A woman with significant symptoms related to endometriosis may benefit from a hysterectomy. However, the patient should be carefully evaluated with demonstrated failure of alternative therapies before the surgery is performed.


Confirmation - presence of both:

(1) prior detailed operative description or histologic diagnosis of endometriosis

(2) one or more of the following:

(2a) Failure of conservative measures to control significant symptoms.

(2b) Presence of persistent, significant adnexal mass.

(2c) Significant involvement of other organ systems: ureteral obstruction, intestinal obstruction, etc.



(1) The patient's desire to preserve reproductive function.


Actions prior to performing hysterectomy:

(1) Therapeutic trial of medical or conservative surgical therapy.

(2) Document involvement of other organ systems.

(3) Confirm the absence of cervical malignancy with cervical cytology.

(4) If abnormal uterine bleeding is present, obtain an endometrial sample for histologic examination.

(5) Evaluate the patient's medical and psychological risks related to surgery and hysterectomy.

(6) Document discuss of implications regarding ovarian function, ovarian involvement in the disease, castration and probability of recurrence.


Alternative therapies:

(1) oral contraceptives or progestins

(2) gonadotropin releasing hormone agonists

(3) danazol

(4) gestinone

(5) local excision or limited resection

(6) localized cauterization or ablation

(7) lysis of adhesions

(8) presacral neurectomy

(9) tuboplasty


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