作者
L. Alio,Stefano Angioni,Saverio Arena,Ludovica Bartiromo,Valentino Bergamini,Nicola Berlanda,Valentina Bonanni,Cecilia Bonin,Laura Buggio,Massimo Candiani,Gabriele Centini,Maurizio Nicola D’Alterio,Ferrari Stefano,Annalisa Di Cello,C. Exacoustós,Luigi Fedele,Maria Pina Frattaruolo,E. Geraci,E. Lavarini,Lucia Lazzeri,Stefano Luisi,Antonio Maiorana,Sofia Makieva,Francesco Maneschi,Francesco Giuseppe Martire,Claudia Massarotti,Alberto Mattei,Ludovico Muzii,Jessica Ottolina,Luca Pagliardini,Alessio Perandini,Federica Perelli,Ida Pino,Maria Grazia Porpora,Valentino Remorgida,Giuseppe Scagnelli,Renato Seracchioli,Eugenio Solima,Edgardo Somigliana,G Sorrenti,Adele Ticino,Roberta Venturella,Paola Viganò,Michele Vignali,Fabrizio Zullo,Errico Zupi
摘要
The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.