Post-Menopausal Endometriosis

Cover image used with licensed permission.

What is endometriosis？

Endometriosis is a chronic disease where the endometrial-like tissue (similar to the uterus lining) grows outside of the uterus and other organs in your abdomen and causes inflammation, scarring, damage to nearby structures, intense pain, and even infertility.
Although endometriosis has been associated with the occurrence of menstrual cycles, affecting about 10% of the people at the reproductive age, it can affect between 2% to 5% of postmenopausal people [Manero, etc., 2009].
The risk of ovarian cancer can increase in women with endometriosis. However, this is very rare [Manero, etc., 2009].

Why is this population also at risk?

Long term effect

Tissue built up over time could cause inflammation, or adhesions

Immunosuppression

Immune system activity decreased with age which could lead to recurrence/re-activation of disease

Ovarian estrogen deficiency

Hormone replacement may stimulate the disease

Autoimmune diseases

The higher-than-average risk of autoimmune diseases in this population could allow tissues to grow

Ovarian Cancer

Though rare, patients with endometriosis may have a slight higher risk to develop ovarian cancer

Treatments can

give back

the

quality of life

By Taking Care of Yourself, You're Taking Care Of Someone Else

Symptoms

Pelvic pain for at Least 6 months

Painful bowel movements

Chronic fatigue

Diaphragmatic/lung pain

Unbearable pain during intercourse

Painful urination

Low back pain

Excessive bleeding

Prevention

The Diagnosis

Pelvic Exam, Ultrasound, and MRI
Laparoscopy - The gold standard minimally invasive diagnostic procedure allowing the doctor to see and remove the disease by using small incisions with the aid of a camera.

Treatment

Stepwise Surgery
- Laparoscopy is typically used to remove the tissue. Hysterectomy can be reserved for select cases in which the disease and the uterus are both excised. Recurrence could still happen.

Aromatase Inhibitor
- If recurrence happens after surgery, aromatase inhibitors may be an option as they reduce local estrogen production in the endometriosis lesion themselves.

References:

Bese T, Simsek Y, Bese N, Ilvan S, Arvas M: Extensive pelvic endometriosis with malignant change in tamoxifen-treated postmenopausal women. Int J Gynecol Cancer. 2003, 13: 376-380. 10.1046/j.1525-1438.2003.13188.x.
Bishop, E. A., Java, J. J., Moore, K. N., Spirtos, N. M., Pearl, M. L., Zivanovic, O., ... & Hurteau, J. (2018). Surgical outcomes among elderly women with endometrial cancer treated by laparoscopic hysterectomy: a NRG/Gynecologic Oncology Group study. American journal of obstetrics and gynecology, 218(1), 109-e1.
de Almeida Asencio, F., Ribeiro, H.A., Ayrosa Ribeiro, P. et al. Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports. Gynecol Surg 16, 3 (2019). https://doi.org/10.1186/s10397-019-1056-x
Geisler JP, Geisler HE. Radical hysterectomy in the elderly female: a comparison to patients age 50 or younger. Gynecol Oncol. 2001;80(2):258-261. doi:10.1006/gyno.2000.6044
González Ramos P, Royo Manero P, Pastor OC, Calleja Aguayo E, De Martino A, Rodino J, Bejarano Lasunción P, Pecondón A, Vicente B, Gracia Romero J, Ortega J, García Manero M, Alcázar Zambrano JL, González de Agüero R, Fabre González E: GREMIO Collaboration Group. University of Zaragoza (Spain). PGR-1 Hot-Dog: a new rat model for the study of the experimentally-induced endometriosis in rats. Proceedings of the 13th World Congress on Human Reproduction: 5-8 March 2009; Venice (Italy). 2009, 89 (161)
Magtibay PM, Heppell J, Leslie KO: Endometriosis-associated invasive adenocarcinoma involving the rectum in a postmenopausal female. Dis Colon Rectum. 2001, 44: 530-533. 10.1007/BF02234612.
Manero, M. G., Royo, P., Olartecoechea, B., & Alcázar, J. L. (2009). Endometriosis in a postmenopausal woman without previous hormonal therapy: a case report. Journal of medical case reports, 3(1), 1-3.
Mutter, G.L. (2014). Endometriosis. In Pathology of the Female Reproductive Tract, pp. 487–508.
Shah, D. (2014). Postmenopausal endometriosis: An enigma revisited. Journal of mid-life health, 5(4), 163.
Soliman NF, Hillard TC. Hormone replacement therapy in women with past history of endometriosis. Climacteric. 2006;9(5):325-335. doi:10.1080/13697130600868711
Tan DA, Almaria MJG. Postmenopausal endometriosis: drawing a clearer clinical picture. Climacteric. 2018;21(3):249-255. doi:10.1080/13697137.2018.1450855
Uccella S, Bonzini M, Palomba S, et al. Laparoscopic vs. open treatment of endometrial cancer in the elderly and very elderly: An age-stratified multicenter study on 1606 women. Gynecol Oncol. 2016;141(2):211-217. doi:10.1016/j.ygyno.2016.02.029