Endometriosis: seeking optimal management in women approaching menopause

Abstract

The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.

Hormonal Replacement Therapy in Menopausal Women with History of Endometriosis: A Review of Literature

“…This disease affects 10–15% of women of reproductive age, and its main symptoms are pelvic pain and infertility [1,2]. Being an estrogen-dependent disease, endometriosis tends to undergo regression after spontaneous or surgically-induced menopause [3,4]. In fact, menopause is associated with a fall in estrogen levels, which often relieves endometriosis-related symptoms, but can trigger menopausal ones, such as mood alterations, vaginal dryness, hot flushes, and night sweats.…”

Medical and surgical interventions to improve the quality of life for endometriosis patients: a systematic review

“…It occurs principally during one's reproductive age, most commonly between the ages of 25 and 35 [3,4]. Its prevalence of 7-10% makes endometriosis one of the most common gynecological chronic inflammatory diseases, and it often affects quality of life (QoL) and fertility [5][6][7][8][9]. Recent literature has shown that many factors contribute to the etiopathogenesis of endometriosis: genetic, hormonal, and immunological factors play a role, while even intestinal permeability may also be involved [10][11][12][13].…”

“…Endometriosis affects the QoL of many women, including social relationships, daily activity, productivity at work, and family planning [17]. According to the clinical context and the patient's needs, the treatment of this pathology can be medical or surgical [8,18]. In both blocking the progression of lesions and causing their regression, medical treatment has been demonstrated to be effective, resulting in improved symptoms.…”

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

“…Nevertheless, post-menopausal deep endometriosis does exist and pregnancy can be complicated by the presence of endometriosis. 18 DE symptoms are not only related to the lesion itself but also to the associated fibrotic reaction causing pelvic adhesions and anatomical distortion that can persist even after the lesion has become inactive ( Figure 1).…”