Hysterectomy
Removal of the uterus, where that is the right treatment. Most often for adenomyosis, rather than for endometriosis alone.
A hysterectomy treats adenomyosis. It does not, by itself, treat endometriosis: disease outside the uterus stays where it is. That distinction matters, because patients are still told a hysterectomy will cure their endometriosis, and it will not.
Will it cure my endometriosis?
No. A hysterectomy does not treat or cure endometriosis, and this is worth understanding properly, because patients are still told otherwise.
The theory of endometriosis most commonly taught is retrograde menstruation. During a period, most blood leaves through the vagina, but nearly all women also have some backward flow out of the fallopian tubes into the pelvis. In roughly 10 percent of women, for reasons that are not clear, cells carried in that flow implant and grow. There are other theories too: spread through the lymphatic system or the bloodstream, and embryonic cells left along the tract the reproductive organs formed from. Some presentations of the disease do not fit the retrograde theory at all.
Endometriosis has been found in women born without a uterus, in places far outside the pelvis including the chest cavity, and, very rarely, in men. So it is unlikely the disease simply comes from the uterus. And even under the classic theory, taking the uterus out does nothing about the cells and scarring already outside it, which are what cause the symptoms.
What the operation is
A hysterectomy removes the uterus. People have one for many different reasons, and the goal is always the same: to help you make your life into what you want it to be.
Two things are usually tied up in the decision. One is uterine symptoms, the cramping and the bleeding. The other is fertility. Much of the conversation before an operation is about the tension between those two.
How it is done
Almost always minimally invasively, through tiny keyhole incisions, with laparoscopic or robot-assisted surgery. The body of the uterus is removed, and any endometriosis is excised through the same small incisions during the same anesthetic.
The uterus itself leaves through the vagina, or, when it is too large, in pieces through a slightly larger opening. The top of the vagina is then closed, and that tissue heals well.
The fallopian tubes come out as well. They serve no purpose without a uterus, and the cancers of the ovary, the tubes, and the lining of the abdomen all originate in the tubes, so removing them lowers the risk of all three.
Almost all of my patients who have a hysterectomy, with or without excision of endometriosis, and even with fibroids, go home the same day. These are outpatient operations.
The cervix
We almost always remove the cervix with the uterus. Both of us practice the same way on this, and the reasons are practical.
The cervix has no significant function once fertility is off the table, and it is where cervical cancer starts, so keeping it means Pap smears continue for as long as it stays. It can also stay involved in the disease: endometriosis can persist in the tissue beside it, and adenomyosis can sit in the top of the cervix itself. And a kept cervix can bleed years later, which frightens everyone involved, sets off investigations, and sometimes ends in removing it after all, as its own operation, called a trachelectomy, which is a genuinely difficult procedure.
The vagina's support comes from other structures around it, so the cervix is not needed for that. Some specialists keep it to help support the vagina where there is prolapse, which is not a common situation in patients having surgery for endometriosis, adenomyosis or fibroids.
Some patients feel strongly about keeping their cervix, and that feeling deserves a real conversation. It can be kept. If it matters to you, we will go through honestly what keeping it involves, and decide together.
The ovaries
This is the more nuanced decision, and age is at the center of it.
The ovaries are the main source of estrogen, and estrogen matters for far more than sexual function: temperature regulation, bone health, heart health, kidney health, and cognition. The younger you are, the more that production matters, so my encouragement is to keep the ovaries unless there is a clinical reason to do otherwise.
There are real reasons. An elevated risk of ovarian or breast cancer, or a known mutation such as BRCA, where removal at certain ages is recommended anyway. A long history of recurrent ovarian problems, such as endometriomas or dermoid cysts, where someone decides to end the cycle of repeated surgeries. Or, from the other direction, hormonal problems severe enough to drive relentless migraines or seizures.
For someone close to menopause or past it, removal can be more reasonable, though the ovaries keep producing some estrogen after menopause, likely into the mid-60s, so even then it is a conversation rather than a default. And when a young woman does have her ovaries removed, the discussion about hormone replacement afterwards is a critical part of the plan.
What recovery is actually like
For most people it is more straightforward than they fear, and it is still a real recovery with rules that matter.
A hysterectomy leaves one large incision that excision alone does not: the closed top of the vagina, called the vaginal cuff. It takes a long time to heal, and it has to heal well, because a cuff that opens or becomes infected is dangerous. Protecting it is why the restrictions exist: nothing in the vagina for at least six to eight weeks, and no heavy lifting for about the same. After excision alone, the equivalent restrictions last a few weeks at most.
There are also parts people do not expect. Pelvic floor muscle spasm is common afterwards. There is usually some bleeding around two to three weeks. And toward the end of the first month most people are simply exhausted.
What it fixes, and what it does not
A hysterectomy fixes symptoms that come from the uterus: bleeding, cramping, blood clots, the low back pain carried by the nerves that serve the uterus, the effect adenomyosis has on the pelvic floor muscles, and the pressure fibroids put on the organs around them.
It does not fix endometriosis. Bowel symptoms, bladder symptoms, most pain with sex, and pain that sits anywhere other than the center of the pelvis will not improve because the uterus has gone. That disease is outside the uterus and it stays where it is.
This is why endometriosis is excised during the same operation, so the symptoms coming from outside the uterus are dealt with at the same time as the ones coming from inside it.
Who should not have one
If there is any inkling that you may want to carry a child, a hysterectomy is not the right choice at that time. It stays available later, if symptoms make it necessary.
Beyond fertility, the people who should not have one are those whose symptoms it will not help, because those symptoms are not coming from the uterus. Separating what the uterus is doing from what the endometriosis is doing, before anyone operates, is most of the work of the consultation.
What it costs
Our professional fee is avg $3,500. Varies ($2,500–$7,000 max) by surgical complexity. The facility bills your insurance separately for hospital care, anesthesia, labs and imaging. Full fee detail →