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.

摘要

与育龄期女性相比, 中年女性子宫内膜异位症的患病率并不低。受影响的妇女在育龄期后向自然过渡到更年期的治疗一直很少受到关注。考虑到有长期病史的患者癌症风险增加, 由于激素治疗的禁忌证和恶性转化的可能性增加, 这些女性的疾病管理存在问题。此高水平的综述旨在首次评估现有疗法的益处, 以帮助指导治疗决策, 以便管理接近更年期的子宫内膜异位症患者。孕激素被证明可有效减轻疼痛, 在这些女性中应该是首选。根据缺乏准确建议的国际指南, 如果药物治疗失败, 子宫与双侧输卵管卵巢切除术应该是完成生殖的女性最终治疗方法。在长期存在或复发性子宫内膜异位囊肿的情况下, 应考虑严格监视或手术切除受影响的性腺, 特别是在有超声囊肿模式改变的情况下。尽管罕见, 也描述了子宫内膜异位症患者各种组织的恶性转化, 并讨论其管理。

Keywords:

• Perimenopause
• endometriosis
• middle-aged women
• management
• endometriosis treatment
• endometriosis malignant transformation

Acknowledgements

All of the authors of the Endometriosis Treatment Italian Club (ETIC Group) conceived the study and discussed the evidence. Paola Viganò, Jessica Ottolina, Ludovica Bartiromo, and Massimo Candiani contributed to the first draft of the article; all authors revised the article and approved the final version.

Conflict of interest

No potential conflict of interest in relation to this topic was reported by the authors.

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.