Management of Recurrent Endometriosis After Hysterectomy and Bilateral Salpingo-Oophorectomy

Persistent or recurrent endometriosis after a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH BSO) has been reported by several investigators.1–3 Although many aspects of endometriosis are incompletely understood, the stimulation and growth of endometrial implants by cyclic ovarian steroids has been demonstrated. Therefore, removing this cyclic stimulation should permit the disease to regress. We don’t know the exact incidence of recurrent endometriosis after “definitive” surgery, but it is thought to be extremely rare following TAH BSO even when the woman takes hormone replacement therapy.4 Several investigators have published reviews with small patient numbers. In 1970, Ranney reported no recurrences when estrogen replacement was not given but a 3% recurrence rate if replacement was given.5 In the same decade, Gray reported no recurrence without hormonal replacement therapy compared with a 20% rate if estrogen therapy was initiated.6 Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

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