- With Mayo Clinic gynecologist and obstetrician
Mary M. Gallenberg, M.D.
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Mary M. Gallenberg, M.D.
Mary M. Gallenberg, M.D.
Dr. Mary Gallenberg is board certified by the American Board of Obstetrics and Gynecology and by the American Board of Internal Medicine in internal medicine and medical oncology.
An Antigo, Wis., native, Dr. Gallenberg is a consultant in the Department of Obstetrics & Gynecology at Mayo Clinic, Rochester, Minn., and an assistant professor at College of Medicine, Mayo Clinic.
Dr. Gallenberg has been with Mayo Clinic since 1990. She was on the Mayo Clinic Women's HealthSource editorial board and has been honored for excellence in teaching. She also won a Mayo Clinic Excellence Through Teamwork award.
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Question
Endometriosis: Risk factor for ovarian cancer?
I just found out I have endometriosis, which my mother also has. She says endometriosis raises our risk of ovarian cancer, so I should have children early and then get a total hysterectomy. What's the real story?
Answer
from Mary M. Gallenberg, M.D.
It sounds like your mother jumped to the wrong conclusion after hearing about a connection between endometriosis and ovarian cancer. A total hysterectomy — surgery to remove the uterus and cervix along with both ovaries and fallopian tubes — is a cancer-prevention option for some women. Surgery to prevent ovarian cancer, known medically as prophylactic bilateral salpingo-oophorectomy (sal-ping-go-o-of-uh-REK-tuh-mee), is reserved for women at high risk of ovarian cancer because they have a cancer-related mutation in their DNA, one of the same genetic mutations that cause some breast cancers.
Endometriosis isn't a reason to have a hysterectomy unless you have widespread disease and severe symptoms unresponsive to less invasive therapies. Many women take birth control pills to manage endometriosis. Birth control pills are also associated with a decrease in ovarian cancer risk.
The options for surgery to treat endometriosis aren't limited to hysterectomy, either. It's often possible to remove endometrial deposits from pelvic organs with laparoscopic (lap-uh-row-SKOP-ik) surgery, which requires only a few small incisions in your abdomen.
Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis multiplies that risk, but it's still relatively low. By contrast, for women who have certain genetic mutations — most commonly, the BRCA1 or BRCA2 mutation, which is also associated with increased risk of breast cancer — the lifetime risk of ovarian cancer is as high as 50 percent.
If you're worried about how endometriosis might affect your fertility, that's a different matter. Endometriosis does cause fertility problems for some women, but normal conception, pregnancy and delivery are often possible after endometriosis treatment with birth control pills, other hormonal therapies or laparoscopy, particularly if you're under 35 years of age.
- Muto MG. Risk reducing salpingo-oophorectomy in women at high risk of epithelial ovarian cancer. http://www.uptodate.com/home/index.html. Accessed June 8, 2010.
- Schenken RS. Overview of the treatment of endometriosis. http://www.uptodate.com/home/index.html. Accessed June 10, 2010.
- Schenken RS. Pathogenesis, clinical features, and diagnosis of endometriosis. http://www.uptodate.com/home/index.html. Accessed June 10, 2010.
- Aziz A. Endometriosis-associated ovarian cancer: A ten-year cohort study of women living in the Estrie Region of Quebec, Canada. Journal of Ovarian Research. 2010;3:2.
- Van Gorp T, et al. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Practice & Research Clinical Obstetrics & Gynaecology. 2004;18:349.
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