Women who had hysterectomy and removal of their ovaries in age younger than 50 need Hormone Replacement Therapy (HRT). For those women hormone implants are a valid alternative. They start with 50mg of oestradiol, (E2) and women with reduced libido use also an implant of testosterone (T) 100mg. They are implanted in the fat of the lower abdomen or the buttock with alternation right or left on each visit. We use local anesthetic (5-10 ml xylocaine) and make an incision 0, 5 to 1 cm at the skin. The implant is inserted with a special instrument 10 cm away from the incision site parallel to the skin. The incision is then close with a stitch or steristrip. A new implant was inserted 6 months later. All women had blood measurement of oestradiol levels at 6 months before the insertion of the new pellet. If the E2 levels were 1000pmol or higher the insertion was postponed. During one year 490 women attended the clinic for pellets. Most women 415 (85%) were very satisfied with the pellets and didn’t wish to use another form of HRT. 151 (31%) of women had tachyphylaxia (had levels of E2 higher than 800 at time period less than 6 months) 18 (3,6%) of women returned to the clinic because the implant was expelled, 102 (20,8%) had minor bleeding at the incision site which stopped with appropriate pressure, 42 (8,5%) had pain at the incision site that lasted more than 24 hrs and 60 (12,2%) returned to the clinic at 4 months for new implant because they had menopausal symptoms.

Conclusion: The E2 implant and in some cases T implants are very useful for hysterectomised women. They act for 6 months and women don’t need to take anything else in a daily or weekly basis. The most important problem was tachyphylaxia because their bodies were used in high levels of E2 and had menopausal symptoms sooner than 6 months.

Evangelos Athanasiou studied medicine at Aristotle University of Thessaloniki (6-year program). He then went to England and had his specialty (5 years) and subspecialty (1 year) in infertility, menopause and fetal medicine ultrasound. After that he returned to Greece and is working in the National Health System (NHS) since 2002 both in secondary and in tertiary hospitals. He has 150 publications , is co author of 2 chapters in Obstetrics & Gynaecology book and has review 15 articles.