No systematic reviews or randomised controlled trials of hysterectomy with or without oophorectomy in women with endometriosis were identified.
The RCOG green-top guideline on the investigation and management of endometriosis says: “Endometriosis associated pain can be reduced by removing the entire lesions in severe and deeply infiltrating disease. If a hysterectomy is performed,all visible endometriotic tissue should be removed at the same time. Bilateral salpingo-oophorectomy may result in improved pain relief and a reduced chance of future surgery” (Namnoum)
The American College of Obstetricians and Gynecologists’ “Management of endometriosis” guideline recommends that “in patients with normal ovaries, a hysterectomy with ovarian conservation and removal of the endometriotic lesions should be considered”
Other guidelines recommend that oophorectomy is only performed in women in whom other treatment options have failed and do not wish to preserve their fertility, e.g.:
American Society for Reproductive Medicine, “Treatment of pelvic pain associated with endometriosis”: “Hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) generally is reserved for women with debilitating symptoms attributed to endometriosis who have completed childbearing and in whom other therapies have failed. ... “Hysterectomy without bilateral salpingo-oophorectomy is less effective, as disease recurrence and subsequent re-operation rates are higher”
Society of Obstetricians and Gynaecologists of Canada, “Endometriosis: Diagnosis and Management.”: “Definitive surgery involves bilateral oophorectomy to induce menopause and may include removal of the uterus and fallopian tubes and, ideally, excision of all visible endometriotic nodules and lesions. It should be considered in women who have significant pain and symptoms despite conservative treatment, do not desire future pregnancies and have severe disease, or are undergoing hysterectomy because of other pelvic conditions, such as fibroids or menorrhagia.”
(Evidence level IV)
- American College of Obstetricans and Gynecologists. Management of endometriosis. Practice Bulletin 114; Obstetrics and Gynecology. 2010 Jul;116(1):223-36
- American Society for Reproductive Medicine. Treatment of pelvic pain associated with endometriosis /Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 2008 Nov;90(5 Suppl):S260-9.
- Namnoum AB,Hickman TN,Goodman SB,Gehlbach DL,Rock JA. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril 1995;64:898–902
- RCOG. The Investigation and Management of Endometriosis. Green-top guideline 24. London: RCOG, 2006.
- Society of Obstetricians and Gynaecologists of Canada. Endometriosis: Diagnosis and Management. Clinical Practice Guideline no 244. Journal of Obstetrics and Gynaecology Canada. Volume 32, Number 7 Supplement 2 July 2010
Classification of evidence levels
- Ia: Evidence obtained from meta-analysis of randomised controlled trials.
- Ib: Evidence obtained from at least one randomised controlled trial.
- IIa: Evidence obtained from at least one well-designed controlled study without randomisation.
- IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study.
- III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
- IV: Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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