Doctors Won't Discuss the 'H-Word'—Will You?

Endometriosis is a common disorder that can lead to serious pain and even infertility. While a hysterectomy may resolve the painful symptoms surrounding the disorder, doctors won't necessarily leap to suggest it.

"The first thing a woman should ask prior to proceeding with a surgical procedure in the form of a hysterectomy is whether there is any other management she can utilize to address whatever issues she's having," said Dr. Megan Wasson, a Mayo Clinic gynecological surgeon.

Let's take a closer look at endometriosis. For people with the disorder, tissues typically growing inside the uterus grow outside the uterus instead, most commonly growing on the fallopian tubes and the ovaries, though it can progress to the bowels and bladder. Symptoms typically include:

• Pain (usually in the abdomen, but also in the lower back or pelvis)
• Nausea
• Diarrhea and constipation
• Painful intercourse
• Painful menstrual cramps
• Heavy periods
• Bleeding in between the menstrual cycle
• Infertility

To eliminate the possibility of other complicating conditions, your doctor may request imaging tests, like an ultrasound or MRI, before diagnosing endometriosis.

Typically, medicinal treatments and self-care measures (such as heating pads) will be suggested before invasive surgery becomes an option.

Hysterectomy: Friend or foe?

There is no cure for endometriosis, but there are ways to alleviate pain and symptoms. The big H (hysterectomy, the surgical removal of the uterus) is one way to combat endometriosis and relieve painful symptoms, but it won't be your doctor's first suggestion. Here's why:

• Hysterectomy is not a cure for endometriosis.
• Multiple surgeries may be needed.
• There is no guarantee a hysterectomy will eliminate all pain.
• There are surgical risks, including blood clots, infection and postoperative bleeding.
• There could be a negative reaction to anesthesia.

Some research suggests an oophorectomy, the removal of the ovaries, is a better way to achieve pain relief. Oophorectomies are not without their own risks, including osteoporosis and early menopause.

A 2014 study from researchers at Johns Hopkins Medical Center suggests 62 percent of patients who complete a hysterectomy without an oophorectomy will continue to experience pain, and 31 percent need a second surgery.

The same study states only 10 percent of patients who elected to have a hysterectomy along with an oophorectomy experienced further pain, and less than 4 percent required a second surgery.

Alternatives to hysterectomy

Continuous pain from endometriosis can leave you desperate for relief. Talk to your doctor about your options, and don't be afraid to address the "H-word" with them. But a hysterectomy is a serious decision, so be aware of alternative treatments and practices that may help. Nonsurgical methods or less invasive surgery may be the best option. A few alternatives include:

• Over-the-counter pain relief
• Oral contraceptives to stop your period and prevent painful flare-ups
• Laparoscopy, a procedure involving a surgeon making small incisions to view and remove excess uterine tissue
• Laparotomy, another surgical procedure commonly used to remove endometrial overgrowth
• Surgery may also be used to cut pelvic nerves and relieve pain

The most important thing to remember, as with any medical procedure or treatment, is that each body is different and will respond to treatments in their own way. Talk to your doctor to find the right treatment for you.