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Endometriosis recurrence prevention

I am 40 years old and have 2 children. I have suffered from endometriosis for the past 7 years. 5 years ago, I had a “chocolate cyst”removed by open surgery and another one on the opposite ovary removed by key-hole surgery 3 years later. Recently, I started to have menstrual pain and backache again. Is there anyway of preventing endometriosis from recurring? What are my treatment options?

Endometriosis is a chronic and progressive disease where the lining of the womb (endometrial tissues) is spilled into the surrounding organs-- fallopian tubes, ovaries and the back of the womb. These endometrial tissues respond cyclically every month to the female hormone, oestrogen, from the ovary and bleed during menstruation. The surrounding areas become irritated by the blood and form scars in the pelvis causing backaches, abdominal cramps during menstruation and pain during sexual intimacy.

There is no definitive cure for the disease which will only regress after menopause when there is little or no circulating oestrogen The treatment for endometriotic cystslis surgical removal. But the recurrence rate is high,ranging from 20-50% within 5 years after surgery.

How fast the disease recurs depends on the following factors:

• Severity ofthedisease at the time of surgery

• Completeness of the surgery

• Use of suppressive hormonal treatment after operation

There are a number of hormonal treatment options that may be used to delay the recurrence. Which option is right for you will depends on your condition. By reducing the levels of blood oestrogen, the chances of endometriosis recurrence are reduced. This can be done using oral contraceptive pills or a GnRH agonist. Recent studies have shown that insertion of Mirena, a hormone impregnated intrauterine contraceptive device (IUD) can be effective for delaying the recurrence. Some women may also choose to use an aromatase inhibitor to stop all production of oestrogen. If medical treatment fails, the surgical removal of the uterus (hysterectomy) with or without removal of the ovaries (bilateral oophorectomy) may be the last resort.

See also the articles“ How does GnRH agonist work and what are the side effects?”under Q&A and “Endometriosis”under Gynae conditions

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