Endometriosis: After Surgery? What Next

Surgical treatment for endometriosis usually resolves the pain, either partially or completely, for at least months, and possibly years. Women who undergo surgical treatment of endometriosis are still very likely to have recurrence.  A study by Vercellini in the British Journal of Obstetrics and Gynecology stated that after endometriosis surgery about 60% have recurrence of pain and that it's very important to take medical therapy after the surgery to make sure the pain doesn't return. They have showing in other studies that just using medical therapy for under 3 months after surgery is of no benefit at all.. Actually the type of surgery that people have is important. If you had a cyst of endometriosis called an endometrioma removal of the whole cyst rather than just cauterizing it, delayed the recurrence of pain and sped up the time to pregnancy in one study conducted in the late 90s. But a study in AJOG in March 2014 showed that 20% of women have a recurrance of an endometrioma within o5 years of their surgery, and over 13% of women have a need for a third surgery. But after surgery it is important to either go on oral contraceptives, DepoProvera, or a medical therapy for endometriosis such as Lupron.http://www.lupron.com/ Lupron is not likely to produce menopausal symptoms if managed in conjunction with birth control pills. At Women's Health Practice when we administer Lupron we prefer add back therapy with a progesterone only pill, or a pill with the lowest possible estrogen dosage, such as LoLoestrin.  It is important for women to get a good source of information regarding Lupron as it is a very effective medicine and gynos will often see women who are not willing to give it a try. It is expensive, and my require preauthorization, but if the pain relief is significant, and it usually is, then it's going to be worth the investment! In a new study in the March 2012 Obstetrics and Gynecology journal a study by Tanmahasamut and coworkers showed that using the progesterone releasing levonorgestrel-releasing intrauterine system LNG-IUS can reduce the pain of endometriosis effectively if used after surgery. Even with the LNG-IUS some women found the pain returning.

Comments

  1. 5 years ago I was having endometrial symptoms near my liver but went undiagnosed. I have also had pain in my kidneys for years that the Doctors dismissed as possible kidney stones. 3 years ago I had a hystorectomy in which my ovaries and cervix were left but my uterus was removed due to cesarian delivery infection. The scar and scar tissue is tremendous as the infection was life threatening. My family and I were told they pulled out my intestines and put them back in to make sure the infection was controlled. 3 months later I was admitted to the ER for the same right upper quadrant pain I had 5 years ago. They did a CT scan and again I was sent home. About a year after that I went into the ER for severe pelvic pain on the left side. I was again sent away (this time all they did was a blood draw). By this time I was like ok I'm just going to ignore all of this. Until 4 weeks ago I found a mass in my abdomen. I went to the ER last Friday were they did 3 different type of ultrasounds. They then told me they found an abdominal mass 7 cm in diameter that looks like endometrial tissue. So I have a follow up appointment in a week with a specialist. I am scared to death that I'm not being taken seriously again and that I could be in stage IV. Since all the poking and prodding on Friday I began having cold clammy palms, a low grade fever of up to 100 degrees ferenheit. There is a warm radiating pain near the area of the cyst that is radiating out and I'm having chills and some mental confusion. These symptoms have been worsening and today my lower back is very painful. Should I go back to the ER?

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  2. We should probably start with a disclaimer that this blog is for background information, to review new research, to talk in general about the gynecologic, obstetric and women's health issues of today. Since we cannot have physical contact, or really have access to accurate medical records it's not possible to actually treat someone. Women should consult their actual physician, or a physician access line in the hospital nearest you to determine if an emergency room visit is warranted. That being said, I will say that most physicians feel that patients running a fever should be seen promptly. In addition to fever other tests can indicate if you have an infection in your system: WBC counts, sed rates, just to name two such tests. It is important to not assume that "because nothing was done" that something "should have been done." That is not always the case. Women with complex medical histories benefit by having either all their records in one place or a set of their own records. When the case gets complicated enough often a making an appointment with a physician for second opinion will be helpful. We wish you well and hope you find a firm diagnosis soon.

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