Using Hysterectomy to Treat Endometriosis

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

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.

Research suggests that pain relief is better achieved if the surgery involves the removal of the ovaries. According to a 2014 study from researchers at Johns Hopkins Medical Center, 61 percent women who had a hysterectomy without an 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 had pain, and less than 4 percent needed a second surgery.

Understandably, this type of dual procedure isn't 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 a hysterectomy/oophorectomy that shouldn't be underplayed, including blood clots, infection, post-operative bleeding, and a bad reaction to the anesthesia.

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 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. Use our Doctor Discussion Guide below to start a conversation with your doctor about the right treatment option for you.

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.