Hi, Welcome to Ask A Doctor. Thanks for the query. I can understand your concern. Endometriosis is a condition where endometriotic tissue grows outside the uterine cavity leading to adhesions, ovarian endometriotic cysts etc. Mild to moderate cases can be treated with medical management. But as you have mentioned that you are having frozen pelvis and stage 4 endometriosis, which indicates: -There are extensive and dense adhesions between pelvic structures, as suggested by ovarian adherence to posterior surface of uterus. So medical management or conservative surgery may not able to remove complete adhesions and it may not be able to remove ovarian cysts without removal of uterus. -If the uterus and ovaries are left, the menstrual cycles will continue and so also the progression of endometriosis. So, by removing these structures further progression and development of new spots of endometriosis can be prevented. So, may be by taking all these points into consideration, your doctor might have recommended Hysterectomy with salpingoopherectomy to you. But as you mentioned, the need for hormone replacement therapy after surgery and the extent of endometriosis that surgery can remove, these points also to be considered before going for surgery. If you have completed your family and age around 40 years, Hysterectomy with salpingoopherectomy is better choice for you for your diagnosis. If you are less than 40 years, you may need to use hormonal therapy for longer period. So, in that case please discuss this in detail with your doctor and proceed accordingly. Usually herbal supplements instead of direct hormones for hormone replacement therapy can have less side effects when used for longer period also. Hope I have answered your query. Will be happy to answer further followup queries. Regards Dr.Sree Gouri SR, OBGYN