What awaits after menopause? Endometriosis, menopause and hormonal treatment: A systematic review

Q Liu, C. Alastruey, M.A. Martínez-Zamora, M Gracia
In: Clínica e Investigación en Ginecología y Obstetricia · 2026 · vol. 53(4) , pp. 101142 · doi:10.1016/j.gine.2026.101142 · W7214066134
Systematic review / meta-analysis OA: hybrid CC0
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This systematic review of six studies indicates that hormone replacement therapy may increase endometriosis recurrence and malignancy risk in menopausal women, although high bias and small sample sizes prevent definitive conclusions.

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Abstract

Introduction Endometriosis is a chronic disease traditionally associated with reproductive age; however, current data indicates that it can persist and, in some cases, become malignant during menopause. Hormone therapy, common during this stage, could represent a risk factor for women with endometriosis given the hormonal dependence of the disease. This article reviews the scientific literature to evaluate the impact of hormone replacement therapy in patients with endometriosis upon reaching menopause. Methods A search was conducted in the PubMed, Cochrane, and Scopus databases for the period 1990–2025. We included observational and randomized studies analyzing the recurrence or malignant transformation of endometriosis in menopausal women in relation to hormone therapy. Results Six studies were identified (2 clinical trials and 4 observational studies). Most describe a higher frequency of recurrence and malignancy in the treated groups, particularly with estrogen monotherapy. However, due to the high risk of bias and small sample sizes, definitive conclusions cannot be drawn. Conclusion This review exposes the scarcity of quality research on a highly prevalent topic in clinical practice, and the compelling need for further studies to provide these women with high-quality clinical care.

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