Prescription Of Hormone Replacement Therapy Research Articles

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.

Quality improvement project - Reducing the inadvertent prescribing of unopposed estrogen in primary care Dr Liz Horrocks Banstead PCN.

The aim of the project was to reduce the risk of patients using the estrogen only part of their hormone replacement therapy (HRT) inadvertently in Banstead PCN. Although understanding about the risk of unopposed estrogen is well understood by prescribers, there are numerous flash points where this exposure can occur which was highlighted by several cases encountered during a study period of 3months. Cases encountered revealed numerous reasons for this exposure which were split into three areas: Prescribing factors, dispensing checks and patient understanding. Quality improvement suggestions were tailored to the factors involved. IT system changes to EMIS, our main computer software provider, were proposed to enable safer prescribing. Following discussion with key stakeholders, increased education for pharmacists was proposed alongside an alert sticker system at the dispensing end point. Patient understanding and education for all parties was delivered through various routes. The IT system alterations required are complex and still awaited. Funding was obtained and stickers distributed. The results from a re-audit from this intervention are awaited. Interim education measures at an individual level were meantime explored and the impact of them assessed. Patient education and the role of social media were explored. I produced a short video which was circulated to doctors with the plan to distribute via other clinician social media accounts. A key discovery through this study is that many of the flash points identified can be difficult to detect and many are not measurable. The increasing number of HRT prescriptions, time pressures in primary care and the known risk from using unopposed estrogen of endometrial cancer means these changes are of potential great value.

Comprehensive meta-analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials.

Menopause is associated with elevated cardiovascular risk due to the loss of the cardioprotective effect of oestrogens. Postmenopausal women are often prescribed hormone replacement therapy (HRT) in order to control menopause symptoms and correct hormone imbalances; however, HRT can impact serum lipids' concentrations. At present, data on the effect of the administration of medroxyprogesterone acetate plus conjugated equine oestrogens (MPACEE) on the lipid profile in females are uncertain, as the investigations conducted so far have produced conflicting results. Thus, we aimed to clarify the impact of MPACEE prescription on the serum lipids' values in women by means of a systematic review and meta-analysis of randomized controlled trials (RCTs). We employed a random-effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention's impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively. A total of 53 RCTs were included in the meta-analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and 69 RCT arms on high-density lipoprotein cholesterol (HDL-C). Administration of MPACEE resulted in a significant reduction of TC (WMD = -11.93 mg/dL; 95% CI: -13.42, -10.44; p < .001) and LDL-C (WMD = -16.61 mg/dL; 95% CI: -17.97, -15.26; p < .001) levels, and a notable increase in HDL-C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL-C, TG), MPACEE dosages (for TC, LDL-C, HDL-C, TG), age (for TC, LDL-C, HDL-C, TG), durations of the intervention (for TC, LDL-C, HDL-C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL-C, TG) administration of MPACEE and serum lipids' concentrations before enrolment in the RCT (for TC, LDL-C, HDL-C, TG). MPACEE administration can influence serum lipids' concentrations in females by raising HDL-C and TG levels and reducing LDL-C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.

Nutrition for Female Menopausal Cancer Survivors: Developing Ireland’s First Resource

Women diagnosed with a hormone-receptor positive (HR+) breast or gynaecological cancer are not routinely prescribed hormone replacement therapy to alleviate menopausal symptoms due to the risk of causing cancer recurrence. Many of these women use herbal or botanical supplements, diet and lifestyle interventions to provide relief. Through an extensive literature review, national focus groups with menopausal female cancer survivors, consultation with an established public and patient involvement panel, and the creation of a national review panel of medical and healthcare professionals, Ireland’s first evidence-based resource is in development for female menopausal cancer survivors.

Hormone Replacement Therapy in Post-Menopause Hormone-Dependent Gynecological Cancer Patients: A Narrative Review.

Advances in the treatment of gynecological cancer have led to improvements in survival but also an increase in menopausal symptoms, especially in young women with premature iatrogenic menopause. A narrative review was performed to clarify the possibility of prescribing hormone replacement therapy (HRT) after hormone-dependent gynecological cancers (ovarian cancer [OC], cervical adenocarcinoma [AC], and endometrial cancer [EC]). HRT can be prescribed to patients with early-stage, grade I-II OC who experience bothersome menopausal symptoms non-responsive to alternative non-hormone therapy after optimal surgery. Caution should be exercised in administering HRT after serous borderline tumors and endometrioid OC, and HRT is not recommended in low-grade serous OC. HRT is not contraindicated in AC survivors. After surgery for EC, HRT can be prescribed in women with early-stage low-grade EC. There is not enough data to give indications to patients with advanced EC. HRT can be discussed with patients, evaluating the risks and benefits of hormone-dependent gynecological cancer. Counseling should be performed by gynecologic oncologists experienced in the management of these patients.

Hormone replacement therapy in gynecological cancer survivors and BRCA mutation carriers: a MITO group survey.

Early iatrogenic menopause in gynecological cancer survivors and BRCA mutation (BRCAm) carriers undergoing risk-reducing salpingo-oophorectomy (RRSO) is a major health concern. Hormone replacement therapy (HRT) is the most effective remedy, but remains underused in clinical practice. The Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group promoted a national survey to investigate the knowledge and attitudes of healthcare professionals regarding the prescription of HRT. The survey consisted of a self-administered, multiple-choice 45-item questionnaire, available online to all MITO members for 2 months starting from January 2022. A total of 61 participants completed the questionnaire (47 out of 180 MITO centers; compliance: 26.1%). Most respondents were female (73.8%), younger than 50 years (65.6%), and gynecologic oncologists (55.7%), working in public general hospitals (49.2%). An 84.4% of specialists actively discuss HRT with patients and 51.0% of patients ask the specialist for an opinion on HRT. The rate of specialists globally in favor of prescribing HRT was 22.9% for ovarian cancer, 49.1% for cervical cancer, and 8.2% for endometrial cancer patients. Most respondents (70.5%) believe HRT is safe for BRCA-mutated patients after RRSO. Nearly 70% of physicians prescribe systemic HRT, while 23.8% prefer local HRT. Most specialists recommend HRT for as long as there is a benefit and generally for up to 5 years. Real-world data suggest that many healthcare professionals still do not easily prescribe HRT for gynecological cancer survivors and BRCA mutation carriers after RRSO. Further efforts are required to implement the use of HRT in clinical practice and to support both clinicians in recommending HRT and patients in accepting it.

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

Prescribing hormone replacement therapy: key considerations for primary care physicians.

Prescribing hormone replacement therapy: key considerations for primary care physicians.

Care, choice, complexities: The circulations of hormone therapy in early menopause

Navigating whether to prescribe hormone replacement therapy (HRT) requires that health practitioners approach a woman’s individual life circumstances, and early menopause (EM) as a particularly intricate experience and condition. Drawing on qualitative interviews with 16 practitioners in Australia, this article examines the modalities of care that emerge in the nexus of EM and HRT. Early menopause emerges in participants’ narratives as far from a ‘unitary’ medical condition, but rather one that reaches across other embodied changes for women which may be moderated by HRT. Thus, different modes of care and tensions surface, and we suggest that these constitute an oscillation between ‘caring for’ and ‘caring with’ in medical practice. This oscillation combines experimentation with and adjustment of HRT, while contending with responsibility, risk and choice, and shared, knowledgeable care. Our goal is not to neatly split ‘caring for’ from ‘caring with’. Rather, we discuss how ambiguities of care circulate through a complex diagnosis and its treatment options. We argue that care, in this context, manifests as potentiality and as a set of flexible practices that at times cannot be fully disentangled from issues of choice and control, and HRT itself.

The Effects of Purple Sweet Potato (Ipomoea Batatas L.) Ethanol Extract on Bladder Urothelial Layer and Smooth Muscle Thicknesses in Menopausal Female Wistar Rats

Highlights: Purple sweet potatoes cultivated in Bali, Indonesia, were found to be rich in phytoestrogen due to the high levels of anthocyanin-type flavonoids. The phytoestrogen in purple sweet potato ethanol extract demonstrated estrogenic activity and the potential to substitute hormone replacement therapy (HRT) as the treatment of lower urinary tract symptoms. Abstract Postmenopausal women experience estrogen hormone deficiency, which can cause thinning of the smooth muscle and urothelial layer of the bladder, leading to lower urinary tract symptoms (LUTS). Hormone replacement therapy (HRT) has been the primary choice for addressing these problems. However, long-term prescription of HRT can result in several adverse effects, including a higher risk of breast cancer and cardiovascular diseases. Phytoestrogen, an estrogen-like compound derived from plants such as purple sweet potatoes (Ipomoea batatas L.), contains anthocyanin that could serve as a better alternative to estrogen replacement therapy. This study aimed to demonstrate the effects of phytoestrogens in purple sweet potatoes on the histomorphology of the bladder in menopausal female Wistar rats (Rattus norvegicus). This experimental study used a posttest-only control group design. A total of 36 Wistar rats undergoing ovariectomy were randomly assigned into two groups, with 18 samples in each group. The experimental group received the purple sweet potato ethanol extract orally, while the control group received a placebo. The structures of the smooth muscle and urothelial layer of the bladder were observed using a microscope. Data were analyzed using an independent t-test to compare bladder smooth muscle and urothelial layer thickness between groups, with a significance of p&lt;0.05. A normality test was performed to determine the normal distribution of the data. Normally distributed data were assessed to find the mean and standard deviation (SD). Significant differences were found in the mean thickness of the smooth muscle and urothelial layer between both groups (p=0.00), with both being thicker in the experimental group. In conclusion, phytoestrogens in purple sweet potatoes can influence the histomorphology of the bladder. Ovariectomized female Wistar rats that received purple sweet potato ethanol extract exhibited thicker smooth muscle and urothelial layer of the bladder.

Analysis of options for prescribing hormone replacement therapy after thyroid organ-sparing surgery

Background. Performing thyroid organ-sparing surgery primarily aims to preserve the quality of life. Organ-sparing surgery should be understood as hemithyroidectomy with mandatory removal of the isthmus and pyramidal lobe of the thyroid (if present). The choice of one or another concept of prescribing hormone replacement therapy remains debatable. The purpose of the study is to determine the proportion of patients who do not need replacement therapy with levothyroxine after organ-sparing surgery on the thyroid gland, among those who were prescribed replacement therapy immediately and one month after discharge from the hospital, as well as to analyze the factors causing hypothyroidism in people with hemithyroidectomy. Materials and methods. The first group included 82 patients with hemithyroidectomy who were prescribed replacement therapy immediately after discharge from the hospital. The second group included 61 patients with hemithyroidectomy. The administration of replacement therapy was postponed for one month. A month after the operation, clinical examinations and monitoring of thyroid-stimulating hormone and free thyroxine indicators were performed. Results. After one month of observation, 72 (87.8%) of 82 patients in the first group continued to take levothyroxine, and 8 (13.1%) of 61 persons in the second group began to take it. In the first group, there was a moderate direct correlation between thyroid-stimulating hormone level before surgery and levothyroxine dose one month after (Spearman’s correlation coefficient 0.304, p=0.009). It was found that the chances of continuing taking levothyroxine after one month in the first group were 47 times higher than the chances of prescribing levothyroxine after one month in the second group. The proportion of patients in the first group who continued to take levothyroxine after one month was significantly higher than the proportion of patients in the second group who started taking levothyroxine after one month (87.8±3.6% vs. 13.1±3.5%, p&lt;0.0001, Fisher’s exact test). Conclusions. Among patients who were prescribed hormone replacement therapy immediately after hemithyroidectomy, 12.2% did not need to continue taking levothyroxine after one month. Among persons in whom the administration of hormone replacement therapy was postponed for one month after hemithyroidectomy, 86.9% of patients did not require the use of levothyroxine in the future. The volume of the thyroid remnant ≤ 3.67 cm3 can be considered a predictor for hypothyroidism occurrence in the future, with a high risk of prescribing hormone replacement therapy. The study of such a factor as the ratio of the remnant thyroid volume to the body weight did not provide statistically reliable data for its use as a predictor of hypothyroidism occurrence in the postoperative period.

Comparative characteristics of extended endoscopic endonasal operations in giant pituitary adenomas with ventricular system extention and craniopharyngiomas

Objective ‒ to evaluate the results of extended endonasal interventions in patients with craniopharyngioma (CPH) and giant pituitary adenoma (GPA) with an extension to ventricular system, to compare the effects of interventions in these pathologies, to determine the basic principles of extended endoscopic endonasal surgical interventions. Materials and methods. The study is based on a retrospective analysis of patients endoscopically operated through the nose in the Department of Endonasal Neurosurgery of the Skull base in the SI «Romodanov Neurosurgery Institute NAMS of Ukraine» from 2014 to 2021. In the group with GPA were 18 (36.7 %) female and 31 (63.3 %) male patients. The mean age of the patients was 54.1±11.3 years. The CPH group included 42 (60.9 %) women and 27 (39.1 %) men. The mean age in this group was 46.6±14.5 years. Results. In 14.3 % of GPA cases, postoperative cerebrospinal fluid leak (CSFL) occurred, which is statistically insignificant compared to the postoperative CSFL level at CPH – 13 %, despite the fact that when removing GPA, we routinely encountered high-flow liquorrhea, given the characteristics of tumor growth (p=0.921). The number of electrolyte abnormalities with CPH was higher than with GPA removal (40.5 % with CPH versus 16.3 % with GPA). For the first time, diabetes insipidus requiring the prescription of hormone replacement therapy due to the removal of GPA that were extending to the ventricular system was diagnosed in the postoperative period in 12.2 % of patients versus 33.3 % in CPH group. Endocrine disorders in the form of hypopituitarism were found in 34.7 % of GPA and 44.9 % of CPH. The median duration of the operation was 227.9±74.9 min for GPA and 318.4±65.4 min for CPH. The area of the trepanation window is always larger in GPA, as it includes an enlarged sellar window and, sometimes, a parasellar direction in the invasion of the cavernous sinuses. Decompression of the optic canals was performed almost exclusively in GPA that extend parasellarly and/or retrosellarly (38,0 % with CPH in comparison to 5.8 % in the GPA group). Closure of the skull base defect was performed with autologous and artificial materials in all cases, as the removal of GPA and CРН was always accompanied by high-flow intraoperative CSFL.Conclusions. After analyzing the results of endonasal surgeries performed in GPA with extension to the ventricular system and CPH, it was noted that the use of extended transtuberculum-transplanum approach provides a wide surgical corridor and provides the possibility of total tumor removal. It is essential to install a lumbar drainage system when working in open liquid spaces. In our opinion, the priority should be given to the safety of operations and prevention of postoperative interventions (preservation of the pituitary stem, perforating arteries, chiasm, minimization of manipulations with the diencephalic areas and the bottom of the III ventricle), rather than increasing radicality in CPH, as in GPA. Fatty graft packaging should be avoided for CPH located near the junction of the optic nerves (in the anterior position of the chiasm), as the absence of the arachnoid barrier increases the risk of involving the optic structures in the postoperative scar.

Correction: Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study.

Correction: Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study.

Is HRT overprescribed?

As general awareness of menopausal symptoms has increased, there has been a rapid rise in prescriptions for hormone replacement therapy (HRT), which is — of course — a good thing, as more perimenopausal women than ever are able to seek help to control their symptoms. However, experts are concerned that women are being prescribed too […]

Hormone replacement therapy in women with history of thrombosis or a thrombophilia.

Findings from the Women's Health Initiative (WHI) randomised placebo-controlled trial (RCT) were published at the beginning of this century. They suggested that hormone replacement therapy (HRT) use increased the risk of cardiovascular disease and venous thromboembolism including pulmonary embolism and deep vein thrombosis The findings led to a decline in HRT prescriptions and negative publicity about the use of HRT for women with significant menopausal symptoms. Subsequent studies have shown that the risk of thrombosis with HRT relates to whether estrogen is combined with a progestogen and the route of administration of estrogen. In healthy women with no background medical problems, transdermal hormone replacement is not associated with an increased risk of thrombosis. However, much less is known about the safety of various HRT preparations in women with a high background risk of thrombosis. These cases can often be challenging for clinicians with uncertainties around testing for thrombophilia, use of anticoagulation and striking a balance between the risks and benefits of prescribing HRT. This article will review the mechanism of thrombosis with differing types of HRT and present the evidence from the relevant trials. The article will also present the evidence that specifically relates to women with a personal history of thrombosis or thrombophilia (heritable and acquired) to enable clinicians to better individualise the risk assessment for each woman requesting HRT and understand the role of thrombophilia screening or concomitant anticoagulation in such situations.

Prescription of hormone replacement therapy among cervical cancer patients with treatment-induced premature menopause

ObjectiveTo examine the utilization of hormone replacement therapy (HRT) among newly diagnosed cervical cancer patients who experienced premature menopause due to primary treatment.MethodsThe MarketScan Databases were used to identify newly...

Hormone replacement therapy prescribing in menopausal women in the UK: a descriptive study.

Recent studies on the prescribing of hormone replacement therapy (HRT) medicines to treat symptoms of menopause are lacking. To describe the prescribing of HRT in a cohort of UK menopausal women. Population-based drug utilisation study using IQVIA Medical Research Database (IMRD-UK). Primary care data of women with recorded menopause and/or aged ≥50 years between January 2010 and November 2021 were extracted from the database. The incidence rate of women who received their first prescription for HRT was calculated annually using person-years-at-risk (PYAR) as the denominator. Incidence rates of HRT were estimated by type and route of administration. Relative changes in annual incidence rates were expressed as percentages and the average percentage change was assessed using linear regression. Annual prescribing prevalence per 100 women was calculated using mid-year menopausal population estimates. The incidence rate of prescribing of HRT increased from 5.01 in 2010 to 18.16 per 1000 PYAR in 2021, a relative increase of 13.64% (95% confidence interval [CI] = 6.97 to 20.30) per year. The incidence rate of fixed combinations of HRT increased from 3.33 to 12.23 per 1000 PYAR in 2010 and 2021, respectively. Transdermal formulations of HRT increased from 1.48 to 14.55 per 1000 PYAR in 2010 and 2021, respectively. The overall proportion of women in receipt of a prescription for HRT changed from 7.89% in 2010 to 6.86% in 2020. This study shows a steady increase in the number of women receiving their first prescription for HRT during the study period, which suggests regained acceptance of HRT medicines.

Use of Hormone Replacement Therapy and Risk of Dementia: A Nationwide Cohort Study.

Estrogen has the potential to influence brain physiology implicated in dementia pathogenesis. Hormone replacement therapy (HRT) might be expected to influence the risk of dementia. Observational data indicated that HRT was associated with reductions in dementia risk, but experimental evidence demonstrates that HRT increases the incidence of dementia. To determine the effect of HRT on the risk of dementia, a retrospective cohort study was performed using a nationwide claims dataset in Taiwan. A population-based longitudinal study was performed using data from the Longitudinal Health Insurance Database in Taiwan. A total of 35,024 women with HRT were enrolled as the exposed cohort and 70,048 women without HRT were selected on the basis of propensity matching as the comparison cohort. All participants were followed up until the diagnosis of dementia, death, or at the end of December 31, 2013, whichever occurred first. Overall, the average duration of follow-up (±SD) in the HRT and comparison cohorts was 12.3 (±2.3) and 12.2 (±2.4), respectively. The Cox proportional hazards regression models were conducted to produce hazard ratios (HRs) with 95% CIs to evaluate the association of HRT with the risk of dementia. In the follow-up period, the cumulative incidence of dementia for the HRT cohort (20.04 per 1,000) was significantly higher than the corresponding cumulative incidence for the comparison cohort (15.79 per 1,000), resulting in an adjusted HR of 1.35 (95% CI 1.13-2.62). There was an increased risk of dementia with a higher cumulative dose of HRT prescription (p for trend <0.0001). This cohort study documented that HRT was associated with an increased risk of dementia. The clinical implications of this study merit further investigations.

Reoperation and pain-related outcomes after hysterectomy for endometriosis by oophorectomy status

More research is needed that compares the outcomes between those who underwent a hysterectomy for endometriosis with conservation of one or both ovaries and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. This study aimed to compare the rate and types of reoperations (primary outcome) and use of other pain-related health services (secondary outcomes) among people who underwent a hysterectomy with conservation of both ovaries, those who underwent a hysterectomy with unilateral salpingo-oophorectomy, and those who underwent a hysterectomy with bilateral salpingo-oophorectomy. This was a population-based, retrospective cohort study of 4489 patients aged 19 to 50 years in British Columbia, Canada, who underwent a hysterectomy for endometriosis between 2001 and 2016. Index surgeries were classified as hysterectomy alone (conservation of both ovaries), hysterectomy with unilateral salpingo-oophorectomy, or hysterectomy with bilateral salpingo-oophorectomy. Reoperation rate was the primary outcome. Secondary outcomes (measured at 3-12 months and 1-5 years after hysterectomy) included physician visits for endometriosis and pelvic pain, prescriptions filled for opioids, and use of hormonal suppression medications and hormone replacement therapy. Reoperation rates were low across all groups, with 89.5% of all patients remaining reoperation free by the end of follow-up (median of 10 years; interquartile range, 6.1-14.3 years). Patients who underwent a hysterectomy alone were more likely to undergo at least 1 reoperation when compared with those who underwent a hysterectomy with bilateral salpingo-oophorectomy (13% vs 5%; P<.0001), most commonly an oophorectomy or adhesiolysis. When oophorectomy as reoperation was removed in a sensitivity analysis, this difference was partially attenuated (6% of hysterectomy alone group vs 3% of hysterectomy with bilateral salpingo-oophorectomy group undergoing at least 1 reoperation). All groups were very similar in terms of rates of physician visits for endometriosis or pelvic pain and the number of days of opioid prescriptions filled. Furthermore, the rate of hormonal suppression medication use was similar among the groups, whereas the rate of prescriptions filled for hormone replacement therapy after hysterectomy with bilateral salpingo-oophorectomy was 60.6% of patients who filled at least 1 prescription at 3 to 12 months after index surgery. Patients who underwent a hysterectomy with bilateral salpingo-oophorectomy had a lower reoperation rate than those who underwent a hysterectomy with conservation of one or both ovaries. However, there was little difference between the groups for the secondary outcomes measured, including physician visits for endometriosis and pelvic pain, opioid use, and use of hormonal suppression medications, suggesting that persistent pelvic pain after hysterectomy for endometriosis may not differ substantively based on ovarian conservation status. One limitation was the inability to stratify patients by stage of endometriosis or to determine the impact of endometriosis stage or the presence of adnexal disease or deep endometriosis on the outcomes. Moreover, hormone replacement therapy prescriptions was not filled by about 40% of patients after hysterectomy with bilateral salpingo-oophorectomy, which may have significant health consequences for these individuals undergoing premature surgical menopause. Therefore, strong consideration should be given to ovarian conservation at the time of hysterectomy for endometriosis.

Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study.

BackgroundLimited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19.MethodsWe undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. We identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models.ResultsThere were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP.ConclusionsWe found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality. Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.