Endometriosis

Question 1

Risk of reoperation at 7y of f/u for endometriosis resection vs. hysterectomy, (both with ovarian preservation)?

Answer 1

58 vs. 19% for hysterectomy

8% rate in subgroup with TLH BSO

UpToDate

Question 2

Timing of menopause in women undergoing TLH w/o BSO?

Answer 2

• 1-4y earlier

UpToDate

Question 3

Postoperative medical therapy of endometriosis: ASRM and European Society of Human Reproduction and Embryology: what is the role?

Answer 3

6-24 months therapy can \ symptoms recurrence and need for multiple surgeries

1st line: OCPs, Progestins alone (continuous Norethindrone 5-15mg qD), LNg IUD
2nd line GnRH agonists, Aromatase I

Question 4

HRT p endometriosis resection and risk of recurrence N-173 RCT (92% TLH)

Answer 4

No HRT - no recurrence

HRT - 0.9% recurrence rate per year:

• peritoneal involvement >3cm: 2.4%/y vs. 0.3%/y for others
• incomplete surgery: 22% per pt vs. 1.9%

Question 5

HRT p endometriosis resection: regiment?

Answer 5

0.625 mg conjugated equine estrogen qD (no advantage to adding progesterone)

If uterus preserved: adding micronized progesterone and dydrogesterone has safer risk profile for the breast

Question 6

HRT for women with significant residual endometriosis: when benefits may outweigh the risks: Climacteric 2015;18(4) 448-52

Answer 6

Menopause b 45yo

Severe symptoms

Question 7

Pain improvement p endometriosis resection surgery:

Answer 7

\pain at 12m w/ laparoscopy: 73 vs 21%

20% will undergo repeat surgery within 2y

Symptoms recurrence: 40% at 10y f/u

/ with: incomplete excision, endometrioma drainage, ovarian conservation, stage III-IV (14% vs. 6% s.I-II)