title: Timing of estrogen replacement therapy following hysterectomy with oophorectomy for endometriosis.
abstract: OBJECTIVE
  To determine whether the immediate initiation of estrogen replacement therapy (ERT) in the postoperative period increases the incidence of symptom recurrence following total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) for the treatment of endometriosis.
  
  
  METHODS
  In a retrospective cohort study, 95 women who underwent TAH with BSO for endometriosis at the Johns Hopkins Hospital during 1979-1991 and who subsequently received ERT were identified by computer search. Follow-up information was obtained from medical records, outpatient charts, and telephone surveys. Pain recurrence in patients who started ERT within 6 weeks after surgery and in those who delayed ERT for more than 6 weeks was compared and adjusted for length of patient follow-up and other covariates.
  
  
  RESULTS
  Sixty women began ERT within the immediate postoperative period, and four (7%) of them had recurrent pain; 35 women began ERT more than 6 weeks after surgery, and seven (20%) of them had recurrent pain. The mean length of follow-up was 57 months. The difference in the crude rate of symptom recurrence following early and delayed initiation of ERT after TAH with BSO was not statistically significant (P = .09). Controlling for length of patient follow-up, no significant differences were observed between the two groups. Adjusting for covariates of stage, age, and postoperative adjunct medroxyprogesterone therapy, those who started ERT more than 6 weeks after surgery had a relative risk of 5.7 (95% confidence interval 1.3, 25.2) for pain recurrence.
  
  
  CONCLUSIONS
  Although the number of patients in the study was too small to reach statistical significance in all analyses, these findings suggest that patients who begin ERT immediately after TAH with BSO are at no greater risk of recurrent pain than those who delay ERT for more than 6 weeks.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. timothy.hickman@mailzone.com
authors.forename: T N
authors.initials: TN
authors.lastname: Hickman
authors.forename: A B
authors.initials: AB
authors.lastname: Namnoum
authors.forename: E L
authors.initials: EL
authors.lastname: Hinton
authors.forename: H A
authors.initials: HA
authors.lastname: Zacur
authors.forename: J A
authors.initials: JA
authors.lastname: Rock
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D010052:Ovariectomy; D017699:Pelvic Pain / Q000209:etiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors