. www.womenshealthlondon.org.uk, accessed 9 December 2008
  • MacGregor A. Understanding the Menopause & HRT. Family Doctor. Poole: Family Doctor Publications Ltd, 2005
  • Menopause - Combined (Hormone Replacement Therapy). Australasian Menopause Society. www.menopause.org.au, accessed 9 December 2008
  • Women's health and the menopause: RCN guidance for nurses, midwives and health visitors. Royal College of Nursing. www.rcn.org.uk, accessed 15 December 2008
  • Menopause and osteoporosis. Australasian Menopause Society. www.menopause.org.au, accessed 15 December 2008
  • Joint Formulary Committee, British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:390-399
  • The AMS Practitioners Guidelines for Oestradiol (E2) Implants. Australasian Menopause Society. www.menopause.org.au, accessed 9 December 2008
  • Sexually transmitted infections (STIs): Thrush and bacterial vaginosis. Family Planning Association. www.fpa.org.uk, accessed 13 November 2008
  • Anaesthesia explained. Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 22 December 2008
  • Kongnyuy E, Norman R, Flight I, et al. Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD001018. DOI: 10.1002/14651858.CD001018. www.cochrane.org

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009

 

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