This operation, which includes removal of the uterus, is only carried out in women with severe pain unrelieved by medicines, and who do not want another pregnancy. Afterwards, hormone replacement therapy with oestrogen is necessary because the removal of the ovaries results in the same effect as the menopause. This treatment may be started immediately after the surgery or, if a lot of endometrial tissue still remains in the abdominal cavity, after a delay of four to six months. This delay allows the endometrial tissue to disappear. Otherwise it would be stimulated to proliferate by the replacement oestrogen.
Endometriosis spontaneously subsides after the menopause as the ovaries become less active.
Before the menopause, only surgical removal of both ovaries can prevent endometriosis from recurring. However, symptoms may improve considerably or even disappear after drug treatment with or without surgical removal of the misplaced endometrial tissue. Treating women who have moderate to severe disease results in pregnancy rates ranging from 40 to 60 per cent. It is not clear if treating women with mild disease improves their fertility. All text and content Mosby International.