Why You May Still Have Endometriosis After a Hysterectomy

Hysterectomy Is Not a Cure For Endometriosis

The sites of endometriosis are in purple. JOHN BAVOSI/SCIENCE PHOTO LIBRARY/Getty Images

What Is Endometriosis?

According to the National Institutes of Health, "endometriosis is a disease in which tissue that normally grows inside the uterus grows outside the uterus. It can grow on the ovaries, fallopian tubes, bowels, or bladder. Rarely, it grows in other parts of the body."  This tissue growth can lead to very mild symptoms in some women to severe symptoms that can lead to anemia, missed days of work, and significant pain.  

While symptoms of endometriosis do vary widely between individual women, the following issues often lead women to seek treatment and a diagnosis:

  • Pain, usually in the abdomen, lower back, or pelvic areas
  • Infertility
  • Heavy periods and bleeding between periods
  • Painful menstrual cramps

Pros and Cons of Hysterectomy for Endometriosis

While there is no cure for endometriosis, it is nevertheless one of the most common reasons that women have a hysterectomy (surgical removal of the uterus) each year. Before considering a hysterectomy for endometriosis, it's important to consider the probable outcomes and the alternatives to surgery as a hysterectomy may or may not relieve the pain of endometriosis.

In some cases, multiple surgeries may be required, and in many cases pain relief is not complete.

Research suggests that relief of endometrial pain is greater if surgery involves removal of the ovaries. According to a study conducted by Johns Hopkins researchers, women who had a hysterectomy that did not include removing the ovaries were far more likely to have endometriosis that caused pain in the years following surgery. In that study, 62% of women who kept their ovaries had endometriosis pain and 31% needed a second surgery.

The results were far different for women who had their ovaries removed during the hysterectomy procedure. Ten percent of those women experienced pain from endometriosis after surgery and less than 4% needed a second surgery.

It may seem that having your ovaries removed with hysterectomy is the obvious answer, but for a woman who may still want children, this means permanent sterility. In addition, if the ovaries are removed, menopause will begin in the days following surgery and hormone replacement therapy may be necessary. Additional risks are associated with having the ovaries removed, a procedure called an oophorectomy.

Alternatives to Hysterectomy for Endometriosis

Endometriosis is not cured by a hysterectomy. Painful symptoms can reoccur and often do. For this reason, laparoscopic and non-surgical treatments are often considered before a hysterectomy.

Alternative treatments for endometriosis may include:

  • pain medication, including over the counter treatments such as Ibuprofen
  • hormone treatments (often in the form of birth control medications)
  • laparoscopy, in which a surgeon inflates the abdomen slightly and then inserts small instruments through a tiny cut to see and remove the endometrial growth
  • laparotomy, in which traditional surgical techniques are used to remove the endometrial growth and, in some cases, ovaries
  • surgery to sever pelvic nerves, in which the uterus remains intact while nerves are cut to relieve pain

The choice of treatment will always be individualized. It is based on a number of factors including age, health, severity of the endometriosis and pain. The treatment of a patient who wishes to have children may be very different than the treatment of a woman who does not want to have children, as some treatments can further impact fertility.  

Before diagnosing and treating endometriosis, your doctor may conduct imaging tests such as an MRI or ultrasound to confirm that there are no other complicating conditions. In most cases, doctors will start with a conservative treatment such as medication before trying any type of invasive surgical treatment.  

A Word From Verywell

It will be important to be clear with your healthcare provider about your goals (child bearing, pain relief, reduced bleeding) and what you want to accomplish with treatment.  Your treatment, should you want to have children, may potentially be very different than the treatment you receive if you are not interested in becoming pregnant.  

The procedure that works best for someone who is anemic and seeking a way to reduce bleeding may not be the ideal treatment for someone who wants to have less pain.  



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