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Abstract

Endometriosis is a chronic, estrogen-mediated inflammatory condition associated with chronic pelvic pain and infertility. The condition affects up to 10% of reproductive aged women and is associated with significant impacts on quality of life, loss of productivity, and social isolation. Surgical intervention has been identified as an important tool in treatment of endometriosis, but the factors associated with treatment response are not clearly defined. Our current study aimed to address these issues by determining the impact of type of surgery, histology, and stage of endometriosis on surgical outcomes. We then evaluated whether conservative surgery for superficial peritoneal endometriosis resulted in positive impacts on pain and quality of life. Finally, we determined whether the characteristics of women undergoing hysterectomies before the age of 40 were different from those of women undergoing hysterectomies at age 40 or older and compared their surgical outcomes by age category. The first part of the thesis demonstrated that surgery was associated with improvement in all surgical outcomes regardless of type of surgery. Women undergoing hysterectomies demonstrated worse baseline quality of life scores but showed greater improvement in outcomes compared to conservative surgery. Stage and histology had little influence on outcomes. For the second part of our study, we found that surgery for superficial peritoneal endometriosis was associated with improvement in all outcomes except for superficial dyspareunia. Finally, the third part of study demonstrated that younger women undergoing hysterectomies tended to have earlier experiences of pain and increased likelihood of having comorbid conditions associated with central sensitization. Women