Hormone therapy after total surgery for endometriosis

Endometriosis is a disease of the premenopausal phase of a woman's life, and estrogen, the hormone produced by the ovaries, is the main culprit. The basis of most of the treatment modalities used for endometriosis is to suppress ovarian production of estrogen and to induce menopause. And it has been seen resolving with menopause either induced by medical therapy such as GnRH analogues or surgical menopause after TAH with BSO or suppression of ovarian functions by oral contraceptive pills. Total surgery—hysterectomy with or without bilateral salpingo-oophorectomy—is considered the definitive option for women who completed childbearing. After total surgery, the patient gets relieved from endometriosis-related symptoms, but climacteric symptoms such as hot flashes, vaginal dryness, sleep, and mood disturbances, which affect the quality of life, appear afterward. In endometriosis, although the total surgery is the last option, compared to all other indications, women are at a younger age with endometriosis and would definitely require HRT. In this particular group of women, there are issues on safety of hormone replacement therapy (HRT), risk of recurrence, and malignant transformation.