Whether endometriosis will come back (recur) after surgery depends on how severe the disease was at the time of surgery and how completely the surgery removed your lesions. Lesions that appear after surgery may be new or pre-existing. For this reason, it may be difficult for your doctor to tell whether your disease has come back or is progressing. Many studies also report patient symptoms as a sign of new disease.
The most recent studies have shown that endometriosis recurs at a rate of 20 to 40 percent within five years following surgery. Pregnancy does not delay the onset of symptoms. In women with advanced endometriosis, one study demonstrated a higher pregnancy rate with in vitro fertilization (IVF-ET) rather than another surgical procedure. Surgery may also be considered to relieve pain.
Surgical removal of the uterus (hysterectomy) with or without removal of the ovaries (bilateral oophorectomy) is often used to treat endometriosis associated with pelvic pain or nearby masses. A recent follow-up study investigated the recurrence of symptoms after hysterectomy with or without removal of the ovaries. In women who kept their ovaries, 62 percent had recurrent symptoms and 31 percent required further surgery. In women who had their ovaries removed, 10 percent had recurrent symptoms and 3.7 percent required further surgery.
Most of the women who had their ovaries removed had been on estrogen replacement therapy. It was demonstrated that many women that have recurrent symptoms after hysterectomy and removal of the ovaries have persistent disease, that is the disease was there at the time of hysterectomy and it was not removed. A large number of these women had endometriosis that involved the bowel.
In women who request treatment as a final option for their symptoms, it is generally recommended that both ovaries and all visible endometriosis be removed. No adverse effects of estrogen therapy on endometriosis have been reported in many studies. Furthermore, two recent studies have shown no advantage in delaying the onset of estrogen replacement therapy.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/22/2006...#4551
