Amer Saad, Bazmi Subul
Division of Translational Medical Sciences, School of Medicine, Royal Derby Hospital Centre, University of Nottingham, Derby DE22 3DT, UK.
Department of Obstetrics and Gynaecology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NT, UK.
J Clin Med. 2023 Jan 1;12(1):336. doi: 10.3390/jcm12010336.
The optimal hormone replacement therapy (HRT) in women who have undergone pelvic clearance for endometriosis remains uncertain with insufficient evidence. The purpose of this case report and the national survey was to highlight the potential HRT-related risks and to establish current HRT practice in this group of women. The case was a 45-year-old woman presenting with recurrence of severe chronic pelvic pain while on oestrogen-only HRT (EO-HRT) for five years after subtotal hysterectomy and bilateral oophorectomy for severe endometriosis. MRI revealed multiple peri-cervical endometriomas and severe right hydroureter/hydronephrosis with complete right renal parenchymal loss. The survey was a 21-item questionnaire administered electronically using SurveyMonkey. It was reviewed and approved by British Menopause Society and British Society of Gynaecological endoscopy and was sent to their members as well as NHS Gynaecologists. A total of 216 physicians responded including 120 (55.6%) Gynaecology Consultants and 96 (44.4%) GPs/Nurses in Menopause clinics. Overall, 68.6% of responders prescribe combined HRT (C-HRT), 11.1% tibolone, 13.0% EO-HRT and 7.8% varied HRT. Fifty-one percent prescribe the progestogen component of C-HRT indefinitely, 22% for 3-6 months and 27% for varied durations. In conclusion, this study highlights the real risk of endometriosis recurrence in EO-HRT users after pelvic clearance for endometriosis. The survey revealed that only two thirds of Gynecologists/Menopause practitioners prescribe combined HRT in this group of women.
对于因子宫内膜异位症而接受盆腔清除术的女性，最佳激素替代疗法（HRT）仍不明确，证据不足。本病例报告及全国性调查的目的是强调与HRT相关的潜在风险，并确立该组女性当前的HRT应用情况。该病例为一名45岁女性，因严重子宫内膜异位症行子宫次全切除术和双侧卵巢切除术后，接受单纯雌激素HRT（EO-HRT）五年，出现严重慢性盆腔疼痛复发。MRI显示多个宫颈周围子宫内膜瘤，以及严重的右侧输尿管积水/肾盂积水，右侧肾实质完全丧失。该调查是一份包含21个条目的问卷，通过SurveyMonkey以电子方式发放。问卷经英国更年期协会和英国妇科内镜学会审核批准，发放给其成员以及英国国家医疗服务体系（NHS）的妇科医生。共有216名医生回复，其中包括120名（55.6%）妇科顾问医生和96名（44.4%）更年期诊所的全科医生/护士。总体而言，68.6%的回复者开具联合HRT（C-HRT），11.1%开具替勃龙，13.0%开具EO-HRT，7.8%开具不同类型的HRT。51%的回复者无限期开具C-HRT的孕激素成分，22%开具3至6个月，27%开具不同时长。总之，本研究强调了因子宫内膜异位症接受盆腔清除术的女性使用EO-HRT后子宫内膜异位症复发的实际风险。调查显示，在该组女性中，只有三分之二的妇科医生/更年期从业者开具联合HRT。
