Endometriosis in the postmenopausal female: clinical presentation, imaging features, and management
Postmenopausal endometriosis is an important clinical entity which is likely under-recognized and in which the Radiologist can play a valuable role. In this review, we describe the clinical presentation and management of postmenopausal endometriosis, appraising the literature and providing case examples. Persons with postmenopausal endometriosis may present with symptoms including pelvic pain or dyschezia, but endometriosis may also be an asymptomatic, incidental finding. Women may or may not have a prior history of endometriosis or a history of symptoms consistent with it. Therapies and conditions which increase exogenous or endogenous estrogen, respectively, increase the risk. Endometriosis can be found in different locations throughout the body, and the possibility of malignancy should be assessed, especially in the postmenopausal population, where age increases cancer risk. Treatment may involve surgery or medical interventions. Guidelines describing appropriate imaging surveillance in these patients are lacking. In the postmenopausal population, Radiologists need to consider endometriosis as a diagnosis, recommend appropriate exams such as MRI and US, and suggest endometriosis-associated malignancies when appropriate, based on classic morphologic features.
KeywordsEndometriosis Postmenopause Magnetic resonance imaging Ultrasonography
The authors wish to thank Sonia Watson, PhD, and Desiree J. Lanzino, PT, PhD, for their help in editing the manuscript.
No sources of funding were utilized to conduct this review.
Compliance with ethical standards
Conflict of interest
No conflicts of interest to disclose.
- 10.Buckley CH (1990) Tamoxifen and endometriosis. Case report. British journal of obstetrics and gynaecology 97 (7):645-646. doi: https://doi.org/10.1111/j.1471-0528.1990.tb02557.x CrossRefGoogle Scholar
- 11.Cohen I, Altaras MM, Lew S, Tepper R, Beyth Y, Ben-Baruch G (1994) Ovarian endometrioid carcinoma and endometriosis developing in a postmenopausal breast cancer patient during tamoxifen therapy: a case report and review of the literature. Gynecologic oncology 55 (3 Pt 1):443-447. doi: https://doi.org/10.1006/gyno.1994.1319 CrossRefPubMedGoogle Scholar
- 12.Cohen I, Beyth Y, Shapira J, Tepper R, Fishman A, Cordoba M, Bernheim J, Yigael D, Altaras MM (1997) High frequency of adenomyosis in postmenopausal breast cancer patients treated with tamoxifen. Gynecologic and obstetric investigation 44 (3):200-205. doi: https://doi.org/10.1159/000291520 CrossRefPubMedGoogle Scholar
- 14.de Almeida Asencio F, Ribeiro HA, Ayrosa Ribeiro P, Malzoni M, Adamyan L, Ussia A, Gomel V, Martin DC, Koninckx PR (2019) Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports. Gynecol Surg 16 (1):3. doi: https://doi.org/10.1186/s10397-019-1056-x CrossRefGoogle Scholar
- 15.Bulun SE, Yang S, Fang Z, Gurates B, Tamura M, Sebastian S (2002) Estrogen production and metabolism in endometriosis. Annals of the New York Academy of Sciences 955:75-85; discussion 86-78, 396-406. doi: https://doi.org/10.1111/j.1749-6632.2002.tb02767.x CrossRefPubMedGoogle Scholar
- 18.Dick AL, Lang DW, Bergman RT, Bhatnagar BN, Selvaggi FP (1973) Postmenopausal endometriosis with ureteral obstruction. British journal of urology 45 (2):153-155. doi: https://doi.org/10.1111/j.1464-410x.1973.tb12132.x CrossRefPubMedGoogle Scholar
- 21.Andriola V, Battaglia M, Ditonno P, Fiore MG, De Fazio M, Memeo R, Altomare DF (2016) The unexpected conundrum of endometrioid carcinoma in deep rectal endometriosis arising 11 years after total hysterectomy bilateral salpingo-oophorectomy. International journal of colorectal disease 31 (2):475-477. doi: https://doi.org/10.1007/s00384-015-2188-8 CrossRefPubMedGoogle Scholar
- 28.Turkyilmaz E, Cinkaya A, Secen EI, Kayacetin S, Yavuz Avsar AF (2016) Postmenopausal Vaginal Endometriotic Cyst: A Case Report. J Clin Anal Med 7 (4):563-566. doi: https://doi.org/10.4328/jcam.4401
- 35.35. Macario S, Chassang M, Novellas S, Baudin G, Delotte J, Toullalan O, Chevallier P (2012) The value of pelvic MRI in the diagnosis of posterior cul-de-sac obliteration in cases of deep pelvic endometriosis. AJR Am J Roentgenol 199 (6):1410-1415. doi: https://doi.org/10.2214/AJR.11.7898 CrossRefPubMedGoogle Scholar
- 39.Li J, Liu R, Tang S, Feng F, Liu C, Wang L, Zhao W, Zhang T, Yao Y, Wang X, Sun C (2019) Impact of endometriosis on risk of ovarian, endometrial and cervical cancers: a meta-analysis. Archives of gynecology and obstetrics 299 (1):35-46. doi: https://doi.org/10.1007/s00404-018-4968-1 CrossRefPubMedGoogle Scholar
- 42.Robinson KA, Menias CO, Chen L, Schiappacasse G, Shaaban AM, Caserta MP, Elsayes KM, VanBuren WM, Bolan CW (2019) Understanding malignant transformation of endometriosis: imaging features with pathologic correlation. Abdom Radiol (NY). doi: https://doi.org/10.1007/s00261-019-01914-7 CrossRefGoogle Scholar
- 44.Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R (2010) Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 256 (3):943-954. doi: https://doi.org/10.1148/radiol.10100213 CrossRefPubMedGoogle Scholar