Hysterectomy:
Hysterectomy, either partial or complete removal of the uterus, is the
final major surgical approach to endometriosis. Normally, your doctor will try to keep
disease in check while preserving the uterus and at least one ovary and fallopian tube, so
you can still become pregnant. However, if recurrent endometriosis is a major threat to
your organs and general health and repeated surgery has made "living with" the
disease intolerable, you need to consider this "radical" surgery. Surgical
menopause in younger women puts them at greater risk of developing coronary heart disease
and osteoporosis.
The operation will be performed under general anesthetic and usually lasts several
hours. The uterus will be removed through an incision in the lower abdomen or at the top
of the vagina. All endometrial tissue found outside the uterus will also be removed and
adhesions repaired. Usually, the operation is combined with a bilateral
oophorectomy, in
which the ovaries and fallopian tubes are removed, so that this source of hormonal
stimulation of endometrial tissue growth disappears.
Estrogen replacement therapy may be started within days, weeks or months, depending on
whether you are experiencing any menopausal symptoms such as hot flashes and whether you
and your doctor are convinced all endometrial tissue is gone. Micronized estradiol
(Estrace), in small doses, by mouth or skin patch (Estraderm), can be balanced with the
hormone progesterone to control any flare-up of endometriosis.