Should hysterectomy be a treatment for endometriosis?

Q: I am 27 and have suffered with endometriosis and fibroid tumors for a long time. My husband and I are not able to conceive, and we adopted a beautiful baby girl four years ago. Now I am considering whether or not to have a hysterectomy. I tried Lupron, and I loved it. I felt better those seven months than I had in about 13 years, but I had to stop because of the bone loss risk. Birth control pills only help to a point, and the last time, within six months, my pain was unbearable. I had laparascopy 3¬Ĺ years ago, and like the other treatments, it was great for a while, but it all grew back at a rapid pace. I think that because the other things are only temporary, hysterectomy would be a better option for me. I would like your advice.

A: Endometriosis is a benign condition that is best imagined by thinking of the lining of the uterus being shed, and then instead of flowing down, out of the cervix and out the vagina, backing up and flowing out of the fallopian tubes and into the pelvis. It can plant anywhere around the pelvis, and can cause considerable pain and infertility. Although it can be well treated by all of the therapies you mentioned, they often are temporary fixes.

Given the extensive therapy you have already received, and the fact that you are only 27, I think you might do very well with a hysterectomy. If you were closer to menopause, I would encourage you to hang in there a bit longer, since menopause is a great cure for endometriosis (after all, Lupron is nothing but menopause in a jar.) But at 27, you could be in for a long course of pain.

My only hesitancy in advising you to go with the hysterectomy is what to do about your ovaries. Even if you leave only a part of one ovary, you could still develop a mass called an endometrioma, which is a cyst of endometriosis. This could give you more pain, and require yet another surgery. And if you did require another operation, it could be very difficult — some surgical cases have been re-operating on women with recurrent endometriosis. So my recommendation would be to take out both ovaries to minimize your chances of pain now or in the future. That means you would need to take estrogen replacement for a very long time.

Good luck on a tough decision. I know you’ve already done a lot of thinking about it already.

 

What you have in your mind?