Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Denmark.
Acta Obstet Gynecol Scand. 2007 Oct;86(10):1158-64. doi: 10.1080/00016340701619407.
Postmenopausal endometriosis is rare. The purpose of this presentation is to give a review of the topic based on existing literature.
A Medline search concerning postmenopausal endometriosis was carried out. Hormone therapy and risk of malignancy in these patients are discussed.
Some 32 case reports on postmenopausal endometriosis were found. The most common location is in the ovaries. Estrogens stimulate endometriosis. There is a risk of recurrence or de novo occurrence of endometriosis after the menopause in patients who take hormone therapy (HT); especially estrogen only therapy (ET). So far, treatment has primarily been surgery (hysterectomy (TAH) and bilateral oophorectomy (BSO)).There is little experience with medical treatment (aromatase inhibitors). The risk of malignant transformation of premenopausal endometriosis is around 1%. Furthermore, patients with endometriosis have an increased risk of ovarian cancer, and, apparently, other malignancies. The risk of malignant transformation appears to be further elevated in patients who take ET, although this subject is not fully elucidated.
Although the condition is rare, it is important to be aware of endometriosis after the menopause. Postmenopausal endometriosis infers a risk of recurrence and malignant transformation. Although solid evidence is lacking, the risk of malignant transformation appears to be lower during combined HT compared to ET. Thus, hormone replacement therapy should generally be reserved for patients with severe climacteric complaints, and if indicated, combined therapy should be used.
绝经后子宫内膜异位症较为罕见。本文旨在基于现有文献对此症进行综述。
检索了有关绝经后子宫内膜异位症的 Medline 文献。本文讨论了此类患者的激素治疗和恶变风险。
共发现 32 例绝经后子宫内膜异位症的病例报告。最常见的发病部位是卵巢。雌激素可刺激子宫内膜异位症。接受激素治疗（HT）的患者（尤其是单独使用雌激素治疗的患者）绝经后复发或新发子宫内膜异位症的风险较高。到目前为止，治疗主要是手术（子宫切除术（TAH）和双侧卵巢切除术（BSO））。采用药物治疗（芳香酶抑制剂）的经验较少。绝经前子宫内膜异位症发生恶变的风险约为 1%。此外，子宫内膜异位症患者发生卵巢癌和其他恶性肿瘤的风险增加，而似乎这种风险会因接受 ET 而进一步升高，尽管这一问题尚未完全阐明。
尽管这种病症较为罕见，但绝经后出现子宫内膜异位症时仍应予以重视。绝经后子宫内膜异位症提示有复发和恶变风险。尽管缺乏确凿证据，但与 ET 相比，联合 HT 的恶变风险似乎较低。因此，激素替代疗法通常应保留给有严重更年期症状的患者，如果需要，应采用联合治疗。
