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Hormonal Replacement Therapy in Menopausal Women with History of Endometriosis: A Review of Literature
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The Impact of Hormonal Replacement Treatment in Postmenopausal Women with Uterine Fibroids: A State-of-the-Art Review of the 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
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Medicina 2019, 55(9), 549; https://doi.org/10.3390/medicina55090549
Received: 29 June 2019 / Revised: 26 August 2019 / Accepted: 26 August 2019 / Published: 30 August 2019
(This article belongs to the Special Issue Hormone Replacement Therapy: Benefits and Risks)
Background and Objectives: Hormonal replacement therapy (HRT) is effective in treating many debilitating symptoms of menopause. However, its use in women with uterine fibroids is widely debated, based on the susceptibility of these tumors to sexual steroids. This review aims to ascertain the effects of HRT on leiomyomas development and growth in postmenopausal women. Materials and Methods: Electronic databases (i.e., MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) were searched from January 1990 until May 2019. All English-written studies evaluating the impact of various HRT regimens on uterine leiomyomas were selected. Results: Seventeen papers, considering a total of 1122 participants, were included. Fifteen of these were prospective trials, of which nine were randomized controlled trials. The remaining two works were a retrospective observational trial and a retrospective case series respectively. Five studies evaluated the effects of tibolone, also comparing it with various estrogen/progestin combinations, while two were about raloxifene. Thirteen studies compared different combinations of estrogens/progestins, the most common being transdermal estrogens (used in nine studies) and medroxyprogesterone acetate at different doses (used in 10 studies). Conclusions: For women with uterine fibroids, the choice of the most appropriate HRT regimen is crucial to avoid leiomyomas growth and the symptoms possibly related to it. Available data are conflicting, but suggest that uterine fibroids might be influenced by HRT, without representing an absolute contraindication to hormonal replacement therapy. Women with uterine fibroids subjected to HRT should be periodically examined and hormonal treatment should be discontinued if leiomyomas appear to increase in size. Moreover, the minimal effective dose of progestin should be employed. View Full-Text
Keywords: menopause; hormonal replacement therapy; uterine fibroids; abnormal uterine bleeding; postmenopausal women menopause; hormonal replacement therapy; uterine fibroids; abnormal uterine bleeding; postmenopausal women
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Moro, E.; Degli Esposti, E.; Borghese, G.; Manzara, F.; Zanello, M.; Raimondo, D.; Gava, G.; Arena, A.; Casadio, P.; Meriggiola, M.C.; Seracchioli, R. The Impact of Hormonal Replacement Treatment in Postmenopausal Women with Uterine Fibroids: A State-of-the-Art Review of the Literature. Medicina 2019, 55, 549.

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