Endometriosis: seeking optimal management in women approaching menopause

被引：28

作者：

Alio, L. ^{[1
]}

Angioni, S. ^{[2
]}

Arena, S. ^{[3
]}

Bartiromo, L. ^{[4
]}

Bergamini, V. ^{[5
]}

Berlanda, N. ^{[6
,7
]}

Bonanni, V. ^{[8
]}

Bonin, C. ^{[5
]}

Buggio, L. ^{[7
]}

Candiani, M. ^{[4
]}

Centini, G. ^{[9
]}

D'Alterio, M. N. ^{[2
]}

De Stefano, F. ^{[4
]}

Di Cello, A. ^{[10
]}

Exacoustos, C. ^{[11
]}

Fedele, L. ^{[6
,7
]}

Frattaruolo, M. P. ^{[7
]}

Geraci, E. ^{[12
]}

Lavarini, E. ^{[5
]}

Lazzeri, L. ^{[9
]}

Luisi, S. ^{[9
]}

Maiorana, A. ^{[1
]}

Makieva, S. ^{[13
]}

Maneschi, F. ^{[14
]}

Martire, F. ^{[11
]}

Massarotti, C. ^{[15
,16
]}

Mattei, A. ^{[17
]}

Muzii, L. ^{[8
]}

Ottolina, J. ^{[4
]}

Pagliardini, L. ^{[13
]}

Perandini, A. ^{[5
]}

Perelli, F. ^{[18
]}

Pino, I. ^{[19
]}

Porpora, M. G. ^{[8
]}

Remorgidao, V. ^{[15
,16
]}

Scagnelli, G. ^{[19
]}

Seracchioli, R. ^{[20
]}

Solima, E. ^{[19
]}

Somigliana, E. ^{[6
,7
]}

Sorrenti, G. ^{[11
]}

Ticino, A. ^{[8
]}

Venturella, R. ^{[10
]}

Vigano, P. ^{[13
]}

Vignali, M. ^{[19
]}

Zullo, F. ^{[21
]}

Zupi, E. ^{[11
]}

机构：

[1] Civ Hosp, Dept Obstet & Gynecol, Palermo, Italy

[2] Univ Cagliari, Dept Surg Sci, Cagliari, Italy

[3] Azienda Osped Perugia, Dept Obstet & Gynecol, Perugia, Italy

[4] IRCCS San Raffaele Sci Inst, Gynecol Dept, Milan, Italy

[5] Azienda Osped Univ Integrata, Dept Obstet & Gynecol, Verona, Italy

[6] Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy

[7] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Gynaecol Unit, Milan, Italy

[8] Sapienza Univ Rome, Dept Gynecol Obstet & Urol, Rome, Italy

[9] Univ Siena, Dept Mol & Dev Med Obstet & Gynecol, Siena, Italy

[10] Magna Graecia Univ Catanzaro, Dept Clin & Expt Med Obstet & Gynecol, Catanzaro, Italy

[11] Univ Roma Tor Vergata, Dept Biomed & Prevent, Rome, Italy

[12] Asola Hosp, Dept Obstet & Gynecol, Mantua, Italy

[13] IRCCS San Raffaele Sci Inst, Div Genet & Cell Biol, Milan, Italy

[14] San Giovanni Addolorata Hosp, Dept Obstet & Gynecol, Rome, Italy

[15] Osped Policlin San Martino, Acad Unit Obstet & Gynaecol, Genoa, Italy

[16] Univ Genoa, Dept Neurosci Rehabil Ophthalmol Genet Maternal &, Genoa, Italy

[17] Ctr Tuscany USL, Dept Minimally Invas Gynaecol Surg, Florence, Italy

[18] Univ Florence, Dept Expt Clin & Biomed Sci Obstet & Gynaecol, Florence, Italy

[19] Univ Milan, Dept Obstet & Gynecol, Macedonio Melloni Hosp, Milan, Italy

[20] Univ Bologna, Gynecol & Physiopathol Human Reprod Unit, S Orsola Malpighi Hosp Bologna, Bologna, Italy

[21] Univ Naples Federico II, Dept Neurosci Reprod Sci & Dent, Sch Med, Naples, Italy

来源：

CLIMACTERIC | 2019年 / 22卷 / 04期

关键词：

Perimenopause; endometriosis; middle-aged women; management; endometriosis treatment; endometriosis malignant transformation; SMALL-BOWEL OBSTRUCTION; ORAL-CONTRACEPTIVE USE; BLADDER ENDOMETRIOSIS; STROMAL SARCOMA; INTESTINAL-OBSTRUCTION; OVARIAN-CANCER; DIAGNOSIS; AGE; ADENOCARCINOMA; MANIFESTATION;

D O I：

10.1080/13697137.2018.1549213

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

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.

引用

页码：329 / 338

页数：10

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