Follow-up and monitoring if confirmed endometriosis

NICE state (1):

• Monitoring for women with confirmed endometriosis
  • consider outpatient follow-up (with or without examination and pelvic imaging) for women with confirmed endometriosis, particularly women who choose not to have surgery, if they have:
    • deep endometriosis involving the bowel, bladder or ureter or
    • 1 or more endometrioma that is larger than 3 cm

Notes:

• Medical treatment:
  • medical treatment is generally effective at treating pain e.g. secondary dyspareunia, especially if only minimal disease. However about 40% of women will have a recurrence of symptoms at some time after cessation of treatment
• Surgical treatment:
  • if surgical treatment is adequate then the recurrence rate is less than 20%. Improvement in fertility is related to severity of disease. The conception rate after treatment for severe disease is about 35%; whilst a 65% conception rate has been reported after treatment for moderate disease. The chance of conception is greatest in the two years following surgery
• if a patient has had a total abdominal hysterectomy, bilateral salpingoophrectomy and resection of other deposits of endometriosis, then hormone replacement therapy can be used with a minimal risk of growth in any residual endometriosis

Reference:

• NICE (September 2017). Endometriosis: diagnosis and management