Will I Need to Have my Uterus Removed if I Have Endometriosis? 

The short answer to this is not necessarily. Removal of the uterus (hysterectomy) should only be considered after all other options have been explored.

Management of endometriosis

Endometriosis can cause severe menstrual-like cramping and infertility. It is classed as a chronic condition and, to date, there is no cure. Treatment focuses on relieving the symptoms and improving quality of life.

One of the first options to consider is over-the-counter pain relief medication. If this is not sufficient, there are less drastic options to consider prior to uterus removal. Hormonal therapy is a temporary solution, reducing, or preventing normal menstruation from occurring. This will also render a patient infertile; however it will not be permanent. There are also less invasive surgical techniques, such as laparoscopy, which can alleviate the symptoms of endometriosis, without impacting on fertility. Unfortunately this type of surgery may only provide short-term relief as the endometrial deposits do sometimes reform.

Undergoing an hysterectomy is perhaps the most drastic approach. Depending on the severity of your symptoms and provided maintaining fertility is not a concern, this type of radical surgery is an option. Sometimes the ovaries are removed at the same time and this is termed an oophorectomy. Uterus removal will certainly prevent further endometrial deposits from forming and, depending on the location of the existing deposits, will lessen their inflammatory effects.

What are the drawbacks to undergoing an hysterectomy?

It is very important to consider that this approach is highly likely to cause the body to enter into an immediate and irreversible menopause. For women who are still of child-bearing age this is a major decision to undertake. Furthermore, premature menopause brings with it a multitude of health concerns, including increased risk of developing cancer, cardiovascular disease and osteoporosis. As oestrogen is considered to be neuroprotective, there is also the possibility that artificially inducing an early menopause could have a detrimental effect on cognitive function later in life. This is in addition to typical menopausal symptoms, such as hot flushes, vaginal dryness, emotional instability, insomnia and reduced libido.

Is having a hysterectomy essential in the management of endometriosis?

Essential? No. An option to consider? Maybe.

Undergoing an hysterectomy is a valid and effective management strategy for some women with endometriosis. There will be no recurrence of the condition and immediate relief from symptoms. However, it is an option best suited to women who are past child-bearing age, with symptoms that cannot be managed by alternative means.

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Sources:

• Ryan, J, et al. “Impact of a Premature Menopause on Cognitive Function in Later Life.” BJOG, vol. 121, no. 13, Dec. 2014, pp. 1729–1739., doi:10.1111/1471-0528.12828.
• Cappelloni, L, and A Gotter. Early Menopause Risk Factors. Healthline, www.healthline.com/health/menopause/risk#medications. Medically reviewed by Michael Weber, MD on December 1, 2016.
• Early Menopause. NHS, http://www.nhs.uk/conditions/early-menopause/. Page last reviewed: 08/12/2017.