In rare circumstances your doctor may discuss with you more radical surgery that involves removal of some reproductive or other organs. Your doctor may consider what is known as ‘radical surgery’. This is where one or more of your organs are removed entirely. There are 2 main types of ‘radical surgery’ performed for endometriosis.
Hysterectomy involves removing the uterus (the womb) and other organs, according to the type of hysterectomy:
- Total hysterectomy (uterus and the cervix removed)
- Subtotal hysterectomy (only the uterus removed
- Total hysterectomy with salpingo-oophorectomy (uterus, cervix, fallopian tubes and ovaries removed)
- Radical hysterectomy (uterus and surrounding tissue, fallopian tubes, part of the vagina, ovaries, lymph glands, and fatty tissue removed)
Oophorectomy is an operation to remove ovaries. A unilateral oophorectomy is removing one, a bilateral oophorectomy is removing both.
The ovaries produce hormones that have been shown to play a role in triggering symptoms of endometriosis. If the ovaries are no longer there to produce these hormones, it is thought that the impact of the symptoms of endometriosis can be reduced. Some people have found relief from their symptoms through removing their ovaries as well as the uterus. Once both ovaries are removed, the menopause is immediately triggered if it hasn’t yet started. The menopause itself can cause symptoms that many find difficult to manage, such as fatigue, vaginal dryness and hot flushes. These can be particularly difficult to manage for people who have undergone surgery at a younger age and who may not have people around them experiencing the same feelings at the same time.
The impact of removing ovaries needs to be considered in light of the risks involved as with all surgery. There are also other less permanent ways of reducing hormones that do not involve removing the ovaries. These options should be discussed with your consultant before deciding on an oophorectomy.
A total hysterectomy does not always resolve the problems endometriosis has already caused. Many people report ongoing symptoms due to scarring or damage to other organs such as the bowel. It’s important to remember that everyone’s experience is different and that there are many people who have had significant relief from endometriosis from less permanent treatments. These include taking hormonal treatments, targeted physiotherapy or through having surgery to remove endometriosis. It can help to talk with others that have had the similar experiences as well as going over the medical risks and benefits with your consultant.
These procedures are all carried out under general anaesthetic. A doctor may consider oophorectomy or hysterectomy for a number of reasons but both are irreversible. You should discuss the advantages and disadvantages of any surgery with your surgeon. It’s important to remember that all surgery comes with some risk that you should consider and discuss with your consultant before undertaking any procedure.