Using Hysterectomy to Treat Endometriosis

What the surgery can and can't do to relieve pain

Hysterectomy—surgical removal of the uterus—is a common treatment for endometriosis. However, it's not usually the first treatment option and may not be the final one, either.

In endometriosis, tissues that normally grow inside the uterus grow outside of it, most often on the ovaries and fallopian tubes. It sometimes extends to the bowels, bladder, and other nearby structures as well.

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

This article looks at the types of hysterectomies that are available, what works best for endometriosis, and what other treatment options you have.

Types of Hysterectomies

While there is no cure for this disease, hysterectomy for endometriosis can help alleviate intolerable symptoms.

What's 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.

Different types of hysterectomies are available. They include:

  • Partial hysterectomy: The uterus is removed, but not the cervix or ovaries.
  • Total hysterectomy: The uterus and cervix are removed, but not the ovaries.
  • Hysterectomy and oophorectomy: The uterus and one or both ovaries are removed.

What Works Best for Endometriosis?

Research suggests a hysterectomy with oophorectomy relieves endometrial pain better than a hysterectomy alone. In one study:

  • Sixty-one percent of people who had a hysterectomy without oophorectomy still had pain and 31% needed a second surgery.
  • Only 10% of those who had a hysterectomy with oophorectomy still had pain, and less than 4% needed a second surgery.

How Is a Hysterectomy for Endometriosis Performed?

The surgery can be done in various ways, regardless of what is removed. It can be:

  • Vaginal, which means there's no incision and offers a faster recovery time
  • Laparoscopic, which includes a few small incisions, has a fairly fast recovery time, and allows the surgeon to get a look at your organs
  • Abdominal, which involves a larger incision and the longest recovery time, and allows the surgeon the best view of your other organs

Discuss the different types with your surgeon to see what's right for you and what type of recovery to expect.

Pros and Cons of Hysterectomy for Endometriosis

If you're considering a hysterectomy, it's important to understand the probable outcomes and the alternatives that may be more appropriate for your specific condition.

Having a hysterectomy is a big decision with serious ramifications to consider.

  • It's irreversible.
  • You'll be permanently sterile (unable to get pregnant).
  • Removing the ovaries triggers menopause and often requires hormone replacement therapy.

The surgery itself comes with risks, as well, such as:

  • Blood clots
  • Infection
  • Post-operative bleeding
  • Bad reactions to anesthesia

Your healthcare provider should go over the risks and benefits of surgery as well as alternative treatments.

Pros
  • Hysterectomy can help alleviate intolerable symptoms

  • Oophorectomy can help alleviate pain

Cons
  • Multiple surgeries may be needed

  • Pain relief may not be complete

  • Oophorectomy leads to permanent sterility and triggers menopause

woman with pelvic pain
BSIP/Universal Images Group/Getty Images

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

Ultimately, the choice of treatment should always be based on the severity of pain, your age and health, and whether you have plans to have a family. 

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.

Before diagnosing and treating endometriosis, your healthcare provider may conduct imaging tests such as an MRI or ultrasound to confirm that there are no other complicating conditions.

In most cases, healthcare providers will start with conservative treatment such as medication before trying invasive surgical treatment. Use our Healthcare Provider Discussion Guide below to start a conversation with your healthcare provider about the right treatment option for you.

Endometriosis Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

A Word From Verywell

It's important to be clear with your healthcare provider about your desired goals of treatment before embarking on any treatment for endometriosis. 

Your treatment may be vastly different if you want to have kids in the future versus being done having children or not wanting to ever get pregnant.

Frequently Asked Questions

  • Can you still have endometriosis after a hysterectomy?

    You can, since endometrial tissue can grow outside of the uterus. The excess tissue needs to be removed as well. Also, residual tissues can be left behind that are susceptible to endometriosis.

  • Does insurance cover hysterectomy for endometriosis?

    This varies greatly by insurance company and policy. Before you make a treatment decision, check with your insurance company to see what's covered, how much of it is covered, and under what conditions.

  • Does having a hysterectomy age you faster?

    It may, especially if your ovaries are removed. The loss of estrogen can contribute to:

    • Cognitive impairment associated with age
    • Low bone mineral density, which can cause osteoporosis and osteoarthritis
    • Less elastic skin, which may look older
    • Loss of connective tissue, which is linked to heart disease and stroke
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institutes of Health, U.S. National Library of Medicine: MedlinePlus. Endometriosis.

  2. American College of Obstetricians and Gynecologists. FAQs: Hysterectomy.

  3. Rizk B, Fischer AS, Lotfy HA, et al. Recurrence of endometriosis after hysterectomyFacts Views Vis Obgyn. 2014;6(4):219–227.

  4. National Institutes of Health. What are the treatments for endometriosis? 

  5. U.S. Food and Drug Administration. Drug trials snapshots: Orilissa.

  6. Endometriosis Foundation of America. Endometriosis after hysterectomy - Dr. Rosanne Kho.

  7. Chronic Disease Coalition. Endometriosis in America: Tips, tricks, and tribulations.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.