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About 1 in 10 people in the U.S. have the hormonal condition polycystic ovary syndrome (PCOS). Given its prevalence, there are thousands of blogs, forums, and social media accounts that share what they think is the best option for treatment.
One question that pops up a lot? How effective hysterectomies can be for PCOS. Hysterectomy is one of the most common surgeries for people with uteruses in the U.S. But unlike some other treatment options, hysterectomies make pregnancy impossible. So, for those of us who want kids, the surgery may not be the right move.
Still… can hysterectomies cure PCOS? Short answer: No. Are other surgical options worth considering? As always, talking to your healthcare provider is the best place to start — but here’s the 101 on what to know about surgical treatment for PCOS.
What is PCOS?
PCOS is a hormonal condition marked by irregular menstrual cycles, higher levels of “male” sex hormones, and multiple immature follicles (which house, develop, and release eggs) on the ovaries.
Because people with PCOS often have irregular cycles, the condition is a leading cause of infertility. Many people with PCOS also experience excessive hair growth (hirsutism in medical-speak), acne, unexpected weight gain, and insulin resistance.
Unfortunately, there’s no known cure for PCOS, but there are treatment options. “Treatment is individualized and depends on what symptoms the patient has and their goals,” explains board-certified OB-GYN Dr. Cordelia Nwankwo, MD, FACOG. “It also involves lifestyle changes with or without medications. They can range from oral contraception to ovulation-induction agents depending on whether the patient wants to prevent or pursue pregnancy. Insulin resistance can be treated with medications like inositol or metformin. Acne can be managed with medications like spironolactone.”
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus. Sometimes the ovaries are also removed in a procedure called oophorectomy.
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Hysterectomies are commonly used to treat conditions like uterine fibroids, endometriosis, uterine prolapse, abnormal uterine bleeding, chronic pelvic pain, and gynecologic cancer. Because hysterectomies stop periods and the ability to get pregnant, they’re also a permanent option for pregnancy prevention.
Some women’s health advocates say hysterectomies are performed too often in the U.S. It’s even more common in certain groups: Black women are 2-3 times more likely than white women to get a hysterectomy for treatment of uterine fibroids.
Are There Surgical Options for Treating PCOS?
Will a hysterectomy cure PCOS?
“No, hysterectomy will not cure PCOS,” says Dr. Nwankwo. Some people believe that hysterectomy is a cure for PCOS because it stops menstrual cycles, theoretically eliminating one aspect of PCOS. But PCOS doesn’t only disrupt menstrual cycles — and people with PCOS may experience symptoms even after menopause.
“PCOS is a metabolic and hormonal issue. Performing a hysterectomy, taking out the uterus, would address the periods/bleeding only,” explains Dr. Nwankwo. “It does nothing for the other symptoms associated with PCOS.”
Although the research here is limited, people with PCOS may continue to have higher levels of “male” sex hormones well after menopause. Among postmenopausal people with PCOS who have more “average” hormone levels, symptoms like excessive hair growth may remain. That said, PCOS symptoms often become more mild over time.
According to the Office on Women’s Health, people with PCOS may have higher rates of conditions like diabetes, stroke, and heart attacks as they get older.
Can an oophorectomy cure PCOS?
While it’s not one of the primary recommendations for PCOS, some people have undergone unilateral (one side) oophorectomy as treatment. Unilateral oophorectomy, like hysterectomy, is an option for people with severe PCOS. A 2020 case study found that the surgery was effective in treating and reducing PCOS symptoms that were resistant to other treatments. (About 15-40% of people with PCOS won’t have regular ovulation after taking ovulation-inducing medication.)
What about laparoscopic ovarian drilling?
These days, surgery for PCOS treatment is pretty uncommon. In some very severe cases, it’s an option. But with so many other nonsurgical treatments available, it’s considered a last resort.
A procedure called laparoscopic ovarian drilling (LOD) is most frequently used to treat medication-resistant PCOS surgically. LOD is a minimally invasive surgery where small holes are made in the ovaries to decrease the production of “male” sex hormones. In LOD, A 2017 Cochrane review concluded that LOD may be an effective option for some people, but that other treatments should be considered first.
If you have PCOS and are wondering about your treatment options, there are many to try first before considering surgery. Talk to your healthcare provider about your symptoms and your reproductive goals to figure out the right treatment plan for you.
Sarah duRivage-Jacobs is a sexual and reproductive health writer, educator, and communicator. In addition to Rescripted, her words can be found on the blogs of reproductive health and mental health companies like Modern Fertility, Hey Jane, Millie, Carrot, Origin, O.school, and Charlie Health. You can visit her website here.