••• CHAPTER 33^ Menopause^335
❍ Is the addition of progestin required in women on estrogen replacement who undergo endometrial ablation?
Yes.
❍ What are some causes of chronic estrogen exposure predisposing patients to a higher risk of endometrial
changes?
Obesity, DUB, anovulation and infertility, hirsutism, high alcohol intake, hepatic disease, diabetes, and
hypothyroidism.
❍ When should endometrial biopsies be performed prior to initiating HRT?
Patients at high risk of endometrial changes associated with chronic estrogen exposure and a history of previous
unopposed estrogen therapy, or patients with abnormal bleeding.
❍ When is an endometrial biopsy recommended when breakthrough bleeding occurs on HRT?
Women who have used unopposed estrogen in the past, an endometrial thickness >5 mm, or after 1 year of
amenorrhea on HRT.
❍ How should women who take unopposed estrogen be followed?
Endometrial sampling or vaginal probe ultrasound yearly.
❍ Why is the estrogen progesterone combination sometimes recommended in hysterectomized women
with endometriosis?
Adenocarcinoma has occurred in patients with endometriosis on unopposed estrogen.
❍ What are some of the potential benefits of androgen replacement?
Improved well-being and sexual behavior.
❍ What negative effects does testosterone replacement therapy have?
Hirsutism and adverse effects on lipids.
❍ Patients with what stage of endometrial cancer can safely take estrogen replacement therapy?
Stage 1 grade 1, and low-grade adenocarcinoma.
❍ What conditions are not contraindications for HRT?
Controlled hypertension, diabetes, and varicose veins.
❍ Does estrogen replacement therapy promote fibroid tumor growth?
No.
❍ What gynecological malignancies are not contraindications to HRT?
Ovarian, cervical, and vulvar.
❍ What effect does estrogen therapy have on colorectal cancer?
It significantly decreases the risk of colorectal cancer.