Endometriosis in Postmenopausal Woman Without Previous Hormonal Therapy: A Case Report

Endometriosis is a benign, estrogen-dependent, chronic gynecological disorder commonly associated with pelvic pain and infertility. The prevalence of pelvic endometriosis is high, affecting approximately 6- 10% of women of reproductive age. Although endometriosis has been associated with the occurence of menstrual cycles, it may affect between 2-5% of postmenopausal women. In this presentation, we would like to draw attention to such cases of postmenopausal endometriosis. A 56-year-old woman was presented with postmenopausal vaginal bleeding. Her menopausal status occured at 46 years of age. She had neither personal history of endometriosis and a prior history of pelvic pain nor previous hormone use. A pelvic ultrasound scan revealed a right ovarian cystic mass of approximately 2.6x2.1cm in size and a left ovarian multiple lobated hemorrhagic cystic mass approximately 5.0x2.8 cm in size. Cancer antigen 25 (CA 125) level appeared to be within the normal range. The patient was then submitted to a computed tomography scan that showed multiple lobated cystic masses at both adnexa. Total abdominal hysterectomy and bilateral salpingooophorectomy was performed. The histological analysis confirmed an ovarian endometriotic cyst. Endometriosis may be found in postmenopausal women, even without a history of previous hormone use. Thus, endometriosis should be considered in the differential diagnosis of postmenopausal adnexal masses.