The management of persistent menopausal symptoms with oestradiol-testosterone implants: clinical, lipid and hormonal results

Abstract

Seventeen patients attending two menopause clinics were treated with combined subcutaneous implants of oestradiol (40 mg) and testosterone (100 mg), because oral oestrogens had not provided adequate symptomatic relief, particularly of decreased libido. There were significant improvements in libido, enjoyment of sex and tiredness (P less than 0.01), and in lack of concentration (P less than 0.05), but there was no significant change in flushes, sweats and depression. Based on an analogue scale, libido increased from a mean basal score of 13.5 to a maximum of 86.1 at 3 mth. Symptomatic improvement was maintained for 4-6 mth. There were no significant changes in total serum cholesterol and triglycerides nor in cholesterol subfractions. When expressed as a percentage of the preimplant values, maximal changes in hormonal parameters were observed at 1 mth. Thus, follicle stimulating hormone (FSH) was 53% of basal, luteinising hormone (LH) 54%, oestradiol 186%, total testosterone 291%, and free testosterone 342%. Only 1 patient complained of hirsutism and weight gain. We conclude that the hormonal implants provided substantial symptomatic relief, particularly of loss of libido, while causing rises to mid-follicular concentrations of oestradiol and maximal testosterone levels about three times normal, without significant effects on plasma lipids.