Gujarat Medical Education and Research Society (GMERS), Medical College and Hospital, Vadodara 390021, India.
Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, FL 32224, USA.
Medicina (Kaunas). 2024 Aug 18;60(8):1341. doi: 10.3390/medicina60081341.
Endometriosis, an inflammatory disease primarily affecting the pelvis and peritoneum, manifests with pelvic pain, dysmenorrhea, dyschezia, dyspareunia, and infertility. Despite its ubiquity, the management of endometriosis is challenging due to its heterogeneous presentation, limitations in diagnostic methods, variable therapeutic responses, and personal and socio-cultural impact on quality of life. This review attempts to consolidate the current literature on endometriosis occurring during and beyond menopause, and to present details regarding management strategies that take into account individual outcomes and goals when managing this condition. The topics included in this review are the clinical features and differential diagnosis of pelvic pain in postmenopausal patients, imaging considerations, serum and laboratory biomarkers, indications for surgery, the principles of hormone replacement therapy, the de novo development of endometriosis after menopause, and malignant transformation. Each topic includes a summary of the current literature, utilizing clinical research, case reports, and expert opinion. Despite a better understanding of the impact of endometriosis beyond menopause, there are many limitations to this condition, specifically with regard to cancer risk and indications for surgery. The existing evidence supports the use of shared decision making and the incorporation of patient preferences in guiding clinical management. Future research endeavors must shed light on the natural history of postmenopausal endometriosis through longitudinal studies in order to foster a deeper understanding of its complicated disease course across women's lifespans.
子宫内膜异位症是一种主要影响骨盆和腹膜的炎症性疾病，其表现为骨盆疼痛、痛经、排便困难、性交困难和不孕。尽管子宫内膜异位症很常见，但由于其表现形式多样、诊断方法有限、治疗反应不同以及对生活质量的个人和社会文化影响，其管理具有挑战性。本综述试图综合目前关于绝经期间和绝经后发生的子宫内膜异位症的文献，并介绍在管理这种疾病时考虑个体结果和目标的管理策略的细节。本综述涵盖的主题包括绝经后患者盆腔疼痛的临床特征和鉴别诊断、影像学考虑、血清和实验室生物标志物、手术指征、激素替代疗法的原则、绝经后新发子宫内膜异位症和恶变。每个主题都包括对当前文献的总结，利用临床研究、病例报告和专家意见。尽管对绝经后子宫内膜异位症的影响有了更好的理解，但这种疾病仍然存在许多局限性，特别是在癌症风险和手术指征方面。现有证据支持使用共同决策并将患者偏好纳入指导临床管理。未来的研究必须通过对绝经后子宫内膜异位症的纵向研究来揭示其自然病史，以加深对女性整个生命周期中其复杂疾病过程的理解。
