Endometriosis is a common disease of the reproductive system, affecting 1 in 10 women. It is a long-term chronic condition in which tissue that is similar to the tissue lining the uterus begins to grow outside of it, in places where it should not be. These places include the ovaries, fallopian tubes, stomach, bladder, bowel and more.
The symptoms of endometriosis are wide and varied, but the most common amongst sufferers is the debilitating, chronic pain, which often prevents people from enjoying normal lives. Many have described pain so severe they cannot get out of bed, work, do exercise or have sex.
A last resort
A hysterectomy, which means the surgical removal of the uterus (womb), is seen as a ‘radical’ treatment option, because it is a major operation with many possible side effects, including early menopause (if ovaries are removed). It also means a woman will no longer be able to fall pregnant, so the decision to undergo one for endometriosis is usually a last resort where symptoms are very severe and only once other treatment options have been exhausted.
The hysterectomy recovery period is also more prolonged than with more minor surgeries, with most people needing to take between 4-12 weeks off work. Sex is not recommended for at least six weeks after surgery.
Will it cure my condition?
Endometriosis is a chronic condition, which means there is currently no cure. As such, any treatment procedure is carried out to address and minimise the symptoms, but there is always a possibility of its reappearance. Even with excellent surgical results the disease is still not ‘cured’ and the endometrial tissue can still be found elsewhere and continue to grow and shed each month.
A hysterectomy is only successful in ending the suffering of endometriosis if all rogue tissue is removed and none is found later, in other parts of the body, like the bowel or abdomen. In such cases, patients can still experience symptoms. As such, it is important that women are aware that endometriosis is not just confined to the uterus; but that it sometimes affects complex areas such as the heart, lungs and brain.
This is why the decision to undergo a hysterectomy is extreme and all the pros and cons should be properly weighed up beforehand in each individual case. Hysterectomies are not, therefore, a blanket solution for everyone.
What factors contribute to how successful the hysterectomy is?
Many patients will experience positive results following a hysterectomy, including a complete end to their endometriosis symptoms. However, this is never certain and there are a few factors which do increase the likelihood of the disease returning, including if the disease is especially severe and in cases where some endometriosis tissue is left behind in other parts of the body.
Moreover, if patients undergo a hysterectomy but still keep their ovaries, the chances of endometriosis symptoms continuing is much higher. This is because the ovaries produce oestrogen, which stimulates endometriosis and causes the tissue to grow. As such, if any endometrial tissue is left over following the surgery, symptoms are likely to reoccur.
A useful way of assessing whether the operation will be successful in alleviating your endometriosis symptoms is by trialling a Gonadotrophin‐releasing hormone agonist (GnRHa) for three months, which acts to mimic a temporary menopause and can help to determine if symptoms will indeed improve.
Hysterectomy and Endometriosis in the news
In February 2018, actress and creator of sitcom ‘Girls’, Lena Dunham, underwent a radical hysterectomy to surgically remove her uterus and cervix. The celebrity has been outspoken in her battle with endometriosis for years, at one stage declaring that she was “disease-free” after undergoing her fifth complex surgery. However, the condition returned several months later, as is the case with many women.
Given that her endometriosis is particularly severe, it remains to be seen whether Dunham’s hysterectomy has put an end to the chronic pain she has experienced for much of her adult life – let’s hope for the best.
Dr. Athanasias from The London Women’s Centre is a leading UK gynaecologist, with several areas of expertise, including endometriosis.
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