Hysterectomy Is Often the Last Resort for Endometriosis

Endometriosis is a painful condition in which the uterine lining grows outside of the uterus. But that description oversimplifies the condition and the secondary complications that can severely degrade your quality of life.

Women like myself are so consumed with pelvic pain, bowel troubles and hormone-induced complications that we are willing to try anything to find relief. The reality is, there is no cure for endometriosis, but understanding the causes can help you find relief.

What causes endometriosis?

The medical community isn't quite sure what causes endometrial tissue to grow outside the uterus. Some theories include problems with menstrual flow that cause blood to back up into the fallopian tubes, while other experts conclude that hormonal imbalances cause an immune system dysfunction that allows endometrial tissue to overgrow.

The real question most women want to know is what can be done to stop endometrial implantation and growth. We hope finding a cause will lead to a cure, but with each answer, new questions arise. Instead, finding a cause for your symptoms can help you to manage the condition.

What is known is that endometrial tissue comes from the uterus, so in the past, removing the uterus (also known as a partial hysterectomy) became a common treatment to stop endometrial growth.

Unfortunately, endometrial tissue will actually implant on surrounding organs and does not need the uterus to continue to grow and spread. This means a hysterectomy will not stop your endometriosis.

The medical community now understands estrogen is the driving force behind endometrial tissue growth, and the ovaries are the primary source of estrogen. While removing the ovaries in an oophorectomy can stop estrogen production, you will also experience premature menopause.

This brings its own set of complications, including increased risk of cancer and permanent infertility.

Treating endometriosis

Overcoming the conundrum of endometriosis is largely dependent on creating a personalized treatment plan, as the symptoms, stages and interventions can vary from one woman to the next. For example, I have minimal (or stage 1) endometriosis, but my C-section caused adhesions, which is not typical of someone with stage 1 endometriosis.

This means my treatment plan will likely be different from someone else with stage 1. Furthermore, just because I have stage 1 does not mean my pain and symptoms are any less impactful than for someone with stage 4.

Diagnosing endometriosis can be difficult. The only true way of diagnosing your stage and the extent of endometriosis is with surgical intervention. This is typically performed laparoscopically, so your gynecologist can find the endometriosis without being as invasive as with standard abdominal surgery.

However, this surgery comes with many risks, and while cutting out or excising the endometrial implants will help to relieve pain and secondary complications, it does not always prevent regrowth.

We hope finding a cause will lead to a cure, but with each answer, new questions arise. Instead, finding a cause for your symptoms can help you to manage the condition.

Many gynecologists will try other treatments before choosing surgical intervention, and this may be required by your insurance company before a laparoscopy will be covered. Most treatments involve controlling your body's natural estrogen levels and treating the secondary complications.

Your doctor will likely prescribe birth control to stop endometrial growth and shrink the lesions over time. This can help reduce pain and bowel and bladder complications, and, for many women, help control the heavy bleeding associated with endometriosis.

If you are trying to become pregnant, your doctor may choose the surgical route earlier. Typically, infertility issues caused by endometriosis can occur when endometrial tissue restricts the fallopian tubes or causes adhesions on the uterus, which can prevent fertilization and implantation of the ovum (or egg).

The process for managing your endometriosis symptoms can be a long and frustrating road. I personally was misdiagnosed, ignored and bounced back and forth between multiple gynecologists and gastroenterologists. Eventually, persistence and finding the right physicians helped me find a treatment plan to manage my symptoms.