Endometriosis is a common gynecological condition that causes pain, scarring, and fertility problems in many women. Endometriosis refers to the disordered growth of the endometrium. The endometrium is the tissue that normally lines the uterus. It responds to a woman’s hormones by gradually building up, and then shedding through the vagina as menstrual blood if no pregnancy occurs.
Women with endometriosis have endometrial tissue growing abnormally outside of the uterus. It may grow on the outer lining of the uterus, on the fallopian tubes, the ovaries, the bladder, or elsewhere in the pelvis. Endometriosis causes severe menstrual cramping, and the abnormal tissue can leave damaging scars on the pelvic organs called adhesions.
What is the Goal of Endometriosis Surgery?
If your doctor suspects you have endometriosis, she may recommend surgery to confirm the diagnosis. Endometriosis cannot be diagnosed until your doctor can directly view endometrial tissue growing outside the uterus.
Although endometriosis can sometimes be managed with medication, it can also be treated with surgery. Your surgeon can laparoscopically remove abnormal tissue, including endometrial implants, cysts, and adhesions. Endometriosis surgery can significantly improve your symptoms and may increase fertility outcomes. This procedure is typically used to treat:
- An endometrioma (an endometriosis cyst growing on an ovary)
- Severe menstrual pain
- Adhesions (scarring) that interfere with fertility or other functions, such as urination
How is Surgery for Endometriosis Performed?
Most surgeries that are done to treat endometriosis are performed laparoscopically. Laparoscopy involves making a few small incisions in the abdomen through which the surgeon will insert surgical instruments and remove harmful tissue. Laparoscopies are less invasive and carry fewer risks than traditional open surgeries. Like an open surgery, however, you will be put under general anesthesia during the procedure.
The surgery will be guided by a laparoscope, which is a slender, flexible instrument with a light and a camera at the end. Using surgical instruments, the surgeon will then use cutting, scraping, high-energy laser, or electro-cauterizing techniques to remove abnormal endometrial tissue and adhesions from your pelvic organs. The entire surgery should take less than 45 minutes.
Does Endometriosis Surgery Work?
Surgery to treat endometriosis may improve symptoms, but it should not be thought of as a cure. Some symptoms may still linger, and they may return within a few months or years.
Relief of Pain
Surgery can relieve severe menstrual cramps for women with endometriosis, but this is not a guaranteed long-term fix. Studies suggest:
- About 7 out of 10 women experience less pain in the first few months after their surgery
- More than half of women will see their symptoms return after two years, and recurrence grows more likely as time goes on
- Hormone therapy in conjunction with surgery can prolong the relief from pain by preventing endometrial implants from re-growing
Some patients, especially patients over age 35, may be better off forgoing surgery and trying other fertility treatments, like in-vitro fertilization (IVF), insemination, or fertility drugs. Your gynecologist may refer you to a fertility specialist if you are trying to get pregnant.
There are a few ways a surgeon can approach treating an endometrioma:
- Draining the fluid
- Partial excision (removing part of the cyst)
- Cystectomy (completely removing the cyst)
Your doctor can talk with you about your condition and the risks and benefits of each procedure.
Endometriosis Surgery Recovery
The upside to laparoscopic surgery is the recovery time. Laparoscopy patients see much quicker recovery times compared to open surgery patients. Laparoscopic surgeries are performed as outpatient procedures, and can usually take place right in your gynecologist’s office. You should be able to return to work within a day or so, and see a full recovery within 2-4 weeks.
There is also less risk associated with laparoscopic surgery, although any surgery will carry some risk. These risks include:
Notify your doctor if you experience a fever, chills, nausea, or vomiting for longer than 24 hours following surgery.
In rare cases, if bleeding cannot be controlled, the surgeon may need to make a larger incision in your abdomen to stop the bleeding
Your surgery may result in scarring. Adhesions are areas of scar tissue that cause the pelvic organs to stick together. Adhesions can cause pain and other problems.
Surgery could damage the bladder, ureter, bowel, uterus, fallopian tubes, or ovaries.