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Hysterectomy for Endometriosis


Hysterectomy for Endometriosis

Hysterectomy is the removal of the uterus. To treat endometriosis, the ovaries are often removed (oophorectomy) along with hysterectomy. This is because ovarian estrogen feeds endometriosis. Without oophorectomy, pain from endometriosis is 6 times more likely to return after a hysterectomy.1

Once the body's estrogen-producing organs (ovaries) are gone, endometriosis growths shrink.

Hysterectomy and oophorectomy are considered a last-resort treatment for endometriosis because it is a major surgery with risks of complications. Removing the ovaries also causes a sudden drop in estrogen; this causes sudden menopause, difficult side effects, and bone-thinning. Normally, a woman takes low-dose estrogen to reverse these problems after having an oophorectomy. But taking estrogen also increases the risk that endometriosis will return.1

Experts recommend first trying other endometriosis treatments, including surgery to remove endometriosis growth and scar tissue, before considering hysterectomy and oophorectomy. Oophorectomy and hysterectomy may be right for you if:

  • You are certain that you will never want to become pregnant again.
  • The function of your abdominal organs, such as the bladder or bowels, is impaired because of scar tissue (however, scar tissue can usually be surgically removed without also taking the uterus and ovaries).
  • Treatment with hormone therapy has failed to relieve pelvic pain or other symptoms.
  • Symptoms of endometriosis are affecting your quality of life.
  • Your endometriosis symptoms outweigh the risks and long-term effects of the surgery.
  • Hormone therapy and/or surgical removal of endometriosis have failed to control your symptoms.

There are several types of hysterectomy. The size, location, and involvement of other abdominal organs determines which hysterectomy procedure is most appropriate.

For more information, see the topics Hysterectomy and Oophorectomy.

How effective is it?

Hysterectomy with oophorectomy drops estrogen levels, which relieves endometriosis pain for most women. But pain does return for up to 15% of women.2 Your risk that endometriosis and pain will return increases if you take low-dose estrogen to protect your bones and prevent menopausal symptoms.1

What else should I know?

An accurate diagnosis is essential to the successful outcome of a hysterectomy. If your symptoms are not accurately diagnosed, a hysterectomy is less likely to relieve your symptoms.

Endometriosis symptoms and growth will stop when you reach natural menopause at about age 50. Hysterectomy has no long-term advantage over waiting for natural menopause to occur.

If you are considering this surgery, weigh the chance of relieving your pain against the risks and costs of a hysterectomy.

References

Citations

  1. Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.

  2. American College of Obstetricians and Gynecologists (2010). Management of Endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225-236.

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerKirtly Jones, MD - Obstetrics and Gynecology
Last RevisedJuly 7, 2011

eMedicineHealth Medical Reference from Healthwise

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