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Can Endometriosis Return After a Hysterectomy?

can-endometriosis-return-after-hysterectomy

ANSWER:

Endometriosis can return after a hysterectomy.

More Info: According to one research study, 62% of the study participants who had a hysterectomy with ovarian preservation experienced a return of their endometriosis symptoms.  Those who had their ovaries removed had a 10% incidence of recurring pain.  [1]

The Type of Hysterectomy Determines the Outcome

The likelihood of the recurrence of endometriosis following a hysterectomy depends on the type of hysterectomy that is performed.  Women whose ovaries have been preserved are at a much higher risk for recurring symptoms than those who had them removed. [2]

A total hysterectomy that removes the uterus and the cervix carries with it the highest risk of recurrence. [3]

A bilateral oophorectomy that removes both ovaries or a bilateral salpingo oophorectomy that removes both ovaries and the fallopian tubes carries a lower risk than the removal of the cervix and uterus alone. [4]

A hysterectomy combined with an oophorectomy is believed to carry the lowest risk factor, though even then there is still a chance of recurrence. [5]

Hysterectomy Not Always an Alternative

Endometrial tissue that attaches itself to the outside of the uterus or the ovaries may be removed during a hysterectomy, but it can also spread to other areas such as the bowels and intestines. Rarely, it can spread beyond the abdominal region. [6]  In these cases, a hysterectomy will not help alleviate the symptoms. [7]

Are There Options Besides Hysterectomy?

There is no cure for endometriosis, but there are medical options that can help to alleviate some of the symptoms.  The effectiveness of any treatment will depend on severity of the condition, the age of the patient, and the desired outcome, such as fertility.

Hormone treatments: In the case that desired pregnancy is not an issue, some women have found relief with hormone therapy.  Hormone therapy can include the use of combined estrogen and progesterone birth control pills to create pseudopregnancy, the use of progesterone injections, or medications that stop the ovaries from producing estrogen. [8]

Surgical options: A laparoscopy can remove endometrial implants and scar tissue, or a hysterectomy to remove diseased organs.

Environmental changes: For some women, an increase in physical activity has helped ease the symptoms of endometriosis.  Regular exercise and a change to a healthy diet are recommended. [9]

Non-traditional therapies: Several research studies have indicated alternative treatments that may merit a closer look.  One such treatment is aromatase inhibitors, which seem to work on women who have recurring endometriosis  and have not had success with conventional medications. [10] Multiparous women with endometriosis who have also had a tubal ligation appeared to have less severity of the disease than those who did not. [11]

 

Resources

[1] Journal of Fertility and Sterility, Namnoum, AB
Incidence of Symptom Recurrence for Endometriosis after Hysterectomy
1995, Volume: 64, No: 5, pages: 898-902

[2][8] National Library of Medicine-National Institute of Health
Endometriosis
http://www.nlm.nih.gov/medlineplus/ency/article/000915.htm  

[3][4][5][7] University of Maryland Medical Center
Endometriosis-Hysterectomy
http://www.umm.edu/patiented/articles/what_radical_surgery_hysterectomy_endometriosis_000074_11.htm

[6][9]eMedicinehealth.com
Endometriosis
http://www.emedicinehealth.com/endometriosis/article_em.htm

[10] Reproductive Biology and Endocrinology
The Emerging Use of Aromatase Inhibitors for Endometriosis Treatment
http://www.rbej.com/content/9/1/87

[11] Journal of the Medical Association Thailand
Effect of Tubal Ligation on Pelvic Endometriosis Externa in Multiparous Women in Chronic Pelvic Pain
2004, Volume: 87, No: 7, pages: 735-739

 

Glossary of Terms

Multiparous: having experienced one or more previous births.

Progesterone: is a female hormone produced by the ovaries during release of a mature egg from an ovary.
WebMD

Pseudopregnancy: an anestrous state resembling pregnancy that occurs in various mammals usually after an infertile copulation.
Merriam-Webster Dictionary

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