Endometriosis at menopause

Endometriosis during menopause is not a common occurrence, since the only final option for complete cure of endometriosis was considered to be the onset of menopause, but today there is a clear tendency for endometriosis to appear only with the onset of menopause. The pathogenesis of the development of such a pathology during menopause has not been fully studied, but it is necessary to clearly differentiate menopause and symptoms of endometriosis, since this disease has more serious consequences in older women.

[ 1 ], [ 2 ], [ 3 ]

Causes of menopausal endometriosis

Endometriosis is a disease, the essence of which lies in the appearance of foci of the endometrium not only in the uterine cavity, but also outside it, which is accompanied by cyclic changes in these areas in the form of menstruation, regardless of localization. The final pathogenesis of the development of this disease has not been studied, but there are many risk factors. Endometriosis is distinguished as genital, when these foci are located on the female genital organs, and extragenital, when the foci can be on any internal organs - the lungs, diaphragm, liver, on the peritoneum. In turn, genital endometriosis is distinguished as internal - on the internal genital organs, and external - on the external genital organs. This classification is important, since monthly bleeding from these endometrioid foci can correspond to the clinical picture of a certain disease, so it is important to establish the correct diagnosis.

The cause of endometriosis is considered to be frequent surgical interventions on the genitals, as well as on the pelvic organs, against the background of hormonal homeostasis disorders, which contributes to the formation of endometrioid foci. The cause of endometriosis development during menopause has not been fully clarified, since this phenomenon is not typical for this age, but risk factors for the development of this pathology during menopause are identified. Such factors include obesity, diabetes mellitus, inflammatory diseases of the genitals, frequent surgical interventions, postpartum trauma.

[ 4 ]

Pathogenesis

The pathogenesis of extragenital endometriosis is that during surgical interventions on the genitals or pelvic organs, or after injuries, the endometrium is randomly dispersed. Through the fallopian tubes or by contact through the surgical wound, microscopic areas of the endometrium get to the peritoneum, from where they can disperse to the liver, diaphragm, and further. These foci of endometriosis during the active first phase of the menstrual cycle, especially if the woman has a hormonal imbalance and hyperestrogenism, begin to actively proliferate. As a result of these processes, the microscopic areas grow and, under the influence of a decline in estrogens and the beginning of the second phase of the menstrual cycle, also begin to actively secrete, which is accompanied by the release of blood.

The pathogenesis of endometriosis development during menopause has not been studied, since against the background of physiological hypoestrogenism, endometrioid foci should fade away, but the opposite phenomenon occurs. It is believed that the development of this process during menopause can be provoked by recent surgical interventions for another pathology, which is accompanied by the same principle of endometrial dissipation. Under the influence of still active estrogens, these areas begin to function, and the lack of estrogens that begins during menopause does not contribute to the attenuation of the process, since these areas become less sensitive to the action of hormones due to an age-related decrease in receptors. This is why hypoestrogenism during menopause is not accompanied by regression of endometriosis. Thus, the main cause of endometriosis during menopause can be considered recent surgical interventions on the pelvic organs. The fact that endometriosis does not occur in many women during menopause can also be explained by the quantitative difference in estrogens and receptors to them.

[ 5 ], [ 6 ], [ 7 ], [ 8 ]

Symptoms of menopausal endometriosis

Symptoms of endometriosis development during menopause differ depending on the localization of the pathological focus. A very important point is correct and timely diagnosis, since very often the symptoms of endometriosis can be assessed by a woman as the beginning of menopause.

The first signs of endometriosis during menopause are menstrual dysfunction, which can have various characteristics. If endometriosis is located in the ovary, cysts are formed that significantly disrupt the normal ovariomenstrual cycle. These disorders can be of the type polymenorrhea, oligomenorrhea, menorrhagia, metrorrhagia. Since such disorders are typical for menopause, a woman does not pay special attention to such manifestations, which is wrong. Most often, clinical manifestations of endometriosis during menopause are profuse bloody discharge, which begins a few days before the expected menstruation and lasts more than a week. Such a cycle is accompanied by severe nagging pain in the lower abdomen long before the onset of menstruation. If a woman has already entered menopause and has not had menstruation for three to six months, then the onset of endometriosis can also be accompanied by symptoms similar to menstruation, but these discharges are longer in time.

Another symptom of endometriosis during menopause may be severe pain syndrome, which is often accompanied by clinical manifestations of acute abdomen. This happens quite often, since endometrioid foci are most often located in the ovary or on the peritoneum, and the release of blood contributes to irritation of the peritoneum with the corresponding reaction. Therefore, women often go to surgery with a clinic of acute abdomen during menopause, when no one thinks about endometriosis, but such a possible diagnosis must be taken into account.

Less often, the symptoms of endometriosis during menopause may manifest as clinical bleeding from other organs, such as pulmonary hemorrhage. In this case, endometrioid foci are located in the thickness of the lung tissue and there may be a cough with the release of bloody sputum, which suggests pulmonary edema. Therefore, it is necessary to take into account the anamnestic data on concomitant diseases and the period of the menstrual cycle.

The course of endometriosis during menopause may be asymptomatic in the case of small areas of endometriosis. Then the degree of bleeding is not sufficient for the manifestation of any local symptoms and it is necessary to pay attention to the general condition of the woman. The only clinical sign may be the manifestation of chronic posthemorrhagic anemia. This will be accompanied by general weakness, pallor, poor appetite, decreased performance, dizziness, fainting. It is necessary to pay attention to these symptoms for further diagnosis and verification of the cause of such anemia.

[ 9 ], [ 10 ]

Complications and consequences

The consequence of endometriosis during menopause in women of this age can often be malignancy. This can be especially true in undiagnosed forms of endometriosis, since there is cell proliferation that cannot be controlled, and this is especially true for conditions with hormonal dysregulation. The consequence of endometriosis can also be bleeding into the abdominal cavity with subsequent clinical presentation of acute abdomen.

Diagnostics of menopausal endometriosis

Given the typical characteristics of the course of endometriosis, diagnosis can often be complicated during menopause. This is due to the fact that in classical cases, endometriosis disappears with the onset of menopause, but in this case, this does not happen.

It is necessary to carefully examine the woman with a detailed description of all complaints and an accurate collection of anamnesis. It is necessary to clarify the nature of the menstrual cycle throughout life, the duration of the cycle, the degree of bleeding, the presence of pain syndrome. It is also necessary to find out when menopause began, its course, features, symptoms from other organs, as well as clinical features. During the examination, it is possible to identify symptoms of anemia in the form of pale skin and mucous membranes, systolic murmur at the apex, pale sclera.

When examining in the mirrors, no particular changes can be detected, since these lesions can be localized anywhere.

The tests that allow us to suspect this pathology can be general and specific. A general blood test can show anemia and its degree, as well as the acute or chronic nature of anemia by the level of reticulocytes. If the patient is admitted with the clinic of acute abdomen, then the normal leukocyte formula in the general blood test allows us to exclude an acute inflammatory process of the abdominal cavity. Among the specific tests, it is recommended to conduct an examination for the level of sex hormones in the blood, which allows us to talk about the level of changes. It is also necessary to conduct an examination for the level of calcium in the blood, which is due to the onset of the menopause period.

To clarify the diagnosis, it is necessary to conduct a cytological examination of the bloody discharge to exclude malignant transformation. For this purpose, diagnostic curettage of the uterine cavity can be performed.

Instrumental diagnostics is highly effective in the case of endometriosis in the ovary. Then a "chocolate" cyst is formed in the ovary, which is diagnosed using ultrasound. In this case, an anechoic heterogeneous formation of the ovary is determined, which has a heterogeneous structure due to the presence of endometrial cells that can secrete blood. In this case, a cavity is not formed, or there is a small cavity that contains blood inside, and since blood has a higher density than liquid, an unclear structure of the formation is determined.

The "gold standard" of instrumental diagnostics of abdominal endometriosis is diagnostic laparoscopy. It often happens that manifestations of endometriosis in the form of an acute abdomen cannot be differentiated, and the diagnosis is made only on the operating table with objective signs of endometrioid areas on the peritoneum.

Sometimes, with severe bleeding into the pelvic cavity, an overhang of the posterior vaginal fornix is detected during examination, which requires an additional diagnostic procedure - a puncture of the posterior vaginal fornix.

[ 11 ], [ 12 ], [ 13 ], [ 14 ]

Differential diagnosis

Differential diagnostics of endometriosis during menopause should be carried out primarily with malignant endometrial formations. Endometrial cancer may be accompanied by a characteristic clinical picture - the appearance of bloody discharge several months or years after the onset of menopause. But with endometrial cancer, there is a reaction of regional lymph nodes, and the results of ultrasound determine the heterogeneity of the uterine cavity. An important element for accurate differentiation of the condition is histological examination, which in cancer has malignant cells.

Also, endometriosis during menopause, which is localized in the ovary with the formation of a cyst, must be differentiated from ovarian cancer and other cysts. In this, the main role is played by ultrasound, which allows you to identify the nature of the formation, the degree of its blood supply, density structure. With ovarian cancer, the structure of the ovary itself is unclear, it is not possible to distinguish its contours. Other cysts have a thin capsule and a uniform structure.

Endometriosis of the abdominal cavity, which initiates the clinical picture of acute abdomen, must be differentiated from:

• acute cholecystitis,
• acute appendicitis,
• renal colic,
• hepatic colic,
• cyst rupture,
• torsion of the cyst stalk,
• necrosis of the myomatous node.

All these conditions must be excluded, as they require emergency surgical intervention. To do this, it is necessary to collect anamnesis and exclude all possible diseases of the gastrointestinal tract, as well as diseases of the reproductive system. Sometimes, diagnostic laparoscopy is indispensable for differential diagnosis.

First of all, it is necessary to exclude the malignant nature of the process, and then carry out additional diagnostics.

Treatment of menopausal endometriosis

Treatment of endometriosis during menopause can be conservative and surgical, which depends on the localization of the process, the degree of clinical manifestations, as well as the number and size of endometrioid foci. But the choice of treatment method is a little complicated due to the state of menopause and hormonal imbalance, so special attention and an individual approach to the treatment of each case are necessary.

Drug treatment of endometriosis during menopause should be carried out taking into account the woman’s hormonal background, as well as the characteristics of the body during menopause.

Drug treatment involves the use of hormonal therapy. For this, taking into account the pathogenetic features of this process, drugs are used that have an increased level of progesterone. At the same time, a decrease in the amount of estrogens contributes to the regression of proliferation and secretion of endometrioid foci.

But, given that a physiological decrease in estrogen secretion occurs in a woman's body during menopause, additional suppression of estrogen levels can enhance changes in other organs and systems, so such treatment should be prescribed very carefully and in combination with other drugs that protect the heart and bones. The main drugs that are best used to treat endometriosis during menopause are combination drugs that contain a small amount of estrogen and progesterone, which contributes to a milder treatment effect. The main drugs used for this purpose are:

1. Triziston is a combined estrogen-progesterone drug. It promotes endometriosis regression by inhibiting cell proliferation and secretion. The drug is available in the form of pills of three colors, which are used according to a special scheme for three weeks, then a break for a week. The course of treatment is at least three to six months. Contraindications for prescribing the drug are malignant tumors of any localization, vascular pathology in the form of thrombosis in the anamnesis, hepatitis. It should be used with caution in diabetes mellitus, since the drug can change glucose tolerance, as well as in arterial hypertension. Side effects may appear in the form of cholestasis, liver dysfunction, embolism, as well as allergic and dyspeptic reactions.
2. Janine is a low-dose biphasic combined estrogen-progesterone drug that helps to balance hormonal levels and suppresses the secretion of endometriotic areas. It is available in the form of 21 pills. The drug is taken from the first day of the menstrual cycle. Due to the content of estrogens and progesterone, the drug can regulate any hormonal imbalance. Take one pill per day for 21 days, then take a break for 7 days, then resume taking. Side effects can develop in the form of dyspeptic manifestations, skin allergic reactions, changes in the mammary gland in the form of pain, swelling, and bloody uterine discharge. Contraindications to the use of the drug are diabetes mellitus, thrombosis and other vascular problems, migraine, as well as pregnancy and lactation.
3. Marvelon is a combined estrogen-progesterone drug that contains 5 times more progesterone. The principle of the drug's action on endometriosis, including endometrioid cysts, is due to the regulation of hormonal levels. The drug is available in tablets of 100 mg and is taken one tablet per day at the same time from day 1 to day 21 of the cycle. This ensures a constant normal concentration of hormones in the blood. Side effects of the drug are allergic reactions, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, impaired libido, weight gain. Contraindications for use are acute liver dysfunction, acute cholecystitis, malignant processes of any localization.
4. Anteovin is a combined two-phase estrogen-progesterone drug that suppresses the normal menstrual cycle by regulating hormonal levels and prevents ovulation. This promotes the regression of functional cysts. The drug is available in the form of tablets, 21 pieces per package. Among them, 11 are white and 10 are pink, according to the difference in composition. Take one tablet from the 5th day of the cycle. Side effects can develop in the form of dyspeptic manifestations, discomfort in the mammary glands and a feeling of their tension. Contraindications to taking the drug are diabetes mellitus, arterial hypertension, epilepsy, varicose veins, and smoking is not recommended while taking this drug.

It is necessary to conduct general strengthening and immunomodulatory treatment in the form of vitamin therapy in parallel with hormone replacement therapy. Vitamins of group A and E are recommended, and better yet, multivitamin complexes. Among physiotherapeutic methods of treatment, iontophoresis and electrophoresis are recommended, as well as radiopulse therapy. It is also necessary to prescribe calcium preparations and prophylactic doses of acetylsalicylic acid.

Surgical treatment of endometriosis during menopause is a priority during menopause, since such treatment is radical and reduces the risk of complications. Such treatment is especially effective for endometriosis in the ovary. In this case, removal of such a cyst contributes to complete regression of symptoms. Surgical treatment should also be carried out for extragenital forms of endometriosis, since they are poorly amenable to surgical treatment.

Folk treatment of endometriosis during menopause

Folk treatment of endometriosis during menopause is of priority importance, since hormonal therapy is often contraindicated or limited in use, and surgical intervention is postponed. Therefore, many methods of folk medicine are used, as well as herbal infusions to regulate the menstrual cycle and stop bleeding.

The main recipes using traditional methods of treatment are:

1. Treatment with honey - one tablespoon of honey should be diluted in a liter of boiled water and douched twice a day. This course should be completed for 7-10 days. Honey has a pronounced relaxing effect on the myometrium of the uterus, and also has a bacteriostatic and immunomodulatory effect. It helps to normalize cell membranes and reduces hypersecretion of the endometrium, which can be used for internal genital forms of endometriosis.
2. The use of celandine is effective for correcting hormonal imbalance and reducing pain in endometriosis. To prepare a decoction, pour a tablespoon of dried celandine leaves with a glass of boiled water and boil for another five minutes, then let it cool and strain. This decoction should be drunk half a glass three times a day for about a week.
3. Beetroot juice helps restore strength and blood circulation after chronic anemia due to endometriosis. For treatment, freshly squeezed beetroot juice is taken on an empty stomach, 50 milliliters for two weeks.
4. Stinging nettle and barberry leaves also help restore hematopoiesis and relax the myometrium with a decrease in the active proliferation of endometriotic foci. For this, a herbal tea is prepared, which has a hysterotropic effect. Stinging nettle and barberry leaves are infused in boiled water and boiled for another five to ten minutes, after which they drink instead of tea up to four times a day.
5. Viburnum tea can be taken several times throughout the day instead of liquid drinks, you can add a spoonful of honey.
6. Nettle can also be used fresh, because it has healing properties and at the same time helps restore blood loss with heavy bloody discharge. For treatment, use the juice from the stems of nettle, freshly squeezed, which is used to soak a tampon and insert it into the vagina for 2 hours in the evening for at least five days.

Homeopathic remedies for the treatment of endometriosis during menopause are also widely used, since they do not contain hormones, but are able to regulate hormonal levels, which improves the clinical manifestations of both endometriosis itself and menopause. The main drugs are:

• Gynecoheel is a combined homeopathic preparation, which is produced in the form of drops and is used 10 drops three times a day, before which it must be dissolved in warm water. Side effects are rarely noted in the form of allergic reactions.
• Lycopodium is a single-component homeopathic preparation that is effective in right ovarian endometriosis. The preparation is available in the form of homeopathic granules of 10 g in a jar, and also in the form of a tincture of 15 ml. Take between meals, dissolve under the tongue until completely dissolved, 1 granule 4 times a day. Not recommended for pregnant women. No side effects have been detected.
• Cyclodinone is a homeopathic drug that normalizes the ovariomenstrual cycle when its second phase is insufficient. The drug is available in tablets or drops. Dosage: 1 tablet in the morning or 40 drops once a day. The course of treatment is at least three months. Contraindications for use are pregnancy and allergic hypersensitivity to the components of the drug.

[ 15 ], [ 16 ]

Prevention

Preventive measures for the development of endometriosis during menopause are non-specific measures in the form of timely treatment of inflammatory diseases and trauma to the genitals, avoidance of surgical interventions beyond the indications, timely and annual consultation with a gynecologist. It is very important for a woman to consult a doctor at the initial manifestations of menopause in order to correct the condition and monitor the hormonal background in order to prevent not only endometriosis, but also pathology from other organs and systems.

[ 17 ], [ 18 ], [ 19 ], [ 20 ]

Forecast

The prognosis for endometriosis is positive in the case of endometrioid cysts, since this is the most easily diagnosed localization and the most easily treated. In the case of extragenital localization of endometriosis, the prognosis for recovery is relatively favorable, since it is difficult to diagnose.

Endometriosis during menopause is a pathology that can have various manifestations from the clinic of acute abdomen to asymptomatic course, but given the possible malignancy of this process, it is necessary to consult a doctor in a timely manner. Treatment methods are selected individually and can be combined. In case of any violations of the condition - you need to consult a doctor, then your health will be in good hands.

[ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ]