Hysterectomy as a treatment for endometriosis?

Q:I am 35 years old, have endometriosis, and am tired of feeling miserable every month. I would like to have a hysterectomy but my doctor doesn’t seem receptive. (I’ve tried birth control pills and the lupron treatments for endometriosis; I wasn’t comfortable with the side effects of lupron). Is this a reasonable course of action for me to take and if so, how do I convince my doctor I am ready for this procedure?

A: Bad endometriosis can be a very uncomfortable problem. If I were your gynecologist, the bottom line for me would be, do you want children? Have you had any, or if not, do you want any? For example, if a patient who has had a tubal ligation comes in with very bad endometriosis, she is an excellent candidate for a hysterectomy.

Unfortunately, to really cure endometriosis, you not only have to have your uterus out but you also have to have both of your ovaries removed as well. Therefore, the other question I would pose to you is, are you prepared to take estrogen replacement therapy for a long period of time? If you don’t take estrogen after ovarian removal at the age of 35, you will have a much higher likelihood of developing osteoporosis and early heart disease.

Of course, hysterectomy is a major surgical procedure, attended by risks of bleeding, infection, and even potential bowel and bladder damage. But if you have carefully weighed all your options and think you are ready, then you should find a gynecologist who will perform the surgery.

If you are not quite ready for this step, other options that you could try (that you did not mention in your question) are two older medications, danocrine and progesterone. You also did not mention if you have had an operative laparoscopy, with something like laser cautery of your endometriosis. Those would be more conservative approaches.

What you have in your mind?