It is believed that endometriosis is not found in women with menstrual function extinct: no menstruation - no endometriosis. Unfortunately, women with natural menopause, the risk of recurrence of endometriosis is 3, 7% in women with surgical menopause - 2, 7%.
Mercifully left ovary after surgery increases the risk of renewed pain in 6, 1 and 8 times, 1 times increased risk of reoperation compared to women, which was removed and the uterus and ovaries. Therefore, the possible recurrence of the disease should always think of women with a history of hysterectomy and classic symptoms of endometriosis - pain.
The first case of endometriosis in postmenopausal women has been described as early as 1950. Since then, periodically there are similar publications, causing permanent interest.
J.C. Rosa-e-Silva and colleagues presented three cases of histologically confirmed disease in postmenopausal women without a history of endometriosis, never received HRT (hormone replacement therapy):
- A woman aged 62 - endometrioma, pelvic pain
- A woman aged 78 years was found endometriosis in postoperative scar after gistrektomii produced 20 years ago
- A woman of 54 years (from 48 years of menopause) diagnosed endometriosis in the rectovaginal septum
It is interesting that in postmenopausal women are more common extragenital endometriosis (large and small intestine, bladder, urethra, lung, liver and skin) and endometrioma.
Diagnosis in such cases is much more difficult. First of all doctors think the exclusion of cancer. Especially difficult to correct diagnosis patients, without reference to a history of endometriosis. The unequivocal answer to the question, it is primarily caused endometriosis or recurrence of an old undiagnosed, does not exist. In relation to endometriosis is dominated by theories and hypotheses. The absolute is believed that surgical treatment should be the first step in the treatment of patients with endometriosis, revealed for the first time in postmenopausal women.
In practice, gynecologists often worried about whether you can conduct HRT patients with endometriosis? Do not use estrogens provoke relapse? And this question is not idle.
Prolonged use of GnRHa (gonadotropin releasing hormone), repeated surgical interventions help reduce the ovarian reserve and the development of early and premature menopause. On the one hand, the earlier a woman enters menopause, the greater the risk of cardiovascular events, urotroficheskih detection, lower cognitive function and quality of life. On the other hand, possible resumption of relapse of pain, repeated surgeries and even malignancy.
Position EMAS: Keeping menopausal women with a history of endometriosis, 2010
• HRT shows women with early / premature menopause before the average age of menopause, and should be considered in older women with severe vasomotor symptoms.
• Data relating to the use of HRT in women with a history of endometriosis is limited. Apparently, it is necessary to apply a continuous combined regimen regardless of whether or not a hysterectomy. This will help reduce the risk of disease recurrence and malignancy of the remaining endometriosis.
• Alternative therapies and kostnoprotektivnye drugs should be used in women who are not receiving hormone therapy.
• Appointment of drugs produced on the basis of herbs should be used with caution because their effectiveness has not been studied properly and may include estrogen-like components with unpredictable effects in these patients.
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