Question And Answer # 95 - Re: Endometriosis following a hysterectomy with menopausal symptoms

Before 25 years old I had two breast surgeries to remove cysts. For years I had endometriosis. (3 laparoscopy surgeries) I could never have children. AT 40 years old I had a hysterectomy and again hormonal treatment to fight the endometriosis. Now I am 45 years and I am having some menopause symptoms like humor changes; insomnia; intercourse pain; dryness, headaches. My breast studies, densitometry, vaginal ultrasound, and laboratories tests shown that everything is OK. I am still ovulating. I visited the best known and recognized gynecologists and some of them wanted to remove my ovaries. I said NO.

Recently a friend told me that the best doctor is the one that is gynecologist and endocrinologist at the same time in order to treat the menopause cycle.

What is your opinion?

Thank you in advance for your prompt response

REPLY:

Hi,

I am sorry that you are having this problem.

I cannot tell you what you should do from where I sit in front of this computer, but I will make some general comments based on your history. I think that the best approach for treating women with endometriosis at present is to surgically remove the endometrioisis when possible. Unfortunately, studies suggest that surgical treatment of endometriosis is frequently unsuccessful when the ovaries are not removed. In patients such as yourself, a previous hysterectomy may result in ovarian dysfunction and menopausal symptoms. In addition, some treatments for endometriosis such as Lupron suppress ovarian function and cause menopausal symptoms.

To complicate things even further, if a patient has residual endometrial tissue and receives estrogen treatment for menopausal symptoms it may stimulate further growth of the remaining endometriosis.The dilemma that patients in this situation face is treatment of their menopausal symptoms may make their endometriosis worse. I believe the recommendation for the ovarian removal may have been based on this concern. If you have not, read the sections of the web site, Ovarian Failure Following Hysterectomy and Should I Keep My Ovaries, as they may provide additional insight. You can also access them form the main menu on the home page.

Dr N
http://www.drn4u.com