EMAS position statement: Managing the menopause in women with a past history of endometriosis.
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.
Moen
Mette H
MH
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
Rees
Margaret
M
Brincat
Marc
M
Erel
Tamer
T
Gambacciani
Marco
M
Lambrinoudaki
Irene
I
Schenck-Gustafsson
Karin
K
Tremollieres
Florence
F
Vujovic
Svetlana
S
Rozenberg
Serge
S
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
D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; C027385:tibolone