Endometriosis persisting after castration: clinical characteristics and results of surgical management

To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women.

In a prospective, longitudinal observational study, 75 patients with previous castration had biopsy-proven 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.

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.

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.