Endometrioza w wieku przed- i okołomenopauzalnym – jak leczyć?

Endometriosis, i.e. extragonadal localization of endometrial stroma and glands is predominantly found inreproductive age women, however it is also diagnosed in teenagers and postmenopausal women. Prevalenceof postmenopausal endometriosis is 2-5% of all endometriosis cases, with majority found in patients usingestrogen replacement therapy (ERT). Etiopathogenesis of endometriosis after menopause is related toextragonadal aromatase activity (androstendione to estradiol conversion). The aim of endometriosis therapyis to relief pain. This effect can be achieved either through pharmacological or surgical treatment. Majorityof endometriosis medications relies on reduction of estradiol production. Combined hormonal contraceptivedrugs (oral, transdermal, transvaginal) and gestagens constitute first-line pharmacological therapy. Second-lineconsists of GnRH analogs, intrauterine system releasing levonorgestrel, danazol, and gestrinone. Progressivelymore and more experimental treatments are applied in postmenopausal endometriosis, just to name aromataseinhibitors suppressing local estrogen production. Surgical therapy may be also considered as first-line approach.Depending on the history of illness, pain intensity, and patient expectations surgery can cover wide spectrumfrom local excision of endometriosis through interruption of neural pathways (presacral neurectomy) finishingwith total hysterectomy with or without bilateral salpingoophoorectomy.