Objective: To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women.
Methods: In a prospective, longitudinal observational study, 75 patients with previous castration had biopsyproven endometriosis excised surgically. Anatomical characteristics of disease were studied using pelvic mapping and compared to the findings in non-castrated women with endometriosis. Preoperative and postoperative verbal analogue pain scales were used to gauge the response to excision of endometriosis.
Results: Patients treated surgically for endometriosis following castration were significantly older (37.8 ± 8.1 versus 31.3 ± 6.9 years, mean ± standard deviation; 95% confidence interval [CI] 4.9-8.1) and slightly more likely to have intestinal involvement (risk ratio 1.3, 95% CI 0.94-1.8) than non-castrated endometriosis patients. Most had marked alleviation of pain after excision of endometriosis.
Conclusions: Endometriosis can remain symptomatic after castration, with or without estrogen therapy. In such patients, there is a 33% frequency of intestinal involvement. At castration, consideration should be given to removal of invasive peritoneal and intestinal disease. Symptom improvement occurs in most patients after excision of endometriosis.
© 1994 The American College of Obstetricians and Gynecologists