{"id":13330,"date":"2021-10-30T09:12:24","date_gmt":"2021-10-30T14:12:24","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=13330"},"modified":"2025-01-24T09:29:45","modified_gmt":"2025-01-24T15:29:45","slug":"lendometriose-peut-elle-reapparaitre-apres-une-intervention-chirurgicale-signes-de-reapparition-de-lendometriose","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/can-endometriosis-come-back-after-surgery-signs-of-endometriosis-returning\/","title":{"rendered":"L'endom\u00e9triose peut-elle r\u00e9appara\u00eetre apr\u00e8s une intervention chirurgicale ?"},"content":{"rendered":"\n

If you\u2019ve undergone surgery for endometriosis<\/a>, you\u2019ve probably wondered \u201cCan endo grow back?\u201d Because there is no actual cure for endometriosis, the answer, unfortunately, is \u201cYes, it can<\/em>.\u201d But the more relevant question for most women is: \u201cHow likely is my<\/em> endometriosis to grow back?\u201d The answer to that question is a much more hopeful \u201cIt depends<\/em>.\u201d The bottom line is that many factors are involved in determining your personal risk of disease recurrence after endometriosis surgery, i.e., your risk of endometrial lesions or endometriomas, growing back. However, the type of surgery you had and the skill level of your surgeon are the two most important factors in whether you\u2019ll experience a return of endometriosis and endometriosis symptoms post-surgery. <\/p>\n\n\n\n

What factors influence my personal risk of endometriosis recurring? <\/strong><\/span><\/h2>\n\n\n\n

Depending on the study, recurrence rates can be as low as 6% after endometriosis surgery, or as high as 67%. Why such a discrepancy? For one thing, length of follow-up varies significantly from study to study, and follow-up longer than 5 years is practically nonexistent in mainstream research. A study that follows women for just one year after endometriosis surgery is likely to find lower rates of recurrence than one that tracks women for three or more years post-surgery. <\/p>\n\n\n\n

Disease location<\/span><\/h3>\n\n\n\n

Research suggests that the location<\/a> of your endometriosis plays a role in the likelihood that it will recur. While endometriosis refers generically to any endometrial (uterine lining)-type tissue<\/a> growing outside the inside of the uterus, endometriomas may be located<\/a> on other reproductive organs, such as the ovaries or Fallopian tubes, on the bladder, appendix or bowel, between the rectum and the uterus, between the rectum and the vagina, and even on the stomach or lungs. Rates of recurrence may be higher in women with ovarian or peritoneal (lining the abdominal cavity) endometriomas. <\/p>\n\n\n\n

Age and disease severity<\/span><\/h3>\n\n\n\n

Recurrence also tends to be higher in younger women, as well as in women who have what\u2019s called deep endometriosis, or deeply infiltrative endometriosis (DIE)<\/a>, meaning that it\u2019s burrowed deep inside an organ or tissue. Women who have endometriosis on both sides of the pelvis also appear to be more likely to experience recurrence.<\/p>\n\n\n\n

Hormonal birth control use and risk of recurrence <\/span><\/h3>\n\n\n\n

Several research studies<\/a> have found that combined hormonal contraceptive<\/a> (meaning contraceptives like the Pill that contain estrogen and progestin, as opposed to progestin-only contraceptives) use after surgery decr<\/em>eases<\/em><\/a> risk of endometriosis recurrence [1][2][3]. This makes some sense since the Pill stops the woman’s cycle, including menstruation, and endometriosis symptoms tend to be worst during menstruation. <\/p>\n\n\n\n

However, there is also evidence that hormonal contraceptive users are more likely to develop endometriosis<\/a> in the first place. Could hormonal contraception, which comes with its own side effects, be causative in developing endometriosis? Or could it lead to worsening of symptoms if women are put on the Pill for heavy and\/or painful periods, delaying actual endometriosis diagnosis (and potentially surgery) for years? On average, 10 years elapse between a woman’s first experience of endometriosis symptoms and her receiving a diagnosis. The unclear role of oral contraception in regards to endometriosis development requires further research. <\/p>\n\n\n\n

While these risk factors can influence your personal risk for disease recurrence, ultimately, the most significant<\/em> factors for recurrence are the type <\/em>of surgery you have and who <\/em>performs the surgery. <\/p>\n\n\n\n

Which kind of endometriosis surgery did you have? Excision or ablation? <\/span><\/h2>\n\n\n\n

In the words of the Endometriosis Foundation of America<\/a>, \u201claparoscopic excision surgery is the gold standard of treatment for endometriosis.\u201d \u201cLaparoscopic\u201d means that rather than cutting the abdomen open \u201cstem to stern,\u201d several small cuts are instead made on the abdomen, just big enough to introduce a small scope with a camera on the end. This allows direct visualization of areas of endometriosis. Excision surgery is surgery that seeks to literally cut out all areas of endometriosis, no matter how deeply embedded they may be. Laparoscopic ablation or cauterization surgery, on the other hand, refers to superficial burning or cautery of visible areas of endometriosis. <\/p>\n\n\n\n

As Natural Womanhood<\/a> previously noted, \u201cAblation uses heat to destroy tissue, while excision uses heat to actually remove it. Ablation can only remove tissue on the surface, while excision can<\/a> dig deeper to remove all of it. A 2017 meta-analysis<\/a> found that excision is a more effective technique\u2014better at reducing dysmenorrhea (period pain), dyschezia (constipation), and chronic pelvic pain\u2014so it\u2019s a good idea to look for a surgeon who does excision rather than ablation [4].”  <\/p>\n\n\n\n

An article at InTouch Fertility<\/a> about NaProTECHNOLOGY\u2019s surgical approach offers further explanation into why excision is preferable to ablation. \u201cEndometriosis acts like an iceberg, where the disease is both above the surface and in the tissue below.\u201d For this reason, excision surgery, which \u201cremoves the disease both above and below the surface\u201d has the best chance of preventing disease recurrence. <\/p>\n\n\n\n

Many research studies have confirmed that ablation surgery does not solve the problem of endometriosis long-term. One 2012 study found that \u201cOne year after laser ablation for painful pelvic endometriosis, 29% of women who continued to be symptomatic were found to have progressive disease, and 42% static disease at second look laparoscopy. Many women may undergo additional surgical intervention as a result of persistent or worsening symptoms. The reoperation rate after laparoscopic treatment of endometriosis has been found to be 21% at 2 years, and 58% at 7 years. Endometriosis was most likely to recur close to the original area of involvement, which may be the result of incomplete excision or ablation\u201d [5].<\/p>\n\n\n\n

Results of another study were even more stark, finding that recurrence occurred within one to two years in up to 40-60% of women who underwent ablation surgery [6].<\/p>\n\n\n\n

The Endometriosis Association of America<\/a> is unequivocal in its recommendation of excision surgery over ablation surgery. \u201cAblation or cauterization only remove the tissue on the surface, but neglect the tissue growing beneath the surface. In most cases, ablation\/cauterization surgery will not be effective for long-term management of endometriosis, because the tissue remains below the surface. Excess scar tissue can also form using these methods due to the high energy and heat applied to surrounding healthy tissue. In many cases, the inflammation following ablation and cauterization can be another source of pain. We do not recommend ablation\/cauterization surgery.\u201d <\/p>\n\n\n\n

The Atlanta, Georgia-based Center for Endometriosis Care cites over two dozen studies that confirm the superiority of excision surgery over superficial ablation or cauterization surgery, which can be found here<\/a>. <\/p>\n\n\n\n

Who performed your endometriosis surgery?<\/span><\/h2>\n\n\n\n

Besides the type of surgery you had, another crucial component is who<\/em> did your surgery. Dr. Thomas Hilgers, founder of NaProTECHNOLOGY, wrote in his book The NaProTECHNOLOGY Revolution<\/em><\/a> that advanced training is absolutely vital for providers who offer excision surgery. He noted that very few doctors receive this level of specialized training, making them more likely to offer the less effective ablation or cauterization option because it is less technically difficult. <\/p>\n\n\n\n

Over several decades of research and extensive experience performing laparoscopic excision surgeries for endometriosis, Dr. Hilgers found that \u201cnear-contact laparoscopy,\u201d in which the scope is placed right next to the tissues being observed rather than kept at a distance (as in traditional laparoscopy), led to decreased recurrence. He also found that performing laparoscopic excision surgery during the first half of the menstrual cycle led to decreased rates of recurrence. NaProTECHNOLOGY-trained surgical fellows are trained in Dr. Hilgers\u2019 methods, which have led to achievement of a <7% recurrence rate of endometriosis following laparoscopic excision surgery. <\/p>\n\n\n\n

I had a hysterectomy along with laparoscopic surgery. How does that impact my risk of recurrence? <\/span><\/h2>\n\n\n\n

Unfortunately, having a hysterectomy for endometriosis<\/a>, even a hysterectomy plus laparoscopic excision, is no guarantee that endometriosis symptoms will resolve. This is because, according to the Endometriosis Association of America \u201cMost endometriosis is located in areas other than<\/em> the reproductive organs. If you simply remove the uterus and do not excise the remaining lesions, patients will continue to have pain.\u201d (emphasis added)<\/p>\n\n\n\n

Research suggests that the \u201cprobability of pain persistence post-hysterectomy ranges around 15% and risk of pain worsening is between 3%-5%\u201d [7]. <\/p>\n\n\n\n

Signs of endometriosis returning <\/span><\/h2>\n\n\n\n

According to the Endometriosis Association<\/a>, symptoms consistent with a recurrence of endometrial lesions after surgery include: <\/p>\n\n\n\n