Willow Health is delighted to be a hub offering HRT implants in Scotland from the Autumn 2024.
A HRT implant is a small pellet containing body identical oestrogen or testosterone that is inserted under the skin. It is a form of HRT usually reserved for those who struggle to absorb hormones through the skin. These implants are an unlicensed treatment in the UK but are used by specialists on a case-by-case basis.
At Willow, we offer HRT implants under strict criteria:
An HRT implant can be fitted under local anaesthetic, usually just under the skin of the lower abdomen. A small 5mm cut is made in the skin and the tiny pellet is inserted into the fatty layer just underneath the skin using a tool called an introducer or trocar.
The small wound is then closed with steristrips and a dressing applied to the skin which is left in place for a couple of days.
We always start with a consultation to be able to discuss with you your own individual risks and benefits of having an implant fitted, to ensure you can make a fully informed decision. The risks and benefits of implants tend to be the same as for any transdermal (via the skin) hormone replacement therapy (HRT).
Typically implants last for 6-9 months and would be replaced based on blood test levels (see below)
The main benefit of having an implant fitted is to achieve a better response to your symptoms when other treatments have failed, including long-term bone protection. Like other transdermal (through the skin) HRT, there is no increased risk of blood clots or stroke.
There is good evidence that implants achieve an adequate level of oestrogen to help protect the bones and prevent osteoporosis.
With an implant, your levels of oestrogen can accumulate over time. In 3% of cases, oestrogen levels can reach very high levels and women can see the return of symptoms due to these high levels.
If we find your oestrogen levels to be very high, then we may need to defer the next fitting and possibly reduce your dose of the implant.
Although the procedure to have an implant fitted is carried out with sterile instruments and deep cleaning of your skin, there is still a small chance of infection to the wound.
There will likely be a small scar left from having an implant fitted. Initially this could appear pink/red, then tends to turn pale/whiteish with time.
Rarely an implant can be rejected by the body and pushed out of the wound as it heals. This mostly occurs with testosterone implants rather than oestrogen implants.
Like any HRT replacement, when you first have an implant fitted you may experience hormonal side effects as your body gets used to these hormones again. For example:
These side effects tend to settle down with time but may last up to 2-3 months.
We use testosterone creams and gels off-licence in the UK for women who struggle with lack of libido. If you are known to struggle to absorb oestrogen through the skin, this may also be the case for testosterone replacement. Typically a testosterone implant may be required along with an oestrogen implant in those who have had a surgical menopause (ovaries removed).
The current unlicensed testosterone implant delivers a female equivalent dose and has a low risk of side effects. The most common side effects are excess facial or body hair growth which is generally reversible upon discontinuation. Less commonly acne, male pattern hair loss or deepening of the voice may occur.
If you are new to HRT implants, we always recommend sorting out the oestrogen implant first and then reassess your symptoms before considering adding testosterone.
Prior to having your first implant fitted, you will have a consultation at Willow to discuss your experience and suitability for an HRT implant. This will include going through any evidence of previous hormone levels with other types of HRT. Depending on this, we may suggest you require an up to date hormone level before any implant is fitted.
After you have your first implant fitted, we will arrange for you to have your hormone levels checked at 6 months, and if still above a certain level we will recheck monthly until it is safe to fit another implant.
Some menopause symptoms may return before the next implant is due, in which case a top-up of an oestrogen patch or gel can be prescribed. You must stop using any additional top-up oestrogen or testosterone 7 days before the blood test but may be resumed straight afterwards.
In those who use implants long term, a blood test once per year is usually sufficient.
If you have a womb (uterus) you will also be need to be using a progesterone to protect your womb from oestrogen. This helps to prevent the risk of developing thickening of the lining of the womb which may lead to endometrial cancer.
We highly recommend a Mirena intrauterine device (IUS) for those having implants fitted but other options can be discussed with your specialist.
HRT implants are consider a non-reversible HRT as once fitted it cannot be removed.
Oestrogen implants tend to last 6-8 months before oestrogen levels drop to a level where a further implant would need to be fitted (if having benefit and keen to continue with implants). However the residual implant may still release small amounts of oestrogen for up to 24 months. If you have a womb, you will need to continue progesterone until your oestrogen level is within the postmenopausal range again.
30 min consultation (face to face or virtual) to assess suitability for implant and counselling
£150
30 min consultation including implant prescription, fitting procedure and aftercare
£395
Can be fitted at same time as oestrogen implant
£125
Oestrogen levels are required for essential monitoring
£40
Oestrogen and Testosterone levels for essential monitoring
£75
