Review

更年期与子宫内膜异位症

Menopause and endometriosis

MATURITAS

影响因子:3.6

分区:医学2区 / 妇产科学2区老年医学3区

发表日期:2024 Dec

作者: Chiara Cassani, Sara Tedeschi, Laura Cucinella, Vittoria Morteo, Cristina Angela Camnasio, Lara Tiranini, Ellis Martini, Rossella E Nappi

DOI: 10.1016/j.maturitas.2024.108129

摘要

由认为子宫内膜异位症仅影响生育年龄女性的观念转变为认识其在绝经后患者中的表现，极大改变了研究视角。尽管这一认识逐渐深入，但关于绝经后子宫内膜异位症的文献资料仍然有限，存在其流行率、临床意义、最佳管理策略及预后等不确定性。绝经后患者的子宫内膜异位症临床表现缺乏特异性，疼痛可能在任何阶段出现。当前主要的治疗策略是手术切除，既用于诊断也用于治疗，同时降低存在恶性肿瘤的风险。在绝经后女性中，疾病管理面临挑战，包括可能禁忌激素替代疗法及复发和恶变的高风险。然而，目前缺乏关于激素替代疗法在子宫内膜异位症患者中的安全性和有效性的确凿证据。现行建议倾向于优先考虑复合激素制剂或Tibolone，而非仅用雌激素治疗，以减少潜在的恶性风险。绝经后伴有子宫内膜异位症的女性中，骨质疏松和心血管疾病的风险增加，可能与早期手术性绝经史有关，但仍需更多研究。本综述总结了相关文献，阐述了子宫内膜异位症与绝经的复杂关系，包括发病机制、症状、肿瘤风险、诊断和治疗策略。

Abstract

The shift in paradigm from the belief that endometriosis exclusively affects women of reproductive age has brought attention to its manifestation in postmenopausal patients. Despite this emerging awareness, there remains a dearth of information in the literature regarding postmenopausal endometriosis, with uncertainties surrounding its prevalence, clinical significance, optimal management strategies, and prognosis. Clinical manifestations of endometriosis in menopausal patients lack specificity, with pain onset possible at any stage of life. The primary approach for symptomatic postmenopausal endometriosis continues to be surgical excision, serving both diagnostic and therapeutic purposes while mitigating the risk of coexisting malignancies. Managing the disease in postmenopausal women presents challenges due to possible contraindications for menopausal hormone therapy and the elevated risk of recurrence and malignant transformation. However, conclusive data regarding the appropriateness of menopausal hormone therapy in women with endometriosis or a history of the disease are lacking. Current recommendations lean towards prioritizing combined menopausal hormone therapy formulations or tibolone over estrogen-only therapies due to their potentially higher malignancy risk. The possible increased risk of osteoporosis and cardiovascular disease in postmenopausal women with endometriosis is likely linked to a history of surgical menopause at an earlier age, but more research is warranted. This narrative review summarizes the available literature and provides insights into the intricate connection between endometriosis and menopause, shedding light on pathogenesis, symptoms, oncologic risk, diagnosis, and treatment.