Recurrent Endometriosis: Surgical Management

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 conservative surgery. The use of oral contraceptive after surgery has been shown to reduce the recurrence of pain symptoms. In women with advanced recurrent endometriosis, 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 completed their families. 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, 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. 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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