The use of Hormone Therapy after Surgery for Endometriosis: An Analysis

Abstract

ultimately lead to an acceleration of cardiovascular disease, osteoporosis and cognitive decline. Hormone therapy (HT) is an effective treatment for many women. Nevertheless, in women with significant endometriosis, estrogen may cause an exacerbation of pain associated with endometriosis. In a study of patients with endometriosis, women who underwent hysterectomy with ovarian conservation had a 6-fold greater risk of developing recurrent pain and an 8-fold greater risk of reoperation (3). It has been suggested that HT may reactivate residual endometriosis or even produce new implants in climacteric women with a history of endometriosis (4). At the same time, there is evidence that endometriosis may also occur in postmenopausal women who do not receive HT. In some women there is also the potential risk of malignant transformation of endometriosis lesions after menopause, occurring either spontaneously or in association with HT (5). Accordingly, we wished to determine what the true risks are of prescribing HT to women after menopause with a history of endometriosis, and to seek data on types of HT in this setting. Methods We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systemic review (Fig. 1).

Endometriosis and menopause—management strategies based on clinical scenarios

“…The rate of postmenopausal recurrence of endometriosis in patients with a clinically moderate to severe disease is approximately 4%. 9 Recurrence may appear after several decades and be affected by the use and type of MHT. 9 Specific guidelines on how to manage endometriosis in peri-and postmenopausal women are based on scarce data consisting mainly of case reports, retrospective studies and women with surgical menopause.…”

“…9 Recurrence may appear after several decades and be affected by the use and type of MHT. 9 Specific guidelines on how to manage endometriosis in peri-and postmenopausal women are based on scarce data consisting mainly of case reports, retrospective studies and women with surgical menopause. 10 Here, we present five hypothetical clinical scenarios to discuss the challenges faced by clinicians managing patients with endometriosis in the peri-and postmenopause.…”

“…Malignant transformation is the progression of benign endometriotic lesions to cancer and is a rare but possible complication to consider in postmenopausal endometriosis. The rate of postmenopausal recurrence of endometriosis in patients with a clinically moderate to severe disease is approximately 4% 9 . Recurrence may appear after several decades and be affected by the use and type of MHT 9 …”

“…The rate of postmenopausal recurrence of endometriosis in patients with a clinically moderate to severe disease is approximately 4%. 9 Recurrence may appear after several decades and be affected by the use and type of MHT. 9 …”