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- Title
Endometriosis at extreme ages.
- Authors
Clim, Ioana-Adelina; Ciortea, R.; Bucuri, Carmen; Marrouche, Yasmina; Suciu, Viorela; Măluțan, A.; Oancea, Mihaela; Iuhaş, C.; Mihu, D.
- Abstract
Introduction. Endometriosis is an estrogen-dependent, chronic, recurrent and progressive inflammatory disease. It affects predominantly fertile women, with a prevalence of 5-10% and a peak between 25-35 years old, but there are situations when the onset of the disease occurs early in adolescence or, less frequently, late in peri- or post-menopause. Materials and method. In order to review the literature on prevalence, pathogenesis, risk factors and endometriosis management at extreme ages, we have accessed the PubMed database using the following keywords: "endometriosis", "adolescents", "menopause". Articles from 2016 have been selected so far. Results. Among adolescents, the exact prevalence of the disease remains unknown. It is estimated that about two-thirds of adolescents with chronic non-responsive pelvic pain will be diagnosed with endometriosis. In peri- or post-menopause, the prevalence varies between 2% and 4%. In case of adolescents, the main pathogenetic mechanism incriminated is retrograde tubal flow during menstruation, while in peri- or post-menopause, the reactivation of previously diagnosed endometriosis outbreaks or, rarely, de novo endometriosis are identified. The importance of the problem lies in the evolutionary nature of lesions in adolescence, which can cause infertility, while in menopause, the predisposition to malignancy of the lesions, the trend of extragonal extension and the invasive character of the lesions are the most important features. Thus, if at menopause, the first-line treatment is the surgical procedure, while in the case of adolescents there is still no consensus - either initially medication due to increased recurrence of the disease and the urgency of multiple surgical interventions, or initial surgical treatment to avoid the development of deep endometriosis. Conclusions. The enigmatic aspect of the pathogenesis of endometriosis is highlighted by the extreme age diagnosis, beyond the theoretical concepts, the management being a real challenge for the practitioner.
- Subjects
ENDOMETRIOSIS; HUMAN fertility; DISEASE prevalence; MENSTRUATION; MENOPAUSE
- Publication
Obstetrică şi Ginecologie, 2019, Vol 67, Issue 2, p83
- ISSN
1220-5532
- Publication type
Article