Endometriosis After Hysterectomy

Endometriosis means deposition of endometrial cells in areas outside the uterus. Endometrial cells that are stimulated by the estrogen hormones form the lining of the uterus wall. When these endometrial cells get deposited outside the uterus, it continues the same function as that of the endometrial cells inside the uterus. This affects the whole reproductive system and the condition worsens with menstrual cycle each month. Endometriosis after hysterectomy can also cause many problems. It can also be a major reason for infertility.

Symptoms of Endometriosis
The main symptoms of endometriosis are:

• Severe pelvic pain and infertility. Pelvic pain can start from the pelvic area and spread through the complete lower part of the body.
• Nausea, vomiting, dizziness, vertigo or diarrhea before periods start or during periods.
• Uncontrolled menses or prolonged periods; blood clots during periods.
• Long-lasting fatigue.
• Mental problems like depression and mood swings.
• Severe pain in legs, thighs and back.
• Frequent ovarian cysts.
• Constipation
• Frequent urinary tract infections.
• Incontinence (uncontrollable urination).
• Long-lasting anemia.

Types of Hysterectomy
Complete or total hysterectomy: Both the uterus and the cervix are removed during complete or total hysterectomy. Many women undergo this type of hysterectomy.

Partial or subtotal hysterectomy: Also known as supracervical hysterectomy, in this hysterectomy the upper two-thirds of the uterus i.e. the uterus only, has to be removed leaving the cervix intact.

Radical hysterectomy: Radical hysterectomy is the process of removal of the uterus, the cervix, the upper part of the vagina as well as the supporting tissues. This hysterectomy is absolutely necessary in case of cervical cancer, if the cancer has spread to a great extent.

Can Endometriosis Recur After a Total Hysterectomy?
In endometriosis, the endometrial cells grow over the fallopian tubes, ovaries or the tissue lining the pelvis. So, if a partial or subtotal hysterectomy is done, only the uterus is removed, leaving the ovaries, fallopian tubes and cervix. The endometrial cells requires estrogen to prevail. Ovaries produce estrogen which influences the endometrial cells outside the uterus. That is why even after a partial hysterectomy, endometriosis can recur, rather it remains, with same symptoms as before the hysterectomy surgery, specially during ovulation. A total hysterectomy also does not remove the ovaries hence, there are chances of endometriosis recurring. However, if both the ovaries are removed, it minimizes endometriosis recurrence, since the source of estrogen i.e. the ovaries are removed. The process of removal of both the ovaries along with the uterus and fallopian tube is called hysterectomy (complete or partial) with bi-lateral salpingo-oophrectomy. Nevertheless, if you are taking estrogen therapy for any reason, this may stimulate the endometriosis again.

All the above surgical methods will not necessarily bring about complete menopause in women. However, it does terminate the possibility of bearing children. In partial hysterectomy, since a very small part of the uterus is left along with the cervix, some women may experience mini-periods. But in total hysterectomy, the entire uterus along with the cervix is removed, so ideally there should not be any periods or bleeding. If the ovaries are still present, they produce the hormones required for the monthly cycle. Hence, the monthly cycle persists i.e. all the other PMS symptoms will persist while only the bleeding will have stopped.

It is always suggested that women who undergo hysterectomy for endometriosis should ask their gynecologist to check the extent of the endometriosis, and then opt for the appropriate removal method to avoid the side effects of a hysterectomy. Do not feel depressed if you are suffering from endometriosis after hysterectomy. Remember, there may be many like you out there, so always have faith!