With endometriosis, a hysterectomy is sometimes performed to alleviate debilitating pain and improve quality of life when previous treatment options have been unsuccessful.
This article outlines the different types of hysterectomies that are performed for endometriosis and their success rates in relieving symptoms. We also discuss two endometriosis home therapies known to help alleviate symptoms before, or in place of a hysterectomy, as well as help patients recover after surgery.
What Is a Hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus, which is also known as the womb, and sometimes the cervix ovaries, and fallopian tubes are also removed. Once the womb is removed, women can no longer get pregnant. A hysterectomy can also initiate menopause symptoms like hot flashes, vaginal dryness, and mood swings.
It is therefore recommended that patients with endometriosis take their time when considering a hysterectomy, particularly if they still want to get pregnant.
The Different Types of Hysterectomy for Endometriosis
Several types of hysterectomy are performed to alleviate the symptoms of endometriosis. Which one is recommended will differ for each patient depending on their symptoms, medical history, and where their endometrial implants are located.
- Subtotal Hysterectomy is when only the uterus is removed
- Total Hysterectomy is when the uterus and cervix are removed
- Radical Hysterectomy removes the uterus, cervix and top of the vagina
- Hysterectomy and oophorectomy is the removal of the uterus, cervix, and ovaries.
When Is a Hysterectomy Recommended for Endometriosis?
A hysterectomy for endometriosis is usually recommended only after other forms of treatment have been unsuccessful in relieving symptoms. Hormone therapy and pain relievers are typically the first form of medical treatment recommended. While holistic health experts might suggest pelvic health physical therapy, yoga, and acupuncture as a first-line treatment in place of hormone therapy.
If symptoms persist, a laparoscopy is often the next step, where keyhole surgery is used to remove endometrial implants growing outside the uterus. If patients continue to suffer persistent pelvic pain and debilitating symptoms after a laparoscopy, and they are no longer hoping to get pregnant, doctors often recommend a hysterectomy as the next step.
How Is a Hysterectomy Performed?
Depending on the patient’s symptoms and health history, hysterectomies are typically performed in one of the following ways.
Vaginal Hysterectomy – The uterus is removed through a surgical incision in the vagina and no visible scar is obvious afterward.
Laparoscopic Hysterectomy – Also known as keyhole surgery, one or more small incisions are made in the abdomen through which gas, a camera, and surgical tools are inserted. With the help of the gas and microscopic camera, the surgeon can perform the procedure from outside the body via an external screen connected to the inserted camera.
Abdominal Hysterectomy – Involving a larger incision across the belly or along the length of it, this type of hysterectomy is considered open surgery. It provides the surgeon with a clear and open view of the pelvic cavity and other organs.
If you are considering a hysterectomy to relieve endometriosis symptoms, it’s important to discuss each method with your surgeon to determine which is best for you and your situation.
Does A Hysterectomy Help Endometriosis?
A hysterectomy can alleviate the pain and symptoms associated with endometriosis by stopping future menstruation. However, it is important to understand that a hysterectomy is not a cure for endometriosis and symptoms are known to reoccur for some patients.
During a seven-year study involving women who underwent surgery for endometriosis, statistics concluded that 40% of those who underwent a laparoscopic subtotal hysterectomy (where only the uterus was removed) reported recurring pain and required more surgery. Of the patients who underwent a hysterectomy and oophorectomy (where both ovaries were also removed) only 8% reported recurring pain and required further surgery.
How Do the Ovaries Contribute to Endometriosis?
Although a hysterectomy can stop menstruation and thereby relieve debilitating symptoms and pain for some women with endometriosis, it is not the case for everyone. In essence, endometriosis is a condition that occurs outside the uterus, and in many cases removing only the uterus does not alleviate symptoms.
That said, women with Adenomyosis (when endometrial tissue grows into the muscular wall of the uterus) can experience relief after a hysterectomy alone. However, if the ovaries are left in place, and all implants are not successfully removed, symptoms can reoccur after a hysterectomy.
This is because the ovaries are the main producers of estrogen, which is what stimulates the growth of endometrial tissue. For this reason, many women with endometriosis also require the removal of the ovaries to stop the re-growth of implants.
Alternatives to a Hysterectomy for Endometriosis
Even though there is no cure for endometriosis, two home therapies are becoming increasingly popular among women suffering from its debilitating symptoms. Whether used instead of hormone therapy, in place of surgery, while recovering from a laparoscopy, or after a hysterectomy - pelvic wands and vaginal dilators have been proven to alleviate endometriosis symptoms in women of all ages.
Pelvic Wands
Before or in place of a hysterectomy, pelvic wands can help to reduce the pelvic pain associated with endometriosis by massaging painful trigger points deep within the pelvis and softening the scar tissue around endometrial implants. This type of relaxation deep within the pelvis also helps to reduce the more severe pain that often occurs before and after menstruation.
After a hysterectomy, pelvic wand massage can prevent the formation of painful scar tissue and the regrowth of endometrial tissue.
Vaginal Dilators
Vaginal dilators are primarily used to relax tight pelvic floor and vaginal muscles that are often symptoms of endometriosis. This type of relaxation in the pelvis can help women who have experienced dyspareunia to enjoy pleasurable sex again without pain or the fear of penetration.
Regular dilation therapy can also help relieve the bloating known as endo belly. Typically resulting from a combination of endometrial tissue growing within the pelvic cavity and tight pelvic floor muscles, vaginal dilators help to soften the scar tissue and relax tight muscles.
After a hysterectomy, dilators can also help women improve the production of natural lubrication to prevent vaginal dryness and ease them comfortably into a renewed sex life.
Conclusion
Although there is no cure for endometriosis, a hysterectomy is sometimes recommended to alleviate the intensity of symptoms. The success of a hysterectomy in relieving symptoms of endometriosis can depend on the severity of each patient’s condition. Successfully removing all endometrial implants is also vital, and the simultaneous removal of the ovaries is often necessary to prevent implant regrowth.
If endometriosis symptoms are severe enough to disrupt your quality of life, speak with your healthcare provider about the different types of hysterectomies available for your condition. It’s important to know what you can expect post-surgery, and whether alternative therapies like dilators or pelvic wands could relieve your symptoms in a less invasive way.
References
Web MD – The Different Types of Hysterectomy and Their Benefits - https://www.webmd.com/women/hysterectomy
Effect of hysterectomy on pain in women with endometriosis: a population-based registry study - https://pubmed.ncbi.nlm.nih.gov/32437082/
Mayo Clinic – Adenomyosis - https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138
Endometriosis Foundation - Endometriosis After Hysterectomy - Dr. Rosanne Kho - https://www.endofound.org/endometriosis-after-hysterectomy-dr.-rosanne-kho
Endometriosis UK – Having a Hysterectomy - https://efaidnbmnnnibpcajpcglclefindmkaj/https://www.endometriosis-uk.org/sites/default/files/2022-10/Having%20a%20Hysterectomy_2022_0.pdf
National Library of Medicine - Recurrence of endometriosis after hysterectomy - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286861/
National Library of Medicine - Physiotherapy Management in Endometriosis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740037/
National Library of Medicine - Clinical Management of Chronic Pelvic Pain in Endometriosis Unresponsive to Conventional Therapy - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8779548/