Hormone replacement therapy subcutaneous implants for refractory menopause symptoms; the patient’s perspective

Abstract

Objective: For women with menopause symptoms refractory to standard hormone replacement therapy (HRT) preparations, HRT implants offer an alternative. The primary objective of this study was to evaluate women’s perceptions regarding efficacy, tolerability, satisfaction and safety of implant therapy. Study design: A single centre service evaluation study performed at Birmingham Women’s & Children’s Foundation Hospital Trust. An anonymised semi-structured survey link was posted to all women ( n = 397) recorded to have received HRT implant(s) at a tertiary Menopause clinic (May 1982 and Dec 2018). Women attending clinic (June 2020 to Sept 2020) were opportunistically invited to complete a written version of the survey. Main outcome measures: Data collected included demographics, medical and surgical history, therapy duration, type, indication and complications. Climacteric symptoms were assessed using the Greene Climacteric Scale. Results: Data was obtained for 119 women. The written survey yielded higher response rates ( n = 73, 61.3%). Most respondents were 51–60 years old ( n = 51 42.9%) and 87.4% ( n = 104) were ‘White British’. 70 women used estradiol only implants. 30.1%% ( n = 34) of patients reported a low Greene Climacteric Scale score (0–5). Subgroup analysis showed prevalence of sexual dysfunction and vasomotor symptoms across ages. There was a lower prevalence of psychological symptoms amongst ≥51 year olds. High satisfaction rates were reported. Conclusions: Data from a large cohort is presented. Good symptom control, satisfaction and long-term efficacy was demonstrated. This study supports the value of HRT implants for refractory menopause symptoms. A national database of implant users would be a useful tool to record satisfaction scores and adverse events.