Leaving endometrioma vs. early menopause


Besides fertility what are the complications of leaving an endometrioma versus the cons of early menopause?

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Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:

It is a great thing that there are two ovaries. This means that one that is really damaged with endo can be removed and this would not result in earlier menopause. Both work equally well in terms of producing estrogen in order to avoid menopausal symptoms.

But if the decision is to remove the only remaining ovary, because the other one had been removed previously, these are some of the things to think about:

1/ How many years from menopause are you? The average is about 51-52 years of age. The closer you are to menopause, the more it is possibly better to remove a badly damaged ovary because the alternative may be another surgery in the near future. Repeat surgery usually gets more difficult and risky, not less so.

2/ Have you consulted with or are under the care of an expert excision surgeon? An expert is better able to preserve as much normal-appearing ovary as possible. For purposes of hormone production, it does not take much ovarian tissue to forestall menopausal symptoms.

3/ Make sure the expert thinks that this is truly only an endometrioma based on imaging and intra-operative findings. Sometimes endometriomas can coexist with benign and even malignant tumors. In some cases, even these can be removed and normal ovarian tissue preserved, but expert judgment is required.

4/ Do you have a personal or family history of cancer? If that is the case, the ovary may need to be removed anyway after age 40-45, depending on the family history details and possibly genetic testing results.

5/ What is the situation with your endometriosis and possibly uterine adenomyosis that is associated with endometrioma(s)? If you have not had endo fully excised then addressing the endometrioma question by itself is not as important as being sure ALL of your endo is being appropriately removed and treated. Whether or not a hysterectomy is also recommended depends on many factors including your preferences, imaging, your symptoms, how much scar/fibrosis is present and the skill base of your surgeon.

6/ Hormone replacement therapy may be estrogen alone or estrogen with progesterone. This usually depends on whether or not the uterus is left behind. You need both to avoid uterine cancer but it is better for your breasts if only estrogen is given as replacement therapy. This involves a detailed risk/benefit discussion and planning with your doc.

7/ If you are not considering traditional hormonal replacement after menopause there may be other mainstream and integrative natural options to help with symptoms, including acupuncture, plant estrogens and more.


*This is not medical advice and is aimed for informational use only. Please contact the doctor’s office or consult your doctor for any medical questions.

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