In 2018, actress and writer Lena Dunham penned an essay for Vogue about her journey with endometriosis and hysterectomy at age 31. After a decade of debilitating pain and multiple hospitalizations due to endometriosis, she decided to undergo a hysterectomy. “My uterus is worse than anyone could have imagined. It’s the Chinatown Chanel purse of nightmares, full of both subtle and glaring flaws,” said Dunham of her uterus after the procedure.
A hysterectomy is a major medical procedure with a long-term impact on fertility. However, for women with endometriosis, it can also be a lifeline to manage the painful condition. What are the pros and cons of a hysterectomy for endometriosis? We talked to the experts to find out:
What is a hysterectomy?
A hysterectomy is a surgical procedure that removes all or part of the uterus and cervix. It’s the most common gynecologic surgery in the United States after a C-section, with an estimated 600,000 performed per year. According to Dr. Jessica Ryniec, a double board-certified physician in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, a hysterectomy is performed for many reasons, among them to treat painful conditions like endometriosis and uterine fibroids, cancer, or as a part of gender-affirming care.
Because of the risks, costs, and recovery time associated with a major surgery like a hysterectomy, it is generally considered after more conservative treatment options, like medical therapy, have been tried and failed.
There are three types of hysterectomies, which can include removal of all or parts of the cervix, uterus, and vagina. These include:
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Subtotal hysterectomy: a hysterectomy that removes all of the uterus, but keeps the cervix
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Total hysterectomy: a hysterectomy that removes the uterus and cervix
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Radical hysterectomy: a hysterectomy that removes the uterus, cervix, part of the vagina, as well as surrounding tissue, generally performed as a treatment for cancer.
Because a hysterectomy removes the uterus, you no longer get your period after the surgery and you are no longer able to get pregnant, which is why Dr. Ryniec suggests a hysterectomy after her patients have finished having children, if the option is available.
Can you still get pregnant after a hysterectomy?
Because a hysterectomy removes all or part of the uterus, it is not possible to get pregnant after a hysterectomy. However, for women wishing to preserve their fertility, there are options! If it is available, Dr. Ryniec suggests egg or embryo freezing before a hysterectomy, although a gestational carrier would be needed for any future pregnancies.
It’s normal to feel a lot of emotions after a hysterectomy, including grief or a sense of loss for your childbearing years. Your doctor can guide you through the best plan for you and your family.
What are the potential benefits of a hysterectomy for endometriosis?
Endometriosis is, unfortunately, not a curable condition, but symptoms can be managed and treated. According to Dr. Ryniec, most endometriosis patients see their symptoms resolve after surgery. A hysterectomy can dramatically improve the quality of life for women with endometriosis, allowing them to live healthier lives with less pain and fewer symptoms. According to one study, the proportion of women suffering severe pain from endometriosis decreased by 76% after a hysterectomy, and 84% were ultimately happy with their decision to get a hysterectomy!
Beyond pain relief, there are other benefits to a hysterectomy. As long as the ovaries aren’t removed, a hysterectomy doesn’t disrupt your hormones and cause early menopause, which comes with long-term health benefits. Additionally, many patients report relief from no longer having periods, as well as no longer having to worry about pregnancy prevention.
What are the downsides of a hysterectomy?
Every major surgery has its downsides, and a hysterectomy is no exception.
The downtime associated with a hysterectomy varies based on the type of surgery performed. A vaginal or laparoscopic hysterectomy is considered less invasive and offers less downtime — most women start to feel better in 2-3 weeks. A hysterectomy that is performed abdominally has a longer recovery time, with most women feeling better in 6-8 weeks. During this downtime, doctors discourage sex, vigorous exercise, and any work that involves manual labor or heavy lifting.
Additionally, there is a risk of endometriosis coming back after a hysterectomy. Dr. Ryniec says that your surgeon will need to ensure that all of the endometriosis is removed from the pelvis to ensure that your symptoms do not return. Although a hysterectomy is considered a permanent solution for endometriosis, there is a risk of recurrence in the case of incomplete excision (removal) of the endometriosis.
You deserve to live a healthy, pain-free life. A hysterectomy is a very personal decision — like all of your health decisions — and your doctor can help guide you to the best treatment plan for you.
Erin Pettis is a content strategist, freelance writer, and women’s health advocate. She lives in New York City and holds an MBA from NYU’s Stern School of Business.