Postmenopausal bladder endometriosis without exogenous estrogen: a case report and literature review

Namei Wu, Wu N, Yuxuan He, He Y, Yazhuo Jia, Jia Y, Wang G, Guoyun Wang
BMC women's health · 2026 · vol. 26(1) · doi:10.1186/s12905-026-04522-y · PMID:42210311 · PMC13430835 · W7162683066
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This case report describes bladder endometriosis in a postmenopausal woman without exogenous estrogen, suggesting impaired estrogen metabolism and chronic inflammation may sustain lesions.

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This paper reports a rare case of postmenopausal bladder endometriosis in a woman with a normal body mass index and no history of exogenous estrogen or estrogen replacement therapy. The patient presented with dysuria; clinical evaluation and imaging suggested bladder endometriosis, and she underwent laparoscopic partial cystectomy with total hysterectomy and bilateral salpingo-oophorectomy, with histopathology confirming endometriosis. The authors additionally discuss a possible mechanism involving liver cirrhosis (impairing estrogen metabolism) and diabetes (associated with chronic inflammation), proposing a synergistic pro-inflammatory microenvironment that could help sustain local estrogen activity and lesion persistence. This paper is centrally about endometriosis — specifically postmenopausal bladder endometriosis occurring without exogenous estrogen.

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Abstract

BACKGROUND: Endometriosis is a common estrogen-dependent disorder that typically affects women of reproductive age and generally resolves following menopause. This report describes a rare case of postmenopausal bladder endometriosis (BE) occurring in a woman with a normal body mass index and no history of exogenous estrogen use. CASE PRESENTATION: A postmenopausal woman with a normal body mass index and no history of estrogen replacement therapy presented with dysuria. Clinical examination and imaging suggested bladder endometriosis. The patient underwent laparoscopic partial cystectomy with total hysterectomy and bilateral salpingo-oophorectomy. Postoperative histopathology confirmed the diagnosis of endometriosis. CONCLUSIONS: This case demonstrates that BE can occur in postmenopausal women in the absence of exogenous estrogen or obesity. The coexistence of liver cirrhosis, associated with impaired estrogen metabolism, and diabetes, characterized by chronic inflammation, may synergistically contribute to a pro-inflammatory microenvironment that sustains local estrogen activity, enabling lesion persistence. Clinicians should consider such systemic factors in non-obese postmenopausal women presenting with symptoms suggestive of endometriosis.
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Abstract

Background Endometriosis is a common estrogen-dependent disorder that typically affects women of reproductive age and generally resolves following menopause. This report describes a rare case of postmenopausal bladder endometriosis (BE) occurring in a woman with a normal body mass index and no history of exogenous estrogen use. Case presentation A postmenopausal woman with a normal body mass index and no history of estrogen replacement therapy presented with dysuria. Clinical examination and imaging suggested bladder endometriosis. The patient underwent laparoscopic partial cystectomy with total hysterectomy and bilateral salpingo-oophorectomy. Postoperative histopathology confirmed the diagnosis of endometriosis.

Conclusions

This case demonstrates that BE can occur in postmenopausal women in the absence of exogenous estrogen or obesity. The coexistence of liver cirrhosis, associated with impaired estrogen metabolism, and diabetes, characterized by chronic inflammation, may synergistically contribute to a pro-inflammatory microenvironment that sustains local estrogen activity, enabling lesion persistence. Clinicians should consider such systemic factors in non-obese postmenopausal women presenting with symptoms suggestive of endometriosis. Similar content being viewed by others Abbreviations - BE: - Bladder endometriosis - BMI: - Body mass index - DIE: - Deep infiltrating endometriosis - IUD: - Intrauterine device - ER: - Estrogen receptor - PR: - Progesterone receptor

Acknowledgements

Not applicable. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Shandong Provincial Hospital Affiliated to Shandong First Medical University. Written informed consent was obtained from the patient for participation. Consent for publication Written informed consent was obtained from the patient for publication of this case report. Competing interests The authors declare no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Wu, N., He, Y., Jia, Y. et al. Postmenopausal bladder endometriosis without exogenous estrogen: a case report and literature review. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04522-y Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04522-y

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Condition tags

endometriosisbladder_endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (27)

SciLite annotations

chemicals 5
estrogen estrogen estrogen estrogen estrogen
organisms 1
noordeloos 2009062

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