Дistinction between endometriosis lesions and cancer is complicated by the fact that some of the risk factors are similar, such as low parity rate, infertility, late childbearing age, and a short duration of oral contraceptive use. The ovaries are the most common location of endometriotic lesions in postmenopausal patients (79.2% of cases). However, in recent years, focus has turned to the diagnosis of endometriosis in postmenopausal patients, given that the onset of pain can start after the onset of menopause, with reports of endometriosis occurring even in 80-year-old patients.

For many years, there has been a long-standing myth that endometriosis is a disease that affects only adult women of reproductive age. This results from the lack of noninvasive tools available for early stage diagnosis. Дespite intensive research conducted in the last decades, endometriosis remains a disease with a delayed diagnosis, especially in older patients. Дespite the fact that postmenopausal endometriosis has the same immunochemical profile as premenopausal endometriosis and has the potential to reactivate under estrogen stimulation, endometriosis lesions in the postmenopausal period seem to be less common, less extensive, and less active in most cases. Phytoestrogens appear to exert estrogenic effects on the uterus, breast, and pituitary and could also support the growth of endometriotic lesions. In addition to the peripheral estrogen production, a high circulating level of estrogen may be of external source, especially in the form of phytoestrogens and HRT. The leading estrogen found in these patients is estrone.ДЄn attractive theory regarding the pathogenic mechanism of postmenopausal endometriosis involves the вЂњestrogen thresholdвЂќ, i.e., when a certain estrogen level is reached or surpassed in postmenopausal patients it activates undetected or вЂњtransientвЂќ foci of endometriosis. The arrest of estrogen production at the level of the ovaries at the time of menopause is counterbalanced by peripheral estrogen production from conversion of androgens (especially in the adipose tissue and skin). Excess estrogen, in general, represents a promoting factor for endometriosis. It is still unclear whether this represents a recurrence or continuation of a previous disease or a de novo condition. Postmenopausal endometriosis is considered to have an even more complex pathophysiology than premenopausal endometriosis.

The pathogenesis of endometriosis remains enigmatic. Д®ndometriosis is an estrogen-dependent inflammatory disease characterized by the presence of ectopic endometrial tissue. The results showed that 33,814 patients (80.36%) were in the premenopausal group (age 0вЂ“45 years), with 23 patients (0.05%) being younger than 15 years of the remaining patients, 7191 (17.09%) were in the perimenopausal (45вЂ“55 years), and 1074 patients (2.55%) in the postmenopausal group, respectively. Patients were sorted in 5 years age groups and also in premenopausal, perimenopausal, and postmenopausal subgroups. performed a retrospective epidemiological study on 42,079 women admitted for surgical treatment with histologically confirmed endometriosis. In order to evaluate the prevalence of postmenopausal endometriosis, Haas et al. In a few cases, postmenopausal endometriosis has been described in women who had no history of endometriosis on imaging or surgery prior to menopause. It commonly represents a side effect of HRT, rarely occurring in patients without a history of HRT or Tamoxifen treatment. The incidence of postmenopausal endometriosis reported in literature is of approximately 2вЂ“5%.

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