Endometriosis is a complex condition in which tissue similar to the lining of the uterus begins to grow outside of the uterus, causing chronic pain, heavy menstrual periods, and in some cases infertility. Although a hysterectomy is often recommended as a last resort, it does not always completely cure endometriosis, as endometriosis can also affect areas other than the uterus, such as the ovaries, bladder, and pelvic cavity. Fortunately, a variety of non-surgical and fertility-sparing treatments allow patients to effectively manage their symptoms without having to resort to such major surgery.
To know how to treat endometriosis without hysterectomy, OnlyMyHealth spoke to Dr Ashish Sujit G, Consultant Obstetrics and Gynaecology, PD Hinduja Hospital, Mumbai.
Understanding Ectopic Endometriosis
“Hysterectomy is often considered a last resort in the treatment of endometriosis, but its effectiveness is limited if the disease has spread to tissues outside the uterus,” says Dr. Sujit. Endometrial tissue can grow in areas such as the ovaries, around the bladder, and the sacrum of the uterus, and the condition is heavily influenced by hormones produced by the ovaries. “This means that a hysterectomy alone may not completely cure the condition. If endometrial tissue has grown into the muscle layer of the uterus (endometriosis), a hysterectomy may provide relief from pain, but other medications that target the remaining endometriotic tissue outside the uterus should be considered.
When to Consider a Hysterectomy
In severe cases where endometriosis affects multiple organs and medical treatments are not effective, a hysterectomy may be performed as part of a more extensive surgical approach. “For patients with advanced endometriosis (stage 3 or 4), a hysterectomy can be combined with removal of the affected tissue around the ovaries and the bladder or rectum. However, this is usually only done in patients who do not want to preserve their fertility,” explains Dr. Sujit. However, endometriosis can persist even after a hysterectomy. “Since hormone production continues as long as the ovaries remain, persistent pain around the menstrual cycle may occur even after the uterus is removed,” he says.
Also read: How to deal with endometriosis? Experts list 4 ways exercise can help
Non-surgical treatments for fertility preservation
For patients who want to avoid surgery and preserve fertility, medical management is often the primary treatment strategy. “Painkillers such as NSAIDs are often the first step to manage period pain. Hormonal treatments such as birth control pills, patches, and vaginal rings provide long-term control of symptoms by correcting the hormonal fluctuations that worsen endometriosis,” says Dr. Sujit.
Additionally, progestin-based treatments and GnRH analogues can effectively control symptoms by suppressing menstrual cycles and creating a “pseudo menopause” that prevents endometrial tissue from growing. Though effective while on treatment, Dr. Sujit says, “These treatments only provide temporary relief, and symptoms may return if treatment is discontinued. Therefore, patients need to understand that maintenance therapy may be necessary.”
Conservative surgery as an intermediate option
For women who want to preserve their fertility, conservative surgery combined with medical management is a viable option. “Conservative surgery focuses on repairing only the affected tissues while preserving vital reproductive structures. For example, removing ovarian cysts or releasing adhesions due to endometriosis can increase the chances of conception,” says Dr. Sujit. He recommends monitoring ovarian reserve by testing anti-Mullerian hormone (AMH) levels before and after surgery to ensure ovarian function is not affected. Conservative treatment may require additional assisted reproduction depending on the extent of endometriosis.
Lifestyle and dietary interventions
In addition to medical treatment, lifestyle changes may help relieve symptoms. A diet rich in fiber, antioxidants and anti-inflammatory substances, regular exercise, stress reduction and adequate sleep can all help control symptoms. Smoking cessation is particularly emphasized to avoid worsening inflammation.
Read more: Does endometriosis increase your risk of cancer? Here’s what experts say
Advances in diagnosis and management
Medical research continues to advance, bringing hope to endometriosis patients. “Research is investigating imaging techniques such as ultrasound shear wave elastography (US-SWE) and PET scans to more precisely identify endometriosis in deep tissues,” Dr. Sujit emphasizes. In addition, genomic studies aimed at understanding the genetic factors that influence endometriosis may open the door to personalized treatment. New therapies that target specific pain pathways, such as the mPGES1 inhibitor NS-580 and the antibody AMY109, are also being investigated to reduce the discomfort associated with endometriosis.
Long-term perspective
While hysterectomy can be effective for some, it comes with its own risks, including early menopause and possible long-term pelvic pain and complications. “Patients need to be aware that hysterectomy is a major surgery and complications from adhesions associated with endometriosis may occur,” warns Dr Sujit. Early menopause can carry additional risks, such as osteoporosis and cardiovascular complications, underscoring the importance of a careful and individualized approach.
Endometriosis presents many challenges, but a combination of medical management, conservative surgery and lifestyle changes provide many options beyond hysterectomy. “Patients need to understand that endometriosis is complex and effective management requires a combination of strategies. Personalised treatment is essential to address each patient’s unique needs and goals,” Dr Sujit concluded.
