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.
There is no way to prevent endometriosis. But there are several things that raise your risk of developing it:
Having a close relative with endometriosis, especially a mother or a sister.
Having a short menstrual cycle -- less than 25 days.
Having menstrual flow lasting more than a week.
Having heavy flow.
Having medical condition that blocks or constricts your cervix or vagina.
Having a birth defect of the uterus, such as a double uterus or a double cervix.
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
Treatment with hormone therapy has failed to relieve
pelvic pain or other symptoms.
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
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.
Fritz MA, Speroff L (2011). Endometriosis. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1221–1248. Philadelphia: Lippincott Williams and Wilkins.
American College of Obstetricians and Gynecologists (2010). Management of Endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225-236.
Primary Medical Reviewer
Adam Husney, MD - Family Medicine
Specialist Medical Reviewer
Kirtly Jones, MD - Obstetrics and Gynecology
July 7, 2011
WebMD Medical Reference from Healthwise
July 07, 2011
This information is not intended to replace the advice of a doctor.
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