Want more iVillage? Sign up for our
Newsletters
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Endometriosis: Should I Have a Hysterectomy and Oophorectomy?
Get the facts
This decision aid is for women who have tried hormone therapy and have had laparoscopic surgery to remove tissue but still have severe symptoms. If you have not tried hormones and want more information, see:
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called “implants.” They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. This can cause pain and can make it hard to get pregnant.
In some cases, scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen makes the implants grow. Because the ovaries make most of your body's estrogen, taking out the ovaries can relieve your symptoms.
While some women never have symptoms, others have severe pain that can make it hard to enjoy daily activities. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and usually go away after menopause.
This surgery works very well to relieve pain from endometriosis. But pain does return for up to 15 out of 100 women who have surgery.2 This means that in 85 out of 100 women who have surgery, the pain doesn't come back.
Taking out the uterus and ovaries is usually the last choice in treatment. This is because:
You can take low-dose estrogen after surgery to protect your bones and prevent symptoms of menopause. But this increases the chance that implants could come back.1
This surgery has different types of risks.
Risks from having surgery
Most women do not have problems from surgery. But problems can include:
Risks from not having ovaries
Without estrogen, you can have severe symptoms of menopause, such as hot flashes, vaginal dryness, moodiness, and depression. Your bones also begin to thin. This increases your risk of osteoporosis in later life. Taking estrogen can prevent these problems.
If you don't want to take estrogen, you can take another type of medicine to make your bones stronger. For more information, see the topic Osteoporosis.
Risks from taking estrogen
Estrogen replacement therapy increases your risks of some health problems. Some of them include:7
Your doctor might suggest surgery if:
Compare your options
Compare
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have had pain before and during my period for years. I tried nonprescription and prescription medicines to control the pain. Nothing was working. Because my pain was so bad, my doctor suggested that I consider a hysterectomy. I didn't like the thought of surgery but had to do something about the pain. Since I'd already had two children, I had the surgery. It has been 6 months now, and I am glad I had the surgery.
Barbara, age 35
Endometriosis made me miserable for a week to 10 days every month. Since my husband and I have three children and did not want any more, I decided it was time to take action to get rid of the pain. I decided that ablation made the most sense, because I wanted to keep my uterus and ovaries. My doctor talked with me about the discomfort and risks of having the wall of the uterus treated with a laser. Frankly, it didn't take more than a week to recover, since the incisions were so small. But you know, after a year or so, the pain started coming back. I'm going to have to rethink my options now. Even though my sister has had long-lasting relief from ablation, it's not for me.
Lucia, age 42
My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did an exam and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. He suggested a hysterectomy but did say that endometriosis can grow back in other places. I still wanted to have a child, so I said no hysterectomy. Fortunately, I did get pregnant, and ever since having my baby my periods have been so much better!
Connie, age 35
My doctor told me endometriosis might be causing my painful periods. I'd never even heard of it before. She told me all about endometriosis and the treatments I could try. She suggested I try taking birth control pills and using ibuprofen before and during my period. It took a couple of months of using this system, but now I hardly have any pain. I am glad I didn't have surgery.
Harriett, age 39
If you need more information, see the topic Endometriosis.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to remove my uterus and ovaries
Reasons not to have the surgery
I tried hormones and had laparoscopic surgery, and my symptoms are still bad.
Medicine is controlling my symptoms.
My quality of life is suffering because of my symptoms.
My symptoms aren't hurting my quality of life.
I'm willing to accept the risks and side effects of surgery.
I'm not willing to accept the risks and side effects of surgery.
I don't plan to get pregnant.
I want to be able to get pregnant.
I'm not close to menopause, so I don't want to wait for the symptoms to go away.
I'm close to menopause, so I prefer to wait for the symptoms to go away.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having the surgery
NOT having the surgery
What else do you need to make your decision?
Check the facts
I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.
If I have my ovaries and uterus taken out, endometriosis will never give me pain again.
I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Next steps
Which way you're leaning
How sure you are
Your comments

Key concepts that you understood
Key concepts that may need review

Patient choices
| Author | Healthwise Staff |
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology |
This decision aid is for women who have tried hormone therapy and have had laparoscopic surgery to remove tissue but still have severe symptoms. If you have not tried hormones and want more information, see:
The endometrium is the tissue that lines the uterus. During each menstrual cycle, a new lining grows, getting ready for a possible pregnancy. If you don't become pregnant during that cycle, the lining sheds. This is your menstrual period.
Endometriosis (say "en-doh-mee-tree-OH-sus") is the growth of this tissue outside of the uterus, usually on the ovaries or the fallopian tubes. It also may grow on the outside surface of the uterus, the bowels, or other organs in the belly.
These growths are called “implants.” They grow, bleed, and break down with each menstrual cycle, just like the lining of the uterus does. This can cause pain and can make it hard to get pregnant.
In some cases, scar tissue forms around implants. This also can cause pain and trouble getting pregnant.
The female hormone estrogen makes the implants grow. Because the ovaries make most of your body's estrogen, taking out the ovaries can relieve your symptoms.
While some women never have symptoms, others have severe pain that can make it hard to enjoy daily activities. In some cases, the problem can affect how well your bowels, bladder, or other organs work.
Pain from implants may be mild for a few days before your menstrual period. It may get better during your period. But if an implant grows in a sensitive area such as the rectum, it can cause constant pain or pain during sex, exercise, or bowel movements.
Symptoms often get better during pregnancy and usually go away after menopause.
This surgery works very well to relieve pain from endometriosis. But pain does return for up to 15 out of 100 women who have surgery.2 This means that in 85 out of 100 women who have surgery, the pain doesn't come back.
Taking out the uterus and ovaries is usually the last choice in treatment. This is because:
You can take low-dose estrogen after surgery to protect your bones and prevent symptoms of menopause. But this increases the chance that implants could come back.1
This surgery has different types of risks.
Risks from having surgery
Most women do not have problems from surgery. But problems can include:
Risks from not having ovaries
Without estrogen, you can have severe symptoms of menopause, such as hot flashes, vaginal dryness, moodiness, and depression. Your bones also begin to thin. This increases your risk of osteoporosis in later life. Taking estrogen can prevent these problems.
If you don't want to take estrogen, you can take another type of medicine to make your bones stronger. For more information, see the topic Osteoporosis.
Risks from taking estrogen
Estrogen replacement therapy increases your risks of some health problems. Some of them include:7
Your doctor might suggest surgery if:
| Have surgery to remove your uterus and ovaries | Don't have this surgery | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
If you need more information, see the topic Endometriosis.
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I have had pain before and during my period for years. I tried nonprescription and prescription medicines to control the pain. Nothing was working. Because my pain was so bad, my doctor suggested that I consider a hysterectomy. I didn't like the thought of surgery but had to do something about the pain. Since I'd already had two children, I had the surgery. It has been 6 months now, and I am glad I had the surgery."
— Barbara, age 35
"Endometriosis made me miserable for a week to 10 days every month. Since my husband and I have three children and did not want any more, I decided it was time to take action to get rid of the pain. I decided that ablation made the most sense, because I wanted to keep my uterus and ovaries. My doctor talked with me about the discomfort and risks of having the wall of the uterus treated with a laser. Frankly, it didn't take more than a week to recover, since the incisions were so small. But you know, after a year or so, the pain started coming back. I'm going to have to rethink my options now. Even though my sister has had long-lasting relief from ablation, it's not for me."
— Lucia, age 42
"My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did an exam and some tests. When all the tests came back normal, he said endometriosis might be the cause of my pain. He suggested a hysterectomy but did say that endometriosis can grow back in other places. I still wanted to have a child, so I said no hysterectomy. Fortunately, I did get pregnant, and ever since having my baby my periods have been so much better!"
— Connie, age 35
"My doctor told me endometriosis might be causing my painful periods. I'd never even heard of it before. She told me all about endometriosis and the treatments I could try. She suggested I try taking birth control pills and using ibuprofen before and during my period. It took a couple of months of using this system, but now I hardly have any pain. I am glad I didn't have surgery."
— Harriett, age 39
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery to remove my uterus and ovaries
Reasons not to have the surgery
I tried hormones and had laparoscopic surgery, and my symptoms are still bad.
Medicine is controlling my symptoms.
My quality of life is suffering because of my symptoms.
My symptoms aren't hurting my quality of life.
I'm willing to accept the risks and side effects of surgery.
I'm not willing to accept the risks and side effects of surgery.
I don't plan to get pregnant.
I want to be able to get pregnant.
I'm not close to menopause, so I don't want to wait for the symptoms to go away.
I'm close to menopause, so I prefer to wait for the symptoms to go away.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having the surgery
NOT having the surgery
1. I'm close to menopause, so I could take medicine and wait for my symptoms to go away rather than have surgery.
2. If I have my ovaries and uterus taken out, endometriosis will never give me pain again.
3. I can take estrogen after surgery to make my bones stronger and to keep from having hot flashes and other menopause symptoms.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
| Author | Healthwise Staff |
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer | Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology |
Last Updated:August 5, 2010
Author:Healthwise Staff
Medical Review:Sarah Marshall, MD - Family Medicine & Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
© 1995-2011 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Welcome to Care Circle, an exclusive tool to help you take care of yourself and your loved ones. Here's how it works:
The information you input is strictly private; you choose who has access to your Care Circle.
How do I add myself or someone else to my care circle?
Click on "Add someone." Fill out the short profile. Choose an avatar. Select the topics and conditions that interest this person from the pulldown menu. You can select as many as you want, but you must choose at least one. Click on "Add Someone" again. You should start getting updates immediately.
How do I save content to my Care Circle?
Click on "Manage My Care Circle." Select the tab of the person for whom you're saving content. Put your cursor over the piece of content that you want to save; a disk icon will appear in the righthand corner. Click on the disk and the piece of content will be moved to a save folder.
How do I add additional topics and conditions for someone in my Care Circle?
Click on "Manage My Care Circle." Select the tab for the person whose preferences you'd like to update. Under "Add More to Follow," select additional topics and conditions.
How do I delete topics and conditions for someone in my Care Circle?
Click on "Manage My Care Circle." Select the tab for the person whose preferences you'd like to update. Under "Follows," scroll over the topic or condition you want to delete. An "X" should appear on the righthand side. Click on the "X" and the topic or condition will be deleted from the list.