EMAS position statement: Managing the menopause in women with a past history of endometriosis

Moen, Mette H.; Rees, Margaret; Brincat, Marc; Erel, Tamer; Gambacciani, Marco; Lambrinoudaki, Irene; Schenck-Gustafsson, Karin; Tremollieres, Florence; Vujovic, Svetlana; Rozenberg, Serge

doi:10.1016/j.maturitas.2010.04.018

« Previous Next »Maturitas
Volume 67, Issue 1 , Pages 94-97, September 2010

EMAS position statement: Managing the menopause in women with a past history of endometriosis

Mette H. Moen
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian university of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Corresponding author at: Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim University Hospital, NO-7006 Trondheim, Norway. Tel.: +47 72 574664; fax: +47 72 573801.
Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford, UK
Marc Brincat
- Department of Obstetrics and Gynecology, Mater Dei Hospital, Malta
Tamer Erel
- Department of Obstetrics and Gynecology, Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey
Marco Gambacciani
- University of Pisa, Department of Obstetrics and Gynecology, Pisa, Italy
Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
Karin Schenck-Gustafsson
- Departmet of Cardiology, Karolinska University Hospital, Stockholm, Sweden
Florence Tremollieres
- Menopause and Metabolic Bone Disease Unit, Hôpital Paule de Viguier, Toulouse, France
Svetlana Vujovic
- Institute of Endocrinology, Clinical Center of Serbia, Belgrade Medical School of medicine, Beograd, Serbia
Serge Rozenberg
- Department of Obstetrics & Gynecology, CHU ST Pierre. Université Libre de Bruxelles, Brussels, Belgium

Received 26 April 2010; received in revised form 26 April 2010; accepted 26 April 2010. published online 17 May 2010.

Abstract

Introduction

Endometriosis is a common disease in women of reproductive age. The symptoms usually disappear after a natural or a surgical menopause. Estrogen-based hormone therapy is required in women with premature or early menopause until the average age of the natural menopause and should be considered in older women with severe climacteric symptoms. However use of hormone therapy raises concerns about disease recurrence with pain symptoms, need for surgery and possibly malignant transformation of residual endometriosis.

Aim

To formulate a position statement on the management of the menopause in women with a past history of endometriosis.

Materials and methods

Literature review and consensus of expert opinion.

Results and conclusions

The data regarding hormone therapy regimens are limited. However it may be safer to give either continuous combined estrogen–progestogen therapies or tibolone in both hysterectomised and nonhysterectomised women as the risk of recurrence may be reduced. The risk of recurrence with hormone therapy is probably increased in women with residual disease after surgery. Management of potential recurrence is best monitored by responding to recurrence of symptoms. Women not wanting estrogen or those who are advised against should be offered alternative pharmacological treatment for climacteric symptoms or skeletal protection if indicated. Herbal preparations should be avoided as their efficacy is uncertain and some may contain estrogenic compounds.

Keywords: Endometriosis, Menopause, Hysterectomy, Oophorectomy, Hormone therapy, Malignancy