Will a Hysterectomy Help My Endometriosis?
Just as endometriosis symptoms are different for each person, results of therapy differ as well. This can make it difficult to choose a type of treatment. If you’ve tried various treatments and still have symptoms, or you’ve been bothered by the side effects from those treatments, you might wonder about hysterectomy.
What is a hysterectomy?
Hysterectomy is surgery to remove the uterus, usually with the attached cervix and fallopian tubes. The ovaries may or may not be removed. Hysterectomy can be very effective at improving pain from endometriosis: a Swedish study published in 2020 interviewed 137 participants who had a hysterectomy for endometriosis pain. Of those with severe pain, three-quarters felt better after surgery. 84% were satisfied with the results of the surgery. That is, those with severe pain had less pain after the hysterectomy, and this was still true three years later.1
Do hysterectomies reduce pain?
Why doesn’t a hysterectomy solve the problem of endometriosis completely? Endometriosis can exist in areas outside the uterus, like the bladder or intestine. Removing the uterus will not remove those areas - though they can be treated during surgery. In some cases, longstanding pain can cause muscle tightness, when the muscles of the pelvic floor or abdomen become painful as a response to the endometriosis pain, or even central pain syndrome2, where the brain and nerves cause an experience of pain. These may continue even after the original source of the pain is removed, and may need to be treated in other ways (read more here: Endo, Chronic Pelvic Pain, and Central Sensitization and here: How Physiotherapy Can Help Endometriosis).
Should the surgeon remove the ovaries too?
If you are thinking about having a hysterectomy, a big consideration is whether or not to have the ovaries removed, since they are a source of the estrogen that tends to make endometriosis worse. For a young person, removal of the ovaries often causes a very uncomfortable, sudden onset of menopause symptoms (and may have long-term health impacts, such as an increased risk of heart disease). There is no one-size-fits-all answer, but there’s some helpful news from the 2020 study: those who had ovaries removed and those who did not have about equal improvements in pain.2
Hormone therapy with estrogen can work very well to treat the symptoms of menopause after removing the ovaries, but there’s a concern that using estrogen may cause the endometriosis to come back. While there is not a lot of evidence to help us answer this question, one study showed only a small chance, less than 1% per year, of endometriosis returning when using estrogen therapy after hysterectomy.3
Will hysterectomy improve my PMS symptoms?
We believe that PMS is a result of the cycle of hormones produced by the ovaries. Removing the uterus, but not the ovaries, will probably not change PMS much one way or the other. Removing both uterus and ovaries usually puts and end to PMS4, and one study showed that most were satisfied with the result5 (all participants used estrogen therapy after surgery). Even a hysterectomy without removing the ovaries was found to improve PMS by about two-thirds.6
Hysterectomy is a big step that can greatly improve symptoms of both PMS and endometriosis in many cases—but may not result in being pain-free. It’s important to find a doctor you trust to discuss your goals and work with you through this process, both before and after surgery.
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