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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can frozen pelvis and stage 4 endometriosis be treated without surgery?

I was recently diagnosed with a frozen pelvis and stage 4 endometriosis. This diagnosis was a surprise to me because I went in for laparoscopy to remove ovarian cysts. It seems that my ovaries are adhered to the back of my uterus and are kissing . There also is a lot of adhesions. My doctor is suggesting a hysterectomy that removes both my ovaries. I m concerned that this will not necessarily cure my endometriosis or rid me of adhesions. Perhaps create me a lifetime of other issues like hormone therapy. I happen to be a fortunate person who does not suffer from pain with my endometriosis. If this surgery is not guaranteed to cure my issues I am unsure why I would choose to go through with it? To stop cancer? Other complications? I am fearful that surgery may start a unstoppable chain of surgeries and pain for me as I understand that endometriosis and adhesions are very difficult to cure. I am wondering if anyone has suggestions about alternative treatments to try before going down the path of surgery? Or, should I be more concerned with other complications if I don t go ahead with the surgery?
Wed, 22 Apr 2020
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OBGYN 's  Response
Hi,
Welcome to Ask A Doctor. Thanks for the query.
I can understand your concern.

Endometriosis is a condition where endometriotic tissue grows outside the uterine cavity leading to adhesions, ovarian endometriotic cysts etc.
Mild to moderate cases can be treated with medical management.

But as you have mentioned that you are having frozen pelvis and stage 4 endometriosis, which indicates:
-There are extensive and dense adhesions between pelvic structures, as suggested by ovarian adherence to posterior surface of uterus.
So medical management or conservative surgery may not able to remove complete adhesions and it may not be able to remove ovarian cysts without removal of uterus.
-If the uterus and ovaries are left, the menstrual cycles will continue and so also the progression of endometriosis. So, by removing these structures further progression and development of new spots of endometriosis can be prevented.
So, may be by taking all these points into consideration, your doctor might have recommended Hysterectomy with salpingoopherectomy to you.
But as you mentioned, the need for hormone replacement therapy after surgery and the extent of endometriosis that surgery can remove, these points also to be considered before going for surgery.
If you have completed your family and age around 40 years, Hysterectomy with salpingoopherectomy is better choice for you for your diagnosis.
If you are less than 40 years, you may need to use hormonal therapy for longer period. So, in that case please discuss this in detail with your doctor and proceed accordingly. Usually herbal supplements instead of direct hormones for hormone replacement therapy can have less side effects when used for longer period also.


Hope I have answered your query. Will be happy to answer further followup queries.
Regards
Dr.Sree Gouri SR, OBGYN
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Can frozen pelvis and stage 4 endometriosis be treated without surgery?

Hi, Welcome to Ask A Doctor. Thanks for the query. I can understand your concern. Endometriosis is a condition where endometriotic tissue grows outside the uterine cavity leading to adhesions, ovarian endometriotic cysts etc. Mild to moderate cases can be treated with medical management. But as you have mentioned that you are having frozen pelvis and stage 4 endometriosis, which indicates: -There are extensive and dense adhesions between pelvic structures, as suggested by ovarian adherence to posterior surface of uterus. So medical management or conservative surgery may not able to remove complete adhesions and it may not be able to remove ovarian cysts without removal of uterus. -If the uterus and ovaries are left, the menstrual cycles will continue and so also the progression of endometriosis. So, by removing these structures further progression and development of new spots of endometriosis can be prevented. So, may be by taking all these points into consideration, your doctor might have recommended Hysterectomy with salpingoopherectomy to you. But as you mentioned, the need for hormone replacement therapy after surgery and the extent of endometriosis that surgery can remove, these points also to be considered before going for surgery. If you have completed your family and age around 40 years, Hysterectomy with salpingoopherectomy is better choice for you for your diagnosis. If you are less than 40 years, you may need to use hormonal therapy for longer period. So, in that case please discuss this in detail with your doctor and proceed accordingly. Usually herbal supplements instead of direct hormones for hormone replacement therapy can have less side effects when used for longer period also. Hope I have answered your query. Will be happy to answer further followup queries. Regards Dr.Sree Gouri SR, OBGYN