Specifics of prescribing menopausal hormonal therapy in patients with the anamnestic endometriosis

In: Obstetrics, Gynecology and Reproduction · 2021 · vol. 14(6) , pp. 675–684 · doi:10.17749/2313-7347/ob.gyn.rep.2020.165 · W3119975284
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This study analyzed 724 patients and found that custom-compounded menopausal hormone therapy with low-dose bioidentical estrogens improves quality of life and prevents bone loss in endometriosis patients.

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The paper reviews principles for prescribing menopausal hormone therapy (MHT) in women with genital endometriosis based on international guidelines and presents observations from 724 patients with endometriosis treated with different MHT types, including 428 perimenopausal and 296 postmenopausal women. It reports that women with endometriosis in both menopausal transition and after menopause had more prominent climacteric and post-ovariectomy syndromes and a higher risk of reduced bone mineral density, particularly related to repeated ovarian surgery and prior long-term “antiestrogen therapy.” The authors state that custom-compounded MHT using low or ultra-low doses of bioidentical estrogen improved quality of life, prevented BMD loss, reduced cardiovascular disease risk, and minimized recurrence risk; a key limitation is that the abstract emphasizes observational data and guideline-based framework rather than detailing comparative trial outcomes. This paper is centrally about endometriosis — it specifically addresses menopausal hormonal therapy prescribing strategies and outcomes in patients with anamnestic genital endometriosis.

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Abstract

Administration of menopausal hormone therapy (MHT) in patients with genital endometriosis (GE) is a controversial issue requiring a patient-personalized approach. Current principles for MHT selection and prescription in patients with anamnestic endometriosis are presented, which are based on the guidelines of the International Menopause Society (IMS), The European Menopause and Andropause Society, local and foreign publications retrieved from electronic data bases PubMed, Cyberleninka. The data of our study on observing 724 patients with GE treated with diverse MHT types were presented and analyzed (428 women in perimenopausal period, 296 in postmenopausal period). Patients with endometriosis in perimenopausal and postmenopausal periods showed more prominent manifestations of climacteric and post-ovariectomy syndromes, as well as high risk of reduced bone mineral density (BMD) due to repeated surgery on the ovaries and preceding long-term “antiestrogen therapy”. Custom-compounded MHT based on components combinations, dosage and administration route provides a significantly improved quality of life for patients with endometriosis, prevents loss of BMD and reduces risk of cardiovascular diseases. Using low and ultra-low dose estrogen bioidentical to natural substances in this patient group minimizes a risk of disease recurrence.
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Abstract

Administration of menopausal hormone therapy (MHT) in patients with genital endometriosis (GE) is a controversial issue requiring a patient-personalized approach. Current principles for MHT selection and prescription in patients with anamnestic endometriosis are presented, which are based on the guidelines of the International Menopause Society (IMS), The European Menopause and Andropause Society, local and foreign publications retrieved from electronic data bases PubMed, Cyberleninka. The data of our study on observing 724 patients with GE treated with diverse MHT types were presented and analyzed (428 women in perimenopausal period, 296 in postmenopausal period). Patients with endometriosis in perimenopausal and postmenopausal periods showed more prominent manifestations of climacteric and post-ovariectomy syndromes, as well as high risk of reduced bone mineral density (BMD) due to repeated surgery on the ovaries and preceding long-term “antiestrogen therapy”. Custom-compounded MHT based on components combinations, dosage and administration route provides a significantly improved quality of life for patients with endometriosis, prevents loss of BMD and reduces risk of cardiovascular diseases. Using low and ultra-low dose estrogen bioidentical to natural substances in this patient group minimizes a risk of disease recurrence.

Keywords

About the Authors M. I. YarmolinskayaRussian Federation Maria I. Yarmolinskaya – MD, Dr Sci Med, Professor of RAS, Head of the Department of Gynecology and Endocrinology, Head of the Сenter «Diagnostics and Treatment of Endometriosis»; Professor, Department of Obstetrics and Gynecology Scopus Author ID: 7801562649. Researcher ID: P-2183-2014. SPIN-код: 3686-3605 3 Mendeleevskaya Liniya, Saint Petersburg 199034; 41 Kirochnaya Str., Saint Petersburg 191015 M. A. Shalina Russian Federation Maria A. Shalina – MD, PhD, Senior Researcher, Department of Gynecology and Endocrinology 3 Mendeleevskaya Liniya, Saint Petersburg 199034 C. I. Seyidova Russian Federation Chimnaz I. Seyidova – MD, Clinical Intern 3 Mendeleevskaya Liniya, Saint Petersburg 199034

References

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Obstetrics, Gynecology and Reproduction. 2020;14(6):675-684. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.165 JATS XML This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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