TIMING OF ESTROGEN REPLACEMENT THERAPY FOLLOWING HYSTERECTOMY WITH OOPHORECTOMY FOR ENDOMETRIOSIS

Objective: To determine whether the immediate initiation of estrogen r eplacement therapy (ERT) in the postoperative period increases the inc idence of symptom recurrence following total abdominal hysterectomy (T AH) with bilateral salpingo-oophorectomy (BSO) for the treatment of en dometriosis. Methods: In a retrospective cohort study, 95 women who un derwent TAH with BSO for endometriosis at the Johns Hopkins Hospital d uring 1979-1991 and who subsequently received ERT were identified by c omputer search. Follow-up information was obtained from medical record s, outpatient charts, and telephone surveys. Pain recurrence in patien ts who started ERT within 6 weeks after surgery and in those who delay ed ERT for more than 6 weeks was compared and adjusted for length of p atient follow-up and other covariates. Results: Sixty women began ERT within the immediate postoperative period, and four (7%) of them had r ecurrent pain; 35 women began ERT more than 6 weeks after surgery, and seven (20%) of them had recurrent pain. The mean length of follow-up was 57 months. The difference in the crude rate of symptom recurrence following early and delayed initiation of ERT after TAH with BSO was n ot statistically significant (P = .09). Controlling for length of pati ent follow-up, no significant differences were observed between the tw o groups. Adjusting for covariates of stage, age, and postoperative ad junct medroxyprogesterone therapy, those who started ERT more than 6 w eeks after surgery had a relative risk of 5.7 (95% confidence interval 1.3, 25.2) for pain recurrence. Conclusion: Although the number of pa tients in the study was too small to reach statistical significance in all analyses, these findings suggest that patients who begin ERT imme diately after TAH with BSO are at no greater risk of recurrent pain th an those who delay ERT for more than 6 weeks. (C) 1998 by The American College of Obstetricians and Gynecologists.