While birth control and other hormone-based medications are often used to treat the symptoms of endometriosis, they are not a cure, and for many, they simply don’t provide enough relief. When these treatments fail, your doctor may suggest laparoscopic surgery or even a hysterectomy.
Unfortunately, laparoscopic surgery for endometriosis only relieves the symptoms temporarily; it doesn't cure the disease completely, either. New implants will continue to grow, likely resulting in the need for future surgeries.
If other treatments have failed to bring you relief, you may consider taking a more drastic step and having a hysterectomy. But how do you know if this is the right option for you? Here are five things you need to know before you consider having a hysterectomy to treat endometriosis.
1. There may be other options
If you’ve had surgery to remove endometrial tissue, tried birth control and other medications, and yet it keeps returning, you may think a hysterectomy is the only other option. However, you may want to talk to your doctor about a procedure called endometrial ablation.
If having children is not in your future, ablation may provide relief without the added physical and emotional toll of a hysterectomy. Ablation is a procedure that destroys the lining of your uterus, according to the American College of Obstetricians and Gynecologists (ACOG), and it can often be completed in your doctor’s office.
It’s important to know that ablation is not birth control. However, while you can still get pregnant after an ablation, doing so will be riskier for both you and the baby, according to ACOG.
Technically, an ablation would only help if there are bleeding issues (heavy periods). It may eliminate periods or lighten them, and by default also lessen cramping associated with menses. But it would not take away other pelvic pain caused by endometriosis.
2. There are multiple types of hysterectomies
When you think of a hysterectomy, you may automatically think of an abdominal hysterectomy with the long incision and even longer recovery time. However, that’s not the only option. Hysterectomy can also be performed vaginally and via laparoscopic surgery.
Additionally, what is removed during a hysterectomy varies. A supracervical hysterectomy involves removing only the uterus but leaves the cervix intact. A total hysterectomy includes removal of the cervix along with the uterus. A total hysterectomy with bilateral salpingoophrectomy (or BSO) includes removal of the ovaries and fallopian tubes. Each type has its own benefits and risks.
3. Hysterectomy is not reversible
While men may (keyword: may) be able to have a vasectomy reversed if they change their mind about having children, there is no reversing a hysterectomy. Therefore, hysterectomy should only be considered if you are sure you do not wish to have children in the future.
4. Removal of your ovaries will cause early menopause
A 2014 study found that the risk of recurrence for endometriosis is as high as 62 percent if the ovaries are left intact. If your hysterectomy includes removal of your ovaries, the change in hormones will result in early menopause.
Symptoms of menopause can include hot flashes, vaginal dryness, and sleep problems, as well as emotional changes and changes to your libido. The severe drop in hormones following a complete hysterectomy can result in more severe menopause symptoms than natural menopause.
These changes in hormones can also affect your thyroid, leading to further symptoms and the need to take additional hormones.
5. Hysterectomy may not cure endometriosis pain
While a hysterectomy will stop excessive bleeding, it may not stop the pain. According to Michael Lewis, M.D., an OB-GYN in Brooklyn, New York, there is about a 15 percent chance that your pain will return even after a hysterectomy.
Dr. Lewis believes that the quality of your surgeon may make all the difference. A hysterectomy without removal of any and all endometrial tissue will not likely solve the problem. However, if all existing endometrial tissue is removed along with a hysterectomy, chances of endometriosis returning are much lower.
The bottom line
As frustrating and painful as endometriosis can be, it's easy to want to just take it all out. However, while it may be the best treatment long-term, hysterectomy is a major surgery that should not be performed without great thought and research. Hysterectomy comes with risks and complications that need to be fully considered. Make sure you are fully informed and have discussed these risks with your doctor prior to making your decision.