Can Treatment Of Recurrent Endometriosis Affect Fertility?

According to studies, endometriosis recurs at a rate of 20 per cent to 40 per cent within five years following conservative surgery.

Endometriosis is a common gynecological disorder in women of reproductive age causing subfertility. It is a condition where the endometrium (the lining of the uterus) goes in a reverse manner toward the pelvic cavity. These are called endometriosis spots and can be detected with the help of laser surgery like laparoscopy. However, there are chances that after 6 months or a year, this condition can recur. This condition will steal a woman's peace of mind and she will not be able to do her daily activities with ease due to unbearable pain.

According to Cleveland Clinic, recurrence of endometriosis after surgery depends on a variety of factors, including the severity of the disease at the time of surgery, whether the lesions were removed completely, and whether postoperative medical suppressive therapy was used.

Recurrence of symptoms after surgery may be due to new or pre-existing lesions. Hence, it is difficult to tell whether the disease has come back or is progressing.

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Citing the most recent studies, Cleveland Clinic stated that endometriosis recurs at a rate of 20 per cent to 40 per cent within five years following conservative surgery.

To know more about this condition and how it is treated, we spoke to Dr Surabhi Siddhartha, Consultant Obstetrician & Gynaecologist, Motherhood Hospital Kharghar. Excerpts:

What happens when endometriosis recurs?

A woman may again encounter the painful symptoms of this condition. The patient will have painful dysmenorrhoea (that are painful menstrual periods caused by uterine contractions), pain during intercourse, pelvic pain, pain with bowel movements or urination. It is a debilitating condition that can disrupt your physical and mental well-being. A woman may become stressed, frustrated, anxious, depressed, and lonely due to recurrent endometriosis.

Treatment of recurrent endometriosis

The treatment includes medication which is given for three months. But, even after taking the tablets, if the pain continues then the patient will have to go for laparoscopic surgery to improve her quality of life and get rid of the excruciating pain.

Surgical removal of the uterus (hysterectomy) with or without removal of the ovaries (bilateral oophorectomy) is carried out to treat endometriosis linked to pelvic pain or nearby masses in those women who have already had children. Moreover, if the patient is not in that fertility phase (like a woman is around 38-39 years, doesn't want to plan pregnancy) then we would go for a hormonal device meaning an intra uterine device (IUD) that can provide long-term birth control (contraception). It is inserted into the uterus, wherein it releases a progestin hormone. This device will give the patient much-needed relief from the pain. It will be difficult for the patient to become fertile again after this. Though, there are chances that one may become pregnant. But, many times, such women who opt for IUD will need IVF treatment as their ovarian functioning is not good.

The Cleveland Clinic also noted that the use of oral contraceptive, other suppressive hormonal therapy, or progesterone intra uterine device (IUD) after surgery helps reduce the recurrence of pain symptoms. Further, it mentioned that there is a higher pregnancy rate with in vitro fertilization (IVF-ET) in women with advanced recurrent endometriosis.

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