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Hormone implant

The Australian Centre for Female Pelvic and Vaginal Rejuvenation
The Australian Centre for Female Pelvic and Vaginal Rejuvenation

Types of hormone implant

Intrauterine contraceptive devices

IUCDs include:

  • Copper releasing devices Multiload & Copper T.
  • Progesterone releasing devices (Mirena and mini Mirena).
Implanon

A small flexible rod that releases Progestogen into the blood stream. It is a contraceptive and is inserted under the skin of the inner aspect of the upper arm.

Depo-Provera

Depo Provera is the trade name for 150mg aqueous suspension of depot medroxyprogesterone acetate. It is a contraceptive administered as an injection every 3 months into the muscle of the upper arm (deltoid), thigh or buttocks.

Oestradiol and Testosterone

Oestradiol and testosterone implants are formulated as small yellow pellets. These are delivered into the subcutaneous fat of the lower abdominal wall every 6 months. The original manufacturers have withdrawn both products but both can be ordered from compounding chemists by special order.

Oestrogen and Testosterone Implants

What are they?

Both oestrogen and testosterone are produced naturally in women and after the menopause, with ovarian failure, their levels drop dramatically. Topping up low or absent levels of these hormones in women who have symptoms of the menopause is called Hormone Replacement Therapy. Implants are considered to be second-line treatments (in most cases) for women who are unable to use or have not benefited from other forms of HRT. You can find out more information about HRT by clicking on here.

Indications for oestrogen implants

Symptoms of oestrogen deficiency including:

  • Hot flashes
  • Night sweats
  • Reduced libido
  • Mood swings/changes
  • Vaginal dryness
  • Joint aches/pains
  • Poor sleep quality

Indications for testosterone implants

Testosterone replacement may:

  • Improve libido
  • Increase energy
  • Reduce hot flushes
  • Improve bone density

Measurement of plasma levels

Oestrogen:

  • Circulating levels drop by 90% at menopause
  • Levels should be checked before each implant is given
  • Levels can be high with recurrence of symptoms when implants are used (‘tachyphylaxis’)

Testosterone:

  • The reference range for circulating testosterone levels before or after the menopause is not known
  • The relationship between circulating testosterone levels and symptoms of deficiency is not clear

Insertion technique for oestrogen and testosterone implants

In an office procedure lasting approximately 15 min, the oestrogen or testosterone pellets are implanted into the subdermal fat of the lower abdominal wall using a stainless-steel wide-bore trocar under sterile conditions and a local anesthetic.

The hormones are formulated as cylindrical crystalline implants that serve as a nearly ideal depot, maintaining serum hormone levels for several months.

An implant sealed in a glass vial

The glass vial cracked open to obtain the implant

Local anaesthetic is drawn up, ready to infiltrate into the skin and subcutaneous tissue

The 3 parts of the trocar set

The sharp ended pusher allows the trocar to be pushed through the skin of abdominal wall

The blunt ended pusher allows the hormone implant to be pushed through the trocar

The implant is placed at the end of the trocar ready for insertion

The blunt ended pusher is readied to push the implant through the trocar

The position of the hormone implant at insertion; just beyond the tip of the trocar

The trocar is pushed at an angle through the skin and into the deep subcutaneous fat layer of the lower abdominal wall. The plunger pushes the implant through and just beyond the tip of the trocar.

Potential complications of insertion

Are uncommon:

  • Wound site bruising or haematoma.
  • Wound infection.
  • Hormone pellet extrusion.
After hormone insertion
  • You can remove the dressing on the wound after 24hrs.
  • You can return to normal activities almost immediately.
  • Do not wear anything tight on the lower abdomen for 24hrs.
  • Inform your doctor if you have any concerns.

Risks related to use of HRT

Oestrogen

  • Nausea
  • Breast enlargement &/or discomfort
  • Bloating
  • Fluid retention
  • Breakthrough bleeding
  • Breast cancer
  • Thrombosis

Testosterone

  • Increased facial and body hair
  • Acne
  • Oily skin
  • Aggression
  • Irritability
  • Scalp hair loss
Laser Vaginal Rejuvenation Institute of Adelaide
Laser Vaginal Rejuvenation Institute of Adelaide