Complications of unopposed oestrogen following radical surgery for endometriosis

Four cases are presented here of patients who had total abdominal hysterectomy and bilateral salpingooophorectomy for severe endometriosis. All were eventually placed on unopposed oestrogen replacement therapy, two immediately and the other two after a few months. All subsequently developed recurrence of their endometriosis whilst on oestrogen therapy, one developing an endometroid carcinoma. All required surgery and three were placed on continuous oestrogen/progestogen preparation or alternatively tibolone (which has oestrogenic, progestogenic and androgenic properties) postoperatively. No further recurrence of their disease occurred. The literature was reviewed regarding oestrogen therapy for women who have had bilateral oophorectomy. There were various suggestions as to management but no report on using continuous oestrogen/ progestogen or tibolone. We suggest this as a logical form of replacement therapy for patients who have bilateraloophorectomy for severe endometriosis, as unopposed oestrogen therapy can cause recurrence.