Hormone Replacement Therapy in Patients with a History of Endometriosis

Introduction to HRT Recommendations

For women with a history of endometriosis who require hormone replacement therapy, combined estrogen/progestogen therapy is recommended rather than estrogen-only therapy, even after hysterectomy, to reduce the risk of disease reactivation 1, 2

Combined estrogen/progestogen therapy is effective for vasomotor symptoms and may reduce the risk of disease reactivation in women with endometriosis who underwent oophorectomy 1, 2
HRT should be continued at least until the average age of natural menopause to prevent long-term health consequences in women with endometriosis who underwent oophorectomy 2

17-beta estradiol is preferred to ethinylestradiol or conjugated equine estrogens for estrogen replacement in women with a history of endometriosis 1
Dydrogesterone (5-10 mg/day) is a progestogen option for women with a history of endometriosis 1
Transdermal estradiol is the preferred delivery method for hypertensive women with endometriosis history 1, 2

Annual clinical review is recommended, paying particular attention to compliance in women with a history of endometriosis 1

For women with BRCA1/2 mutations but without personal history of breast cancer after prophylactic bilateral salpingo-oophorectomy, HRT remains a treatment option, according to the European Menopause and Andropause Society 1
HRT is generally contraindicated in breast cancer survivors, as recommended by the American College of Obstetricians and Gynecologists 1
For women with endometriosis and migraine, HRT should not be considered contraindicated, but consider changing dose, route of administration or regimen if migraine worsens during treatment, as suggested by the North American Menopause Society 2