Endometriosis: Recurrence & Surgical Management
Whether endometriosis comes 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% 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.