Is It Possible to Have Endometriosis After a Hysterectomy?

You can still have endometriosis after a hysterectomy done to treat it. Surgery to remove some or all of the uterus is sometimes done if the condition has not responded to less-invasive treatments. While it may reduce pain, it isn't an endometriosis cure.

There are several reasons endometriosis can persist after hysterectomy, including incomplete tissue removal and the presence of lesions outside of the uterus. (Perhaps surprisingly, most post-surgery endometrial lesions appear in the bowels.)

This article discusses why endometriosis after hysterectomy can occur, how it's treated, and why the decision to proceed with surgery is carefully weighed.

Why Endometriosis Can Recur After Hysterectomy

There are many possible reasons for a recurrence of endometriosis after hysterectomy. These include some tissue being left behind, pre-existing lesions outside of the uterus, and the use of hormone replacement therapy.

The type of surgery you have can also increase your risk.

Incomplete Removal of Tissue

Endometriosis may come back if parts of the lesions causing it remain after surgery.

Some lesions may be missed during a hysterectomy because they:

• May not look like a typical lesion
• Are not colored like a lesion
• Are too deep to be detected with a laparoscope (a thin telescopic tube with a light inserted into small incisions made in the abdomen)
• Cannot be reached during surgery

Type of Hysterectomy

The type of hysterectomy surgery you have can also affect your risk of endometriosis after surgery.

Women who have a partial hysterectomy (in which only the uterus is removed) or a total hysterectomy (in which the uterus and cervix are removed) are more likely to have endometriosis recurrence than those who choose an oophorectomy—the surgical removal of one or both ovaries in addition to the uterus.

Rarely, a person may experience something called ovarian remnant syndrome following an oophorectomy. This is where some ovarian tissue, even microscopic amounts, remains after the oophorectomy.

Like other missed tissue, this may result in recurrent endometriosis.

Lesions Outside of the Uterus

Lesions may be located in places not typically looked at in a hysterectomy. For example, a lesion in the intestinal tract could be left behind after a hysterectomy.

The bowels are the most common location for post-hysterectomy lesions to occur.

Hormone Replacement Therapy

The risk of recurrence of endometriosis may be higher in women who start hormone replacement therapy (HRT) after hysterectomy.

However, HRT will not cause endometriosis in someone who has never had it.

Signs of Recurring Endometriosis After Hysterectomy

Recurring endometriosis can be difficult to diagnose from a healthcare provider’s perspective, but there are signs and symptoms you would see or feel. The most common symptoms of recurring endometriosis are:

• Pelvic pain
• Pain from sex

Other symptoms that may arise after a hysterectomy are symptoms you will probably easily recognize, as they mirror symptoms of endometriosis before it is treated. They include:

• Intensely painful period cramps
• Heavy bleeding during your period

In some cases, rectal pain and bleeding may also occur.

The tough part about diagnosing recurring endometriosis after hysterectomy is that it is hard to identify the exact cause of the persistent pain because there could be multiple factors at play. For example, lasting pain could be caused by post-surgical scar tissue. 

In addition to noting your symptoms, your healthcare provider may do a laparoscopy, a procedure to check the pelvic organs, to see if there are any more lesions that could be causing persistent pain.

Treatment Options After Hysterectomy

If a hysterectomy fails to get rid of endometriosis pain, there are other treatment options still available. Other treatments may include:

• Hormone therapy
• Birth control
• Pain medications
• Another surgery, if lesions were missed
  

Deciding to Get a Hysterectomy

Choosing to get a hysterectomy to eliminate the symptoms of endometriosis is a big decision. Continuing to experience endometriosis symptoms after a hysterectomy is a real possibility, and that must be considered.

Talking with your healthcare provider about the pros and cons of a hysterectomy to treat your endometriosis can help you understand if the risks outweigh the benefits in your case.

For example, multiple surgeries may be needed if endometriosis pain persists after the first surgery, and even then, the pain could come back.

A hysterectomy can’t be reversed, and it may or may not be the answer to your endometriosis pain. If your healthcare provider has suggested a hysterectomy to treat your endometriosis, it’s a good idea to get a second opinion.

Summary

While a hysterectomy is an accepted treatment for endometriosis, there is no guarantee that it will get rid of endometriosis symptoms.

Sometimes lesions are missed during surgery, which means the underlying cause of endometriosis is still there and causing pain.