{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:25:52Z","timestamp":1792146352893,"version":"4.4.0"},"reference-count":9,"publisher":"BMJ","issue":"6722","license":[{"start":{"date-parts":[[1990,2,17]],"date-time":"1990-02-17T00:00:00Z","timestamp":635212800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1990,2,17]]},"abstract":"<jats:p>OBJECTIVE--To provide information on endometrial stimulation after discontinuation of treatment with oestradiol implants. DESIGN--Long term follow up of withdrawal bleeding patterns in women taking progestogens cyclically every month after oestradiol implant treatment was ended. SETTING--Specialist menopause clinic. SUBJECTS--10 Postmenopausal patients (at least 12 months' amenorrhoea after the last spontaneous period) who were treated with oestradiol implants for typical symptoms of oestrogen deficiency. The oestradiol dose was 50 mg, reimplantation occurring roughly every six months. Patients subsequently either needed to discontinue the hormone treatment for medical reasons or expressed a desire to stop treatment. MAIN OUTCOME MEASURE--Duration of endometrial stimulation--defined as the presence of withdrawal bleeding in response to progestogen given cyclically--after insertion of the last oestradiol implant. RESULTS--Four patients eventually stopped bleeding, their mean duration of bleeding being 35 months (range 27-43 months). One patient required hysterectomy 26 months after the last implantation because of persistent irregular bleeding despite treatment with high doses of progestogen. Three patients bled for 22, 30, and 36 months and then restarted oestrogen treatment because symptoms returned. The last two patients subsequently continued to bleed 12 and 21 months after the last implantation. CONCLUSIONS--The duration of endometrial stimulation after implantation can be prolonged, up to 43 months. Insertion of oestradiol implants can carry a long term commitment to the cyclical administration of progestogen and regular withdrawal bleeding if endometrial hyperplasia and carcinoma are to be avoided.<\/jats:p>","DOI":"10.1136\/bmj.300.6722.436","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"436-438","source":"Crossref","is-referenced-by-count":17,"title":["Prolonged endometrial stimulation associated with oestradiol implants."],"prefix":"10.1136","volume":"300","author":[{"given":"K F","family":"Gangar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M I","family":"Whitehead","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M P","family":"Cust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1990,2,17]]},"reference":[{"key":"ref_1","first-page":"331","article-title":"Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women","volume":"297","author":"Savsas, M.; Studd, J.W.W.; Fogelman, I.; MN1, Dooley; J, M1ontgomery; Murby, B.","year":"1988","unstructured":"Savsas M, Studd JWW, Fogelman I, Dooley MN1, M1ontgomery. J, Murby B. Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women. BrMUedj 1988;297:331-3.","journal-title":"BrMUedj"},{"key":"ref_2","first-page":"147","article-title":"Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study","volume":"298","author":"Persson, I.; Adami, H.-O.; Bergkvist, L.","year":"1989","unstructured":"Persson I, Adami H-O, Bergkvist L, et al. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. BrMedj 1989;298:147-51.","journal-title":"BrMedj"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1111\/j.1471-0528.1986.tb07868.x","article-title":"The effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome","volume":"93","author":"Miagos, A.L.; Brewster, E.; Singh, R.; O'Dowd, T.; Brincat, M.; Studd, J.W.W.","year":"1986","unstructured":"Miagos AL, Brewster E, Singh R, O'Dowd T, Brincat M, Studd JWW. The effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome. BrJ Obstet Gvnaecol 1986;93: 1290-6.","journal-title":"BrJ Obstet Gvnaecol"},{"key":"ref_4","article-title":"Pharmaceutical Societv of Great Britain. Brtish national formulary. Number 17","author":"Association, British Medical; the Royal","unstructured":"British Medical Association and the Royal Pharmaceutical Societv of Great Britain. Brtish national formulary. Number 17. London: Pharmaceutical Press, 1989:254."},{"key":"ref_5","first-page":"601","article-title":"Symptoms of oestrogen deficiency ass -iated with supraphysiological plasma oestradiol concentrations in women with oestradiol implants. BrMed3'","volume":"299","author":"Gangar, K.; Cust, M.; Whitehead, M.I.","year":"1989","unstructured":"Gangar K, Cust M, Whitehead MI. Symptoms of oestrogen deficiency ass -iated with supraphysiological plasma oestradiol concentrations in women with oestradiol implants. BrMed3' 1989;299:601-2."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/0002-9378(85)90566-6","article-title":"Endometrial responses to transdermal estradiol in postmenopausal women","volume":"152","author":"Whitehead, M.I.; Padwick, M.L.; Endacott, J.; Prvse-Davies, J.","year":"1985","unstructured":"Whitehead MI, Padwick ML, Endacott J, Prvse-Davies J. Endometrial responses to transdermal estradiol in postmenopausal women. Am J Obstet Gvnecol 1985;152:1079-84.","journal-title":"Am J Obstet Gvnecol"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/0002-9378(85)90567-8","article-title":"and metabolic effects of transdermal estradiol in the management of postmenopausal women","volume":"152","author":"Padwick, M.I.L.; Endacott, J.; Efficacy, Whitehead M.I.; acceptability","year":"1985","unstructured":"Padwick MIL, Endacott J, Whitehead MI. Efficacy, acceptability, and metabolic effects of transdermal estradiol in the management of postmenopausal women. Amlm Obstet Gvnecol 1985;152:1085-91.","journal-title":"Amlm Obstet Gvnecol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1038\/bjc.1989.91","article-title":"Endometrial cancer and patterns of use of oestrogen replacement therapy: a cohort study. Br J'","volume":"59","author":"Paganini-Hill, A.; Ross, R.K.; Henderson, B.E.","year":"1989","unstructured":"Paganini-Hill A, Ross RK, Henderson BE. Endometrial cancer and patterns of use of oestrogen replacement therapy: a cohort study. Br J' Cancer 1989;59:445-7.","journal-title":"Cancer"},{"key":"ref_9","first-page":"822","article-title":"Endometrial disease after treatment with oestrogens and progestogens in the climacteric","volume":"7","author":"Paterson, M.I.E.L.; Wade-Evans, T.; Sturdee, D.W.","year":"1980","unstructured":"Paterson MIEL, Wade-Evans T, Sturdee DW, et al. Endometrial disease after treatment with oestrogens and progestogens in the climacteric. Br Med 7 1980;280:822-4.","journal-title":"Br Med"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.300.6722.436","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.300.6722.436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T21:39:31Z","timestamp":1765489171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.300.6722.436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1990,2,17]]},"references-count":9,"journal-issue":{"issue":"6722","published-online":{"date-parts":[[1990,2,17]]},"published-print":{"date-parts":[[1990,2,17]]}},"alternative-id":["10.1136\/bmj.300.6722.436"],"URL":"https:\/\/doi.org\/10.1136\/bmj.300.6722.436","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1990,2,17]]}}}