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 led by the universities of Aberdeen and Edinburgh.
The authors say the results, published in BJOG: An International Journal of Public Health, should help women with a new diagnosis make timely reproductive choices and assist with clinical service planning.
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 removal or destruction of 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, 162,966 women who had laparoscopic sterilisation and 17,834 age-matched women from the general population.
The results show that 62% of women with endometriosis had further surgery, with a median time of less than two years to a second procedure. Half of all women with endometriosis had undergone repeat surgery within five and a half years and one in five women had hysterectomy or removal of one or both ovaries.
Dr Lucky Saraswat, Consultant Gynecologist and Honorary Senior Lecturer at the University of Aberdeen who led the study, said: “Endometriosis is a common gynaecological condition, but little is known about the long term surgical risks in women. Our study shows that women with the condition have a higher risk of repeat surgery. Greater awareness of the risk of multiple surgical procedures including hysterectomy 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 cure for endometriosis and it can be difficult to treat. One treatment option is surgery which can be used to remove or destroy areas of endometriosis tissue, which can help relieve pain, slow the growth of endometriosis tissue, and fertility and stop the condition returning. The kind of surgery will depend on where the tissue is.
“Clinicians and women should discuss the benefits and risks of all treatment options including pain killers and hormonal contraceptive use before considering types of surgery and hysterectomy should be considered as a last resort.”
Professor John Thorpe, Deputy Editor-in-chief of BJOG, said: “This is the largest study of the long term risks women with endometriosis face and should help both healthcare professionals and patients when making decisions about treatment.”