"Ask Dr. Cook" is a series of questions and answers regarding endometriosis. The current subject and answer can be found on Current Ask Dr. Cook web page. The questions may represent a summary of questions I have been asked by several different patients. I hope you find this information helpful. If you have a question you would like answered, please Submit A Question.

Recurrent endometriosis after hysterectomy

Question:
#1
I had a total abdominal hysterectomy and bilateral salphingo-oophorectomy done 5 years ago. I live in constant pelvic pain and was just diagnosed with having an Endometrioma and 3 more cysts, all in a month. I live in constant left sided pelvic pain. I take hormone replacement therapy. Intercourse is very very painful we have tried different positions, etc. but nothing helps. I do have 1 child aged 7, but I need info on this pain. Can it be endo on my bowel, bladder etc.?

#2
I had a hysterectomy and ovaries removed 5 yrs ago. I have been having a lot of bleeding since May and I was told yesterday that I may have endometriosis. They did 3 biopsies to make sure it's what they think it is. They said that it may be endometriosis in the vaginal cuff. What can I expect from this?? Is it possible that it may be cancer??

Answer:
#1
It sounds like they supposedly took your uterus and ovaries out 5 years ago. An endometrioma is usually found in the ovary, which raises the question if there is a piece of an ovary left inside. This is actually easier than you might think. The ovary can look a lot like scar tissue and it lays on top of a fairly large blood vessel. Women with Stage III or IV endometriosis often have the ovaries stuck to the pelvic sidewall (with adhesions) and endometriomas in the uterus. When the ovary is removed a portion can be left behind, looking like scar tissue attached to the underlying blood vessel. The surgeon will often not clean the "scar tissue" off of the blood vessel thinking that it is not causing the patient any harm and not worth the "risk" of operating that close to the blood vessel. If the endometrioma and cysts or on the left side this is probably the cause of your pain. If you had stage III or IV endometriosis it is very possible that you could have endometriosis on your bowel (most common site of "recurrence" after a hysterectomy), bladder or vaginal cuff. Operating on women with endometriosis who have had a hysterectomy can be very different than that on a woman that is undergoing her first laparoscope. You need to find a surgeon who is experience in dealing with your type of situation.

#2

It is highly unlikely that this represents cancer. The biopsies that they took are entirely appropriate and will determine definitively if this is a benign process. If the endometriosis is not removed from the vaginal cuff and area behind the vagina just before removing the uterus, the patient is at a high risk of having persistent growth of the endometriosis and symptoms such as bleeding and pain with intercourse. If this is endometriosis, it probably in the space between the vagina and the rectum. It may also be in other areas of the pelvis. A thorough laparoscopic examination will determine if this is the case. Also the very top of the vagina may need to be removed to excise all of the endometriosis. This is not a problem from a sexual functioning standpoint.

Updatede October 29, 2005