Relation between hormone replacement therapy and postmenopausal endometriosis.

Potential Hormone Replacement therapy-related risks and current practice

Key Points

Highlights:

• Endometriosis can continue after menopause; thus, combined HRT therapy should be carefully considered.

Importance:

• The study discusses a case report of menopausal endometriosis and confers healthcare providers’ views.

What's done here:                                       

• A cross-sectional survey developed by the British Menopause Society (BMS) and the British Society of Gynecological endoscopy (BSGE) has been applied to the societies’ members.
• The survey questioned the issues encountered when prescribing HRT after inducing surgical menopause in women with endometriosis.
• The questions included scenarios in different age groups, type of HRT, the timing of HRT after surgery, type and duration of the progestogen component of C-HRT, and the reason for the choice of HRT.

Key Results:

• 216 responders including clinicians and menopause practitioners have completed the survey.
• 68.6% of the responders selected combined HRT, 13.0% estrogen only, 11.1% Tibolone, and 7.8% varied HRT depending on endometriosis severity and completeness of excision.
• Estrogen Only-HRT is prescribed by 7.9% of Endometriosis specialists, 12.5% of Gynecology consultants, and 25% of Gynae consultants (GPs and educated nurses) with an interest in Menopause.
• When the rationale is questioned, responders, offer combined HRT to prevent the recurrence of endometriosis (79%), development of de novo endometriosis (39%), or malignant transformation of residual endometriosis (42%).
• 51% of responders have been prescribed the progestogen component of C-HRT indefinitely, 22% for 3–6 months, and 27% for varied durations.
• The authors suggested C-HRT until the natural age of menopause by referring to the British Menopause Society's (BMS) current suggestions.

Limitations:

• The study is a self-reported share of experience but as it is an area of no certain guideline-level suggestions sharing knowledge is still valuable.

Lay Summary

The faith of endometriosis after oophorectomy with hysterectomy is unknown. It is clear that applying only a hysterectomy but leaving the affected tissue behind is not a solution for endometriosis-related symptoms. Either total clearance or leaving endometriotic tissues behind when oophorectomy is performed, the patient starts to live with menopausal consequences. Thus, hormone replacement therapy for surgically induced menopause of endometriosis patients is critical.

The survey-based study based on a case report conducted by Dr. Amer et al in the UK questioned the experience of the clinicians on the topic and was published in the Journal of Clinical Medicine MDPI. 

The cross-sectional survey developed by the British Menopause Society (BMS) and the British Society of Gynecological endoscopy (BSGE) has been applied to the societies’ members, and the survey questioned the issues encountered when prescribing HRT after inducing surgical menopause in women with endometriosis. The questions included scenarios in different age groups, the type of HRT, the timing of HRT after surgery, the duration of the progestogen component of Combined-HRT, and the reason for the choice.

Two hundred and sixteen responders including clinicians and menopause practitioners have completed the survey. 68.6% of the responders selected combined HRT, 13.0% estrogen only, 11.1% Tibolone, and 7.8% varied HRT depending on endometriosis severity and completeness of excision. Estrogen-only is prescribed by 7.9% of endometriosis specialists, 12.5% of gynecology consultants, and 25% of GPs and educated nurses with an interest in menopause. When the rationale is questioned, responders, offer combined HRT to prevent the recurrence of endometriosis, development of de novo endometriosis, or malignant transformation of residual endometriosis.

More than half of the responders were prescribed the progestogen component of Combined-HRT indefinitely. Given the inconsistent nature of the responses, the results indicate a need for a guideline suggesting the type, duration, and timing of HRT after surgically induced menopause of endometriosis patients.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36615134/