EP31.22: Endometriosis and the peri‐ and postmenopausal patient

Typically, we think of the endometriosis patient as being symptomatic and in the fertile age bracket but we are largely ignoring a group of patients who remain undiagnosed suffering from unexplained pelvic pain and infertility. These are the patients in the peri- and postmenopausal age group who often present for pelvic imaging with symptoms of abnormal bleeding or pain. It is imperative that we move beyond measuring and describing the endometrium and assessing the ovaries to a more thorough and rigorous ultrasound examination of the pelvis. Unlike other hormonal conditions, endometriosis does not disappear post menopause and it can in fact become stimulated by the hormonal upheaval during perimenopause, this can cause a significant impact on the female pelvis. Likewise, the undiagnosed postmenopausal patient may still have hormonal surges that result in stimulation of latent endometriotic nodules. Peri- and postmenopausal patients rarely present for a specific endometriosis ultrasound and are often unaware that they have this condition. Although laparoscopic surgery remains the gold standard for diagnosing endometriosis a transvaginal or transrectal ultrasound offers a cost-effective and easier alternative to assessing the female pelvis. It should be performed to allow for a thorough investigation of the female pelvis and examine for endometriotic deposits. Assessment should be made for adherent organs, endometriotic bowel disease and the presence of ovarian adenocarcinomas. The presence of endometriosis will also have an impact on the type of HRT prescribed for these women. The peri- and postmenopausal patient should not be ignored in the context of endometriosis. It is essential that this group of women be imaged diligently to not only assess the uterus and ovaries but to extend the examination to assess all areas of the pelvis to exclude endometriotic nodules, adherent organs and endometriosis related ovarian pathology.