Radical Hysterectomy for Severe Endometriosis
Surgery as Treatment for Severe Pain from Pelvic Endometriosis
Oct 31, 2009
A radical hysterectomy removes the ovaries, fallopian tubes, uterus and cervix. When radical hysterectomy surgery is done for severe pelvic endometriosis, it’s done for intractable pain that doesn’t respond to less invasive measures, such as medication to suppress hormones. Choosing to have a hysterectomy for endometriosis is difficult enough; it’s even more difficult to opt for radical hysterectomy, which will cause immediate menopause and infertility.
Hysterectomy Alone as Treatment for Severe Pelvic Endometriosis
Endometriosis is found outside the uterus; the ovaries are the most common site. Removing the uterus doesn’t change the monthly hormone fluctuations that cause endometrial tissue to bleed, so just having a hysterectomy for endometriosis may not improve symptoms of severe endometriosis. If hysterectomy is the only surgery done for pelvic endometriosis, the chances for pain reduction will be higher if all endometrial implants are also removed.
Benefits and Risks of Radical Hysterectomy for Severe Pelvic Endometriosis
The biggest benefit of radical hysterectomy for severe pelvic endometriosis is that without the ovaries, the monthly menstrual cycle will cease, and with it, hopefully, the severe pain from pelvic endometriosis. For the patient, this is also the most serious side effect.
Without ovaries, there’s no way to have biological children in the future. Women who have hysterectomies for endometriosis can use a gestational carrier and get pregnant using in vitro fertilization (IVF), but without ovaries to produce egg, this isn’t possible.
One way to preserve the ability to have biological children even after radical hysterectomy is to preserve the oocytes in one of the following ways:
- Undergo an IVF cycle to produce embryos that can be frozen and later implanted in a gestational carrier
- Undergo egg freezing after an IVF cycle (not a perfected technique yet, but getting better) to preserve eggs that can be fertilized later.
- Remove the ovary and preserve, so that eggs can be removed later. Fertilizing immature eggs is still in the early stages, but research will undoubtedly refine this technique over time.
Sudden cessation of the production of hormones that regulate the menstrual cycle can cause severe menopause symptoms. Hormone replacement therapy is usually started to keep symptoms under control and decrease severe mood swings and hot flashes.
Continuing Pain After Treatment for Endometriosis
Even more upsetting to the women with severe pelvic endometriosis is the possibility that, even having a radical hysterectomy for endometriosis, pain may continue. Studies aren’t conclusive on why this happens, but pain may come from endometriosis still present on the bladder, intestines and peritoneum. Pain may also result from adhesions (scar tissue) that forms as a result of surgery.
Endometriosis can be found in almost any bodily tissue; one theory is that in some people, certain types of tissue can turn into endometriosis; this ability of tissue to turn into something else is called metaplasia, described in Pathology of the Female Reproductive Tract by Stanley J. Robboy, M. C. Anderson, and Peter Russell. Endometriosis outside the pelvis that isn’t removed, or even found, can continue to cause pain.
Weighing the Pros and Cons of Radical Hysterectomy for Severe Pelvic Endometriosis
Making the choice to have a radical hysterectomy is a difficult one, even for women who have severe pain from pelvic endometriosis. All the possible less drastic methods to treat endometriosis, such as medication or laparoscopic surgery, should be undertaken before resorting to having a radical hysterectomy for endometriosis. Radical hysterectomy is a surgery that can’t be fixed at a later date, so consider all the ramifications carefully.
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