After months on a Canadian waitlist, Jennifer Todd flew to Mexico to pay for endometriosis surgery out of pocket. This wasn’t her first procedure, but it promised a major improvement in her quality of life.
“Before surgery, I felt overwhelmed and defeated. I even had to take medical leave from work while waiting,” Todd said. She described the decision to travel for surgery and find a trusted surgeon as very stressful.
At 37, she was physically and emotionally exhausted. “I felt embarrassed and ashamed that I couldn’t manage my pain enough to work, care for my child, or participate in family events. Only 3-5 days per month were manageable, and that was isolating,” she recalled.
After her first excision surgery, doctors recommended a hysterectomy to manage her adenomyosis, a condition related to endometriosis in which lesions grow inside the uterus. Todd still hoped to have another child, facing a common dilemma: choosing between potential pregnancy or relief from chronic pain. For endometriosis patients, a hysterectomy often only relieves pain if all disease tissue is properly removed beyond the uterus.
“I tried to get pregnant for 18 months but couldn’t. My pain increased, so my surgeon and I decided it was time for a hysterectomy,” Todd said. She underwent a hysterectomy and oophorectomy—removing both her uterus and ovaries—along with excision of endometriosis and bowel resection. She admitted that giving up the possibility of pregnancy was difficult, but enduring daily pain was harder.
When Surgery Brings Menopause
In the U.S., about 600,000 hysterectomies are performed annually, with roughly 100,000 for endometriosis. While a hysterectomy does not remove endometriosis outside the uterus, it is often recommended when symptoms severely affect quality of life.
Removing the ovaries triggers surgical menopause. Unlike natural menopause, which happens gradually, surgical menopause is sudden. The abrupt hormone drop can cause hot flashes, insomnia, fatigue, mood swings, weight gain, low libido, anxiety, and depression. For patients under 35, hysterectomy may also increase long-term health risks like heart disease.
For endometriosis patients, this transition can be especially challenging. They often face the relief of less period pain alongside the onset of new symptoms caused by hormone loss.
Todd relied on hormone replacement therapy (HRT) after surgery. “HRT has changed my life, but it took nearly a year to find the right combination and dosage,” she said. She also noted a lack of research on endometriosis recurrence in patients taking HRT, which can be stressful for those navigating this treatment.
Different Experiences, Similar Challenges
Patricia Kirsch had a hysterectomy and oophorectomy at 50 after years of endometriosis. “My doctor warned me that removing my ovaries would trigger menopause immediately. I didn’t care at the time,” she said.
Recovery was difficult. Hot flashes, fatigue, and post-surgery discomfort left her angry and depressed. She declined HRT due to remaining endometriosis lesions. “I didn’t want estrogen to worsen them,” she explained.
Beyond physical challenges, Patricia experienced emotional grief. “I’ve never had children, and realizing I never would brought me to tears,” she said. She had to cope with both the physical and emotional changes from surgery.
A Complex Choice
A hysterectomy can end one struggle while creating another. Surgical menopause brings profound physical, emotional, and hormonal effects. Many patients feel unprepared for these changes. Endometriosis adds complexity, and HRT decisions can be uncertain.
The decision to undergo a hysterectomy is rarely simple. The surgery meant to relieve pain can introduce new problems, such as mood instability, joint pain, urinary issues, or incomplete symptom relief. Relief comes at a cost, but for some, like Patricia, the surgery ultimately improves quality of life. “I can manage my symptoms now, and I know I’ll get through menopause in time,” she said.
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