Interrupted therapy
This was used commonly in the past, but it is rarely used today. The commonest form is three weeks on tablets, one week off. It was thought that the week’s rest prevented build-up in the lining of the uterus, but it has now been found that this is not the case in all instances. Continuous oestrogen therapy, with progestogens, is the method of choice.
Therapy control
The ultimate goal of hormone treatment is complete relief of symptoms. It may be required for a few months, a few years, or for life, or may be necessary at intervals only with recurrent symptoms. We use the relief of symptoms as the indication of effectiveness of treatment.
Vaginal wall smear A vaginal wall smear test gives some indication of oestrogen levels, but is of little use in routine management as any small amount of infection in the vagina alters the appearance of the smear. This test is therefore not routinely used in our clinics.
Implants
If oestrogen is unable to be taken orally, then it may be introduced under the skin in pellets. Testosterone may be added to this if a loss of sex interest and energy is unrelieved by oral oestrogens.
Implants give good results and the procedure is simple. It takes approximately 10 minutes and is done in the office or out-patients department. Using a small amount of local anaesthetic, the pellet is inserted into a small cut in the skin. Implants are particularly useful for young women who have had both uterus and ovaries removed. It is also useful for older women whose loss of sex interest is a problem. If the woman still has her uterus progestogens must also be given, as in oral therapy.
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