Using Hysterectomy to Treat Endometriosis

What the Surgery Can and Cannot to Relieve Pain

Endometriosis is a disease in which tissue that normally grows inside the uterus grows outside the uterus. It most commonly grows on the ovaries and fallopian tubes but can sometimes extend to the bowels, bladder, and adjacent structures. This tissue growth can lead to symptoms ranging from mild to debilitating, including:

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

Hysterectomy as Endometriosis Treatment

While there is no cure for endometriosis, many women will undergo a hysterectomy (surgical removal of the uterus) to help alleviate intolerable symptoms of the disease. If considering a hysterectomy, it's important to understand the probable outcomes and the alternatives that may be more appropriate for your specific condition.

What is most important to understand is that a hysterectomy is not a guaranteed cure for endometriosis. Multiple surgeries may be needed, and in many cases the pain relief will not be complete.

Research suggests that pain relief is better achieved if the surgery involves removal of the ovaries. According to a study from researchers at Johns Hopkins Medical Center, 61 percent women who had a hysterectomy without a oophorectomy (removal of the ovaries) continued to experience endometriosis pain after the procedure, often for years. Of these, 31 percent needed a second surgery.

By contrast, only 10 percent of the women who underwent a hysterectomy with oophorectomy has pain, and less than 4 percent needed a second surgery.

Understandably, this type of dual procedure is right for every woman as it is irreversible and will lead to permanent sterility. In addition, if the ovaries are removed, menopause will begin in the days following the surgery, often requiring hormone replacement therapy.

There are also surgical risks to an hysterectomy/oophorectomy that shouldn't be underplayed, including blood clots, infection, post-operative bleed, and a bad reaction to the anesthesia.

Alternatives to Hysterectomy

However desperate you may be to treat persistent endometriosis pain, hysterectomy should never be the first-line option. Instead, consider non-surgical alternatives or less invasive surgical procedures to directly treat the tissue overgrowth.

  • Over-the-counter pain like Advil (ibuprofen)
  • Oral contraceptives that can stop your period and prevent painful flares
  • Laparoscopy, a type of surgical procedure involving small "keyhole" incisions to view and remove excess uterine tissue
  • Laparotomy, a traditional surgery used to remove the endometrial overgrowth
  • Surgery to sever the pelvic nerves to obtain pain relief

In July 2018, the U.S Food and Drug Administration approved Orilissa (elagolix) as the first prescription drug used to treat endometriosis pain. Taken once or twice daily, Orilissa has proven effective in alleviating both menstrual and non-menstrual pelvic pain as well as pain during sex.

Ultimately, the choice of treatment should always be individualized based on the severity of pain, your age and health, and whether or not you have plans to have a family. 

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 desired goals of treatment before embarking on any treatment for endometriosis. Your treatment, should you want to have kids, will likely be vastly different than if you already have family or are not interested in becoming pregnant. 

7 Natural Treatments for Endometriosis
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