Endometriosis causes tissue that normally grows on the inside lining of your uterus to implant in other parts of your abdomen. The misplaced tissue can cause symptoms like pain that can occur during your period, sexual intercourse, or bowel movements. Having endometriosis can also make it harder for you to get pregnant.
Treatments can both relieve your pain and improve your odds of conceiving. But it can be difficult to know what to expect from surgery and whether or not it’s the right decision for you. Here are some answers to questions you may have about surgery for endometriosis.
What treatments are used for endometriosis?
Doctors use two main treatments for endometriosis: medicine and surgery.
For some women with mild symptoms, pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) are enough to control symptoms. For other women, hormones from a birth control pill or intrauterine device (IUD) can prevent endometrial tissue from growing. Surgery is never a first response.
When should I consider surgery?
Your doctor might recommend surgery if you have severe endometriosis that is very painful, and if medicine hasn’t helped. Surgery might also be an option if you’ve been trying to get pregnant but have been unsuccessful. Removing the endometrial tissue could increase your odds of getting pregnant.
Having surgery is a big decision — especially if you’re considering a hysterectomy, which removes your uterus and possibly your ovaries. Without ovaries and a uterus, you can’t get pregnant.
Talk over all of your options with your doctor. Weigh the pros and cons of each one. It’s also helpful to get a second opinion.
What types of surgery are used to treat endometriosis?
Doctors perform two main types of surgery to treat endometriosis:
- Conservative surgery removes as much of the endometrial tissue as possible, but preserves your reproductive organs (ovaries and uterus). When your doctor does this procedure through small incisions, it’s called laparoscopy. Laparoscopy can also be used to diagnose endometriosis.
- Hysterectomy treats more severe endometriosis. The surgeon removes your uterus, and possibly your cervix and ovaries. If you have this surgery, you’ll no longer be able to get pregnant.
What happens during surgery?
Each procedure is performed differently.
You might need to prepare a day or so before your surgery. For example, your doctor might ask you to take medicine to completely empty your bowels the day before your surgery.
- You will be pain-free under general anesthesia.
- Your belly will be filled with gas to help the surgeon see inside your abdomen.
- The surgeon will make a few small incisions near your belly button. They’ll insert a lighted scope into one incision. Surgical instruments will be inserted into the other openings.
- The surgeon will use a knife, heat, or a laser to remove as much of the endometrial tissue as possible from organs like your ovaries, bladder, fallopian tubes, and rectum. A sample of this tissue may go to a lab for testing. The surgeon will also remove any scar tissue in these organs.
- Lastly, the surgeon will close up your incisions.
You should be able to go home on the same day as your surgery.
A hysterectomy removes your uterus and possibly your cervix. You might also have surgery to remove your ovaries and fallopian tubes, which is called oophorectomy.
Hysterectomy surgery can be done in a few different ways:
- Abdominally. The surgeon makes an incision in your lower pelvis and removes your uterus and other reproductive organs through this incision.
- Vaginally. The surgeon removes your uterus and cervix through your vagina. There is no incision.
- Laparoscopically. The surgeon makes a few small incisions through your abdomen. Your uterus and possibly your cervix and ovaries are removed through these incisions.
You might be able to go home on the same day as a laparoscopic hysterectomy. But open surgery typically requires an overnight hospital stay.
What to expect after surgery
You’ll recover faster after laparoscopic surgery than after an open hysterectomy. Your activities may be limited for the first couple of days or weeks after your procedure. Ask your doctor when you can go back to driving, working, and exercising. A full recovery from a hysterectomy can take four to six weeks.
After laparoscopy, you may have shoulder pain. This is caused by gas trapped in your belly. The pain should go away within two to three days.
Once you’ve had a hysterectomy, you will no longer get a period. If you had your ovaries removed, you’ll begin menopause. This means you may experience the effects of menopause, like hot flashes, vaginal dryness, and bone density loss. Talk to your doctor about how to manage these and other menopause symptoms.
Risks from surgery
Surgery to treat endometriosis is safe. But, like all surgeries, it can have risks, such as:
- damage to nearby nerves and blood vessels
- an abnormal connection between two organs in the abdomen (fistula)
Call your doctor if you have any of these symptoms after your surgery:
- redness, swelling, or pus draining from the incision site
- fever over 101°F (38°C)
- heavy bleeding from your vagina or the incision site
- pain that is severe or that gets more intense
Can surgery cure endometriosis?
Surgery can relieve pain, and laparoscopic surgery can potentially help you get pregnant. But, it doesn’t necessarily cure endometriosis — even if you have a hysterectomy. If any endometrial tissue is left in your abdomen, you may still have symptoms.
Endometriosis can come back after surgery. In 20 percent to 40 percent of women who have conservative surgery, symptoms return within five years. Remaining tissue can grow, and it’s impossible to remove every cell of misplaced tissue.
Your likelihood of having a recurrence depends on the severity of your endometriosis and whether your surgeon is able to remove most of the endometrial tissue during the procedure. Having your ovaries removed is more likely to relieve your symptoms long term, because it stops the hormone swings that the tissue is responding to. But once the ovaries are removed, you’ll be in menopause, and that is likely to lead to menopausal symptoms. Weigh these pros and cons when making your decision to have surgery for endometriosis.