Systemic MHT in individuals with endometriosis

Endometriosis may occur or recur during menopause. Treatment of endometriosis may involve hysterectomy, and bilateral salpingo-oophorectomy (which causes premature ovarian insufficiency (POI) or early menopause). Use of systemic MHT may be associated with recurrence of endometriosis, or potentially malignant transformation, although the risk appears to be less with combined MHT. Data to guide management are limited.

For individuals with endometriosis who need systemic MHT, specialist referral is advised for individual assessment of the benefits of therapy (symptom relief, quality of life and prevention of chronic disease [particularly if the patient has POI or early menopause]) and the risk of recurrence or malignant transformation. Continuous combined MHT, tibolone or conjugated estrogens+bazedoxifene are preferred for individuals with endometriosis over cyclical combined MHT or estrogen-only MHT.