Diagnosis and Management of Vaginal Endometriosis Involvement in Postmenopausal Woman. A Case report

Volume 2 - Issue 3

Baquedano Mainar L*, Herrero Serrano R, Espiau Romera A, Gabasa Gorgas L, Pallarés Arnal V, Benito Vielba M, Ortega Marcilla S and Lamarca Ballesteros M

Received: March 01, 2019;   Published: March 07, 2019

DOI: 10.32474/OAJRSD.2019.02.000138

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Abstract

Endometriosis is a pathology which affects up to 10% of the female population in reproductive age characterized by the presence of actively functional endometrial ectopic tissue that suffers cyclical changes that are induced by the ovarian hormones, which produces a chronic inflammatory reaction. This disease occurs during the reproductive years and is rarely diagnosed after menopause.

Case Report: A 51 years old woman, who had had a unilateral laparoscopic adnexectomy due to an endometrioma one year before, was admitted because of postmenopausal vaginal bleeding. The medical examination only showed two polypoid formations of 1 and 3cm located on posterior vaginal fornix which presented with smooth cystic surface. A histological analysis was carried out revealing an endometriotic nature. Despite the bleeding, the patient was asymptomatic, consequently a close monitoring was adopted.

Discussion: Typically, endometriosis resolves after natural or iatrogenic menopause due to declining estrogen levels. Nonetheless, case reports over the years have highlighted the incidence of recurrent postmenopausal endometriosis. Occurrence or progression of postmenopausal endometriosis lesions could be related to extra-ovarian production of estrogen by endometriosis lesions and adipose tissue, which becomes the major estrogen-producing tissue after menopause. Hormone therapy (HT) may reactivate endometriosis and stimulate malignant transformation in women with a history of endometriosis.

The risk of malignant transformation of premenopausal endometriosis is around 1%. Furthermore, patients with endometriosis have an increased risk of ovarian cancer and other malignancies. These transformations appear to be further elevated in patients who take HT, although this issue is not fully elucidated. The evidence is currently insufficient to support a conclusion about the optimal HT for women with endometriosis. Given the uncertain risks of initiating it, it is laborious to determine the best management.

Conclusión: Vaginal involvement is an atypical endometriosis location, especially in menopausal women, thus close surveillance is necessary.

Keywords:Endometriosis; Menopause; Vaginal Diseases; Vaginal Bleeding

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