Endometriosis

Due to the effects on bone density, treatment of endometriosis with one of these agents is usually limited to 6 months or less.

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Surgery (either laparoscopy or laparotomy) is usually reserved for women with severe endometriosis, including adhesions and infertility. Conservative surgery attempts to remove or destroy all of the outside endometriotic tissue, remove adhesions, and restore the pelvic anatomy to as close to normal as possible. Nerve removal (neurectomy) may rarely be performed during surgery as a means of relieving the pain associated with endometriosis.

Definitive surgery is appropriate for the woman with severe symptoms or disease, and no desire for future childbearing. This type of surgery involves abdominal removal of the uterus (hysterectomy), both ovaries, both fallopian tubes, and any remaining adhesions or endometriotic implants. Hormonal replacement therapy may be indicated after removal of the ovaries and should be tailored to the individual woman's needs.

Expectations (prognosis):

Fertility rates in women with mild endometriosis are very high, even without therapy. Enhanced fertility after surgery for endometriosis depends on the extent of the endometriosis.

Pregnancy rates, achieved after conservative surgery in women previously considered to be infertile, are approximately 75% for mild endometriosis, 50-60% for moderate cases, and 30-40% for severe cases.

Complications:

Infertility may result from endometriosis, but not in every patient -- especially if the endometriosis is mild. Endometriosis has been known to recur even after a hysterectomy. Other complications are rare. In a few cases endometriosis implants may cause obstructions of the gastrointestinal or urinary tracts.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of endometriosis occur, or if back pain or other symptoms recur after treatment of endometriosis.

Screening for endometriosis should be considered if your mother or sister has been diagnosed with endometriosis, or if you are unable to become pregnant after 1 year of attempting to conceive.