Omeprazole for duodenal ulceration in Crohn's disease.

decline suggests that the implanted oestradiol is eliminated from body tissues much more slowly than thought previously (figure). We emphasise that according to the recommendations in the Data Sheet Compendium our patients were not overdosed but were treated with a conventional regimen of 50 mg oestradiol implants reinserted roughly every six months. The mean oestradiol dose a year was 83 mg, which we would not consider to be excessive. Two of the three patients on whom data are available had plasma oestradiol values within the premenopausal range at the time of the last implant. Our main anxiety with long lasting implants is the long term risk of endometrial malignancy. Less than three years of treatment with oral, unopposed oestro-gens increases the risk of endometrial cancer ninefold for two to 14 years after treatment is withdrawn.'0 We suspect that prolonged unopposed stimulation by oestrogen after discontinuation of implant treatment will increase the risk of endometrial neoplasia and hence progestogen needs to be added monthly for as long as withdrawal bleeding occurs. Even then endometrial hyperplasia may arise (cases 5 and 9). This could have been due to an inadequate progestogen dose or to poor compliance. Patients with implants who fail to comply strictly with taking progestogen are known to be at an increased risk of endometrial hyperplasia: one series reported an incidence of 56%. " Achieving good compliance with taking progestogen may be difficult. Symptomatic and psychological side effects are well recognised,4 and there can be few women who perceive a monthly withdrawal bleed as a blessing. Implant treatment in women with an intact uterus carries the possibility of a long term commitment to taking progestogen; clinicians should advise their patients to continue taking progestogen cyclically for as long as the withdrawal bleeding continues, not for a defined period of time such as four to eight months after the last implantation. Skeletal effects of oral oestrogen compared with subcutaneous oestrogen and testosterone in postmenopausal women. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. effects of norethisterone in postmenopausal women on oestrogen replacement therapy: a model for the premenstrual syndrome. Symptoms of oestrogen deficiency ass-iated with supraphysiological plasma oestradiol concentrations in women with oestradiol implants. metabolic effects of transdermal estradiol in the management of postmeno-pausal women. Antroduodenal ulceration associated with Crohn's disease is fairly unresponsive to medical treatment and often leads …