Hysterectomy for Adenomyosis

A hysterectomy for adenomyosis is surgery to remove the uterus in order to treat symptoms caused by adenomyosis, a condition where endometrial-like tissue grows into the muscular wall of the uterus. Because adenomyosis lives within the uterine muscle, removing the uterus is the only treatment that reliably eliminates adenomyosis itself. Learn more about the condition here: adenomyosis.

Many people pursue hysterectomy after years of debilitating symptoms—like painful periods, chronic pelvic pain, and heavy menstrual bleeding—that affect work, relationships, exercise, and emotional wellbeing. It can be a relief to finally have a clear explanation and a path forward, especially when you’ve been told your pain is “normal.”

Importantly, adenomyosis often coexists with endometriosis. If endometriosis is also present, a hysterectomy alone may not address all pain drivers—so evaluation and a whole-person plan through our services and, when appropriate, surgery and advanced excision matters.

A hysterectomy may be recommended when adenomyosis symptoms are severe and persistent—especially heavy bleeding, anemia, worsening cramps, pressure/bloating, and daily pain that doesn’t respond well enough to medical management. It’s also considered when symptoms are significantly affecting quality of life (sleep, work, intimacy, mental health) and you’re ready for a definitive option.

It’s most often discussed after trying other treatments such as anti-inflammatory medications, hormonal suppression (see hormonal therapy), or integrative support (see integrative medicine and lifestyle care). Some patients also benefit from specialized support for muscle and nerve sensitization, such as Pelvic Floor Therapy, either before or after surgery.

Because hysterectomy ends the ability to carry a pregnancy, it’s usually recommended only when you are certain you do not want future uterine pregnancy—or when fertility-sparing options are not appropriate. If preserving fertility is a goal, your specialist may discuss alternatives (such as adenomyomectomy in select cases) and will also evaluate for coexisting endometriosis or other conditions that can mimic adenomyosis (see related conditions).

The most common goals of hysterectomy for adenomyosis are lasting relief from heavy bleeding and significant improvement in uterine cramping/pressure. Many patients notice that the “uterus-based” symptoms—like severe cyclical pain, clotting, and cycle-driven pelvic heaviness—improve dramatically. If you’ve been struggling with fatigue related to heavy bleeding and anemia, energy may improve as bleeding resolves.

However, outcomes depend on the full picture. If you also have endometriosis, pelvic floor dysfunction, bladder/bowel overlap, or nerve sensitization, you may still need targeted treatment for those contributors—such as excision of endometriosis, pain-focused care (see pain management), and/or Pelvic Floor Therapy. The best next step is a comprehensive evaluation through evaluation and diagnosis.

You can also expect a meaningful decision-making process. A good surgical plan addresses: whether the cervix will be removed, whether ovaries will be preserved, how to manage any endometriosis seen at surgery, and what recovery support you’ll need. If you want a specialist opinion, you can schedule a consultation.

A hysterectomy removes the uterus; the cervix may or may not be removed depending on your anatomy, symptoms, and surgical goals. Many hysterectomies for adenomyosis are performed using minimally invasive approaches (laparoscopic or robotic), which often means smaller incisions and faster recovery than an open abdominal incision. At Lotus, surgical planning is individualized as part of our services and, when indicated, surgery and advanced excision.

A key part of hysterectomy planning for adenomyosis is deciding what to do with the ovaries. Removing ovaries can reduce estrogen but can also trigger immediate menopause and long-term health effects; preserving ovaries often avoids surgical menopause. If ovary removal is being considered, your surgeon should discuss the pros/cons carefully and personalize the plan to your age, symptoms, risk factors, and goals.

Because adenomyosis commonly overlaps with endometriosis, an endometriosis-informed approach matters. If endometriosis is suspected or confirmed, your surgeon may recommend treating endometriosis at the same time (often with excision) so the hysterectomy is not “the end of the road” but one part of a complete, pain-relief strategy. Learn more about endometriosis here: endometriosis.

Recovery varies based on the surgical approach and the complexity of your case, but many patients go home the same day or after a short hospital stay with minimally invasive surgery. In the first 1–2 weeks, it’s common to feel fatigue, soreness, and a “tugging” sensation with movement; pacing yourself and prioritizing rest is part of healing. Your team will give clear instructions about lifting limits, driving, showering, and symptom monitoring.

Most people gradually increase activity over 2–6 weeks, but full internal healing takes longer. Even when incisions look “fine,” your pelvis is still recovering. If you have persistent pelvic muscle tension or pain with sitting, bowel movements, or intercourse, pelvic rehabilitation can be an important part of recovery—see Pelvic Floor Therapy.

Call your surgical team promptly if you develop fever, worsening pain not controlled with your plan, heavy bleeding, shortness of breath, or concerning urinary/bowel symptoms. If you’re planning surgery or want a second opinion on whether hysterectomy is right for you, you can schedule a consultation and discuss options at our Santa Monica office or Arroyo Grande office.

A hysterectomy is common, but a hysterectomy for adenomyosis in the real world is often not “simple”—especially when symptoms overlap with endometriosis, adhesions, ovarian cysts, bladder/bowel symptoms, or long-standing pain sensitization. If endometriosis is missed or not treated, patients may still have symptoms after surgery even though bleeding improves. Specialist-level evaluation helps ensure the plan matches your true pain drivers (see evaluation and diagnosis).

Surgeon expertise matters for outcomes that patients care about: maximizing symptom relief, minimizing complications, preserving ovarian function when appropriate, and addressing coexisting endometriosis with the right approach (excision is considered the gold standard). Lotus is led by Dr. Steven Vasilev, a quadruple board-certified surgeon known for advanced minimally invasive endometriosis surgery.

It also matters emotionally. Many patients come to hysterectomy after years of being dismissed. A specialist team should take your symptoms seriously, explain options clearly (including non-surgical supports like pain management and integrative medicine and lifestyle care), and help you make a decision you feel at peace with. If you’re weighing your next step, schedule a consultation.