FEATURES OF DIAGNOSIS, CLINICAL PICTURE AND CARE TACTICS FOR ENDOMETRIOSIS IN POSTMENOPAUSE

The aim of this study is to investigate the diagnostic features, clinical features, and management tactics for postmenopausal endometriosis using the examination and treatment results of patient B., 64 years old, admitted for surgery with the diagnosis: "Right ovarian cyst. Stage 2 hypertension, risk 3. Left knee coxarthrosis. Left-sided hemiparesis (consequences of surgical treatment of a tumor of the right parietal lobe. Obesity grade 3. Adhesions of the abdominal cavity." From the anamnesis it was found that 16 years ago, the patient at the age of 48 years underwent a subtotal hysterectomy with left appendages due to large uterine fibroids in combination with endometriosis. Over the past 10 years, she has not been examined by a gynecologist. Intraoperatively, a pronounced adhesive process of the small pelvis was found. The right ovary is represented by a giant cyst 20 cm in diameter, with a smooth external capsule, intimately fused with the small and large intestine. When isolating the tumor from the adhesive process, a linear defect of the sigmoid colon of 2 cm was found. The defect was sutured, the right appendages along with the cyst were removed. Histology: endometrioid ovarian cyst. Postoperative period - Without complications. This clinical case can be explained by the genetic-epigenetic theory, which considers the pathophysiology of endometriosis to be the result of the combined effects of genetic and epigenetic adverse influences, particularly, in this case, obesity and CNS pathology, possibly leading to altered sensitivity of sex steroid receptors, which respond to even a slight increase in estrogen levels synthesized in adipose tissue and, locally, in the endometriosis itself. Management tactics should be proactive, involving surgical removal of the endometriosis followed by histological examination.