Surgical Menopause

A 39-year-old nulliparous female with stage IV endometriosis presented to a reproductive endocrinologist reporting chronic disabling pelvic pain with and outside of her periods, dyspareunia, and intermenstrual bleeding. She was taking naproxen with minimal pain relief. She had a history of a laparoscopic left ovarian cystectomy 2 years prior, at which time she was noted to have a frozen pelvis with no visualization of the uterus or right ovary, dilated tubes bilaterally, dense adhesions, and a 6 cm left hemorrhagic cyst, favoring an endometriotic cyst on pathology. Clinically, she had a normal Pap smear, and on physical examination, she was in no apparent distress with normal vital signs and had a BMI of 20.8 and a genitourinary exam significant for a small tender uterus with decreased mobility and a tender left adnexa with no palpable masses. She had an MRI study of her abdomen and pelvis that showed a complex left adnexal fluid collection approximately 3–4 cm in size, a normal right ovary, bilateral hydrosalpinges, and a 2 cm posterior intramural fundal fibroid. Three management options were discussed with the patient: Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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