Menopausal Syndrome: In all cases the objective should be determination of the minimum amount of hormone that will maintain the patient symptom-free. With adequate clinical improvement, usually obtainable in two weeks or less, gradual reduction in dosage are advisable. Subcutaneous implantation- implant one 25mg, Estradiol Pellet and repeat when necessary. The pellets provide constant estrogen levels for approximately 3 months. 

Hypogenitalism and Sexual Infantilism: \- 1.5mg of estradiol or 1.66mg of estradiol benzoate intramuscularly two to three times weekly. Subcutaneous implantation - implant one 25mg, Pellet and repeat when necessary. 

Amenorrhea and Oligomenorrhea Associated with Hypogonadism: 1.5mg of estradiol or 1.66mg of estradiol benzoate intramuscularly two to three times weekly during the first two weeks of an arbitrary 28-day menstrual cycle; progesterone is given the last two weeks of the theoretical cycle. This regimen is continued for 3-6 months. The patient then is allowed to go untreated for 2 months to determine whether or not she can maintain the cycle without hormonal therapy. If not, additional courses of therapy as outlined should be prescribed. 

Postpartum Breast Engorgement: \- 1.5mg of estradiol or 1.66mg of estradiol benzoate is administered intramuscularly daily begining at the first sign of engorgement and continuing until the symptoms are controlled. Restriction of fluids and a tight binder should also be employed. 

Inoperable Breast Carcinoma in Postmenopausal Women: \- 1.5mg of estradiol or 1.66mg of estradiol benzoate intramuscularly three or more times weekly according to the severity of the pain. 

Carcinoma of the Prostate: \- 1.5mg of estradiol or 1.66mg of estradiol benzoate intramuscularly three times weekly. Subcutaneous Implantation - Implant one 25mg pellet and repeat when necessary. 

Senile Vaginitis; Pruritis Vulvae; Kraurosis Vulvae: \- 1.0 to 1.5mg of estradiol or 1.0 to 1.66mg of estradiol benzoate intramuscularly three times weekly for two or three injections, then 0.5 to 1.0mg of estradiol or 0.33 to 1.0mg of estradiol benzoate twice weekly for maintainance. 

The pellets may be implanted conveniently and quickly by means of an injector or they may be administered by making an incision in the skin. Either method, though readily carried out in the physician's office, is a minor surgical procedure, and all aseptic precautions must be observed.

BY INJECTOR: The pellet may be quickly and easily implanted by means of the Bardani or Bartor Pellet Injectors. The areas usually selected for implantation are the intrascapular region or the posterior axillary line. Aseptic precautions must be observed for any surgical procedure. The skin is carefully cleaned, followed by the application of iodine and alcohol. The area is infiltrated with procaine 1:100. Make a very small incision (about 2mm long and 1mm deep) into the skin with a sharp scalpel to allow free passage of the large injector needle. The injector needle of the Kearns injector, with sharp plunger in place, is inserted into the incision and gently forced into the subcutaneous tissue at the desired site of implantation. The sharp plunger is withdrawn, and the pellet inserted into the hollow needle. The simplest method for placing the pellet in the needle is to allow the pellet to slide from the vial in which it is packed into the slot provided in the needle. The pellet is pushed as far as possible through the needle by means of the blunt plunger and held in place with the plunger while the needle is gently withdrawn. When the needle comes in contact with the knob of the plunger, both are withdrawn together. When the injector has been withdrawn, the wound may be closed with a single stitch or a skin clip. In many instances, apposition of the edges of the wound with adhesive tape is sufficient. 

BY INCISION: The intrascapular region or the posterior axillary line are convenient site for implanting pellets. The operative field is prepared in the usual manner with iodine and alcohol and the area is infiltrated with procaine 1:100 solution. An incision about 1 centimeter in length is made. With blunt dissection, a pocket about two centimeters in depth is prepared in the subcutaneous tissue below and away from the incision. The edges of the pocket may be held apart by a smal dilator and the pellet inserted into the bottom of the pocket with small forceps. Force should not be used when inserting pellets. The incision is closed with one or two sutures. 

Treated patients with an intact uterus should be monitored closely for signs of endometrial cancer and appropriate diagnostic measures should be taken to rule out malignancy in the event of persistent or recurring abnormal vaginal bleeding.