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Hormonal Replacement Therapy in Menopausal Women with History of Endometriosis: A Review of Literature

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy
Author to whom correspondence should be addressed.
Medicina 2019, 55(8), 477;
Received: 29 June 2019 / Revised: 9 August 2019 / Accepted: 12 August 2019 / Published: 14 August 2019
(This article belongs to the Special Issue Hormone Replacement Therapy: Benefits and Risks)
PDF [294 KB, uploaded 14 August 2019]


Hormonal replacement therapy (HRT) is effective in treating the symptoms of menopause. Endometriosis is defined as the presence of functional endometrial tissue outside the uterine cavity with a tendency towards invasion and infiltration. Being an estrogen-dependent disease, it tends to regress after menopause. Nevertheless, it affects up to 2.2% of postmenopausal women. Conclusive data are not available in the literature on the appropriateness of HRT in women with endometriosis or a past history of the disease. The hypothesis that exogenous estrogen stimulation could reactivate endometriotic foci has been proposed. The aim of this state-of-the-art review was to revise the current literature about endometriosis in perimenopause and menopause and to investigate the possible role of HRT in this setting of patients. An electronic databases search (MEDLINE, Scopus,, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) was performed, with the date range of from each database’s inception until May 2019. All of the studies evaluating the impact of different HRT regimens in patients with a history of endometriosis were selected. 45 articles were found: one Cochrane systematic review, one systematic review, five narrative reviews, two clinical trials, two retrospective cohort studies, 34 case reports and case series. Some authors reported an increased risk of malignant transformation of endometriomas after menopause in patients assuming HRT with unopposed estrogen. Low-quality evidence suggests that HRT can be prescribed to symptomatic women with a history of endometriosis, especially in young patients with premature menopause. Continuous or cyclic combined preparations or tibolone are the best choices. HRT improves quality of life in symptomatic post-menopausal women, who should not be denied the replacement therapy only due to their history of endometriosis. Based on low-grade literature evidence, we recommend to prescribe combined HRT schemes; tibolone could be considered. View Full-Text
Keywords: menopause; hormone replacement therapy; menopause hormonal therapy; endometriosis; pelvic pain menopause; hormone replacement therapy; menopause hormonal therapy; endometriosis; pelvic pain
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Zanello, M.; Borghese, G.; Manzara, F.; Degli Esposti, E.; Moro, E.; Raimondo, D.; Abdullahi, L.O.; Arena, A.; Terzano, P.; Meriggiola, M.C.; Seracchioli, R. Hormonal Replacement Therapy in Menopausal Women with History of Endometriosis: A Review of Literature. Medicina 2019, 55, 477.

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