Oestrogen may be given in three ways:
• by mouth (orally)
• as a cream or pessary applied locally
• by implants or pellets placed under the skin.
If the uterus is still present, progestogens at regular intervals are essential to stop the build-up in the lining of the uterus, with resultant bleeding or changes which might give rise to cancer of the uterus. Some believe that progestogens should be given in all cases.
The common oestrogens on the market at present are ethinyl-oestradiol (the synthetic oestrogen), conjugated equine oestrogen (Premarin), oestradiol valerate (Progynova), Piperazine oe-strone sulphate (Ogen) and Oestriol. Only ethinyloestradiol is available on the NHS. There are also several progestogens on the market, none of which are on the NHS list.
The government has not altered the NHS list for oestrogens since it was originally decided upon even though this therapy has gone ahead considerably. Complaints have been forwarded to the appropriate bodies from many authorities without results. It is something that women could lobby for through their local members.
Ethinyloestradiol in some instances causes nausea and headaches and is unsuitable for smokers or for women with high blood pressure as it increases thrombosis. It is the oestrogen in the oral contraceptive pill. All other oestrogens are very costly.
Progestogens are also costly and are not on the NHS listing for this purpose although it is recognised that they are necessary if oestrogen is to be taken safely. This is particularly hard on women from outer suburbs and the country areas who cannot attend public hospitals where these tablets are free.