Silent onset of postmenopausal endometriosis in a woman with renal failure in hormone replacement therapy: a case report

Ugo Indraccolo, Fabrizio Barbieri, F Barbieri
Journal of medical case reports · 2010 · vol. 4(1) , pp. 248 · doi:10.1186/1752-1947-4-248 · PMID:20684788 · PMC2923173 · W2111975495
article OA: gold CC0 ⤵ 7 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

A postmenopausal woman with prior endometriosis on hormone replacement therapy developed severe renal failure from infiltrating endometriotic nodules causing ureteral compression, despite lacking typical pelvic pain.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This case report describes a 54-year-old woman with prior ovarian endometriosis and surgical menopause who took estrogen-only hormone replacement therapy for seven years and then developed postrenal renal failure from bilateral hydronephrosis caused by two large deeply infiltrating endometriotic nodules compressing both ureters, with no pelvic pain and normal serum Ca-125. After ureteral stenting and subsequent laparoscopic excision of nodules with adhesiolysis, renal function did not improve at the time of surgery, and postoperative recovery was complicated by broncho-pneumonia; mild renal impairment persisted after discharge but appeared stable after stent removal. The authors discuss potential mechanisms for postmenopausal endometriosis, including aromatase activity within endometriotic tissue and the possibility of estrogen effects from exogenous hormone therapy, while noting that silent growth can lead to serious complications. This paper is centrally about endometriosis — specifically a case of silent onset of postmenopausal endometriosis presenting as ureteral obstruction and renal failure during hormone replacement therapy.

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Abstract

INTRODUCTION: Postmenopausal endometriosis is a rare form of a common disease, since the absence of estrogenic hormone production should halt disease progression. CASE PRESENTATION: We present the case of a 54-year-old Italian Caucasian woman in surgical menopause with a history of ovarian endometriosis, who underwent voluntary hormone replacement therapy for seven years. She developed postrenal renal failure due to bilateral compression of the pelvic ureteral tract caused by two large, deeply infiltrating endometriotic nodules with no pelvic pain. She underwent operative laparoscopy with adhesiolysis of enteroenteric adhesions and excision of the endometriotic nodules encompassing the juxtavesical tract of the ureters, without obtaining improvement of renal failure. CONCLUSION: Postmenopausal endometriosis can manifest itself in an unpredictable and potentially very serious manner. It is therefore important to carefully evaluate the risks and benefits of administering hormone replacement therapy to patients with previous endometriosis.

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endometriosis

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