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Endometriosis: Should I Have a Hysterectomy and Oophorectomy?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Endometriosis: Should I Have a Hysterectomy and Oophorectomy?
Get the facts
- Have your uterus and ovaries removed to treat symptoms from endometriosis.
- Keep using hormone therapy or have more laparoscopic surgery to remove endometriosis and scar tissue.
This decision aid is for women who have tried hormone therapy and have had laparoscopic surgery to remove tissue but still have severe symptoms. Other women decide to use hormone therapy before having surgery.
Key points to remember
- There is no cure for endometriosis. Hormone therapy or taking out tissue with laparoscopic surgery can ease pain. But pain often returns within a year or two.1
- Taking out the ovaries (oophorectomy) and the uterus (hysterectomy) usually relieves pain. But the pain relief doesn't always last. Pain comes back in up to 15 out of 100 women who have this surgery.1 This means that in 85 out of 100 women who have surgery, the pain doesn't come back.
- When your menstrual periods stop at around age 50 (menopause) and your estrogen levels drop, endometriosis growth and symptoms will probably also stop. In some cases, scar tissue remains after menopause and can cause problems.
- Taking out the uterus and ovaries is a major surgery with short-term and long-term risks. Recovery usually takes 6 to 8 weeks.
- The sudden drop in estrogen after taking out the ovaries causes worse menopause symptoms than you would have with natural menopause. The low estrogen also makes your bones start to thin at a younger age. This raises your risk of osteoporosis later in life. It's one reason why some doctors remove only one ovary when treating a younger woman.
- If you have your ovaries removed, you can choose to take estrogen therapy. It will protect your bones and prevent menopause symptoms after your ovaries are removed. But it may also make endometriosis come back.2
- Taking out your uterus and ovaries may be a good choice if you don't plan to have children (or more children).
- You also may want to have surgery if you're not close to menopause and your symptoms are so bad that you're willing to accept the risks and side effects of surgery.
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called "implants." They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. This can cause pain and can make it hard to get pregnant.
In some cases, scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen makes the implants grow. Because the ovaries make most of your body's estrogen, taking out the ovaries can relieve your symptoms.
While some women never have symptoms, others have severe pain that can make it hard to enjoy daily activities. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and usually go away after menopause.
This surgery works very well to relieve pain from endometriosis. But pain does return for up to 15 out of 100 women who have surgery.1 This means that in 85 out of 100 women who have surgery, the pain doesn't come back.
Taking out the uterus and ovaries is usually the last choice in treatment. This is because:
- It is a major surgery with a long recovery.
- It makes you unable to get pregnant.
- It causes a sudden drop in your level of estrogen. This leads to menopause and side effects such as making your bones thinner.
You can take low-dose estrogen after surgery to protect your bones and prevent symptoms of menopause. But this increases the chance that implants could come back.2
This surgery has different types of risks.
Risks from having surgery
Most women don't have problems from surgery. But problems can include:
- A fever. A slight fever is common after any surgery.
- Trouble urinating.
- Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks after surgery is normal. But call your doctor if bleeding continues to be heavy.
- Continued pain. Pelvic pain that you had before surgery may not be helped by surgery.
- Change in sexual function.
- Rare problems, such as:
- Blood clots in the legs or the lungs.
- Scar tissue (also called adhesions).
- Injury to other organs, such as the bladder or bowel.
- A collection of blood at the surgical site.
- Problems from general anesthesia.
- Severe blood loss that causes you to need more blood (transfusion).
Risks from not having ovaries
Without estrogen, you can have severe symptoms of menopause, such as hot flashes, vaginal dryness, moodiness, and depression. Your bones also begin to thin. This increases your risk of osteoporosis in later life. Taking estrogen can prevent these problems.
If you don't want to take estrogen, you can take another type of medicine to make your bones stronger.
Risks from taking estrogen
Estrogen therapy (ET) increases your risks of some health problems. Some of them include:
- Stroke. Taking estrogen slightly increases the risk of stroke.3
- Blood clots. It slightly increases the risk of blood clots in the legs (deep vein thrombosis) and lungs (pulmonary embolism). These can be deadly. This risk is greatest in the first year of use.4
- Breast cancer. The Million Women Study shows that, in women using ET for 10 years, the number of breast cancers is slightly higher than in women not taking ET.5 Although the Women's Health Initiative (WHI) trial found no increase in breast cancer over 7 years of ERT use, experts take the breast cancer risk seriously.6
- Gallstones. Women who use ET are more likely to have gallstones that cause symptoms than women who do not use ET. (High estrogen levels are linked to gallbladder disease.)7
Your doctor might suggest surgery if:
- You have severe symptoms.
- You're not close to menopause.
- You don't plan to get pregnant.
- You tried hormones or had laparoscopic surgery to remove tissue, but your symptoms are still bad.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- Surgery takes about 1 to 2 hours.
- You may stay in the hospital for 2 or 3 days.
- Recovery usually takes 6 to 8 weeks.
- You will no longer have periods or be able to get pregnant.
- Your pain may get much better or go away.
- Problems with your bladder, bowels, or other organs may go away.
- You may feel that your quality of life is better.
- You have the risks of major surgery, which include infection, blood clots, damage to the bladder or bowels, and bleeding. You also could have changes in sexual function.
- You may have hot flashes, vaginal dryness, and depression because of sudden menopause.
- Early menopause means that your bones will start to thin earlier than they would with natural menopause. This increases the risk for osteoporosis.
- If you take estrogen after surgery, you have an increased risk of stroke, blood clots, and breast cancer.
- The pain could come back. Pain returns in up to 15% of women who have this surgery.1
- Some treatments, such as hormones, may make your symptoms better.
- You avoid the risks of surgery to remove your uterus and ovaries.
- You may be able to have children.
- Hormones might not relieve your pain. Or the pain could come back after you stop taking the medicine.
- Hormones have side effects that can include menopause symptoms, rapid bone loss, and an increase in cholesterol.
- Problems with other organs, such as your bladder or bowels, could start or get worse.
- If you have laparoscopic surgery, you have the risk of infection, bleeding, and damage to your bladder or bowels.
- You could have side effects from NSAIDs used for pain.
Personal stories about surgical treatment of endometriosis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have had pain before and during my period for years. I tried nonprescription and prescription medicines to control the pain. Nothing was working. Because my pain was so bad, my doctor suggested that I consider a hysterectomy. I didn't like the thought of surgery but had to do something about the pain. Since I'd already had two children, I had the surgery. It has been 6 months now, and I am glad I had the surgery.
Barbara, age 35
Endometriosis made me miserable for a week to 10 days every month. Since my husband and I have three children and did not want any more, I decided it was time to take action to get rid of the pain. I decided that ablation made the most sense, because I wanted to keep my uterus and ovaries. My doctor talked with me about the discomfort and risks of having the wall of the uterus treated with a laser. Frankly, it didn't take more than a week to recover, since the incisions were so small. But you know, after a year or so, the pain started coming back. I'm going to have to rethink my options now. Even though my sister has had long-lasting relief from ablation, it's not for me.
Lucia, age 42
My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did an exam and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. He suggested a hysterectomy but did say that endometriosis can grow back in other places. I still wanted to have a child, so I said no hysterectomy. Fortunately, I did get pregnant, and ever since having my baby my periods have been so much better!
Connie, age 35
My doctor told me endometriosis might be causing my painful periods. I'd never even heard of it before. She told me all about endometriosis and the treatments I could try. She suggested I try taking birth control pills and using ibuprofen before and during my period. It took a couple of months of using this system, but now I hardly have any pain. I am glad I didn't have surgery.
Harriet, age 39
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to remove my uterus and ovaries
Reasons not to have the surgery
I tried hormones and had laparoscopic surgery, and my symptoms are still bad.
Medicine is controlling my symptoms.
My quality of life is suffering because of my symptoms.
My symptoms aren't hurting my quality of life.
I'm willing to accept the risks and side effects of surgery.
I'm not willing to accept the risks and side effects of surgery.
I don't plan to get pregnant.
I want to be able to get pregnant.
I'm not close to menopause, so I don't want to wait for the symptoms to go away.
I'm close to menopause, so I prefer to wait for the symptoms to go away.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having the surgery
NOT having the surgery
What else do you need to make your decision?
Check the facts
I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.
- TrueYou're right. When your menstrual periods stop and your estrogen levels drop, endometriosis growth and symptoms will probably also stop. You could take pain medicine and hormones until then.
- FalseSorry, that's not right. When your menstrual periods stop and your estrogen levels drop, endometriosis growth and symptoms will probably also stop. You could take pain medicine and hormones until then.
- I'm not sureIt may help to go back and read "Key points to remember." When your menstrual periods stop and your estrogen levels drop, endometriosis symptoms will probably also stop. You could take pain medicine and hormones until then.
If I have my ovaries and uterus taken out, endometriosis will never give me pain again.
- TrueSorry, that's not right. Taking out the uterus and ovaries usually relieves pain. But not for everyone. Pain returns in up to 15% of women who have this surgery.
- FalseYou're right. Taking out the uterus and ovaries usually relieves pain. But not for everyone. Pain returns in up to 15% of women who have this surgery.
- I'm not sureIt may help to go back and read "Get the Facts." Taking out the uterus and ovaries usually relieves pain. But not for everyone. Pain returns in up to 15% of women who have this surgery.
I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.
- TrueThat's right. You can choose to take estrogen therapy. It will protect your bones and prevent menopause symptoms. But talk to your doctor to make sure it's right for you.
- FalseThat's not right. You can choose to take estrogen therapy. It will protect your bones and prevent menopause symptoms. But talk to your doctor to make sure it's right for you.
- I'm not sureIt may help to read "Key points to remember." You can choose to take estrogen therapy. It will protect your bones and prevent menopause symptoms. But talk to your doctor to make sure it's right for you.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Specialist Medical Reviewer||Kirtly Jones, MD - Obstetrics and Gynecology|
- American College of Obstetricians and Gynecologists (2010). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
- 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 Women's Health Care Physicians (2004). Stroke. Obstetrics and Gynecology, 104(4, Suppl): 97S–105S.
- American College of Obstetricians and Gynecologists Women's Health Care Physicians (2004). Venous thromboembolic disease. Obstetrics and Gynecology, 104(4, Suppl): 118S–127S.
- Million Women Study Collaborators (2003). Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet, 362(9382): 419–427.
- Women's Health Initiative Steering Committee (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA, 291(14): 1701–1712.
- Cirillo DJ, et al. (2005). Effect of estrogen therapy on gallbladder disease. JAMA, 293(3): 330–339.