What is endometriosis?
endometrium is the tissue that lines the uterus.
During each menstrual cycle, a new endometrium grows, getting ready for a
possible pregnancy. If you don't become pregnant during that cycle, the
endometrium sheds, which you know as your
endometrium tissue that grows outside of the uterus, usually on the
fallopian tubes or on the outer surface of the uterus,
the bowels, or other abdominal organs. In rare cases, it can affect other
organs and structures in the body.
Endometriosis growths are
called "implants." These implants grow, bleed, and break down with each
menstrual cycle, just like the endometrium does. This can cause pain and can
make it difficult to become pregnant (infertility). In some cases, scar tissue
forms around implants. Scar tissue can also cause pain and infertility and can
interfere with an organ's normal function.
What are the risks of endometriosis?
women never have symptoms, others have severe pain. In some cases,
endometriosis interferes with other organs, such as the bowels or
When is hysterectomy and removal of the ovaries an option for the treatment of endometriosis?
Hysterectomy and oophorectomy are
considered a last-resort treatment for endometriosis. This is because it is a
major surgery that results in permanent infertility, and removing the ovaries
causes a sudden drop in estrogen. This causes sudden, usually severe menopause,
difficult side effects, and bone-thinning. Normally, a woman takes low-dose
estrogen to prevent these problems after having an oophorectomy. But taking
estrogen may also increase the risk that endometriosis will return.
Hysterectomy and removal of the ovaries may be a treatment option
- Endometriosis symptoms decrease your quality
- Scar tissue impairs the function of abdominal organs
(although scar tissue can usually be surgically removed without also taking the
uterus and ovaries).
- You have tried treatment with hormone therapy and continue to
have pelvic pain or other symptoms.
- You have no future plans for
- Your symptoms outweigh the risks and long-term
effects of the surgery. This includes the long-term risks of taking
estrogen therapy to protect against bone-thinning
after your ovaries are removed versus the risk of osteoporosis if you don't
take estrogen therapy.
How effective is hysterectomy and removal of the ovaries for the treatment of endometriosis?
Oophorectomy and hysterectomy is
highly effective in relieving endometriosis pain.2
But pain does return for up to 15% of women.1 Your
risk of recurring endometriosis increases if you take low-dose estrogen to
protect your bones and prevent menopausal symptoms after surgery.2 This is because estrogen "feeds" endometriosis.
What are the risks of having an oophorectomy and hysterectomy?
Perhaps the most important
long-term issue to consider is your body's early drop in estrogen after an
oophorectomy. Without estrogen, you have difficult menopausal symptoms (hot flashes, vaginal dryness, moodiness,
depression), and your bones begin to thin. This
increases your risk of osteoporosis in later life. Taking estrogen therapy can
prevent these effects.
If you don't want to take estrogen, you
can take another type of bone-strengthening therapy to protect your bones after
oophorectomy. For more information on prevention, see the topic
Risks of estrogen replacement therapy
Estrogen replacement therapy (ERT) increases your risks of:3
- Stroke. ERT use slightly increases the
risk of stroke during the first year of use.4
- Blood clots. ERT slightly increases the risk of blood clots in
the legs (deep vein thrombosis) and lungs (pulmonary embolism), which can be life-threatening.
This risk is greatest in the first year of use.5
- Breast cancer. Research is mixed on breast cancer
risk, although a slightly increased breast cancer risk after 10 years of use is
- Uterine (endometrial) cancer (only if you have a
uterus). Taking progestin with estrogen eliminates this risk.6
- Gallstones. Women who use estrogen
replacement therapy are 2 to 3 times more likely to have gallstones than women
who do not use it.8
- Asthma. Newly diagnosed asthma appears to be more
common among women taking estrogen than women who are not. (Estrogen is thought
to be a factor that causes asthma or makes it worse across the life
- In some cases, a worsening of
- Ovarian cancer (which is rare). In women using ERT over 5
years, the number of ovarian cancers is slightly higher. Using ERT causes
ovarian cancer in about .4 per 1,000 women. (This is the same as 1 in 2,500
Most women do not have
complications after a hysterectomy. But complications can include:
- Fever. A slight fever is common after any
- Difficulty urinating.
heavy bleeding. Some vaginal bleeding within 4 to 6
weeks after a hysterectomy is expected. But call your health professional if
bleeding continues to be heavy.
- Continued pain. Pelvic pain that
was present before surgery may not be relieved by surgery.
in sexual function.
- Rare complications. These include infection;
blood clots in the legs (thrombophlebitis) or in the lungs
(pulmonary embolus); the formation of scar tissue; injury to other organs, such
as the bladder or bowel; a collection of blood at the surgical site (hematoma);
heart problems; breathing problems; and problems from anesthesia. In very rare
cases, complications from surgery lead to death.
If you need more information, see the topic