June 2021: First patients treated at IFEM Endo with HIFU for rectal endometriosis
Although not strictly speaking a treatment for endometriosis (which, by definition, lies outside the uterus), hysterectomy is frequently associated with endometriosis surgery for women with adenomyosis who no longer wish to become pregnant. In this context, hysterectomy increases the chances of pain relief after surgery.
On the other hand, hysterectomy alone, without removal of the endometriosis lesions, is not usually effective in treating pelvic pain.
The uterus is located in the center of the pelvis, behind the bladder and in front of the rectum. It is attached to neighboring structures by fibro-conjunctive bands called ligaments:
The uterus is connected to the two fallopian tubes, the end of which (the tubal pinnae) is opened towards the ovary, to capture the eggs. During a hysterectomy, the tubes are usually removed along with the uterus, and the surgical procedure is called bilateral salpingectomy .
The ovaries, on the other hand, are not continuous with the uterus, but simply connected to it by fibrous bands (the utero-ovarian ligaments). During a hysterectomy, the ovaries can be preserved by sectioning the utero-ovarian ligaments. In this case, it's a total hysterectomy with bilateral salpingectomy and preservation of the ovaries . Women operated on using this technique retain normal ovarian activity and are not menopausal (there is no weight gain, hot flushes or other menopausal symptoms after surgery).
In other cases, the ovaries may be removed at the same time as the uterus, in the form of a total hysterectomy with bilateral adnexectomy (the term "adnexa " covers the tube and ovary on either side). In this case, menopause begins the day after surgery.
The uterus consists of a body, an isthmus and a cervix, the latter being visible at the bottom of the vagina. Hysterectomy is total, when the uterus is removed entirely with the cervix; this procedure involves circular incision of the vagina around the cervix, extraction of the uterus through the vagina, followed by closure of the vagina by suturing the edges of the previously incised vagina.
Hysterectomy can be subtotal, if the uterus is sectioned at the isthmus, and the cervix is preserved. In this case, no incision is made in the vagina. However, subtotal hysterectomy is rarely used in women with adenomyosis and/or endometriosis, as there may be lesions in the cervix or utero-sacral ligaments, which if left in place would render surgical treatment incomplete, with the risk of symptoms persisting.
16%
of women operated on for pelvic endometriosis have a hysterectomy at the same time
10-15
women/year undergo hysterectomy several years after surgery for colorectal endometriosis followed by one or more pregnancies
20%
of hysterectomies at the same time as surgery for colorectal endometriosis in the ENDORE randomized trial
Bibliography
IFEM Endo, a center specializing in the management of endometriosis and complex forms of the disease, is there to support you throughout your endometriosis care journey.
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