title: Endometriosis in postmenopausal women without previous hormonal therapy: report of three cases.
abstract: BACKGROUND
  Endometriosis is a benign, estrogen-dependent, chronic gynecological disorder associated with pelvic pain and infertility. The disease most commonly affects women during the reproductive age, although postmenopausal patients do rarely present it. These rare occurrences are generally associated with hormonal use.
  
  
  METHODS
  We present three cases of endometriosis in postmenopausal patients who have no history of hormone therapy and no previous history of endometriosis or infertility.
  
  
  METHODS
  In case 1, a 62-year-old woman presented with acyclic pelvic pain and a left ovarian homogeneous cystic mass. After laparoscopic salpingoophorectomy and histological analysis, an ovarian endometriotic cyst was confirmed. In case 2, a 78-year-old woman presented with a painful abdominal wall mass that was confirmed by ultrasound and tomography. Her past medical history included an abdominal hysterectomy 20 years prior to the discovery of this mass. The lesion was surgically excised and histological analysis showed areas of endometrial stroma and glands surrounded by fibrosis, compatible with endometriosis. In case 3, a 54-year-old woman presented with chronic pelvic pain and a nodule in the rectovaginal septum was noted during gynecological examination. Menopause occurred at 48 years of age. She had no previous dysmenorrhea. Ultrasound confirmed the nodule in the rectovaginal septum. The patient was submitted to a diagnostic colonoscopy that revealed a friable lesion, which was subsequently biopsied. The histological diagnosis was endometriosis.
  
  
  CONCLUSIONS
  These three cases of postmenopausal endometriosis support the celomic metaplasia theory for the genesis of this disease.
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors.forename: J C
authors.initials: JC
authors.lastname: Rosa-e-Silva
authors.forename: B R
authors.initials: BR
authors.lastname: Carvalho
authors.forename: H de F
authors.initials: Hde F
authors.lastname: Barbosa
authors.forename: O B
authors.initials: OB
authors.lastname: Poli-Neto
authors.forename: A C J S
authors.initials: AC
authors.lastname: Rosa-e-Silva
authors.forename: F J
authors.initials: FJ
authors.lastname: Candido-dos-Reis
authors.forename: A A
authors.initials: AA
authors.lastname: Nogueira
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001706:Biopsy; D004715:Endometriosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010049:Ovarian Diseases / Q000175:diagnosis / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000601:surgery; D017698:Postmenopause; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler