A majority of 50 postmenopausal women diagnosed with endometriosis had no previous history of the disease, a review of cases treated over a 5-year period at one institution found.
Endometriosis is not just a disease of the childbearing years. When pelvic pain, adnexal masses, and other typical signs and symptoms of endometriosis in menopausal or postmenopausal women are present, the disease may indeed be present, Dr. Ash Dabbous said in a poster presentation at the World Congress on Endometriosis.
A total of 42% of these patients were not on hormone replacement therapy (HRT), illustrating that exogenous hormones are not necessary for endometriosis to develop postmenopausally, added Dr. Dabbous, an ob.gyn. at the University of Texas, San Antonio.
In general, endometriotic lesions are believed to depend on estrogen for proliferation and to regress in the absence of ovarian function. There have been previous reports, however, of symptomatic endometriosis recurring in oophorectomized women who were not on HRT.
Endometriosis is a disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining. Although endometriosis can occur very rarely in postmenopausal women, it is found almost exclusively in women of reproductive age. All other manifestations of endometriosis exhibit a wide spectrum of expression. The lesions are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can occur anywhere in the body.
Symptoms range from nonexistent to extreme. They can include painful menstrual cramps, pain during intercourse and/or elimination, abnormal uterine bleeding and infertility.
An estimated 2%-4% of endometriosis cases are diagnosed in the postmenopausal period.
In a review of surgical pathology databases at Emory University Hospital Systems in Atlanta, Dr. Dabbous and his associates found records for 50 postmenopausal patients who underwent surgery between 1995 and 2000 who had a histologic diagnosis of endometriosis. This constitutes the largest series of postmenopausal endometriosis cases ever studied, he said.
A total of 57% of the women had no previous history of endometriosis, and 60% had undergone previous abdominal surgery, he said at the meeting, sponsored by the World Endometriosis Society and the American Society for Reproductive Medicine.
The women averaged 57 years in age and had been menopausal for an average of 7 years. Of the 50 patients, 38 experienced natural menopause. Eighty percent of the patients studied were white.
The women went to surgery primarily to treat adnexal masses or postmenopausal bleeding. Others were being treated for endometrial cancer, a second look at ovarian cancer, myomas, pain, or other reasons. Some patients had more than one indication for surgery.
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