Endometriosis

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INTACT UTERUS:

There is limited evidence available to guide clinical practice on prescribing HRT in women with endometriosis.
For women who choose to take HRT, a combined regime should be used, starting with a low oestrogen dose.
Low doses of oestrogen are recommended due to concerns that oestrogen treatments could reactivate endometriosis and cause a disease flare.
Current recommendations favour continuous progestogen regimes, and these appear preferable to sequential regimes.
HRT should be reviewed or stopped if symptoms of endometriosis occur.

FOLLOWING HYSTERECTOMY:

Following hysterectomy for widespread endometriosis, continuous combined HRT regimes are advisable to reduce the risk of stimulating any residual endometroid deposits that may remain in the pelvis.
Using combined HRT is not necessary however in all cases and only where there is risk of residual disease.
There is limited evidence available on this to guide clinical practice.

NOTE:

Women with endometriosis should be carefully counselled about a theoretical possibility of disease recurrence with HRT use. Risk of recurrence is likely to be minimised where low oestrogen and a continuous progestogen is used.
Women should be advised to seek a review if they experience endometriosis like symptoms on HRT.

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