Does a Hysterectomy Cure Endometriosis?

by Dr. Sallie Sarrel

 

I’m 43 and I don’t want a hysterectomy.

There has been much controversy over the claim in the media that a hysterectomy cures endometriosis. Hysterectomy, while it has a role in treatment of pelvic pain and uterine disorders, does not cure endometriosis. For me, having a hysterectomy is a very involved decision. It is not so simple just to take the uterus because I am unable to have a child after all of endometriosis’s damage.

Being a pelvic floor physical therapist that specializes in endometriosis, I know all of the current research. I have seen patients soar after hysterectomies, and I have also seen them continue to suffer in pain and anguish. Because of my experience, I will admit that this makes me a challenging patient to work with. I am 43 with a long history of endometriosis. I have endured 5 very expensive surgeries. During one of those surgeries, I had an ovary removed without any previous discussion of its removal. I attempted to freeze eggs, multiple times, all to no avail, because when the ovary was removed, the other ovary failed. While I own a leading pelvic physical therapy practice for endometriosis care, I also live in constant pain – pain that has worsened since this past summer, pain that is so bad I miss work, cannot care for my mother who survived a stroke, and pain that prohibits me from any of my social and sporting activities. Multiple well-respected doctors have suggested that a hysterectomy will solve my issues. With my history; most doctors would perform a hysterectomy and call it a day. There’s a catch though, for me and everyone else with a uterus: hysterectomy is a personal choice. As with any medical decision that you will need to make during your life, there are pros and cons. Here is why a hysterectomy may not be right for me for now (and why it may not be right for you, either):

Despite what some doctors say, hysterectomy does not fix endometriosis. This goes directly against modern concepts of endometriosis and feeds antiquated and equally unproven theories of retrograde menstruation. Endometriosis under a microscope has little to do with the actual lining of the uterus and probably even less to do with retrograde menstruation, or the backflow of menstrual blood through the tube. Remember all women experience some degree of retrograde menstruation, but all women do not have endometriosis. Hysterectomy may treat other conditions like adenomyosis, a condition that impacts the walls of the uterus that many women with endometriosis get. Hysterectomy may treat fibroids or other conditions. But, endometriosis is not one of those conditions. If you fully excise the endometriosis at its root, it is now thought that the disease does not persist.

I see many women as patients whose cause of pelvic pain, while initially triggered by endometriosis, is no longer driven by endometriosis. Common diseases that go hand in hand with endometriosis include interstitial cystitis, an inflammatory bladder condition and pelvic floor dysfunction, a muscular issue. The nerves in the whole body often can become sensitized from the long-term presence of pelvic pain or endometriosis. Removing the uterus would do little to help with the pain caused by these other diseases. Even when we remove the disease through excision these other causes of pain remain.

Treating the cause of pain is crucial. Hysterectomy was pushed onto me as one of the best treatments for my pain without acknowledging the role my three pelvic hernias may be causing, for example. Far too many doctors push hysterectomy as a solution to pelvic pain when they are not treating the true cause of the pain, and the woman continues to suffer.

For some reason everyone seems to be telling me that since I am over 40, my uterus is useless. It seems like people feel like since my fertile years are over, I might as well find a garbage can to throw my uterus away… Except, being a pelvic physical therapist, I know that this isn’t true.. The uterus and the uterine ligaments provide support against prolapse, or a falling out of the vagina, that aren’t exactly replicated the same post hysterectomy. Modern surgical techniques do a wonderful job suspending the ligaments to provide all the support they can, but there is a risk for prolapse. I treat prolapse all the time in my practice, we can get good results with pelvic physical therapy but overall it is better to avoid the need for therapy in the first place. I don’t want to live with the current amount of pain I am in, but I don’t want to give up running or tennis or having a normal bowel movement either. When women opt to have a hysterectomy, they have to be willing to live with everything that is going to be absent. Certainty that you can endure everything the procedure might bring is crucial.

If adenomyosis is present, if there is actual disease, infection, or injury to the uterus itself, I understand the value of a hysterectomy. But for endometriosis, hysterectomy does little to treat the disease. Research shows that hysterectomy does however, increase cardiac risk, stroke risk and has limited connections to neurodegenerative disorders like Parkinson’s and Alzheimer’s as well. Even with the ovaries present, there may be a decrease in estrogens, which can cause many problems including depression.

Even through all the recent backlash in the media about hysterectomy, I applaud women for making the decision they believe is right for their own bodies. My support for the population I treat and I am a part of will never waiver. The most important thing is that women are fully informed and prepared to make the right decision for their bodies, and ready to handle the effects of whatever decision they make. It can be a scary decision, and I support any woman who suffers from endometriosis and whatever choice they make as they try to find their way to wellness. What I don’t support is the medical machine trying to push women into procedures they may not need, especially when it may or may not fix the pain. Hysterectomy does not treat endometriosis, it treats uterine disorders. Just like I respect the brave women who have taken the leap and chosen hysterectomy, it is time to respect those of us who don’t.

Dr. Sallie Sarrel is a Pelvic Physical Therapist in New York and New Jersey and endometriosis advocate who has the disease herself. She is known to lecture around the world on the importance of pelvic physical therapy an adjunct to excision surgery for endometriosis care. She is also a USTA National Tennis Champion and a woman seeking relief from her life altering pelvic pain and endometriosis. You can reach Sallie directly at salliesarrel@yahoo.com.

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