Women with endometriosis have a significantly higher risk of multiple operations, shorter time to repeat surgery and hysterectomy compared with those without the condition, reveals a large study published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).
The authors say the results should help women with a new diagnosis make timely reproductive choices and assist with clinical service planning.
The findings show that 62% of women with endometriosis had further surgery, with a median time of less than two years to a second surgical procedure. Half of all women with endometriosis had undergone repeat surgery within 5.5 years and one in five women had hysterectomy or removal of one or both ovaries.
Endometriosis is a common gynaecological condition affecting 2-10% of women of reproductive age. It develops when tissue similar to that found in the lining of the womb is present elsewhere in the body, such as the lining of pelvis, ovaries, bowel and/or bladder.
Keyhole surgery is used to diagnose the condition as well as to treat it by removing or destroying the endometriosis tissue. Few studies have reported on long term recurrence after treatment and the risk of further surgery.
A team of researchers from the Universities of Aberdeen and Edinburgh analysed data on 281,937 Scottish women, including 17,834 women with a surgical diagnosis of endometriosis, 83,303 women with normal laparoscopy (no evidence of endometriosis), 162,966 women who had laparoscopic sterilisation and 17,834 age-matched women from the general population.
Dr Lucky Saraswat, Consultant Gynecologist and Honorary Senior Lecturer at the University of Aberdeen who led the study, said:
“Our study shows that women with the condition have a higher risk of repeat surgery, including hysterectomy. This is usually carried out in an attempt to improve painful symptoms and infertility that associated with the condition. Greater awareness of the long term risks of multiple surgical procedures can be useful in counselling women with a new diagnosis of endometriosis and enable them to make timely reproductive choices.”
Mr Edward Morris, Consultant Gynaecologist and Vice President of the Royal College of Obstetricians and Gynaecologists, said:
“There is no known absolute cure for endometriosis and it can be difficult to treat. It is important that doctors treating women with endometriosis balance the needs of managing the woman's symptoms with her fertility needs at all times.
“Clinicians and women should discuss the benefits and risks of all treatment options including pain killers and hormonal medical treatments before considering types of surgery. Radical surgery such as removal of ovaries or hysterectomy should only be once all other options have been considered.”
Professor John Thorp, Deputy Editor-in-chief of BJOG, said
“Endometriosis is a common gynaecological condition, but little is known about the repeat surgical risks in women. This is the largest study of long term surgical risks women with endometriosis and should help both healthcare professionals and patients when making decisions about treatment.”
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Article: Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study
BJOG 2017: DOI: 10.1111/1471-0528.14793
NICE guidelines on endometriosis (2017):
RCOG patient information leaflet:
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