Harvard Women's Health Watch

By the way, doctor: Can I have endometriosis even after a hysterectomy?

Q. I had a laparoscopic supracervical hysterectomy a year ago. Six months ago, I started having severe pelvic pain. It seems to develop a few days before I would normally have had a menstrual period (I still have both ovaries). Is it possible to experience symptoms of endometriosis after a hysterectomy? I also wonder if I might have pelvic adhesions and this is causing the pain.

A. Your diagnosis is right on track. When a woman's symptoms are cyclical, it suggests a hormone-related phenomenon — in this case, endometriosis. Endometriosis is a condition in which tissue similar to the lining of the uterus (the endometrium) becomes implanted on surfaces in the abdominal cavity, including the outside of the uterus, ovaries, bowel, and nearby organs. Like the endometrium, this wayward tissue builds up and sheds monthly in response to the rise and fall of hormones during the menstrual cycle. But unlike menstrual fluid, which escapes through the vagina, endometrial blood and tissue remain trapped in the abdominal cavity, triggering pain, inflammation, and sometimes adhesions, a type of scarring (which can also result from surgery). Although adhesions could be contributing to your symptoms, they don't explain them.

You didn't say whether you underwent hysterectomy for endometriosis. (Fibroids, abnormal uterine bleeding, and endometriosis are the most common reasons for the procedure.) Presumably an attempt was made to remove all visible, diseased tissue. But endometriotic implants can be microscopic or they may be located where removal is dangerous. The hormones that your ovaries continue to produce may be triggering the proliferation of tissue from these areas and the associated and sometimes gut-wrenching pain.

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