Postmenopausal Endometriosis
Conditions
Keywords
Postmenopausal endometriosis, Transvaginal ultrasound, Ultrasound
Brief summary
Endometriosis is traditionally considered a disease of reproductive-age women; however, residual lesions may persist after menopause and be detectable at imaging. The prevalence and sonographic characteristics of such findings in postmenopausal women remain poorly defined. This prospective observational study aims to assess the prevalence and ultrasonographic features of findings suggestive of deep endometriosis and endometrioma-like cysts in postmenopausal women undergoing routine gynecological examination using a standardized transvaginal ultrasound protocol. The study also explores clinical factors associated with these findings to improve interpretation and clinical management in this population.
Detailed description
This is a prospective observational study including consecutive postmenopausal women attending gynecological outpatient clinics for routine evaluation. Participants undergo a standardized transvaginal ultrasound performed by an expert operator according to the International Deep Endometriosis Analysis (IDEA) group criteria, with systematic assessment of pelvic compartments and soft markers. Ultrasound findings suggestive of deep endometriosis and/or endometrioma-like cysts are recorded and morphologically characterized. Clinical data, including demographic variables, reproductive history, pain symptoms during reproductive life, and hormonal exposure after menopause, are collected using a structured questionnaire and medical records. The primary objective is to determine the prevalence and describe the sonographic phenotype of suspected endometriosis-related findings in postmenopausal women. Secondary objectives include identifying clinical factors associated with these findings through multivariable analysis and improving the differentiation between benign residual lesions and clinically relevant or suspicious pathology in this setting.
Interventions
PROCEDUREAnamnesis
Collection fo clinical data
PROCEDUREUltrasonographic evaluation
Ultrasonographic evaluation according to stardardized criteria for detecting endometriosis
Sponsors
Simone Ferrero
ASL4-Liguria
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
50 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Women aged ≥50 years * Postmenopausal status, defined as ≥12 consecutive months of spontaneous amenorrhea not attributable to pregnancy, lactation, medical therapy, or other pathological causes * Attendance at participating gynecological outpatient clinics for routine examination * Ability to undergo transvaginal ultrasound examination * Ability to provide informed consent
Exclusion criteria
* Previous surgical and/or radiological diagnosis of endometriosis * History of hysterectomy and/or bilateral oophorectomy (any surgical approach) * Active pelvic malignancy at the time of enrollment * Inability to undergo or tolerate transvaginal ultrasound examination (e.g., severe introital stenosis, vaginismus, or never sexually active) * Non-interpretable ultrasound examination due to technical limitations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Prevalence of ultrasound findings suggestive of deep endometriosis in postmenopausal women | Baseline | Proportion of postmenopausal women presenting at least one ultrasound finding suggestive of deep endometriosis and/or endometrioma-like cysts, as assessed by standardized transvaginal ultrasound according to the International Deep Endometriosis Analysis (IDEA) criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ultrasonographic characteristics of endometriosis-like lesions | Baseline | Morphological description of ultrasound findings suggestive of deep endometriosis, including lesion size, margins, echotexture, vascularization, and anatomical distribution within pelvic compartments |
| Association between ultrasound findings and reproductive-age symptoms | Baseline | Association between the presence of ultrasound findings suggestive of endometriosis and history of dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility during reproductive life. |
| Association between ultrasound findings and time since menopause | Baseline | Evaluation of the relationship between time elapsed since menopause and the presence of ultrasound findings suggestive of deep endometriosis. |
| Association between ultrasound findings and hormonal exposure | Baseline | Assessment of the association between ultrasound findings suggestive of endometriosis and current or past use of hormone replacement therapy or local estrogen therapy. |
| Prevalence of endometrioma-like ovarian cysts | Baseline | Proportion of postmenopausal women presenting ovarian cysts with ultrasound features suggestive of endometriomas, including typical and atypical morphology. |
Countries
Italy
Outcome results
None listed