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CARS Archives

Endometriosis, Hysterectomy, and Estrogen Replacement
Title:Timing of estrogen replacement therapy following hysterectomy with oophorectomy
Author: T.Hickman et al.
Address: Baltimore, Maryland
Source: Obstetrics and Gynecology 5:673-677 (May) 1998
Summary: This retrospective cohort study investigates whether the immediate post -operative introduction of estrogen replacement therapy (ERT) following hysterectomy (TAH) with oophorectomy (BSO) increases the incidence of symptom recurrence in women with endometriosis. 95 women were identified by computer search. All had undergone a TAH and BSO between the years 1979 and 1991 and all had endometriosis. Pain recurrence was compared between the women who had received ERT before 6 weeks following the procedure and those who had received it 6 weeks after. Information was gathers via patient medical records, out patient charts and telephone survey. The group that received ERT with in the immediate 6 weeks included 60 women. Four of these women (7%) experienced recurrent pain. 35 women received ERT after the initial 6 weeks and 7 (20%) experienced recurrent pain. Adjusting for covariates of stage, age and postoperative adjunct medroxyprogesterone therapy, the women who began ERT after the initial 6 weeks following TAH and BSO had a relative risk of 5.7 (95%) confidence interval 1.3, 25.2,) for pain recurrence. This information suggests to the authors, that patients who begin ERT immediately following surgery are at no greater risk of recurrent pain than those who delay ERT for more than 6 weeks.
Comment: An important variable is the degree of active endometriosis at the time of surgery. If residual disease is considerable, I suggest 3 to 4 months before beginning HRT. Progestins should be considered in the initial stages of HRT. It has been my experience that the return of pain in patients placed on high doses of estrogen is pronounced.

 

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