Endometriosis is when endometrial tissue (the tissue that lines the inside of the uterus) grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes, and the tissue lining your pelvis. Rarely, endometrial-like tissue may be found beyond the pelvic cavity.
Endometriosis symptoms include severe pelvic pain, uterine cramping, heavy periods, and pain with intercourse. The abnormal tissue can also form scars on the pelvic organs called adhesions, which can cause infertility problems.
How do I know if I have endometriosis?
Endometriosis is probably the most misdiagnosed condition in all of women’s health. Diagnosing endometriosis is complicated because other conditions can often cause the symptoms of endometriosis. This can lead to years of needless suffering, as I discussed on The Doctors TV Show.
While a laparoscopy is the only way to confirm a diagnosis of endometriosis with 100% accuracy, a doctor’s experience in treating the condition can help address pain or infertility much sooner and more effectively. That’s why seeing a doctor with extensive experience treating endometriosis is critical. Tragically, most patients who come to my office have suffered for 10 years or more.
How effective is laparoscopic surgery for endometriosis?
The key goals of removing endometriosis tissue growth via a laparoscopic surgical procedure are to help reduce pain and avoid infertility. However, I only recommend surgery to patients who have not responded to non-surgical treatments.
If a laparoscopy (also called keyhole surgery) is performed, I insert a thin, flexible, lighted instrument through two small incisions in your abdomen and inspect your pelvic organs for signs of endometriosis, implants (growth of endometrial tissue), or scar tissue.
If I detect any endometrial tissue interfering with the function of your ovaries, fallopian tubes, bowel, or bladder, I remove it. This can be done by cutting, scraping, laser treatment, or using an electric current. This allows me to view tissue or take a biopsy (tissue sample).
Suppose an endometrial cyst, or endometrioma, is present on your ovary. In that case, we may opt for one of three treatment methods: draining the cyst, partially removing it, or completely excising it.
About seven of ten women report less pain during the first few months following laparoscopy surgery. However, it is very important to note that surgery does not cure endometriosis but rather takes out abnormal endometrial tissue from within the pelvis.
Without hormonal suppression therapy, symptoms will return in more than half of these women. Studies have shown that starting hormone therapy — such as birth control pills — after surgery can extend endometriosis pain relief by preventing endometrial tissue from growing back quickly.
Ablation vs. excision for endometriosis treatment
Ablation is a superficial treatment in which the endometriosis lesions are burned to remove them. However, this technique only removes the lesion’s surface and may not completely remove the original lesions, leading to recurrence. Even a tiny amount of leftover endometrial tissue can cause significant pain and other symptoms.
Moreover, ablation is not recommended for patients who want to carry a pregnancy in the future, as burning any tissue in the pelvic region, especially near the ovaries, may lead to scar tissue formation and result in poor fertility outcomes.
Excision, on the other hand, involves dissecting underneath the endometrial lesions down to healthy, non-endometriotic tissue and then removing the endometriotic tissue entirely from below. This technique allows biopsies to be sent to a pathologist for confirmation and ensures complete lesion removal.
Does endometriosis cause infertility?
If you are experiencing infertility and have moderate to severe endometriosis, surgical removal of endometrial tissue may enhance your chances of becoming pregnant. However, this may not apply to women with mild endometriosis.
It’s important to remember that multiple factors, including age and other health concerns, can affect fertility. Women over 35 years old may benefit more from non-surgical interventions like in vitro fertilization (IVF), artificial insemination, or fertility medications.
What’s the recovery from minimally invasive endometriosis surgery?
Our patients undergoing minimally invasive endometriosis surgery experience a much quicker recovery than those undergoing open abdominal surgery. They typically return to work within a day or so and fully recover within two to four weeks.
Immediately following your outpatient surgery, it is expected to experience some discomfort upon waking up. However, you will be prescribed medications to help alleviate any pain. You should not drive or engage in sexual activity, swimming, or bathing in tubs until given the go-ahead. It is typical for the first period after a laparoscopy to be heavier and more painful than usual.
A unique side effect caused by laparoscopic surgery is shoulder pain, which may last for 24-48 hours following surgery.
A follow-up appointment will be scheduled to review findings and discuss hormonal treatment options.
Is there any risk in having laparoscopy surgery?
Laparoscopic surgery is considerably safer and carries significantly less risk than laparotomy (an open abdominal surgery). The likelihood of complications with laparoscopy is only 0.3%, and it is further reduced with an experienced surgeon. Despite the infrequency of complications, it is important to know what they are.
Potential risks include:
Infection
Internal bleeding may require a larger abdominal incision to manage effectively.
Adhesions are internal scars that can develop after surgery and can cause pelvic organs to stick together.
Damage to nearby structures, such as your bladder, bowel, or blood vessels.
Are all laparoscopic surgeries the same?
In short, no. The surgeon’s expertise is crucial for accurately diagnosing and treating endometriosis. Expertise in this field is gained by treating a large number of patients with endometriosis.
Surgical skill is particularly significant in treating endometriosis-related infertility, as the success rates of pregnancy following endometriosis surgery can vary considerably among surgeons.
Dr. Aliabadi, a nationally recognized endometriosis specialist near me
Dr. Thais Aliabadi is part of a small minority of gynecologists and surgeons in the United States who are experts in advanced minimally invasive techniques to remove endometrial scar tissue of any size during the same procedure in which they diagnose your endometriosis.
This means that you can undergo a diagnosis and treatment for your condition in one general anesthesia session, including removing any endometrial tissue or masses, regardless of size. Dr. Aliabadi’s surgical proficiency, decades of experience, and thousands of such surgeries make this possible. She is an esteemed authority in this field and has instructed surgeons worldwide in laparoscopic techniques.
Experience plays a pivotal role. And this is where the difference lies between Dr. Aliabadi and most other OB-GYNs. Dr. Thais Aliabadi, a renowned endometriosis specialist with over two decades of experience in this field, can assist you in comprehending the available endometriosis treatment options and creating an individualized treatment plan to relieve pain and improve your quality of life.
Endometriosis affects hundreds of thousands of women each year. If you believe you are experiencing symptoms or suffering from endometriosis or have questions about it, we encourage you to see your healthcare provider, preferably an expert in its treatment.
Dr. Aliabadi is an attending physician at Los Angeles’ Cedars Sinai, Department of Obstetrics and Gynecology, and a member of the American College of Obstetricians and Gynecologists.
If you want to establish care with Dr. Aliabadi, please make an appointment online or call us at (844) 863-6700.
The gynecology, surgery, and obstetrics practice of Dr. Thais Aliabadi, a member of the American College of Obstetricians and Gynecologists, and the Outpatient Hysterectomy Center is conveniently located for patients throughout Southern California and the Los Angeles area. We are near Beverly Hills, West Hollywood, Santa Monica, West Los Angeles, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.
Endometriosis Surgery FAQs
How to diagnose endometriosis without surgery?
The only definitive way for a healthcare professional to diagnose endometriosis is through surgery, typically a laparoscopy, where a surgeon inserts a small camera into the abdomen to look for signs of endometriosis tissue. However, several non-surgical approaches can also be used to diagnose endometriosis, including a pelvic exam, imaging, blood tests, and symptom evaluation by an endometriosis specialist.
What is endometriosis surgery?
The key goal of endometriosis surgery is to help reduce pain and avoid infertility. During a laparoscopy, your surgeon will make minor cuts near the belly button and insert a small camera and other instruments to visualize and remove endometrial tissue.
How quickly can endometriosis grow back after surgery?
Studies have shown that recurrence rates can be as high as 20-40% within the first two years after surgery, although rates tend to decrease over time. Starting hormone therapy or oral contraceptives — such as birth control pills — after surgery can extend endometriosis pain relief by preventing endometrial tissue from growing back quickly.
When to have surgery for endometriosis?
Surgery for endometriosis may be recommended if symptoms are severe, other treatments have been ineffective, or infertility is a concern.
How often can you have laparoscopic surgery for endometriosis?
Surgery is typically recommended only when symptoms are severe or other treatments have been ineffective. It is not typically recommended to undergo laparoscopic surgery for endometriosis frequently, as surgery carries risks and does not cure the condition.
How long after endometriosis surgery can I get pregnant?
The timing of pregnancy after endometriosis surgery can vary depending on individual factors, such as the extent of the endometriosis, the type of surgery performed, and the woman’s age and fertility status. In general, it is recommended to wait at least 2-3 months after surgery to allow the body to heal before attempting to conceive.
Does endometriosis surgery help fertility?
Endometriosis surgery can help improve fertility in some women with endometriosis, especially if the surgery involves removing adhesions, scar tissue, or other growths that may be affecting fertility. Surgery may also help improve the chances of success with fertility treatments, such as in vitro fertilization (IVF).
Can you get pregnant after endometriosis surgery?
Yes, many women are able to get pregnant after endometriosis surgery—especially if the surgery successfully removes or reduces endometrial lesions. However, fertility outcomes vary depending on factors like age, the severity of the disease, and whether both ovaries and fallopian tubes are healthy.
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What are the chances of recurrence after surgical treatment for pelvic pain and infertility?
The chances of recurrence after surgical treatment for pelvic pain and infertility can vary depending on the extent of the endometriosis and the effectiveness of the surgery in removing the endometrial tissue. Factors such as age and other health concerns can also influence the likelihood of recurrence.
How does minimally invasive surgical excision affect future fertility?
Minimally invasive surgical excision for endometriosis can positively impact future fertility by removing endometrial lesions and scar tissue that may interfere with conception. This technique aims to improve reproductive outcomes and increase the chances of success during fertility treatments like in vitro fertilization (IVF).
What are the postoperative expectations for individuals after undergoing minimally invasive treatment for pelvic conditions?
After undergoing minimally invasive treatment for pelvic conditions, individuals can expect shorter recovery times, reduced pain, and minimal disruption to daily activities. The benefits include no hospital stay, quicker recovery, and improved chances of success with fertility treatments like IVF. It's essential to follow postoperative guidelines to ensure optimal outcomes and healing.
How does minimally invasive removal of pelvic lesions affect menstrual periods and bowel function?
Minimally invasive removal of pelvic lesions can improve menstrual periods and bowel function by reducing pain and discomfort associated with endometriosis. This technique allows for targeted removal of lesions, potentially easing symptoms and restoring normal function to the affected areas.
Are minimally invasive treatment options for pelvic conditions suitable for all ages and stages, including adolescents and postmenopausal women?
Minimally invasive treatment options for pelvic conditions are generally suitable for individuals of all ages and stages of life, including adolescents and postmenopausal women. These procedures offer benefits such as shorter recovery times and reduced pain, making them a viable option for a wide range of patients.
Can minimally invasive procedures for pelvic pain and infertility improve the chances of conception?
Minimally invasive procedures for pelvic pain and infertility can improve conception chances by removing endometrial tissue or growths that may impact fertility. These procedures, like laparoscopic surgery, aim to address underlying issues causing pain and infertility to potentially enhance fertility outcomes.
How do different surgical approaches for treating pelvic conditions compare in terms of risks, benefits, and costs?
Surgical approaches for treating pelvic conditions vary in risks, benefits, and costs. Minimally invasive laparoscopic surgery offers shorter recovery, fewer complications, and lower costs compared to traditional open abdominal surgery. Although the initial cost might be higher, the overall benefits and reduced risks make laparoscopic surgery a favorable option.
Are there alternative non-surgical treatments available for managing pelvic pain associated with menstrual cycles?
Yes, non-surgical treatments such as medication, hormone therapy, lifestyle changes, physical therapy, and acupuncture can help manage pelvic pain related to menstrual cycles. Working with an endometriosis specialist to tailor a treatment plan for individual needs is crucial for effective pain management.
Is minimally invasive exploration a common diagnostic tool for adolescents with suspected pelvic conditions?
Minimally invasive exploration is not commonly used as a diagnostic tool for adolescents with suspected pelvic conditions due to its invasive nature. Other non-surgical approaches, such as pelvic exams and imaging, are typically favored for initial evaluation in this patient population.
What role does robotic assistance play in the surgical management of pelvic conditions known to cause pain and infertility?
Robotic assistance in surgery aids in precise, minimally invasive removal of endometriosis lesions, scar tissue, and endometrial cysts contributing to pelvic pain and infertility. Benefits include shorter recovery times and improved outcomes for patients with these conditions.
Can surgical intervention for pelvic conditions be considered a definitive cure or simply a treatment?
Surgical intervention for pelvic conditions may provide relief but is not always a definitive cure. It depends on the condition, extent of surgery, and individual factors affecting recurrence or long-term outcomes. Consulting with a specialist is crucial to assess the best approach for each case.
What are the insurance coverage options for surgical procedures aimed at managing pelvic pain and infertility?
Insurance coverage for surgical procedures targeting pelvic pain and infertility varies. It is recommended to consult with your insurance provider to understand coverage options for endometriosis surgeries and fertility treatments, considering factors like preauthorization, in-network providers, and any potential out-of-pocket costs.
How does the effectiveness of minimally invasive techniques compare to open procedures for treating pelvic conditions?
Minimally invasive techniques offer shorter recovery times, reduced pain, and quicker return to daily activities compared to open procedures for treating pelvic conditions. These techniques, such as laparoscopy, ensure safer surgeries with less risk and improved outcomes for patients undergoing treatment for pelvic conditions.
How long is the healing period following a minimally invasive procedure for pelvic conditions, and when can normal activities be resumed?
Following a minimally invasive procedure for pelvic conditions, the healing period typically ranges from 1-2 weeks. Normal activities can usually be resumed after this time, but more strenuous exercise or heavy lifting may need to wait longer, around 4-6 weeks.
How does conservative surgery preserve fertility?
Conservative surgery for endometriosis can preserve fertility by removing adhesions or scar tissue that may be impacting fertility. It can improve the success of fertility treatments like IVF by addressing factors hindering conception. Additionally, conservative surgery may prevent further progression of endometriosis, supporting future pregnancy chances.
What preoperative assessment is essential?
A preoperative assessment essential for endometriosis surgery includes a pelvic exam, imaging, blood tests, and symptom evaluation by an endometriosis specialist to determine the best course of action for diagnosis and treatment.
How do surgeons prevent adhesion formation?
Surgeons can prevent adhesion formation during endometriosis surgery by using techniques like tissue barriers, meticulous surgical precision, and minimizing tissue trauma. Proper postoperative care, including early mobilization and the use of anti-adhesion agents, also plays a key role in preventing adhesion formation.
Does minimally invasive surgery reduce recovery?
Minimally invasive surgery typically reduces recovery time compared to traditional open surgeries, resulting in shorter hospital stays, less pain, and quicker return to daily activities. This approach offers benefits such as faster healing and lower risk of complications, ultimately enhancing the overall recovery process for patients undergoing surgical procedures.
Are fertility rates improved post-procedure?
Surgery for endometriosis can improve fertility, especially when adhesions or growths affecting fertility are removed. It may also enhance success rates of fertility treatments like IVF. Success varies based on individual factors and the extent of the condition.
What anesthesia is preferred for resection?
For resection, general anesthesia is preferred due to its ability to provide deep sedation and pain control for the duration of the surgery. This ensures the patient remains comfortable and unaware during the procedure, allowing the surgical team to work efficiently and effectively.
Are there long-term impacts on menstruation?
Having endometriosis can lead to long-term impacts on menstruation, including heavy periods, severe pelvic pain, and potential fertility issues. Seeking early diagnosis and treatment from a specialist like Dr. Aliabadi can help manage these long-term effects and improve overall quality of life.
Can surgery address deep infiltrative types?
Surgery can address deep infiltrative types of endometriosis by using advanced minimally invasive techniques to remove scar tissue and endometrial growths, providing relief and potentially improving fertility outcomes. Dr. Aliabadi's expertise allows for precise diagnosis and treatment in one procedure for better patient outcomes.
Which imaging confirms diagnosis pre-surgery?
Imaging, a pelvic exam, blood tests, and symptom evaluation by an endometriosis specialist can confirm a diagnosis pre-surgery. Surgery is typically the definitive diagnostic method, often via laparoscopy, to visualize and diagnose endometriosis with certainty.
Are postoperative hormone treatments effective?
Postoperative hormone treatments can be effective in managing symptoms and preventing the recurrence of endometriosis after surgery. Your doctor can provide guidance on the best hormonal therapy options for your specific situation. It's important to follow your healthcare provider's recommendations for the most effective results.
How is bowel involvement surgically managed?
During laparoscopy, any endometrial tissue affecting the bowel can be removed through cutting, scraping, laser treatment, or electric current usage. Excision, dissecting beneath lesions to healthy tissue, is more effective at preventing recurrence compared to ablation techniques.
What factors influence surgery success rates?
Several factors influence surgery success rates, such as the extent of endometriosis, the type of surgery performed, the woman's age, fertility status, and any underlying health conditions. Personalized treatment plans are crucial for optimal outcomes in endometriosis surgery.
How is urinary tract endometriosis treated?
For urinary tract endometriosis, treatment options may include hormonal therapy to suppress the growth of endometrial tissue, pain medication to manage symptoms, or surgery to remove the affected areas and improve quality of life. Consulting with an endometriosis specialist can help determine the best course of action.
Do surgical outcomes vary by technique?
Surgical outcomes for endometriosis can vary by technique. Excision surgery involves removing endometrial tissue entirely, providing more comprehensive treatment. Ablation may not fully eliminate lesions, leading to potential recurrence and fertility issues in the future. Optimal surgical techniques should be tailored to individual patient needs and desired outcomes.
What post-surgery pain management is standard?
Post-surgery pain management typically includes a combination of prescription pain medications, such as opioids or NSAIDs, along with over-the-counter pain relievers. Non-pharmacological methods like ice packs, elevation, and relaxation techniques are also commonly used to manage pain. Follow your doctor's instructions for the best pain relief plan.
When is medical management insufficient?
Medical management may be insufficient when symptoms are severe, other treatments fail, or infertility is a concern. Surgery for endometriosis may then be recommended to provide effective relief and improve fertility outcomes.
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