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  • Q&A with Australian Health Practitioners

    Has my endometriosis returned?

    Related Topics
    Endometriosis Pelvic Pain Women's Health
    I was diagnosed with endometriosis two years ago after suffering with painful intercourse, painful periods and ongoing pelvic pain that was starting to interfere with study. I'm 21 and married. In august last year I had a laparoscopy but I found this wasn't successful for me and the pain never resolved at all even though the endo was removed from my right ovary. Since then I have changed to a different pill and then to the ladoven injection monthly. I find the injection incredibly pain for 24 hours after. For the last few months I have been having sharp pain in my ribs and abdomen, I have had ultrasounds and scans but nothing has been detected. Is it possible my endo has spread into my abdo cavity? If so what are my chances for having children? Would it be worth having another laparoscopy?
    • 1 answer
    • Dr Joseph Jabbour
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  • Dr Joseph Jabbour

    Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician

    Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile

    There is definitely a recurrence of endometriosis after the initial treatment of the disease. This depends on the degree of severity of the disease. Stage IV endometriosis has a higher recurrence rate. Some studies show a recurrence rate of 14% of the disease at laparoscopy 2 years after the initial surgical excision. 20% of women with severe endometriosis will require repeat laparoscopy 2 years after the first surgery. The risk of recurrence at 10 years can be as high as 40%.

    Endometriosis is associated with a risk of up to 15% of infetility in women. If you have no other factors that may predispose you to infertility, your chances of having children are good. Studies have shown that the optimal time to conceive is the first 6 months after excision of endometriosis. 

    It would definitely be worthwhile having another laparosopy to excise the endometriosis if your symptoms have returned and are severe in nature. Endometriosis can spread to other areas in the abdominal cavity such as the upper abdomen, the diaphragm (muscle layer dividing the thoracic area from the abdominal area and used for breathing) and has even been found in locations outside the pelvis and abdomen. You should see a specialist experienced with the excision and treatment of endometriosis- it may be the gynaecologist who treated you did not efficiently treat all the deposits of endometriosis.

    If you are not planning to have a pregnancy after the surgery, having the Mirena IUD is efficient at controlling symptoms. If you plan to conceive, the recommendation would be to try for a pregnancy as soon as possible after the surgery. If you fail to conceive within 6 months of timed intercourse, you can attempt ovulation induction with Intrauterine Insemination, or IVF. 

    This pain could be caused by a different disease process. Therefore a thorough history and examination followed by imaging would be warranted to exclude other causes for the pain. 

    All the best.

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