<![CDATA[Introduction: Postmenopausal endometriosis is a rare condition that presents diagnostic and therapeutic challenges, requiring evidence from various study designs. This systematic review evaluates the quality of available case reports and interventional studies to determine the reliability of evidence supporting hormonal suppression therapy and surgical management in postmenopausal endometriosis. Case Presentation: Risk of bias was assessed using the JBI Critical Appraisal Checklist for Case Reports and the Cochrane RoB 2 tool for randomized or quasi-experimental studies. Each domain was evaluated to determine methodological rigor and reporting completeness. Result: Included studies demonstrated that hormonal and surgical therapies offer varying degrees of effectiveness in managing postmenopausal endometriosis. Retrospective findings showed that menopausal hormone therapy may reduce symptoms, although adjustments to dose or regimen were sometimes required due to recurrence. Randomized and comparative trials evaluating different hormonal regimens reported symptom improvement without significant changes in metabolic parameters, although stimulation of residual endometriotic tissue remained a consideration. Controlled trials comparing hormonal therapy with surgical intervention indicated that treatment decisions should be individualized and carefully monitored. Case reports consistently documented favorable outcomes following surgical removal of lesions, with long-term follow-up showing no recurrence in several patients. Reports of medical therapy, including aromatase inhibition with supportive bone-protective treatment, demonstrated reductions in lesion activity and stabilization of bone density. Overall, both medical and surgical approaches were associated with symptom relief and stable clinical outcomes, with no major complications reported across studies. Conclusion: Evidence on treatment effectiveness in postmenopausal endometriosis remains limited by methodological weaknesses in interventional studies. While case reports support the potential benefits of surgical and hormonal therapies, more rigorous prospective studies are needed to strengthen clinical recommendations.]]>
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