Estradiol implants, hormone levels and reported symptoms

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Abstract
Subcutaneous estradiol implants are used to give hormone replacement therapy following hysterectomy and oophorectomy. They may be renewed when symptoms return or when estradiol levels fall. Eighteen women who had requested renewal of implants were assessed on a number of endocrine and psychological measures. All except one reported psychological or vasomotor symptoms but only two had estradiol levels below the normal menstrual range of 200-800 pmol/1. Twelve reported vasomotor symptoms and had lower levels of estradiol but were no different on psychological measures. Symptom rating scores, personality scores and anxiety scores were not related to estradiol levels. Two case histories describe symptoms in women with supraphysiological levels of estradiol. Women who had levels of estradiol within normal range yet reported hot flushes were no more 'anxious' or 'neurotic' than those not reporting hot flushes. Six women requested renewal of the estradiol implant who did not have vasomotor symptoms or vaginal dryness which are regarded as estrogen dependent symptoms. There is no clear relationship between absolute levels of estradiol and reported symptoms. A possible explanation is that symptoms are triggered by a fall in estrogen levels. An alternative explanation is that psychological factors such as locus of control may be important.