title: EMAS position statement: Managing the menopause in women with a past history of endometriosis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To formulate a position statement on the management of the menopause in women with a past history of endometriosis.
  
  
  METHODS
  Literature review and consensus of expert opinion.
  
  
  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.
authors.affiliation: Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. mette.moen@ntnu.no
authors.forename: Mette H
authors.initials: MH
authors.lastname: Moen
authors.forename: Margaret
authors.initials: M
authors.lastname: Rees
authors.forename: Marc
authors.initials: M
authors.lastname: Brincat
authors.forename: Tamer
authors.initials: T
authors.lastname: Erel
authors.forename: Marco
authors.initials: M
authors.lastname: Gambacciani
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.forename: Florence
authors.initials: F
authors.lastname: Tremollieres
authors.forename: Svetlana
authors.initials: S
authors.lastname: Vujovic
authors.forename: Serge
authors.initials: S
authors.lastname: Rozenberg
mesh_terms: D004715:Endometriosis / Q000188:drug therapy*; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008593:Menopause; D008594:Menopause, Premature; D009652:Norpregnenes / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; C027385:tibolone