I recently experienced excruciating abdominal pain and was found to have a mass behind my uterus. After a total hysterectomy with removal of both ovaries, I was diagnosed with extensive endometriosis. I was started on estrogen therapy right after surgery. I have read that endometriosis can return in the presence of estrogen. When I asked my doctor about this, she said that I was cured. Does that make sense, or should I see a reproductive endocrinologist to be sure?

B.K.

Your doctor does not understand endometriosis. First, you do not cure this disease. Often hysterectomy may relieve symptoms, but using of unopposed estrogen -- that is, estrogen unaccompanied by progesterone -- is likely to stimulate any residual disease. In fact, I have seen patients with bowel obstruction requiring bowel surgery in cases where the uterus was removed and estrogen was prescribed alone. I recommend that my patients who undergo hysterectomy and removal of the tubes and ovaries for endometriosis be placed on combined estrogen and progesterone replacement.

The other error is that many physicians believe that removing the uterus removes the endometriosis. Often, diseased tissue remains in the space between the rectum and vagina or deep along the side of the pelvic bone. I would recommend you get a second opinion from a skilled endometriosis surgeon to explore all your options.