Endometriosis in Women Aged 45 Years Old or More

Objective:To investigate the clinical features and treatment of endometriosis in women aged 45 or older.Methods:All the clinical data of 288 cases of endometriosis in women aged 45 or older who received surgical treatment in our hospital from Jan 1st,1995 to Dec 31st,2002 were reviewed retrospectively.Results:The patients' age ranged from 45 to 67.The main clinical presentation included pelvic mass(76.7%),dysmenorrhea(49.3%) and abnormal vaginal bleeding(29.2%).76% of the patients had other gynecological diseases such as leiomyoma(61.8%),adenomyoma(37.8%),and gynecological malignant neoplasm or precancerous lesions(5.9%) that including three ovarian cancers,one ovarian borderline tumor,one uterine sarcoma,two endometrial cancers and six atypical hyperplasia,and four CIN.60.4% of the patients underwent hysterectomy and bilateral salpingo-oophorectomy,34.7% underwent hysterectomy,4.9% received fertility-sparing surgical treatment.Progesterone was given to 73 cases(25.3%) after surgery and 18 cases(6.3%) received pseudo-menopause treatment.78 cases(27.1%) received hormone replacement therapy.245 patients(85.1%)were followed up,175 of whom were followed for more than six months,5 cases relapsed 6 to 36 months after surgery,the relapse rate was 2.9%.Conclusions:Women aged 45 years old or more with endometriosis often have atypical presentations and other estrogen dependent diseases;they also have high incidence of gynecological neoplasm and precancerous lesions.Total hysterectomy and bilateral salpingo-oophorectomy is recommended to these patients.Postoperative hormone replacement therapy does not seem to increase the incidence of relapse.