For HRT, does it matter how the estrogen is administered?
In short, yes. Here’s how the various types of hormone replacement therapy affect treatment:
If the medication is administered as an oral drug, it must be taken every day. Additionally, it must pass through the liver, which increases the risk of hypercoagulability and thrombophlebitis. It can also cause nausea and issues with digestion. Finally, this oral medication can increase inflammatory markers, SHBG, triglycerides and blood pressure.
If the application is transdermal or vaginal, the medication must be administered once or twice a day. There’s also a risk of skin irritation, and about 45 per cent of women don’t absorb it sufficiently. It can also be transmitted to others.
At one time, it could be injected, but this method is now rarely used because of its inconsistent release in the body.
If hormone replacement therapy is administered subcutaneously using pellets or implants, this route ensures a constant release over the course of several months. There may be some discomfort with this therapy during the insertion or if rejection occurs. However, there are few restrictions during the recovery period in the days after the implantation.
What are the benefits of bioidentical hormone replacement therapy for women using implants?
- It’s a physiological replacement therapy
- It uses bioidentical hormones
- It’s biologically active
- It gets absorbed directly
- It’s effective because it maintains stable blood levels
- It doesn’t have peaks during the day
- It has minimal side effects
- It’s practical because it lasts for three to four months
- It can lower cholesterol and triglyceride levels
- It can improve sensitivity to insulin
- It’s not associated with weight gain
- It’s the best method for improving bone density
- It doesn’t increase inflammatory markers and SHBG
- It doesn’t increase the risk of breast cancer
- It doesn’t create a risk of blood clots, thrombophlebitis, heart attack or stroke
How does bioidentical hormone replacement therapy using subcutaneous implants work?
- An estrogen pellet is made of pure estradiol.
- The pellets are compressed using thousands of pounds of pressure, then sterilized by E-Beam (not autoclave).
- They’re manufactured by a specialized pharmacy.
- Quality control is performed by an independent pharmacy.
- They start to be effective about 10 days after implantation and can last between three and four months.
- Their absorption isn’t based on a predetermined duration, but rather on the person’s heart rate and blood pressure. This means the duration of the implant’s efficacy can vary depending on how much physical activity the woman engages in. Active women, especially runners, will benefit from the treatment for about three months, whereas those who are less active will draw less estrogen from the pellets and cause them to last closer to four months
What’s the process for women to be considered for hormone replacement therapy?
- You’ll have an initial consultation with Dr. Marois at one of our clinics in one of our clinics. You’ll discuss your medical history and current symptoms. At the end of the appointment, if you’re a candidate for this procedure, you’ll be given a referral for blood work.
- A follow-up appointment will be scheduled one month later, and if the results confirm that you’re a candidate for hormone replacement therapy, a nurse will explain the bioidentical hormone treatment. You’ll also be asked to fill out a questionnaire about your symptoms. This appointment should take about 30 minutes.
- You’ll then schedule an appointment to have the implants inserted.
What can women expect during a hormone replacement therapy procedure using implants?
- First, you’ll be greeted by a nurse. The dosage of estrogen and/or testosterone will be determined, with the help of a computer program, based on your blood test results and symptoms.
- You’ll lie on your side or on your stomach, and a local anesthetic will be administered by Dr. Marois at the implantation site and in the subcutaneous path above the gluteal fold. He will then make a small incision and insert a trocar through which the estrogen and/or testosterone implants will be inserted into the subgluteal fat. Dr. Marois will finish the procedure by applying bandages as needed.
- A nurse will apply pressure to the site for seven minutes. During this time, you’ll be given instructions and recommendations for your recovery.
- A blood test will be scheduled for six weeks after the initial procedure.
- A follow-up phone call with a nurse will be made after two months of treatment to re-evaluate your symptoms and blood test results. If the test results show that your prescription needs to be adjusted, Dr. Marois will make the necessary changes. It’s always a good idea to book your follow-up in advance.
- At any time during your treatment, you can call the clinic to schedule a phone consultation with a nurse if you have questions or feel that your treatment may need to be adjusted.
What are the disadvantages of bioidentical hormone replacement therapy for women using implants?
- It’s a procedure that requires local anesthesia
- There may be some discomfort when the implants are inserted
- There’s a minor risk of bleeding and infection
- There’s a minor risk of implant rejection
- You’ll need to avoid exercise, especially physical activity involving the legs, for 48 hours
- This treatment isn’t covered by the RAMQ or most private insurance plans
- The cost for the treatment is approximately $4.50 per day
What steps need to be taken to prepare for the procedure?
No special preparation is required prior to this procedure.
What steps should be taken following an implantation procedure for bioidentical hormone replacement therapy for women?
- The insertion site will be covered with two layers of bandages. The external layer can be removed any time after 24 hours. It should be removed as soon as any blood soaks through. Remove the second layer (the foam tape) three days after the procedure.
- We recommend placing an ice pack over the insertion site for 20 minutes every two hours for the first 24 hours.
- Don’t take a bath or swim in a hot tub or pool for three days. You can shower, but don’t scrub the area until the incision has fully healed (about seven days).
- Don’t engage in any exercise involving areas around the incision for the first three days. This includes running, using an elliptical machine and doing squats or lunges.
- The sodium bicarbonate in the anesthetic may cause swelling around the area for one to three days; this is normal.
- The implantation site may be uncomfortable for two to three weeks. If you experience itching or redness, you can take Benadryl for relief (50 mg orally every six hours). However, you must be careful, as this may cause drowsiness.
- You may experience bruising, swelling and/or redness around the implantation site and this may last from a few days to two to three weeks.
- You may notice some pink or red discolouration on the outer bandage; this is normal.
- If the incision begins to bleed, apply firm pressure for five minutes.
- If the bleeding doesn’t stop after applying pressure or there’s pus around the wound, call a nurse at our clinic at the coordinates provided on the post-operative recommandations.
Susan R. Davis & al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. Journal of Sexual Medicine, 2019.
Rahmani, A., Afsharnia, E., Fedotova, J., Shahbazi, S., Fallahi, A., Allahqoli, L., Ghanei-Gheshlagh, R., Abboud, S., & Alkatout, I. (2022). Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review. The Journal of Sexual Medicine, 19(7), 1098-1115. DOI: https://doi.org/10.1016/j.jsxm.2022.03.614