Still, endometriosis—which affects as many as one in every ten women in the United States—remains one of the most misunderstood and misdiagnosed disorders. Because of this, treatment options, including hysterectomies, can also be difficult to gauge.
In order to get a better grasp of what endometriosis is—as well as the when and why hysterectomies are an option for some women—we spoke to gynecological experts.
What is Endometriosis?
The uterus is lined with a tissue that grows during your period called the endometrium. Endometriosis, explains Dr. Kelly Wright, MD, of the Obstetrics & Gynecology Department at Cedars Senai, is when the cells that are typically inside the uterus get outside of the uterus, including the ovaries and pelvis.
The cells then build up and grow into lesions. “When this happens, every time a woman cycles, it can cause pain and inflammation,” she says. These symptoms can include heavy periods, back pain, bowel problems, and painful sexual activity, among other issues.
Complications from endometriosis—a chronic condition with no cure—can lead to fertility problems and mental health-related issues, including depression.
Treatment Options for Endometriosis
If you have been diagnosed with endometriosis, you and your doctor will begin with conservative treatment options. Dr. Jeff Arrington, FACOG, ACGE, of The Center for Endometriosis Care, explains that this can include over-the-counter medication treatments (such as Ibuprofen), hormonal contraceptives, hormone therapy, and conservative surgery.
Conservative and minimally invasive surgery, or a laparoscopy, allows a surgeon to remove these lesions. This is done by making a small incision in the abdomen and looking inside the pelvis with a small laparoscopy. Dr. Wright says that this kind of surgery is aimed to “remove all of the disease, but to preserve all of the GYN organs as much as possible.”
However, if none of the conservative treatment options work and the pain is pervasive, a hysterectomy may be considered. A hysterectomy, Dr. Arrington says, is typically reserved for patients that have fibroids, uterine disease, or adenomyosis.
What is a Hysterectomy?
There are different kinds of hysterectomies to be aware of: a supracervical hysterectomy and a total hysterectomy.
A supracervical hysterectomy, Dr. Wright explains, is the removal of the top, diseased part of the uterus, but the cervix is left in place.
A total hysterectomy is the removal of the entire uterus (the top part), as well as the cervix (the bottom part), the ovaries and the fallopian tubes. (Dr. Arrington notes that the removal of the fallopian tubes is often done as a cancer prevention risk.)
The recovery time for hysterectomies vary, but the average for a supracervical is around two weeks, while a total hysterectomy can take upwards of six to eight weeks. During that time, Dr. Arrington says that patients are placed on strict limitations, including no heavy lifting, no strenuous exercises, and no sexual intercourse.
Hysterectomy for Endometriosis Diagnosis
A hysterectomy should never be the first course of action when it comes to treating endometriosis, and it is not indicated for most cases of endometriosis. As Dr. Arrington puts it, “It is not the definitive treatment.”
However, for patients who have run through options with their doctor and they are no longer able to manage their pain symptoms related to endometriosis.
Dr. Wright points out that while a hysterectomy does not entirely get rid of endometriosis, for women with endometriosis and adenomyosis inflammatory cells, it is the best chance at pain relief. She says that if the endometriosis is located within the uterus, there is upwards of 95 percent success rate when it is appropriately diagnosed. (If the endometriosis is in other locations, it may not be as successful.)
Because a hysterectomy eliminates the option of a woman being able to bear children, it is important that you and your doctor discuss this, especially regarding any family planning you may or may not have done.
This sometimes difficult decision may cause emotional distress, so Dr. Wright says having a support system in place in addition to your doctor is important, whether that be from friends, family, or a therapist.
She also says it’s important to remember that having a hysterectomy “doesn’t make you less of a woman,” adding, “It doesn’t change your hormones in any way and it doesn’t remove the ligaments or nerves related to good sexual function.”
If you have been properly diagnosed by your doctor and you have come to the conclusion that a hysterectomy is the right choice for you when it comes to treating your pain related to endometriosis, Dr. Wright says that this can, ultimately, improve your overall quality of life.