Hysterectomy May Not Be The Only Option For Many Women With Endometriosis and Pelvic Pain

Source: Huffington Post – January 9, 2015

Women who have had hysterectomies for conditions such as uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain might not have needed the procedure.

According to recent research published in the American Journal of Obstetrics and Gynecology, researchers found as many as one in five reproductive-age women may not have needed a hysterectomy. They looked at women from 52 hospitals who had endometriosis, chronic pelvic pain, abnormal bleeding, and uterine fibroids and found that, while women 40 years old or younger were more likely to be offered alterative treatment options, 40% of the women in the study were not offered other treatments before their hysterectomy.

The researchers also analyzed tissue samples from women who had the procedure. Overall, they found performing a hysterectomy was unnecessary in as many as one in five women, and was highest among women with endometriosis and pelvic pain. Although the number of hysterectomies has declined by 36.4% since 2002, the procedure is still the most common performed gynecological surgery in the United States.

I estimate that between 30% and 40% of our patients with these gynecological issues have been offered a hysterectomy before coming to RADfertility. These patients are women who would like to be pregnant at some point, but can’t imagine having a hysterectomy because they don’t want to lose the option of pregnancy.

Unfortunately, some of these women are very young, in chronic pain, and are being told that hysterectomy is their only option. Our hope is that some of these women realize they have a fixable problem and find a physician who knows how to treat their issue. The women who come to RADfertility with these symptoms work very hard to find an answer, and often find us through a referral from another women’s health practice, or through word of mouth by actively talking about their problem with friends and loved ones.

What I tell my patients is that their uterus is not responsible for their pain; therefore, a hysterectomy would not provide relief. Through a detailed history and work-up, we’re able to make a thorough diagnosis at RADfertility for these women and find the source of their pain. We ask for comprehensive personal histories. We perform physical exams, which include a vaginal ultrasound. If a patient comes to us with abnormal or heavy bleeding, we will use a sonohysterography to examine the uterine cavity, which gives us a good sense of the health of their uterine lining.

We know from our evaluation how we need to treat our patients. All the gynecological issues in this study—chronic pelvic pain, endometriosis, uterine fibroids, and polyps—are identified through our work-up and can be treated with laparoscopic surgery. Our surgery is minimally invasive and we perform it with our patients’ future fertility in mind.

Prior to surgery, we suppress our patients with Lupron and we continue that suppression with add-back estrogen therapy after surgery. As our patients get closer to 40 years of age and when they know they’re finished building their family, I think that’s an appropriate point where a lot of patients would stop taking Lupron, and consider removing their ovaries and moving forward with a hysterectomy.

However, many women’s health professionals today still regularly offer hysterectomy to young women of pre-childbearing and childbearing age. If the field of women’s health is going to change how they recognize the diagnosis and treatment of these conditions, we have to start with training the residents and caregivers who will see these women in the future. We’re thrilled to be working with the residents because they will move on after their rotation at RADfertility to become great diagnosticians who critically think about their patients’ problems and how to treat them.

Learn more about how the surgeons at RADfertility can help women live without chronic pain by visiting our Endometriosis & Pelvic Pain Center.