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Diseases & Conditions

Recurrent Endometriosis: Surgical Management

Whether endometriosis will come back (recur) after surgery depends upon three factors:

  • how severe the disease was at the time of surgery
  • how completely the surgery removed the lesions
  • whether postoperative medical suppressive therapy was used

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 conservative surgery. The use of oral contraceptive, other suppressive hormonal therapy, or progesterone intra uterine device (IUD) after surgery has been shown to reduce the recurrence of pain symptoms. In women with advanced recurrent endometriosis and infertility, one study demonstrated a higher pregnancy rate with in vitro fertilization (IVF-ET) rather than another surgical procedure. Surgery or medical therapy may be considered to relieve pain in infertility patients.

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 in patients who have finished having children.

A recent follow-up study investigated the recurrence of symptoms after hysterectomy with or without removal of the ovaries. In patients who kept their ovaries, a higher proportion of women required further surgery compared with women who had their ovaries removed. However, removal of ovaries is accompanied by significant side effects. Therefore, it is recommended in some women to leave the ovaries in if they are normal at the time of surgery. If the ovaries are removed, no adverse effects of estrogen therapy on endometriosis recurrence have been reported in many studies. Furthermore, two recent studies have shown no advantage in delaying the onset of estrogen replacement therapy after surgical removal of ovaries.

References

© Copyright 1995-2014 The Cleveland Clinic Foundation. All rights reserved

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. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 8/1/2014... index#4551