Why Endometriosis Comes Back
Recurrence of endometriotic lesions is stimulated by estrogens, the female hormones produced by the ovaries. During the normal menstrual cycle, blood levels of estradiol (the main estrogen) fluctuate between 40 and 400 pg/mL. These levels are necessary to achieve pregnancy but they also contribute to the recurrence of endometriosis.
How to Prevent Recurrence
Estradiol levels between 50 and 70 pg/mL are adequate for normal body functions, do not reactivate endometriosis, and will prevent menopausal changes. There are two methods to prevent or delay recurrence of endometriosis in a woman who is not planning to conceive: 1) By changing the hormonal environment from estrogenic to strongly progestational using certain types of birth control pills, and 2) By maintaining blood estradiol levels between 50 and 70 pg/mL using GnRH analogs and add-back regimens.
Management of Recurrent Endometriosis
In women with recurrent endometriosis and recurrent pelvic pains, several options of treatment may be considered. Clinical response to prior surgery and medical treatments as well as frequency and intensity of side effects of these treatments should be the guidelines in treatment selection. If there was a good and lasting response after surgical resection, another laparoscopic surgery may be considered. It should, however, be kept in mind that repeated surgeries cause adhesions and destruction of healthy ovarian tissue and may adversely affect fertility.