Endometriosis and pain
Surgery, usually with the aid of laparoscopy, can alleviate most types of pain due to endometriosis. Pain arising from the menstrual cycle, or pain noted throughout the month, as well as pain during intercourse. Surgical treatment can usually improve pregnancy rates in women with early stage endometriosis, such as stage I or II. Some lesions are more painful than others, but the basis for this difference is not well understood.
Pain after surgery is more often seen in women with mild endometriosis, as they may be more sensitized to pain. Over time, pain may be reactivated by hormonal changes due to progesterone resistance and increased aromatase activity. These factors increased inflammation in the lesions. Also, depression and anxiety can contribute to pain in some patients. Pain recurrence could also be due to incomplete removal of a lesion, either due to its location or lack of recognition.
Endometrioma is described as a blood-containing pseudocyst resulting from ovarian endometriosis with hemorrhage. Medical therapy unfortunately will not cause regression of the endometrioma.
Most patients with an endometrioma are symptomatic and need to exclude malignancy.
Studies demonstrated that the excision (surgery) of the endometrioma cyst was associated with a reduced rate of recurrence, and increased spontaneous pregnancy rates when compared with ablation therapy. Recurrence rate of endometrioma after surgery is 8-29%. Continuous oral contraceptive use is beneficial post-surgery.
However, surgery for endometrioma can result in decreased ovarian reserve due to damage to the ovary and decrease in the number of oocytes.
If the patient is experiencing pain than surgery, it does not imply that the likelihood of pregnancy is reduced.
Endometrioma may not require surgery if it is measuring less than 5 centimeters, and the patient is planning to have IVF.
If you have further questions on endometriosis or to schedule an appointment, please call (713)467-4488.