The effect of hormone therapy after surgical menopause on endometriosis recurrence

Hormonal therapy after surgical menopause does not affect endometriosis recurrence.

Key Points

Highlights:

• When an endometriosis patient receives menopausal hormone therapy after surgical menopause, no matter it is a single agent or combined, it would not cause to recurrence of endometriosis.

Importance:

• Endometriosis may recur in up to 15% of women regardless of the addition of hormone therapy.
• The Global Consensus statement recommends hormonal replacement therapy until the age of natural menopause for women who have surgical menopause.
• There is not enough data about the balance between the conceptual advantage of avoiding recurrence and the risk of metabolic derangement.

 What's done here:

• This retrospective cohort study included 330 women with endometriosis who underwent a total hysterectomy and bilateral salpingo-oophorectomy.
• The researchers aimed to reconsider the association between post-surgical menopausal hormone therapy and endometriosis recurrence.

Key results:

• Among 330 patients, 287 were treated with menopausal hormonal therapy (estrogen, estrogen/progesterone, or tibolone).
• The remaining 43 women composed the non-hormone therapy group. 
• The overall reoccurrence rate of endometriosis was 3% and was not statistically different between the groups.
• There were no serious adverse events, and there was no significant difference among the groups for the most annoying symptoms (breast tenderness, dizziness, and headache).

Limitations:

• The strengths are the large sample size and prolonged follow-up.
• Besides the observational and retrospective nature, the definition for recurrence to be based on symptoms instead of histopathological or surgical confirmation is a limitation.
• The age range for the group without hormone therapy is different and may cause bias concerning the recurrence.
• The hormone therapy algorithm was changed widely, but usage of old hormonal regimes question the value of the results.

Lay Summary

Definitive surgery for severe and advanced endometriosis is hysterectomy with bilateral oophorectomy, which may cause vasomotor symptoms, sleep deprivation, mood change, and dyspareunia in the patients. Furthermore, after the surgical removal of the ovaries, the sudden drop in estrogens causes impairment of quality of life, and hormonal therapy is recommended especially in younger women who had surgical menopause.

Although European or American global consensus statements recommend hormonal replacement therapy until the age of natural menopause for women undergoing surgical menopause for endometriosis, the decision is rather difficult due to the probability of disease recurrence or malignant transformation, based on the estrogenic effect. Studies in the literature on this subject have either a small sample size or a short follow-up. 

Tanmahasamut et al., from the Siriraj Hospital of Mahidol University, Bangkok, Thailand, aimed to evaluate the long-term follow-up results of menopausal hormone therapy for their surgical menopause patients with endometriosis. For this purpose 330 women with endometriosis who underwent a total hysterectomy and bilateral salpingo-oophorectomy in the same center were selected and evaluated stratified by their hormone therapy. In the study population, 287 were hormone therapy users (estrogen users: 230, combined estrogen and progestins users 39, tibolone users: 18); and 43 were non-hormone users. The mean follow-up duration was 6,0 years.

The endometriosis recurrence rate was overall 3% and was not statistically different between the groups. There were no serious adverse events in the patients. Furthermore, there was no significant difference among the groups for the most annoying symptoms such as breast tenderness, dizziness, and headache. This observational retrospective cohort study was recently published in the journal named "Climacteric".

Research Source: https://pubmed.ncbi.nlm.nih.gov/34783284/