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endometriosis after menopause

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Year: 2019
COI code: DTOGIMED03_145
Paper Language: English

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Authors endometriosis after menopause

Maryam Hashemi Arani - associate professor of medical science of Isfahan university
Zahra Asgarirad - associate professor of medical science of Isfahan university
Reihaneh Hosseini - associate professor of medical science of Isfahan university


Background and Aim : Endometriosis is a common, hormone-dependent gynecologic disease. The exactprevalence of this disease remains unknown, but is thought to be around 6–10%, with only 2–5% beingdiagnosed after menopause . Endometriosis can occur in post-menopausal women with or without hormonalreplacement therapy which indicates the complex mechanism of perpetuation of this pathology. Althoughendometriosis is a benign proliferative disease; it does share common characteristics with neoplasticprocesses [inflammatory state, invasion of adjacent tissues, induction of angiogenesis, and resistance toapoptosis . Malignant transformation of endometriosis is a well-documented though rare phenomenon thatoccurs most commonly in the ovariesMethods : Case report A 53 year old woman G2P2 with spontaneous menopause at age 49 was referredfor persistent ovarian cysts for 2 years as an incidental finding in ultrasound. She had no pelvic pain orinfertility in the past. Her surgical history was laparoscopic cholecystectomy and once cesarean section.She had never taken HRT. The gynecologic exam revealed fullness in both adnexa .TVS showed a normaluterus with endometrial thickness measured 2 mm. A cyst measured 40*40 mm with thick wall and multipleseptations was seen in right ovary .There was another cyst measured 30*20 mm with the same features inleft ovary. CT scan confirmed above findings. Tumor markers were normal. The patient underwentlaparoscopy and revealed frozen pelvis with stage IV endometriosis(score:114).Afteradhesiolysis,enterolysis and bilateral ureterolysis ,bilateral salpingo-oophorectomy was carried out and sentfor frozen section. Right ovarian cyst was endometrioma and left side was serocystadenoma.Recovery wasuneventful and she was discharged on day 3.The permanent pathology confirmed these findingsResults : Discussion Estrogenic stimulation by the ovary during the reproductive phase maintainsendometriosis but, after menopause, several mechanisms are supposed to lead to the hormonal continuancewhich are hormone replacement therapy (HRT, without an associated progestin), and other estrogensecretors such as adipose tissue or the adrenal glands. Studies show that the endometriotic tissue couldsecrete its own estrogen, confirmed by the possible presence of aromatase expression in these ectopiclesions . Research suggests that the postmenopausal state leads to a certain degree of immunosuppressionthat could perpetuate endometriosis , but it is not known whether it is a continuation of a past illness or ade novo development. Our patient did not report any pain or fertility issues and the diagnosis ofendometriosis was never assumed beforehand. The first choice of treatment of postmenopausalendometriosis is a surgical procedure with optimal cytoreduction, due to the risk of malignant degeneration.The association of endometriosis with an increased risk of malignancies has been described but is debatedin the medical literature. Indeed, women with endometriosis were more likely to develop ovarian cancerthan healthy ones, but the causality link is not clearly established. . Age is a risk factor for manymalignancies, from which we may hypothesize a higher malignant transformation potential risk forpostmenopausal women with endometriosisConclusion : Conclusion It should be kept in mind that endometriosis is still an evocable diagnosis evenafter menopause .



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COI code: DTOGIMED03_145

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Hashemi Arani, Maryam; Zahra Asgarirad & Reihaneh Hosseini, 2019, endometriosis after menopause, 3rd debatable topics on obstetrics gynecology & infertility, تهران, دانشگاه علوم پزشكي و خدمات بهداشتي و درماني شهيد بهشتي, the text, wherever referred to or an achievement of this article is mentioned, after mentioning the article, inside the parental, the following specifications are written.
First Time: (Hashemi Arani, Maryam; Zahra Asgarirad & Reihaneh Hosseini, 2019)
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