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Hysterectomy as surgical treatment of endometriosis: hormone replacement therapy or not HYSTERECTOMY AS SURGICAL TREATMENT OF ENDOMETRIOSIS: HORMONE REPLACEMENT THERAPY OR NOT
The decision whether or not to have hormone replacement therapy if your ovaries are removed is difficult and complex because there is considerable controversy about the role of hormone replacement therapy following a radical hysterectomy for endometriosis.
Hormone replacement therapy is the administration of synthetic hormones to replace those which were previously produced by the ovaries in order to prevent or minimize the effects of menopause. It usually involves the use of both synthetic oestrogen and progesterone but sometimes only synthetic oestrogen is used.
The two main forms of administration are tablets and implants and there are a variety of strengths which can be used depending on the severity of your menopausal symptoms.
The most common side effects of hormone replacement therapy are nausea and sore breasts, although in the long-term it is possibly associated with a slightly increased risk of developing breast cancer. Hormone replacement therapy will prevent or reduce the effects of surgical menopause but it may also slightly increase the likelihood that you will have a persistence or recurrence of your endometriosis.
Hormone replacement therapy will prevent or reduce most of the symptoms of menopause, including hot flushes, night sweats and a dry vagina. More importantly, it will significantly reduce the likelihood that you will develop heart disease or osteoporosis later in life.
There is a risk that the oestrogen component of hormone replacement therapy will lead to a persistence or recurrence of the implants remaining in your body. Many gynecologists believe that because the concentrations of hormones used are much lower than those produced by the ovary the risk of recurrence is small - probably only about 3% to 5%.
Nevertheless, some gynecologists recommend waiting a minimum of three to six months after a radical hysterectomy before starting hormone replacement therapy. This delay should allow any remaining endometrial implants to degenerate and waste away, reducing the chances that it will cause a persistence or recurrence of your endometriosis.
Some gynecologists suggest that using only a synthetic progesterone such as Provera, rather than both oestrogen and progesterone, as an interim measure for the first few months after surgery will reduce the likelihood of recurrence while still providing some relief from the early symptoms of surgical menopause.
If you are unlucky enough to have a recurrence of your symptoms of endometriosis while on hormone replacement therapy it may be possible to treat the recurrence by stopping or adjusting the dosage. It may also be possible to treat it by having a course of one of the standard hormonal treatments such as Provera or Danazol.
If you do not take hormone replacement therapy you will have a reduced likelihood of having a persistence or recurrence of your endometriosis but you will probably experience the effects of surgical menopause and you will have an increased likelihood of developing heart disease and osteoporosis later in life.
A few women continue to produce enough oestrogen in their bodies to prevent or minimize the effects of surgical menopause. Many women will experience marked symptoms and, although they are often disruptive and unpleasant, some women find that they are easier to cope with than their endometriosis symptoms.
Some women have found that they have been able to prevent or minimize the symptoms of surgical menopause by having a good diet, particularly one high in foods which contain natural oestrogens such as grains, as well as vitamin and mineral supplements, regular vigorous exercise and regular sexual activity.
*58/41/5*
WOMEN’S HEALTH
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Hormonal treatment of endometriosis: the oral contraceptive pill