Subcutaneous hormone replacement therapy.

It is estimated that 75% of women are in an acute estrogen deficiency state within a few years after the onset of the menopause. Every woman inevitably reaches this phase except for a fortunate few who have some source of endogenous estrogens available to them. We believe it would be prudent to offer hormone replacement therapy to every woman with symptoms of the menopause, and to those in whom symptoms are not patently manifest, if an estrogen deficit is present as indicated by vaginal cytology. Certainly even in the absence of symptoms, the presence of osteoporosis is sufficient reason to initiate small doses of estrogens (along with increased calcium and protein uptake, and exercise) for the remainder of the woman's lifetime. Crystalline pellets of 17 beta-estradiol offer excellent relief of symptoms for those postmenopausal women who fare poorly on oral estrogens or intramuscular injections. Although somewhat more expensive than other modes of therapy, pellet use is convenient, highly effective and associated with few side effects.