A hysterectomy can sometimes be recommended as part of treatment for endometriosis, but it isn’t necessarily a cure.
That’s because endometriosis involves tissue growing outside the uterus. Removing the uterus may relieve some symptoms, especially those related to menstruation, but it doesn’t address endometrial lesions elsewhere in the pelvis or abdomen.
If endometriosis tissue remains in the body after surgery, symptoms like pelvic pain, bloating, or digestive issues can continue. In some cases, endometriosis may even progress after a hysterectomy, particularly if the ovaries are preserved and continue producing estrogen, which can fuel the disease.
For those experiencing persistent endometriosis symptoms after surgery, further treatment may be needed. This could involve hormone therapy, additional surgery, or other approaches, depending on the location and severity of the remaining endometriosis.
Can Endometriosis Return After Surgery?
A hysterectomy can relieve some symptoms of endometriosis, but it isn’t a cure. That’s because endometriosis involves tissue growing outside the uterus. Even after the uterus is removed, endometriosis can persist or return, especially if lesions were left behind or the ovaries remain in place.
During a hysterectomy, a surgeon removes as much visible endometriosis as possible. But microscopic lesions can be difficult to detect and may continue to cause pain or other symptoms later on.
In some cases, the disease may even progress after surgery, particularly if estrogen is still present in the body.
If you’ve had a hysterectomy but are still experiencing symptoms, it may be helpful to speak with a specialist. Dr. Jackie Wong offers some guidance on managing endometriosis after hysterectomy, whether through hormonal therapy, surgery, or other approaches.
Common Symptoms to Look Out For
When you know what to look out for when it comes to symptoms, you can reach out for care sooner rather than later, and manage things more effectively.
Recurrent endometriosis symptoms may include:
- Chronic pelvic pain: Ongoing discomfort in the lower abdomen, pelvis, or lower back.
- Pain during or after sex: A common symptom if endometrial tissue is near the vaginaor pelvic nerves.
- Bowel or urinary symptoms: This might include painful bowel movements, bloating, constipation, diarrhea, or pain with urination.
- Fatigue: Low energy levels that may be linked to chronic pain, poor sleep, or inflammation.
- Mood changes: Persistent pain and fatigue can contribute to irritability, low mood, or anxiety.
When to Talk to a Medical Provider
If you’re noticing these symptoms—or if they’re getting worse—it’s worth consulting a healthcare provider who has experience managing endometriosis. They'll be able to assess whether endometriosis is the likely cause or if another condition may be contributing.
You should seek medical advice if:
- Symptoms persist or return after surgery
- Pain disrupts your daily activities or sleep
- You notice new or changing symptoms
- Medications are no longer helping
You don’t need to wait until symptoms become severe. The earlier the intervention, the better your chances of handling your symptoms.
Risk Factors for Recurrence
There are a few different factors that can contribute to the persistence or recurrence of symptoms after you've undergone surgery. Getting to know the risks can help guide your treatment decisions and long-term care.
Ovarian Conservation and Estrogen Production
In many cases, the ovaries are left in place during a hysterectomy, especially in younger patients, to avoid triggering early menopause.
However, this ovarian preservation also means that the body continues to produce estrogen, which can stimulate any remaining endometrial tissue.
Estrogen plays a key role in the growth and activity of endometriosis, so continued hormone production may increase the risk of symptoms returning.
When Ovary Removal May Be Considered:
For endometriosis patients with severe or deeply infiltrating endometriosis, removing the ovaries (a procedure called an oophorectomy) may be recommended at the time of hysterectomy. This can reduce estrogen levels and lower the risk of recurrence.
That said, the decision to remove the ovaries is complex and should take into account age, symptom severity, long-term health goals, and whether fertility preservation is a concern. A specialist in endometriosis can help weigh the risks and benefits.
Ovarian Remnant Syndrome
In some cases, small pieces of ovarian tissue may be unintentionally left behind during surgery. This is called ovarian remnant syndrome. Even tiny remnants can continue producing estrogen, which may trigger the return of endometriosis symptoms.
Common signs include:
- Pelvic pain
- Painful sex
- Ovarian cysts
Because this condition can be hard to detect, diagnosis may need imaging studies or a diagnostic laparoscopy to identify the residual ovarian tissue.
Hormone Replacement Therapy (HRT)
After ovary removal, some people are prescribed menopausal hormone therapy to relieve menopause-related symptoms and protect bone health.
However, hormone therapy containing estrogen may reactivate residual endometrial tissue. This doesn’t happen to everyone, but it’s something to consider when planning your treatment.
In some cases, non-hormonal options or low-dose, localized estrogen (such as vaginal estrogen) could be safer alternatives. Decisions around hormone therapy should always be personalized and made in consultation with a provider who's familiar with endometriosis management.
Incomplete Removal of Endometrial Tissue
During a hysterectomy, the surgeon aims to remove endometrial lesions as much as possible. But even with a thorough surgery, some endometrial implants may be left behind, especially if they’re microscopic or located in hard-to-reach areas. If this tissue remains, symptoms can continue or return.
In situations where pain or other symptoms persist after hysterectomy, a follow-up laparoscopy can help locate (and remove) any remaining endometriosis. Working with a surgeon who has specific expertise in excising endometriosis is important here, and can make a significant difference in long-term outcomes.
Diagnosis and Monitoring
If your symptoms continue or come back after a hysterectomy, it’s important to figure out why it's happening before you can move on to further treatment.
Remaining endometriosis is one possibility, but it’s not the only one to consider.
Imaging and Diagnostic Tools
Different imaging techniques can help detect residual or recurrent endometriosis. Each offers a slightly different view:
- Pelvic ultrasound: This non-invasive test uses sound waves to create images of the pelvic organs. It can sometimes detect endometriomas (ovarian cysts caused by endometriosis) or other abnormalities.
- MRI (magnetic resonance imaging): MRI provides high-resolution images that are useful for identifying deep infiltrating endometriosis and scar tissue.
- CT scan (computed tomography): CT scans are less commonly used but may be helpful in assessing the extent of disease or ruling out other issues.
- Laparoscopy: This is a minimally invasive surgery that allows direct visualization of the pelvic cavity. It’s currently the most accurate way to confirm endometriosis and may also allow for tissue removal or biopsy during the same procedure.
Other Possible Causes of Pelvic Pain
Persistent pain after hysterectomy isn’t always caused by endometriosis. Other conditions can produce similar symptoms, including:
- Adhesions (internal scar tissue from prior surgeries)
- Pelvic floor dysfunction
- Interstitial cystitis (bladder pain syndrome)
- Irritable bowel syndrome (IBS) and other bowel symptoms
- Musculoskeletal disorders
- Neuropathic pain
These conditions can overlap, making diagnosis more complex, which is why a thorough evaluation is so crucial.
Treatment Options Post-Hysterectomy
When you're dealing with disruptive symptoms even after undergoing surgery, additional treatment may be needed. The right approach depends on factors like whether the ovaries were removed, how severe the symptoms are, and how the body responds to previous treatments.
Hormonal Therapy
One option is hormonal medications. These can help suppress the activity of any remaining endometrial tissue and alleviate lingering symptoms. Common options include:
- Progestin therapy: Medications such as norethindrone acetate or medroxyprogesterone acetate work by opposing estrogen and can help ease pain.
- Aromatase inhibitors: These reduce estrogen production in other parts of the body. They’re often used alongside progestins to prevent estrogen from stimulating further endometriosis growth.
- GnRH agonists: These medications temporarily lower estrogen levels by suppressing ovarian function. They’re typically used short-term to manage more severe symptoms.
Hormonal therapy, like all other treatments, should be guided by an experienced healthcare provider. The choice of medication—and how long to use it—depends on you, your body, and your needs.
Pain Management
When hormonal therapy alone isn’t enough, other strategies may help manage chronic pain:
- NSAIDs (nonsteroidal anti-inflammatory drugs): Over-the-counter options like ibuprofen or naproxen can help reduce inflammation and relieve mild to moderate pain.
- Prescription pain medication: For more severe pain, stronger medications may be used under close medical supervision. These are typically reserved for short-term relief.
- Pelvic floor physical therapy: Targeted therapy can help release muscle tension, improve pelvic mobility, and ease pain linked to muscle dysfunction.
- Acupuncture: Some patients find relief from symptoms with acupuncture. While evidence is mixed, it may be a helpful adjunct for some.
- Mind-body techniques: Stress can amplify chronic pain. Practices like meditation, breathwork, and gentle movement (such as yoga) may support pain coping, though they’re not a standalone treatment.
Pain management often works best when it combines multiple different approaches, but be sure to chat with your provider before making any decisions or starting new medications.
Surgical Treatments
When other treatments don’t provide enough relief, additional surgery may be necessary to remove remaining endometriosis lesions or scar tissue.
- Laparoscopic excision surgery: A minimally invasive approach that allows a surgeon to carefully remove visible endometriosis and scar tissue.
- Robotic-assisted laparoscopic surgery: This is a variation of standard laparoscopy that provides enhanced precision and control during the procedure.
- Hysterectomy with bilateral salpingo-oophorectomy: In severe or recurring cases, removal of the uterus, ovaries, and fallopian tubes may be considered to reduce estrogen production and address widespread disease. This option is typically reserved for those who haven’t responded to other treatments.
Surgical decisions should always be made with an experienced endometriosis specialist. The goal is to weigh the benefits of symptom relief against the risks of surgery, taking your full medical history into account.
Lifestyle and Self-Care
While medical and surgical treatments are central to managing endometriosis, certain lifestyle changes can also help ease symptoms and improve overall well-being.
These strategies don’t replace clinical care, but they can offer additional support when used alongside it.
Nutrition
An anti-inflammatory diet may help reduce ongoing inflammation and support symptom control. This typically means focusing on whole foods—especially fruits, vegetables, whole grains, and sources of omega-3 fats like fatty fish, flaxseeds, or walnuts.
Some people also find it helpful to limit processed foods, red meat, or caffeine, though responses vary.
Exercise
Regular movement can improve blood flow, reduce inflammation, and support physical and mental health.
Low-impact activities like walking, swimming, or yoga are often well-tolerated and can be adapted as needed based on comfort and energy levels.
Stress Management
Chronic stress may contribute to increased pain and flare-ups. Techniques such as deep breathing, meditation, or even structured journaling can help reduce stress over time.
What’s most effective tends to depend on the individual, so it’s worth exploring different approaches.
Sleep
Poor sleep can also make it harder to cope with other symptoms like pain and fatigue.
Maintaining a consistent sleep schedule, limiting your screen time at night, and keeping your sleep environment quiet and dark are all small changes that can support better rest and recovery.
Support Networks
Connecting with others who understand what you’re going through can be helpful, both emotionally and practically.
Online communities like MyEndometriosisTeam and Endo Warriors provide spaces to share experiences and resources. Roon is both a reliable source of information from medical experts, and a space where you can learn more about others' lived experiences—offering you guidance and reminding you that you're not alone.
Complementary Therapies and Supplements
Some people with endometriosis find some relief from treatments like acupuncture or massages.
Certain supplements, such as omega-3 fatty acids, turmeric, or vitamin D, are sometimes used to reduce inflammation or support overall health.
However, some supplements can interact with medications or affect your hormone levels, so it’s important to speak with your doctor before starting anything new.
Long-Term Outlook
The long-term outcomes after hysterectomy vary depending on a few factors, including the severity of endometriosis, whether the ovaries were removed, and how the body responds to treatment over time.
For many women who undergo hysterectomy, lasting relief can be achieved, but it isn’t a guaranteed cure.
No matter what, ongoing care remains important. Regular follow-ups with your provider can help track symptoms, adjust treatment when needed, and address any new issues that may come up over time. This kind of continuity can make a meaningful difference in long-term outcomes.
It’s also worth considering the broader effects of hysterectomy. When the ovaries are removed, especially before natural menopause, there may be changes in hormone levels that lead to menopausal symptoms like hot flashes, bone loss, or increased cardiovascular risk. In those cases, menopausal hormone therapy or other interventions may be recommended to help manage these effects safely.
In short, hysterectomy often leads to meaningful relief—but it’s often not the end of care. With the right clinical follow-up and a management plan tailored to your needs, you'll have the ability to maintain good long-term health and keep your symptoms well-controlled.
Making Informed Choices About Endometriosis After a Hysterectomy
Managing endometriosis after a hysterectomy can be complex. While many find meaningful relief after surgery, it’s not always a complete solution. Persistent or recurring symptoms are possible, especially if endometriosis lesions remain or the ovaries are left intact.
Understanding the full range of treatment options—from hormonal therapy and pain management to lifestyle changes and, when needed, additional surgery—can help you make informed decisions about your care.
Long-term management is most effective when guided by a provider with expertise in endometriosis. A personalized approach—built around your specific symptoms, medical history, and goals—can improve outcomes and support your overall well-being.
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Frequently Asked Questions (FAQ):
What are the symptoms of endometriosis after a hysterectomy?
Even after a hysterectomy, some people continue to experience symptoms of endometriosis. Common signs include chronic pelvic pain, pain during bowel movements or sex, bloating, and fatigue. If the ovaries were preserved, hormone fluctuations may continue to fuel endometrial lesions.
Can you have endometriosis without a uterus or cervix?
Yes. Endometriosis involves tissue similar to the uterine lining growing outside the uterus. Removing the uterus or cervix doesn’t eliminate existing lesions in other areas, such as the ovaries, bowel, or pelvic wall. That’s why symptoms can persist or return after hysterectomy.
What are the symptoms of endometriosis in the bowel?
Bowel endometriosis can cause symptoms like bloating, constipation, diarrhea, pain during bowel movements, or rectal bleeding, especially around your period, if you still have functioning ovaries. These symptoms can overlap with other conditions like IBS, so it’s important to talk to your doctor for an accurate diagnosis.
How to tell if your endometriosis is back?
Recurring symptoms—especially pelvic pain, painful sex, or GI discomfort—may suggest that endometriosis is active again. A recurrence doesn’t always mean new lesions have formed; existing ones may still be active or inflamed. Imaging or diagnostic surgery may be needed to confirm recurrence.
Can you get endometriosis after having it removed?
Yes. Even after hysterectomy or excision surgery, endometriosis can come back. Recurrence rates vary depending on factors like surgical technique, whether the ovaries were removed, and how extensive the disease was. Ongoing follow-up care is important for monitoring symptoms and managing long-term outcomes.
