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Endometriosis: Seeking Optimal Management in Women Approaching Menopause

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Endometriosis: Seeking Optimal Management in Women Approaching Menopause Climacteric ISSN: 1369-7137 (Print) 1473-0804 (Online) Journal homepage: http://www.tandfonline.com/loi/icmt20 Endometriosis: seeking optimal management in women approaching menopause L. Alio, S. Angioni, S. Arena, L. Bartiromo, V. Bergamini, N. Berlanda, V. Bonanni, C. Bonin, L. Buggio, M. Candiani, G. Centini, M. N. D'Alterio, F. De Stefano, A. Di Cello, C. Exacoustos, L. Fedele, M. P. Frattaruolo, E. Geraci, E. Lavarini, L. Lazzeri, S. Luisi, A. Maiorana, S. Makieva, F. Maneschi, F. Martire, C. Massarotti, A. Mattei, L. Muzii, J. Ottolina, L. Pagliardini, A. Perandini, F. Perelli, I. Pino, M. G. Porpora, V. Remorgida, G. Scagnelli, R. Seracchioli, E. Solima, E. Somigliana, G. Sorrenti, A. Ticino, R. Venturella, P. Viganò, M. Vignali, F. Zullo & E. Zupi To cite this article: L. Alio, S. Angioni, S. Arena, L. Bartiromo, V. Bergamini, N. Berlanda, V. Bonanni, C. Bonin, L. Buggio, M. Candiani, G. Centini, M. N. D'Alterio, F. De Stefano, A. Di Cello, C. Exacoustos, L. Fedele, M. P. Frattaruolo, E. Geraci, E. Lavarini, L. Lazzeri, S. Luisi, A. Maiorana, S. Makieva, F. Maneschi, F. Martire, C. Massarotti, A. Mattei, L. Muzii, J. Ottolina, L. Pagliardini, A. Perandini, F. Perelli, I. Pino, M. G. Porpora, V. Remorgida, G. Scagnelli, R. Seracchioli, E. Solima, E. Somigliana, G. Sorrenti, A. Ticino, R. Venturella, P. Viganò, M. Vignali, F. Zullo & E. Zupi (2019): Endometriosis: seeking optimal management in women approaching menopause, Climacteric, DOI: 10.1080/13697137.2018.1549213 To link to this article: https://doi.org/10.1080/13697137.2018.1549213 Published online: 10 Jan 2019. Submit your article to this journal View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=icmt20 CLIMACTERIC https://doi.org/10.1080/13697137.2018.1549213 REVIEW Endometriosis: seeking optimal management in women approaching menopause L. Alioa, S. Angionib, S. Arenac, L. Bartiromod, V. Bergaminie, N. Berlandaf,g , V. Bonannih, C. Bonine, L. Buggiog , M. Candianid, G. Centinii,M.N.D’Alteriob, F. De Stefanod, A. Di Celloj, C. Exacoustosk, L. Fedelef,g , M. P. Frattaruolog , E. Geracil, E. Lavarinie, L. Lazzerii, S. Luisii, A. Maioranaa, S. Makievam, F. Maneschin, F. Martirek, C. Massarottio,p , A. Matteiq, L. Muziih, J. Ottolinad, L. Pagliardinim, A. Perandinie, F. Perellir, I. Pinos, M. G. Porporah, V. Remorgidao,p, G. Scagnellis, R. Seracchiolit, E. Solimas, E. Somiglianaf,g , G. Sorrentik, A. Ticinoh, R. Venturellaj, P. Viganom , M. Vignalis, F. Zullou and E. Zupik aDepartment of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy; bDepartment of Surgical Sciences, University of Cagliari, Cagliari, Italy; cDepartment of Obstetrics and Gynecology, Azienda Ospedaliera Perugia, Perugia, Italy; dGynecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; eDepartment of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy; fDepartment of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy; gGynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; hDepartment of Gynecology, Obstetrics and Urology, ‘Sapienza’ University of Rome, Rome, Italy; iDepartment of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy; jDepartment of Clinical and Experimental Medicine, Obstetrics and Gynecology, Universita degli Studi Magna Graecia, Catanzaro, Italy; kDepartment of Biomedicine and Prevention, Universita degli studi di Roma ‘Tor Vergata’, Rome, Italy; lDepartment of Obstetrics and Gynecology, Asola Hospital, Mantova, Italy; mDivision of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy; nDepartment of Obstetrics and Gynecology, San Giovanni Addolorata Hospital, Roma, Italy; oAcademic Unit of Obstetrics and Gynaecology, Ospedale Policlinico San Martino, Genoa, Italy; pDepartment of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy; qDepartment of Minimally Invasive Gynaecological Surgery, Centre Tuscany USL, Florence, Italy; rDepartment of Experimental, Clinical and Biomedical Sciences, Obstetrics and Gynaecology, University of Florence, Florence, Italy; sDepartment of Obstetrics and Gynecology, University of Milan, Macedonio Melloni Hospital, Milan, Italy; tGynecology and Physiopathology of Human Reproductive Unit, University of Bologna, S. Orsola-Malpighi Hospital of Bologna, Bologna, Italy; uDepartment of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy ABSTRACT ARTICLE HISTORY The incidence of endometriosis in middle-aged women is not minimal compared to that in the repro- Received 17 May 2018 ductive age group. The treatment of affected women after childbearing age to the natural transition Revised 29 October 2018 toward menopause has received considerably poor attention. Disease management is problematic for Accepted 2 November 2018 these women due to increased contraindications regarding hormonal treatment and the possibility for Published online 11 January 2019 malignant transformation, considering the increased cancer risk in patients with a long-standing his- tory of the disease. This state-of-the-art review aims for the first time to assess the benefits of the KEYWORDS available therapies to help guide treatment decisions for the care of endometriosis in women Perimenopause; endometri- approaching menopause. Progestins are proven effective in reducing pain and should be preferred in osis; middle-aged women; these women. According to the international guidelines that lack precise recommendations, hysterec- management; endometriosis tomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have com- treatment; endometriosis pleted their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal malignant transformation of affected gonads should be considered in cases of long-standing or recurrent endometriomas, espe- cially 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. Introduction specific management concerns of reproductive age women, Endometriosis has traditionally been considered a disease of including infertility and pelvic pain. Data on postmenopausal the reproductive years. The prevalence of the disease seems disease, although more limited and largely confined to case to be 5%, with a peak between 25 and 35 years of age1.As reports and retrospective studies, have some space in the an estrogen-dependent disease, it tends to undergo regres- current literature. Conversely, there has so far been a notable sion after menopause. Indeed, Punnonen et al.2 describe a lack of interest for the treatment options of affected women frequency of 2.2% for postmenopausal endometriosis. after childbearing age to the natural transition Current literature on endometriosis addresses justifiably toward menopause. CONTACT Paola Vigano [email protected] Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan 20132, Italy. ß 2019 International Menopause Society 2 L. ALIO ET AL. Table 1. WHO Medical Eligibility Criteria (MEC)19 revised for women with endometriosis and modified according to age-related important cardiovascular risk factors. Age 18–40 years Age 40 years No cardiovascular risk factors COCa,Ra, POPa, LNG-IUDa POPa, LNG-IUDa, COCb,Rb Body mass index 30 POPa, LNG-IUDa, COCb,Rb POPa, LNG-IUDa, COCb,Rb Smoking <15 cigarettes/day Ra, POPa, LNG-IUDa, COCb POPa, LNG-IUDa,Rb 15 cigarettes/day Ra, POPa, LNG-IUDa, COCb POPa, LNG-IUDa Hypertension POPa, LNG-IUDa POPb, LNG-IUDb >2 cardiovascular risk factors including vascular diseases POPb, LNG-IUDb POPb, LNG-IUDb COC, combined oral contraceptives; LNG-IUD, levonorgestrel intrauterine device; POP, progestogen-only pill; R, vaginal ring. aMEC category 1: method can be used in any circumstances. bMEC category 2: method can be generally used. According to an estimation of the Icelandic population ovarian reserve7, hence earlier occurrence of menopause in between 1981 and 2000, using Iceland’s extensive record affected women must be considered. Coccia et al.8 con- linkage systems in which each case of visually diagnosed ducted a longitudinal prospective cohort study to investigate and histologically verified endometriosis was cross-checked the age of menopause in patients who underwent surgery against the nationwide pathology registry, age-specific inci- for endometriosis. Unfortunately, out of the 302 evaluated dence in the age groups 30–34, 35–39, and 40–44 years was patients the mean age of menopause was only recorded for estimated at 13.4, 13.3, and 13.2/10,000 person-years, 43 women, which should not be considered a representative respectively. For the age group 45–49 years it was only number. Additionally, a high percentage of women with pre- slightly lower, being around 12/10,000 person-years during mature ovarian failure (16.3%) was observed, the majority of the latter half of the study period (1991–2000)3. In a retro- whom were submitted to ovarian cystectomy for bilateral spective German epidemiological study, a descriptive analysis endometriomas. This underlies the need for a well-designed of 42,079
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