Endometriosis 'myths'. (Guest Editorial).

Many gynecologic surgeons believe that the definitive surgical treatment for all cases of endometriosis is hysterectomy and bilateral salpingo-oophorectomy. That belief is a harmful myth.

I fully support hysterectomy for endometriosis patients whose symptoms are primarily uterine and salpingo-oophorectomy for patients whose symptoms are ovarian. However, I would challenge physicians who perform these surgeries on endometriosis patients to finish the job and remove all other visible endometriotic lesions at the same time. If these lesions are not removed, symptoms may persist in a significant number of patients, and a large proportion of their doctors will dismiss those symptoms as impossible to treat.

The theory behind hysterectomy and bilateral salpingo-oophorectomy is that it removes the bulk of endometriotic lesions and leaves the rest to shrink in the resulting nonestrogenic environment. In reality, only 3.7% of patients have endometriosis confined to their uterus, tubes, and ovaries. Thus, removal of these organs leaves the majority of their endometriosis in place, and these lesions are largely operational.

Endometriotic lesions have varying levels of estrogen and progesterone receptors, compared with normal endometrium. Some lesions may never have depended on estrogen, and some can manufacture their own estrogen. In these cases, removal of the uterus, tubes, and ovaries will have no impact.

There are no studies showing that endometriosis is destroyed by low levels of estrogen. This is yet another myth that is both destructive to patients and science.

Studies have shown that after hysterectomy and bilateral salpingo-oophorectomy 7% of endometriosis patients remain symptomatic and 1.7% require reoperation because of the severity of their symptoms. That means 9,000 women remain symptomatic and 2,000 require reoperation in the United States each year.

I see many of those women, who come to me from all over the world. Many of them have ...