ObjectiveDesign A prospective study.Setting The Northern Endometriosis Centre at South Cleveland Hospital, Middlesbrough and St.James's University Hospital, Leeds.Population Fifty-seven consecutive patients undergoing laparoscopic excision of invasive endometriosis.Methods Questionnaires, both pre-operatively and four-month post-operatively, for a number of different symptoms associated with endometriosis were completed by patients. Details of fertility, previous treatments and quality of life as measured by SF12 and EuroQOL (EQ-SD) and sexual activity questionnaire, as well as linear pain scores for several symptoms, were recorded. Details of intra-operative findings was also collected.Main outcome measures Effect of laparoscopic excision on pain scores and quality of life, operative findings, type of surgery, length of surgery and incidence of intra-and post-operative complications.Results Patients with endometriosis were severely ill with significant pain and impairment of quality of life and sexual activity. Four months after radical laparoscopic excision for deep endometriosis there was significant improvement in all the parameters measured including their quality of life based on EuroQOL evaluation: EQ-SD (0.595:0.729, P = 0.002) and EQ thermometer (68.9:77-7, P = 0.008); SF12 physical score (44.8:51.9, P = 0.015); sexual activity (habit P = 0.002, pleasure P = 0-002 and discomfort P IO.001). Only the mental health score of SF12 failed to show any statistical improvement (47.1:48.4, P = 0.84). Symptomatically, there was a significant reduction in dysmenorrhoea (median 8-0:4.0, P I 0-OOl), pelvic pain (median 7.0:2.0, P IO.OOl), dyspareunia (median 6.0:0.0, P I 0.001) and rectal pain scores (median 4-0:0.0, P I 0-001). Complications were noted, but were deemed to be acceptable for the extent of the surgery.Conclusions This is an early analysis of the first 57 cases studied, but structured evaluation suggests that meaningful improvements in clinical symptoms and quality of life can be obtained with this approach with acceptable levels of operative morbidity. Further follow up of this series is required, but early evidence would suggest that the technique should be further evaluated as part of a randomised trial.To assess the effect of endometriosis and radical laparoscopic excision on the quality of life of women with this conhtion.

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Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years. The probability of requiring further surgery is 36%. Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence.

Background:Women at high ovarian cancer risk, especially those with mutations in BRCA1/BRCA2, are encouraged to undergo bilateral risk-reducing salpingo-oophorectomy (BRRSPO) prior to the natural menopause. The decision to use HRT to cover the period of oestrogen deprivation up to 50 years of age is difficult because of balancing the considerations of breast cancer risk, bone and cardiovascular health.Methods:We reviewed by questionnaire 289 women after BRRSPO aged ⩽48 years because of high ovarian cancer risk; 212 (73%) of women responded.Results:Previous HRT users (n=67) had significantly worse endocrine symptom scores than 67 current users (P=0.006). A total of 123 (58%) of women had ⩾24 months of oestrogen deprivation <50 years with 78 (37%) never taking HRT. Bone density (DXA) evaluations were available on 119 (56%) women: bone loss with a T score of ⩽−1.0 was present in 5 out of 31 (16%) women with no period of oestrogen deprivation <50 years compared with 37 out of 78 (47%) of those with ⩾24 months of oestrogen deprivation (P=0.03).Interpretation:Women undergoing BRRSPO <50 years should be counselled concerning the risks/benefits of HRT, taking into consideration the benefits on symptoms, bone health and cardiovascular health, and that the risks of breast cancer from oestrogen-only HRT appear to be relatively small.