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Should I undergo a surgery for endometriosis?

Q: I am a 45-year-old single woman and 13 years back I got my right ovary and fallopian tubes removed surgically. I had chocolate cyst and endometriosis. My left ovary also had endometriosis, which was punctured during the surgery. I was put on Danazol for two years after the surgery. My recent ultrasound shows that my left ovary has hyperechoeic cyst measuring 1.5 x 1.1 cm - chocolate cyst + adhesions with intramural fibroid measuring 1.8 x 1.7 cm in anterior uterine wall. My gynaecologist has advised me to be on Lupride for the next three months and then get my ovary and uterus removed, as I will have menopause in a couple of years anyway. I would like to have my own children some day and therefore am seeking opinion. Kindly advise.

A:Taking Lupride will help the symptoms and also treat the endometriosis. Small fibroids that are not causing any heavy menstrual bleeding can be left alone and followed up with ultrasound examination every six months for growth in size of fibroids as well as to check the ovarian endometriosis. Unfortunately, chocolate cysts do not respond very well to treatment sometimes, and surgery may be needed later if symptoms persist. Also, it is at the time of surgery that the actual decision of whether or not the ovary can be saved, by simply removing the cyst, is taken. A transvaginal ultrasound can sometimes help in determining how much normal ovarian tissue is present. Conservative surgery is a possibility, usually in younger people, as we also have to keep in mind the risk of the disease recurring. You could go ahead with Lupride and have a repeat transvaginal ultrasound after the course, and take the decision for surgery later, if the symptoms do not abate, or the response on the scan is poor.

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