Endometriosis: Should I Have a Hysterectomy and Oophorectomy?

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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

Your options

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.
  • 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.footnote 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 4 to 6 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.footnote 1
  • 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.
FAQs

What is endometriosis?

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.

How will endometriosis affect you?

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.

How well does surgery help symptoms?

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.footnote 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.footnote 1

What are the risks of surgery?

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.
  • Continued pain. Pelvic pain that you had before surgery may
    not be helped by surgery.
  • Change in sexual function.
  • Infection.
  • 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) may increase the risk of health problems in a small number of women. A woman's increase in risk depends on her age, her personal risk, and when she starts ET. Some of the problems include:footnote 2

  • Stroke.
  • Blood clots.
  • Gallstones.
  • Dementia.
  • Urinary incontinence.

Why might your doctor recommend surgery?

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

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have surgery to remove
your uterus and ovaries

Have surgery to remove
your uterus and ovaries

  • Surgery takes about 1 to 2 hours.
  • You may stay in the hospital for 2 or 3
    days.
  • Recovery usually takes 4 to 6 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 out of 100
    women who have this surgery.footnote 1
Don't have this surgery

Don't have this surgery

  • You may keep taking
    hormones.
  • You may have
    laparoscopic surgery (or more surgery if you had it
    already) to remove tissue.
  • You may take
    medicines such as ibuprofen or naproxen (NSAIDs) to
    relieve pain.
  • 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.

More important
Equally important
More important

My quality of life is suffering because of my symptoms.

My symptoms aren't hurting my quality of life.

More important
Equally important
More important

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.

More important
Equally important
More important

I don't plan to get pregnant.

I want to be able to get pregnant.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.
2, If I have my ovaries and uterus taken out, endometriosis will never give me pain again.
3, I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. American College of Obstetricians and Gynecologists (2010, reaffirmed 2016). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
  2. LaCroix AZ, et al. (2011). Health outcomes after stopping conjugated estrogens among postmenopausal women with prior hysterectomy. JAMA, 305(13): 1305–1314.
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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

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.
  • 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 4 to 6 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.1
  • 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.
FAQs

What is endometriosis?

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.

How will endometriosis affect you?

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.

How well does surgery help symptoms?

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.1

What are the risks of surgery?

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.
  • Continued pain. Pelvic pain that you had before surgery may
    not be helped by surgery.
  • Change in sexual function.
  • Infection.
  • 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) may increase the risk of health problems in a small number of women. A woman's increase in risk depends on her age, her personal risk, and when she starts ET. Some of the problems include:2

  • Stroke.
  • Blood clots.
  • Gallstones.
  • Dementia.
  • Urinary incontinence.

Why might your doctor recommend surgery?

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.

2. Compare your options

  Have surgery to remove
your uterus and ovaries
Don't have this surgery
What is usually involved?
  • Surgery takes about 1 to 2 hours.
  • You may stay in the hospital for 2 or 3
    days.
  • Recovery usually takes 4 to 6 weeks.
  • You will no
    longer have periods or be able to get pregnant.
  • You may keep taking
    hormones.
  • You may have
    laparoscopic surgery (or more surgery if you had it
    already) to remove tissue.
  • You may take
    medicines such as ibuprofen or naproxen (NSAIDs) to
    relieve pain.
What are the benefits?
  • 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.
  • 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.
What are the risks and side effects?
  • 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 out of 100
    women who have this surgery.1
  • 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

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

3. 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.

             
More important
Equally important
More important

My quality of life is suffering because of my symptoms.

My symptoms aren't hurting my quality of life.

             
More important
Equally important
More important

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.

             
More important
Equally important
More important

I don't plan to get pregnant.

I want to be able to get pregnant.

             
More important
Equally important
More important

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.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. 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

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.

  • True
  • False

  • I'm not sure

You'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.

2.
If I have my ovaries and uterus taken out, endometriosis will never give me pain again.

  • True

  • False
  • I'm not sure

You're right. Taking out the uterus and ovaries usually relieves pain. But not for everyone. Pain returns in up to 15 out of 100 women who have this surgery.

3.
I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.

  • True
  • False

  • I'm not sure

That'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.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Kirtly Jones, MD - Obstetrics and Gynecology

References
Citations
  1. American College of Obstetricians and Gynecologists (2010, reaffirmed 2016). Management of endometriosis. ACOG Practice Bulletin No. 114. Obstetrics and Gynecology, 116(1): 225–236.
  2. LaCroix AZ, et al. (2011). Health outcomes after stopping conjugated estrogens among postmenopausal women with prior hysterectomy. JAMA, 305(13): 1305–1314.

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