There are various definitions of recurrence, so what exactly is recurrence of endometriosis?
Recurrence of endometriosis refers to the reappearance of endometrial-like tissue after it has been completely surgically removed. This can manifest as new lesions or the regrowth of previously excised disease. True recurrence differs from persistence, which results when endometriosis is left behind and not actually fully excised. Recurrence may be clinically suspected based on symptoms and can be confirmed through imaging or surgical findings.
Apart from surgery, are there any other risk factors that can lead to recurrence?
Apart from incomplete surgery, some factors can contribute to the recurrence of endometriosis, including but not limited to the presence of other gynepathologies, such as adenomyosis and/or concomitant adhesion; higher stages of disease; lesion subtype such as the presence of bowel lesions; and whether pharmacological therapy is used postoperatively or not. It is critical to note that the recurrence or persistence of pain is not always synonymous with the presence of endometriosis; secondary pain generators may often be present.
How does hormone medication work as a method of prevention for recurrence?
Hormonal medication aims to suppress the stimulation of endometrial-like tissue and inhibit its growth during therapy. It is intended to treat endometriosis-associated pain and theoretically can suppress recurrence while used. Drugs to treat endometriosis‐related pain include synthetic progestins, combined hormonal contraceptives, GnRH analogs, aromatase inhibitors, danazol, SERMs and SPRMs. While more recent publications indicate reduced reoperation rates for endometriosis in those who are treated with hormones in association with their surgery, a 2020 Cochrane Review exploring the effectiveness of hormonal suppression before, after or both before and after surgery for endometriosis determined that “the data was inconclusive.” Still, there is evidence that hormone suppression may help prevent postoperative recurrence, particularly endometriomas.
What is the rate of recurrence in endometriosis after excision and for what period of time?
Recurrence rates after endometriosis surgery vary widely and are operator-dependent. Rates are heavily influenced by factors such as extent of disease and completeness of surgical excision. Rates have been previously reported between 20%-40% within 5 years; however, more current data published by dedicated centers of expertise indicates overall rates of recurrence of less than 10%.
Is endometriosis a disease that can be cured?
There is no universal, definitive cure for endometriosis. Multidisciplinary treatments is directed at symptom management and meticulous removal of disease to reduce recurrence and persistence, with goals directed at alleviating symptoms and improving quality of life.
Is the presence of an endometrioma after surgery a sign of recurrence?
Endometriomas have a high recurrence/persistence rate, and their presence after surgery can indicate both persistence or true recurrence of the disease.
Why is the rate of recurrence higher in women under 25 years old or a bit older?
While risk predictors remain under debate, younger patients may have higher recurrence rates due to increased hormonal activity, i.e., higher plasma estrogen levels, more aggressive disease and disease subtype may be associated with endometriosis recurrence. In contrast, still other data indicates that those in the 35 + age group are positively associated with recurrence when compared to non-endometriosis controls, driving home the importance of patient-centric care adapted to the individual in order to apply tailored therapies for every patient.
What is the recurrence rate for bowel endometriosis based on the procedure done?
While the recurrence rate after colorectal surgery for endometriosis may be as high as up to 50% at 5 years, as with all forms of the disease this may vary based on the skill of the surgeon and type of surgical intervention. For example, current data implies that that the risk of recurrence is lower when segmental resection or disc excision is performed than when rectal shaving is performed.
What are the signs of endometriosis returning?
Clinical signs of endometriosis recurrence may be the same as or include those experienced at primary onset, i.e., pain (for example, persistent or new pelvic pain), changes in menstrual patterns, such as increased pain or heavy bleeding, recurrence of pain during or after sex, GI or urinary dysfunction/pain, bloating, fatigue and more. As with initial onset, timely diagnosis and effective intervention are key towards isolating and treating the diagnosis.
Can some of these symptoms be caused by adhesions?
Yes, symptoms such as pelvic pain and discomfort during intercourse can also be caused by adhesions, which are scar tissues that can form after surgery or due to chronic inflammation. Adhesions can cause similar symptoms to endometriosis and complicate the diagnosis and management, as can a number of other conditions including but not limited to adenomyosis, for example.
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