更年期和子宫内膜异位症
Menopause and endometriosis
影响因子:3.60000
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
摘要
范式转移到了子宫内膜异位症专门影响生殖年龄的妇女的信念上，引起了人们对绝经后患者的表现的关注。尽管有这种新兴的意识，但文献中仍然缺乏有关绝经后子宫内膜异位症的信息，其流行，临床意义，最佳管理策略和预后的不确定性。绝经患者子宫内膜异位症的临床表现缺乏特异性，在任何生活阶段都可能发作。症状性绝经后子宫内膜异位症的主要方法继续是手术切除，既适合诊断和治疗目的，同时降低了共存恶性肿瘤的风险。在绝经后妇女中管理这种疾病，这是由于绝经激素疗法的禁忌症以及复发和恶性转化的风险升高，这引起了挑战。但是，缺乏有关子宫内膜异位症或疾病史的绝经激素治疗适当性的结论性数据。目前的建议倾向于优先考虑更年期激素疗法的组合，或者由于其潜在的恶性风险而不是雌激素疗法而不是雌激素疗法。子宫内膜异位症的绝经后妇女中骨质疏松症和心血管疾病的风险可能增加与早期外科绝经史有关，但有必要进行更多的研究。这项叙述性综述总结了可用的文献，并提供了有关子宫内膜异位和更年期之间复杂联系的见解，阐明了发病机理，症状，肿瘤学风险，诊断和治疗。
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.