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Endometriosis

Will I Need to Have my Uterus Removed if I Have Endometriosis?  

By Dr. Kate Dudek

The short answer to this is not necessarily. Removal of the uterus (hysterectomy) should only be considered after all other options have been explored.

Endometriosis can cause severe menstrual-like cramping and infertility. It is classed as a chronic condition and, to date, there is no cure. Treatment focuses on relieving the symptoms and improving quality of life. If fertility is not a concern, one option is radical surgery to remove the uterus, either alone, or with simultaneous ovary removal (oophorectomy). This will certainly prevent further endometrial deposits from forming and, depending on the location of the existing deposits, will lessen their inflammatory effects. However, the drawback to this approach is that it can cause the body to enter into the menopause and this is non-reversible. For women who are still of child-bearing age this is a major decision to undertake. Furthermore, premature menopause brings with it a multitude of health concerns, including increased risk of developing cancer, cardiovascular disease and osteoporosis. As oestrogen is considered to be neuroprotective, there is also the possibility that artificially inducing an early menopause could have a detrimental effect on cognitive function later in life. This is in addition to typical menopausal symptoms, such as hot flushes, emotional instability, insomnia and reduced libido.

If over-the-counter pain relief medication is not sufficient, there are less drastic options to consider prior to uterus removal. Hormonal therapy is a temporary solution, reducing, or preventing normal menstruation from occurring. This will also render a patient infertile; however it will not be permanent. There are also less invasive surgical techniques, such as laparoscopy, which can alleviate the symptoms of endometriosis, without impacting on fertility. Unfortunately this type of surgery may only provide short-term relief as the endometrial deposits do sometimes reform.

In conclusion, a hysterectomy is certainly one option. There will be no recurrence and immediate relief from symptoms. However, it is an option best suited to women who are past child-bearing age, with symptoms that cannot be managed by alternative means.   

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