endometriosis, hysterectomy, OB GYN, Uncategorized

Not Everyone with Endometriosis Should Get a Hysterectomy Like Lena Dunham

The internet is aflame with people suffering from endometriosis wondering if they should be getting a hysterectomy after Lena Dunham revealed she had one at the age of 31.

Best wishes to Lena Dunham in her future health, it sounds like she has been through so much the past few years. I would not presume to know all the details behind her medical condition. She is quoted regarding her recent health battles here , and she has an article coming out in Vogue in March detailing her personal experience.

However, it is important for people to understand that not everyone with endometriosis or chronic pelvic pain should get a hysterectomy- in fact, the overwhelming majority should not. The truth of the matter is that it’s the ovaries that cause the problem with endometriosis and therefore you cannot be cured from endometriosis if the ovaries remain. A hysterectomy means simply taking out the uterus (typically with cervix too) but leaving the ovaries behind.

The simple fact is that endometriosis pain is tied to the estrogen provided by the ovaries. Therefore, even if the uterus is removed, the pain may continue if even just one ovary remains.

So, why don’t we just take out the ovaries too?

It’s complicated. You need the ovaries for more than just the obvious ability to produce an egg to allow for the ability to get pregnant and conceive a child. While the sole purpose of the uterus is for childbearing, the ovaries involve much, much more.

The estrogen produced by ovaries is protective to our bones and cardiovascular health as well, amongst many other things. Taking out the ovaries prematurely would cause an instant menopause in a woman in her 20’s or 30’s which has serious ramifications on long term health.

This is the reason why many physicians are reluctant to do such a major surgery as hysterectomy and/or removing of the ovaries in a woman in her 30’s. Your reproductive choices are absolutely your right. However, it is important to understand that simply removing a uterus will not cure a patient of endometriosis. Knowing this fact, it makes little sense to go through a major surgery to remove an organ which is not directly causing endometriosis.

Endometriosis implants can be found throughout the abdominal cavity. During surgical procedures, I’ve personally seen implants on bowel (intestines), pelvic sidewall, bladder, and even in the skin of the abdominal wall. Therefore, you can see how taking out the uterus may relive some pain, but it is not a cure.

Is there ever a time for removing both the uterus and ovaries in someone at a young age with debilitating pain from endometriosis? The answer is yes, rarely.

This is only after a multitude of other less risky and effective measures have been attempted and failed. It is exceedingly rare that a patient would not benefit from other methods of suppressing estrogen for short periods of time. Therefore, the case where a hysterectomy is needed for endometriosis alone is very rare and should never be a first treatment for endometriosis.

A hysterectomy alone may be considered for other reasons such as excessive bleeding not responding to less invasive treatments, large fibroids, uterine abnormalities, and even cancer. We may never know all the reasons behind Lena Dunham’s decision to have her uterus removed- that is between her and her doctor. However, given the fact the ovaries remain tells me it’s about more than endometriosis.

So, to any patients suffering with endometriosis, please know there is always more to t story and discuss all options with your doctor.

This article should not be taken as medical advice, but each patient should explore options with their own physician regarding treatment options for this painful and sometimes debilitating condition called endometriosis (there are many!).

 

Advertisements

Do you have thoughts on this topic?