At 65, why is my mom having endometritis in menopause?

Question

Hello, Doctor,

My mother is 65 years old, completed menopause over 12 years ago, and her recent scan showed active endometriosis lesions, which have left us completely stunned. She takes no estrogen supplements and has had no hormonal exposure we were aware of. We always believed this disease would disappear once periods stopped permanently. Her doctors have not given us a satisfactory explanation for why the lesions are still active and growing. Can you please explain?

How does endometriosis in a post-menopausal 65-year-old disprove the menstrual theory entirely?
Is there a completely different mechanism driving this disease?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

It is interesting to find endometriosis in your mother at a menopausal age, knowing the fact that the level of estrogen decreases in the post menopausal period, and logically, endometriotic tissue should also decrease.

Endometriosis in post menopausal women is rare, typically due to reduced estrogen levels, causing most endometriosis to regress. However, the disease can persist or develop due to the following mechanisms:

An external source of estrogen, such as in hormone replacement therapy. This is not the cause in your mother, as she is not on any external estrogen source.
Endogenous estrogen, which is continuously secreted by body fat (adipose tissue) after menopause, can sometimes reactivate dormant endometriotic tissue, therefore causing symptoms in a post menopausal woman. This is more common in fat post menopausal women. This is a likely cause in your mother.
There may be an estrogen secreting tumour. The estrogen secreted from the tumour can reactivate dormant endometriosis, making it symptomatic again. A pelvic scan can help rule out this.

In my opinion, the reasons are;

Estrogen Secretion from adipose tissue.
Possible estrogen secreting tumour.

So, she would need some further evaluation to check for an endogenous source of estrogen. An abdominopelvic ultrasound scan is useful for her.

I hope this information helps you.

Feel free to ask further queries.

Thank you.