Why a Hysterectomy Does Not Work for Endometriosis

Dr. Laurence Orbuch is a OBGYN and Excision Specialist for Endometriosis. He has practices in both New York and Los Angeles. His passion is helping people with endometriosis live the life they deserve without being hampered by pain. He will be a part of our Endometriosis 101 panel, a place to learn all about how to manage endometriosis from diagnosis, to surgery and more. 
Due to a lack of training and knowledge, many OB-GYNs aren’t aware that hysterectomies aren’t an effective treatment for endometriosis. Removal of the uterus and or ovaries does not eradicate the endometriosis, which is by definition outside the uterus. Hysterectomy therefore has NO impact on the activity of endometriosis, but tragically there are physicians who still believe this. The first line surgical intervention for patients with known or suspected endometriosis, is excision surgery by a skilled and experienced excision surgeon. 
Hysterectomy can be an appropriate recommendation to a patient when accompanied by excision surgery on women who also have coexisting adenomyosis, a condition where endometrial cells/tissue grow into the muscle of the uterus. Adenomyosis can cause severe pain, heavy periods, an enlarged uterus and inflammation. Again, in the absence of adenomyosis, the first line surgical option should be excision surgery accompanied by hormonal therapy, NSAIDS, other appropriate pain management therapies, pelvic floor physical therapy etc... 
For patients who have undergone multiple excision surgeries along with other conservative treatment modalities, but still suffer from persistent pain, hysterectomy may also be warranted. The approach to treating endometriosis must be a logical and methodical one, taking into consideration the clinical picture and propriety of treatment options. 
It is also imperative that governing bodies such as ACOG (American College of Obstetrics and Gynecology) adopt more up to date guidelines in accordance with the current literature which supports all of the above recommendations, and not purely palliative measures. 

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