Endometriosis with menopause

Endometriosis during menopause is not a frequent occurrence, since the only definitive option for complete cure of endometriosis was considered the onset of menopause, but to date there is a clear trend of endometriosis only with the onset of menopause. Finally, the pathogenesis of the development of such pathology in menopause has not been studied, but it is necessary to clearly differentiate the menopause and the symptoms of endometriosis, since this disease in older women has more serious consequences.

[1], [2], [3]

Causes of the endometriosis with menopause

Endometriosis is a disease whose essence 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 of these sites 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 distinguishes genital, when these foci are located on the female genital organs, and extragenital, when the foci can be on any internal organs - lungs, diaphragm, liver, peritoneum. In turn, genital endometriosis distinguishes the internal - on the internal genital organs, and external - on the external genital organs. This classification is important, since the monthly discharge of blood from these endometriotic foci may correspond to the clinic of a particular disease, so it is important to establish a diagnosis correctly.

The cause of development of endometriosis is frequent surgical interventions on the genitals, as well as on the pelvic organs, against the background of hormonal homeostasis, which contributes to the formation of endometriotic foci. The cause of the development of endometriosis in menopause is not fully understood, since this phenomenon is not typical for this age, but there are risk factors for the development of this pathology in menopause. Such factors include obesity, diabetes mellitus, inflammatory diseases of the genitals, frequent surgery, postpartum trauma.

[4]

Pathogenesis

The pathogenesis of the development of extragenital endometriosis consists in the fact that during operative interventions on the genitals or organs of the small pelvis, or after injuries, the endometrium is randomly dispersed. From the fallopian tubes or contact through the surgical wound, the microscopic areas of the endometrium come to the peritoneum, from which they can scatter to the liver, the diaphragm, and thence. These foci of endometriosis with the active first phase of the menstrual cycle, especially if a woman has a hormonal disorder and hyperestrogenia is observed, begin to actively proliferate. Due to these processes, the microscopic areas grow and under the influence of the decline of estrogens and the onset of the second phase of the menstrual cycle are also actively secreted, which is accompanied by the release of blood.

The pathogenesis of endometriosis development in menopause has not been studied, since on the background of physiological hypoestrogenic endometriosis foci should fade away, but the opposite phenomenon occurs. It is believed that the development of this process in menopause may be triggered by recent surgical interventions for another pathology, which is accompanied by the same principle of dissemination of the endometrium. Under the influence of still active estrogens, these sites begin to function, and the lack of estrogens that begins with menopause does not contribute to the attenuation of the process, since these sites become less sensitive to the action of hormones due to age-related decrease in receptors. That is why hypoestrogeny in menopause is not accompanied by regression of endometriosis. Thus, the main cause of the development of endometriosis in menopause can be considered recent surgical interventions on the pelvic organs. The fact that endometriosis is not found in many women with menopause can also be explained by the quantitative difference between estrogens and receptors.

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

Symptoms of the endometriosis with menopause

Symptoms of endometriosis development in menopause differ, depending on the localization of the pathological focus. Very important is the correct and timely diagnosis, as very often the symptoms of endometriosis can be regarded by a woman as the beginning of menopause.

The first signs of endometriosis in menopause are disorders of menstrual function, which can have different characteristics. If the endometriosis is located in the ovary, then cysts are formed, which significantly disrupt the normal ovario-menstrual cycle. These violations can be of the type of polymenoria, oligomenorrhoea, menorahia, metroragia. Since such violations are characteristic of menopause, the woman does not pay much attention to such manifestations, which is wrong. Most often, the clinical manifestations of endometriosis with menopause are copious spotting that begins several days before the expected menstruation and lasts more than a week. This cycle is accompanied by strong pulling pains in the lower abdomen long before the appearance of menstruation. If a woman has already entered the menopause and has no menstruation for three to six months, the onset of endometriosis may also be accompanied by similar symptoms as menstruation, but these discharges are more time-consuming.

Another symptom of endometriosis in menopause may be severe pain syndrome, which is often accompanied by clinical manifestations of an acute abdomen. This happens quite often, since endometriotic foci are most often located in the ovary or on the peritoneum, and the secretion of blood contributes to the irritation of the peritoneum with the corresponding reaction. Therefore, often women get into surgery with a clinic of an acute abdomen or menopause, when nobody thinks about endometriosis, but such a possible diagnosis should be taken into account.

It rarely happens that the symptoms of endometriosis in menopause may be manifested by a bleeding clinic from other organs, for example, pulmonary hemorrhage. In this case, endometriotic foci are located in the thickness of the lung tissue and there may be a cough with the discharge of bloody sputum, suggesting pulmonary edema. Therefore, it is necessary to take into account anamnestic data on the concomitant diseases and the period of the menstrual cycle.

The course of endometriosis with 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 a manifestation of chronic posthemoragic 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 with menopause in women of this age can often be malignancy. Especially it can be with undiagnosed forms of endometriosis, as there is a proliferation of cells that can not be controlled, and especially it concerns states with hormone background dysregulation. The consequence of endometriosis can also be bleeding into the abdominal cavity with the subsequent clinic of an acute abdomen.

Diagnostics of the endometriosis with menopause

Given the typical characteristics of the course of the disease of endometriosis, diagnosis often in the menopause may be complicated. This is due to the fact that in classical cases, endometriosis disappears when the menopause occurs, but in this case this does not happen.

It is necessary to carefully examine a woman with detailed complaints and 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 the climax began, its course, features, symptoms from other organs, and also clinical features. On examination, you can identify the symptoms of anemia in the form of pale skin and mucous membranes, systolic noise at the top, pallor sclera.

When viewed in mirrors, no special changes can be identified, since these foci can be localized anywhere.

Analyzes that allow you to suspect this pathology, it can be general and specific. A general blood test can show anemia and its degree, as well as acute or chronic anemia in terms of reticulocyte count. If the patient entered with the clinic of the acute abdomen, then the normal leukocyte formula in the general blood test allows to exclude the acute inflammatory process of the abdominal cavity. Among specific tests, it is recommended to conduct a test for the level of sex hormones in the blood, which allows us to speak about the level of changes. It is also necessary to conduct a test for the level of calcium in the blood, which is due to the beginning of the period of menopause.

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

Instrumental diagnosis is highly effective in the detection of endometriosis in the ovary. Then the "chocolate" cyst is formed in the ovary, which is diagnosed by ultrasound. This determines the anehogenous non-uniform ovarian formation, which has a non-uniform structure due to the presence of endometrial cells that can secrete blood. In this case, the cavity does not form, or there is a cavity of small dimensions that contains blood inside, and since blood has a higher density than liquid, a fuzzy structure of formation is determined.

The "gold standard" for instrumental diagnosis of endometriosis of the abdominal cavity is diagnostic laparoscopy. It often happens that manifestations of endometriosis in the form of an acute abdomen can not be differentiated, and the diagnosis is placed only on the operating table with objective signs of the endometrioid sites on the peritoneum.

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

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

Differential diagnosis

Differential diagnosis of endometriosis in menopause should be carried out primarily with malignant forms of the endometrium. Endometrial cancer can be accompanied by a characteristic clinic - the appearance of bloody discharge in a few months or years after the onset of menopause. But with endometrial carcinoma there is a reaction of regional lymph nodes, and ultrasonography determines the heterogeneity of the uterine cavity. An important element for accurate differentiation of the condition is a histological examination, which in cancer has malignant cells.

Also, endometriosis with menopause, which is located 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 to reveal the nature of education, the degree of its blood supply, the density of the structure. In ovarian cancer, the structure of the ovary itself is not clear, it is impossible to distinguish its contours. Other cysts have a thin capsule and a homogeneous structure.

Endometriosis of the abdominal cavity, which initiates the clinic of an acute abdomen, must be differentiated from:

• acute cholecystitis,
• acute appendicitis,
• renal colic,
• hepatic colic,
• ruptured cysts,
• torsion of the legs of the cyst,
• necrosis of the myomatous node.

All these conditions must be eliminated, since they require emergency surgery. For 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 the differentiation of the diagnosis without diagnostic laparoscopy is not complete.

First of all, it is necessary to exclude malignant character of the process, and then conduct additional diagnostics.

Treatment of the endometriosis with menopause

Treatment of endometriosis with climax can be conservative and operative, which depends on the localization of the process, the degree of clinical manifestations, and the number and size of endometriotic foci. But the choice of a method of treatment is a little complicated because of the state of menopause and hormonal disruption, so special attention and an individual approach to the treatment of each case is necessary.

Medicamentous treatment of endometriosis with menopause should be carried out, taking into account the hormonal background of a woman, as well as the peculiarities of the organism in menopause.

Drug treatment involves the use of hormone therapy. To do this, taking into account the pathogenetic features of this process, use drugs that have an elevated level of progesterone. In this case, a decrease in the amount of estrogens promotes regression of proliferation and secretion of endometriotic foci.

But, considering that in the body of a woman during the climax there is a physiological decrease in the secretion of estrogens, the additional suppression of the level of estrogens can increase the changes on the part of other organs and systems, so this treatment should be administered with caution and in combination with other drugs that protect the heart and bones. The main drugs that are best used to treat endometriosis with menopause are combined medications that contain both a small amount of estrogens and progesterone, which contributes to a milder effect of treatment. The main drugs that are used for this purpose are:

1. Triziston is a combined estrogen-progesterone drug. It promotes regression of endometriosis due to oppression of cell proliferation and secretion. The preparation is available in the form of a three-color pills, which are applied on a special schedule for three weeks, then break for a week. The course of treatment is not less than three to six months. Contraindications for the prescription of the drug are malignant formations of any localization, pathology of blood vessels in the form of thromboses in the anamnesis, hepatitises. It should be used with caution in diabetes, because the drug can change glucose tolerance, as well as with hypertension. Side effects can appear in the form of cholestasis, impaired liver function, embolism, as well as allergic and dyspeptic reactions.
2. Janine is a low-dose, two-phase, combined estrogen-progesterone drug that helps level the hormonal background and suppress the secretion of the endometrioid sites. It is available in the form of pills, the number of which is 21. The reception starts from the first day of the menstrual cycle. Thanks to the content of estrogens and progesterone, the drug can regulate any hormonal imbalance. Receiving one pills a day for 21 days, then a break for 7 days, then the reception resumes. Side effects can develop in the form of dyspeptic manifestations, skin allergic reactions, changes in the breast as a pain, swelling, and bloody uterine discharge. Contraindications to the use of the drug - is diabetes, thrombosis and other problems with blood vessels, migraines, as well as pregnancy and lactation.
3. Marvelon is a combined estrogen-progesterone drug that contains more progesterone 5 times. The principle of action of the drug on endometriosis, including endometriosis cysts, is determined by the regulation of the hormonal background. The drug is released in tablets of 100 mg and taken one tablet per day at the same time from 1 to 21 days of the cycle. This ensures a constant normal concentration of hormones in the blood. Side effects of the drug are allergic manifestations, dyspeptic manifestations in the form of nausea, vomiting, discomfort in the mammary glands, violation of libido, weight gain. Contraindications to use are acute violations of liver function, acute cholecystitis, malignant processes of any localization.
4. Antevin is a combined two-phase estrogen-progesterone drug that suppresses the normal menstrual cycle by regulating the hormonal background and prevents the process of ovulation. This contributes to the regress of functional cysts. The drug is available in the form of tablets of 21 pieces per pack. Among them 11 are white, and 10 - pink, respectively, the difference in composition. One tablet is taken with a 5 day cycle. Side effects can develop in the form of dyspeptic manifestations, discomfort in the mammary glands and a sense of their tension. Contraindications to taking the drug are diabetes, arterial hypertension, epilepsy, varicose veins, and smoking is not recommended at the time of taking this medication.

It is necessary in parallel with hormone replacement therapy to perform general strengthening and immunomodulating treatment in the form of vitamin therapy. Recommended vitamins A and E, and preferably multivitamin complexes. Among physiotherapeutic methods of treatment, ionophoresis and electrophoresis are recommended, as well as radio-pulse therapy. It is also necessary to prescribe calcium preparations and preventive doses of acetylsalicylic acid.

An operative method of treatment of endometriosis in menopause has a priority in the menopause, since such treatment is radical and the risk of complications decreases. Such treatment is especially effective in endometriosis in the ovary. At the same time, the removal of such a cyst contributes to a complete regression of the symptomatology. Surgical treatment should also be performed with extragenital forms of endometriosis, since they are not amenable to surgical treatment.

Alternative treatment of endometriosis with menopause

Alternative treatment of endometriosis in menopause is a priority, because often hormone therapy is contraindicated or limited in use, and surgical intervention is postponed. Therefore, many methods of alternative medicine are used, as well as herbal preparations for regulating the menstrual cycle and for stopping bleeding.

The main recipes using alternative therapies are:

1. Treatment with honey - one tablespoon of honey should be diluted in liter of boiled water and douching twice a day. This course must be completed within 7-10 days. Honey has a pronounced relaxing effect on the uterine myometrium, and it also has a bacteriostatic and immunomodulating effect. It promotes the normalization of cell membranes and reduces the 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 the pain syndrome in endometriosis. To prepare the broth a tablespoon of dried celandine leaves should be poured a glass of boiled water and boil for another five minutes, then let cool and strain. This broth should be drunk half a cup three times a day for about a week.
3. Beet juice helps restore strength and blood creation after chronic anemia in endometriosis. For treatment, freshly squeezed beet juice is taken on an empty stomach at 50 milliliters for two weeks.
4. The leaves of nettle and barberry nettle also contribute to the restoration of hemopoiesis and relax the myometrium with a decrease in the active proliferation of endometriotic foci. To do this, prepare a tea-broth from herbs, which has a hysterotropic effect. The leaves of the nettle and barberry nettle are insisted in boiled water and boiled for five to ten minutes, after which they drink tea instead of tea up to four times a day.
5. Tea from the viburnum can be taken throughout the day several times instead of liquid drinks, you can add a spoonful of honey.
6. Nettle can also be used fresh, because it has medicinal properties and at the same time contributes to the restoration of blood loss with strong bloody discharge. For the treatment use juice from the stems of nettle, freshly squeezed, which is impregnated with a tampon and inserted into the vagina for 2 hours in the evening for not less than five days.

Homeopathic remedies for the treatment of endometriosis in menopause are also widely used because they do not have hormones in their composition, but are able to regulate the hormonal background, which improves the clinical manifestations of both endometriosis and menopause. The basic preparations:

• Ginekohel - a combined homeopathic preparation, which is available in the form of drops and applied 10 drops three times a day, before it must be dissolved in warm water. Side effects are noted rarely in the form of allergic phenomena.
• Likopodium is a monocomponent homeopathic preparation that has efficacy in endometriosis of the right ovary. The preparation is released in the form of homeopathic granules of 10 g in a jar, also in the form of a tincture of 15 ml. Take between meals, dissolve under the tongue until completely dissolved by 1 granule 4 times a day. Not recommended for pregnant women. Adverse events were not detected.
• Cyclodinone is a homeopathic preparation that normalizes the ovario-menstrual cycle when its second phase is inadequate. The drug is released in tablets or drops. Dosage - 1 tablet in the morning or 40 drops once a day. The course of treatment is not less than three months. Contraindication to use is pregnancy and allergic hypersensitivity to the components of the drug.

[15], [16]

Prevention

Measures to prevent the development of endometriosis in menopause are non-specific measures in the form of timely treatment of inflammatory diseases and traumatism of genital organs, avoidance of surgical interventions outside the indications, timely and annual consultation with a gynecologist. It is very important for a woman to see a doctor with the initial manifestations of menopause in order to adjust the condition and monitor the hormonal background with the goal of preventing not only endometriosis, but also pathology from other organs and systems.

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

Forecast

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

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

[21], [22], [23], [24], [25], [26]