Deep and bowel disease, surgical outcomes, imaging and staging, recurrence, medical treatment after surgery, adenomyosis and fertility or miscarriage.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language pages are Endometriosis and Adenomyosis .
Each week the literature is searched for new papers on endometriosis and adenomyosis, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Digest of 19 October 2026
Search window 13 to 19 October 2026
One in six women needs further surgery after an operation for ovarian endometriosis, one in three after ovarian-conserving surgery
Finnish national register cohort of 13,912 women whose first surgically verified diagnosis of ovarian endometriosis came with an ovarian procedure between 1987 and 2012, followed through the registers to 2019 (median 20.7 years).
Finding
The 30-year cumulative risk of any reoperation was 17.3% (about one in six) and of ovarian reoperation 16.5%, with a median 3.4 years to the first and under two years to each later one. Compared with oophorectomy, enucleation or resection carried a higher risk of any reoperation (aHR 1.43, 95% CI 1.28-1.60) and other ovarian procedures higher still (aHR 2.20, 95% CI 1.67-2.89); the authors put this at roughly one in three reoperated after ovary-conserving surgery against one in ten after oophorectomy. Young age, a family history of endometriosis, a primary diagnosis of endometriosis and prior infertility each raised the risk, and hysterectomy before or at the index operation lowered it. Reoperated women had fewer births (61.6% vs 70.7%) and more infertility (51.5% vs 17.1%); reoperation was more common after index surgery in 1996-2012 than in 1987-1995 (19.0% vs 12.4%), and by the fourth or later operation 13.4% of procedures were for deep infiltrating endometriosis.
Supports current practicestrong evidence
Gives long-term national figures for counselling before endometrioma surgery and backs an individualised, fertility-conscious choice between keeping and removing the ovary rather than any change in technique.
What it means
For a woman deciding about surgery for an endometrioma, this gives a figure I can quote: about one in six women needs another operation over the following decades, sooner in younger women, those with a family history and those with infertility, and keeping the ovary roughly trebles that chance compared with removing it.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Vasopressin during endometrioma cystectomy speeds haemostasis but does not protect ovarian reserve: randomised trial
Single-centre randomised controlled trial at a Korean university hospital, September 2018 to July 2021: 75 women having laparoscopic cystectomy for a unilateral endometrioma, stratified by baseline AMH and randomised to vasopressin injection or no injection; the primary outcome was the change in serum AMH at 12 months, analysed by intention to treat and per protocol.
Finding
Vasopressin shortened bleeding control (2.2 vs 6.5 minutes, p = 0.002) and cyst stripping (8.9 vs 14.4 minutes, p = 0.054), but the fall in AMH at 12 months was the same in both arms (-0.96 vs -1.14 ng/mL, p = 0.488), with the same pattern in women with baseline AMH below 3 ng/mL and 3 to 7 ng/mL. AMH fell significantly at three months and partly recovered at six and twelve months in both groups (group-by-time interaction p = 0.816), and the specimens contained the same thickness and proportion of ovarian tissue in each group.
No changemoderate evidence
Vasopressin shortens the operation but should not be presented as protecting the ovary; the trial is small and single-centre, and it leaves the egg-sparing technique neither proven nor disproven.
What it means
For the woman having an endometrioma removed, the loss of ovarian reserve after cystectomy (AMH down by about 1 ng/mL at a year, with partial recovery from three months) happened whether or not vasopressin was used to reduce bleeding and diathermy.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Structured MRI reports for deep endometriosis are more complete and more useful to surgeons, but take longer: randomised reader study
Single-centre randomised reader study in France: 20 radiology residents were assigned to free-text or structured reporting, 15 completed the same 22 pelvic MRI examinations (330 reports: 154 free-text, 176 structured), judged against a reference standard set by two pelvic radiologists; in an exploratory paired assessment two expert gynaecological surgeons rated 44 reports, one of each format per examination.
Finding
Structured reports were more complete (+8.1 percentage points, 95% CI 4.1-12.1; clinically weighted +5.6, 95% CI 1.3-10.0) and were rated higher by the surgeons for completeness, usefulness for decision-making and adequacy to clinical needs, with similar clarity; they took 4.52 minutes longer (95% CI 3.05-5.99) and carried nearly three times as many explicit negative statements that contradicted the expert reference (rate ratio 2.94, 95% CI 1.73-4.98), mainly compartment-based 'no disease' lines.
Supports current practicemoderate evidence
Backs asking for compartment-based structured MRI reports before deep endometriosis surgery, with the caveat that an explicit 'no disease' statement for a compartment is not always right and the readers were trainees.
What it means
For the woman with suspected deep endometriosis, this supports asking for an MRI report that works through each compartment of the pelvis, as the specialist endometriosis radiologist in my multidisciplinary team does (EXPERTISE, deep endometriosis; endometriosis page, 'How I assess endometriosis'): structured reports were more complete and surgeons found them more useful.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Estetrol/drospirenone for endometriosis pain: better than placebo, no better than other hormonal treatment, on 198 women
Systematic review to Cochrane and PRISMA standards (PubMed, Embase, CENTRAL; two independent reviewers, risk-of-bias assessment) of estetrol 15 mg with drospirenone 3 mg for endometriosis symptoms: two randomised trials and two observational cohorts, 198 women in all; no meta-analysis was possible.
Finding
The pill reduced pelvic pain compared with placebo, with no significant difference against other active hormonal regimens; it improved dysmenorrhoea and quality of life (sleep, global improvement, overall health status); dyspareunia results were inconsistent; intermenstrual bleeding or spotting was the commonest side effect. No effect sizes are given in the abstract and nothing could be pooled.
No changeweak evidence
Too little evidence to prefer this pill over the combined pills and progestogens already used; it is an option for women who want it.
What it means
For a woman choosing a hormonal treatment for endometriosis pain, this says the newer estetrol pill reduces pain compared with placebo, as combined pills generally do, with no evidence that it beats the pills and progestogens already used, and spotting as its commonest side effect.
Conflicts of interest: Funding not stated in the abstract; proprietary product, so the included trials' sponsorship should be checked in the full text.
Reviewed by Mr Jan, .
About 1 in 100 women are first diagnosed with endometriosis after the menopause, mostly after a surgical menopause; HRT after a natural menopause did not raise the risk: Nurses' Health Study II
Prospective analysis of the population-based Nurses' Health Study II in the United States: 80,148 women with no report of endometriosis before the menopause, followed from the first questionnaire reporting menopause (baseline 1989) to 2019 for a laparoscopically confirmed first diagnosis of endometriosis after the menopause, analysed by age at menopause, surgical or natural menopause and hormone use with multivariable Cox models.
Finding
883 women (1.1%, about 1 in 90) reported a first diagnosis of endometriosis after the menopause, at a median age of 50.6 years (48.5 after a surgical menopause, 54.7 after a natural one), a median 4.0 years after it; 69.9% of the diagnoses followed a surgical menopause and 69.5% were in current hormone users. Compared with a natural menopause without hormones (110 cases), hormone use after a natural menopause carried no excess (137 cases; HR 1.16, 95% CI 0.89-1.49), whereas a surgical menopause carried a higher risk both without hormones (78 cases; HR 5.79, 95% CI 4.29-7.81) and, to a lesser degree, with them (477 cases; HR 3.86, 95% CI 3.08-4.82). The authors read the cases as a mixture of unrecognised persistent or recurrent disease and new lesions.
Supports current practicemoderate evidence
Confirms that endometriosis can present after a surgical menopause, which is why combined rather than oestrogen-only HRT is advised where disease is left behind, and that HRT after a natural menopause does not bring it on; it does not test the choice of HRT regimen.
What it means
For a woman considering HRT after a natural menopause, this is reassuring: hormone use did not increase the chance of endometriosis being found.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Endometriosis and Adenomyosis
The plain-language pages on what the condition is, how I assess it and the choices, written for the women I see.
