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Estrogen replacement therapy and the surgeon.

D P Shackelford¹, J F Lalikos

¹Department of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina 27858, USA.

American Journal of Surgery

|July 6, 2000

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Estrogen replacement therapy (ERT) is common in postmenopausal women. This review suggests ERT need not be withdrawn before surgery, and should be offered post-operatively to improve healing and reduce risks.

Area of Science:

Geriatric Medicine
Surgical Oncology
Pharmacology

Background:

The population aged over 65 is growing, increasing surgical demand by 50%.
Postmenopausal women frequently use estrogen replacement therapy (ERT) for symptom relief and disease prevention.
Women constitute the majority of the elderly population undergoing surgery.

Purpose of the Study:

To review the impact of ERT on wound healing and fracture repair.
To assess ERT's effect on perioperative cardiac morbidity and thrombosis.
To provide evidence-based recommendations for ERT management in surgical patients.

Main Methods:

A comprehensive literature review was conducted using the Medline database.
Studies examining estrogen therapy and surgical outcomes were systematically analyzed.

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Evidence regarding wound healing, bone repair, cardiovascular events, and thrombosis was synthesized.

Main Results:

Limited data exists on the direct impact of ERT on surgical wound healing and fracture repair.
Current evidence does not strongly support or refute a significant increase in perioperative cardiac morbidity or thrombosis with ERT.
The review highlights a lack of conclusive studies on ERT's role in surgical contexts.

Conclusions:

There is insufficient evidence to warrant the routine discontinuation of ERT upon hospital admission for surgery.
Postmenopausal women not on ERT should be considered for therapy initiation upon regaining ambulatory status.
Further research is needed to clarify the risks and benefits of ERT in surgical patients.