Menopausal hormonal therapy in surgically menopausal women with underlying endometriosis

Abstract

Objective

This study aimed to investigate the relationship between menopausal hormone therapy (MHT) and endometriosis recurrence in women who underwent hysterectomy with bilateral salpingo-oophorectomy to treat endometriosis.

Method

This retrospective cohort study included 330 women who underwent definitive surgery to treat endometriosis during 1996–2012. Follow-up data until December 2018 were analyzed. Patients were grouped as MHT non-users (non-MHT, n = 43), estrogen-only therapy (ET, n = 230), estrogen–progestogen therapy (EPT, n = 39) and tibolone (n = 18).

Results

The mean age at surgery was 41.5 ± 5.3 years. The overall median follow-up duration was 6.0 years (interquartile range [IQR]: 3.0–10.4), and the median duration of MHT use was 66.0 months (IQR: 36.0–116.3). The overall recurrence rate was 3.0% (95% confidence interval: 1.5–5.5) and there was no significant difference in recurrence among the study groups. Disease recurrence resolved after MHT discontinuation, or change in MHT type and/or dose.

Conclusions

No significant association between MHT use and endometriosis recurrence was found in this study. The endometriosis recurrence rate was non-significantly different between ET and EPT. Recurrent endometriosis can be successfully treated without invasive measures. No study patients had malignant transformation after a median follow-up of 6 years. Our findings suggest that any of the three evaluated MHT regimens can be used in surgically menopausal Thai women with underlying endometriosis.

摘要

目的：本研究旨在探讨绝经激素治疗（MHT）与子宫内膜异位症复发的关系。方法：这项回顾性队列研究纳入了1996-2012年间接受确定性手术治疗子宫内膜异位症的330名女性。分析了截至2018年12月的随访数据。患者被分为非MHT组（non-MHT, n = 43）, 单用雌激素治疗组（ET, n = 230）, 雌激素-孕激素治疗组（EPT, n = 39）和替勃龙组（n = 18）。结果：平均手术年龄为41.5±5.3岁。总体中位随访持续时间为6.0年（四分位数间距[IQR]：3.0–10.4）, MHT应用的中位持续时间为66.0个月（IQR:36.0–116.3）。总复发率为3.0%（95%置信区间：1.5-5.5）, 研究组之间的复发率没有显著差异。停用MHT或改变MHT类型和/或剂量后, 疾病复发消失。结论：本研究中未发现MHT的使用与子宫内膜异位症复发之间有显著相关性。子宫内膜异位症复发率在ET和EPT之间无显著差异。复发性子宫内膜异位症可以在不采取侵入性措施的情况下成功治疗。在中位随访6年后, 没有研究患者发生恶变。我们的发现表明, 评估的三种MHT方案中的任何一种都可以用于患有潜在子宫内膜异位症的手术绝经的泰国女性。

Keywords:

• Menopausal hormone therapy
• surgical menopause
• endometriosis
• endometriosis recurrence

Acknowledgements

The authors gratefully acknowledge Miss Nichamon Pingkul, their research assistant, for data collection, and Miss Nerisa Thornsri, MSc of the Clinical Epidemiology Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, for her assistance with statistical analyses.

Potential conflict of interest

All authors hereby declare no personal or professional conflicts of interest, and no financial support from the companies that produce and/or distribute the drugs, devices or materials described in this report.

Source of funding

Nil.