I get questions every day regarding endometriosis recurring in the future. A common question is “Will the disease pop up in other organs and locations in the body?“.
I think we need to go back to: where does endometriosis come from? While the prevailing opinion is Sampson’s Theory, or retrograde menstruation, meaning the menstrual flow goes backward through the tubes. Under this theory, the living cells land on the peritoneum and then begin to grow. Based on my experience/opinion, I think the majority of the excision surgeons nationally, this can’t be true for many reasons. My belief is a person is born with changes in the embryonic cell placement of endometrial cells (outside the uterus) and later the pubertal hormones activate the development of the endometrial cell cluster of endometriosis. If one focuses on this theory, then once excised or completely destroyed in any way, that endometriosis lesion is not coming back and because birth was the start, there will be no “new disease” popping up anywhere else.
Another myth that should be addressed here is spreading or invading. In all my years of doing surgery for endometriosis, I have never felt that the disease invades a tissue. The lesion can grow in size, with limitations, and the fibrosis can cause decreased blood flow compromising adjacent tissues such as bowel or bladder resulting in wall breakdown and the lesion ending up inside the bladder or bowel cavity. This is extremely unusual, therefore disproving any sort of primary invasion. In addition, I have never seen evidence of spreading or seeding like cancer in a metastatic way. The lesions they are born with are the ones they live with throughout their life unless excised and they don’t multiply like weeds!
Hope this clears some of the mystery as patients repeatedly ask these questions. Those that experience “recurrence” with ablation really have persistence as the lesions were not successfully eradicated with the prior surgery(ies).
Michael D. Fox, MD
Jacksonville Center Reproductive Medicine
Advanced Reproductive Specialists