What is endometriosis?
Endometriosis is a disorder in which 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 the symptoms of endometriosis can often be caused by other conditions. 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 it’s critical to see a doctor with extensive experience treating endometriosis. 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 where the endometriosis lesions are burned to remove them. However, this technique only removes the lesion’s surface and may not altogether 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, is a technique that 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 much quicker recovery than open abdominal surgery patients. Our patients 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?
Compared to a laparotomy (an open abdominal surgery), laparoscopic surgery is considerably safer and carries significantly less risk. The likelihood of complications with laparoscopy is only 0.3% and 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 that 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 and bowel or blood vessels.
Are all laparoscopic surgeries the same?
In short, no. The surgeon’s expertise is crucial not only for accurately diagnosing endometriosis but also for treating it effectively. 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
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. This is possible because of Dr. Aliabadi’s surgical proficiency, decades of experience, and thousands of such surgeries. 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 of or suffering from endometriosis or have questions about it, we encourage you to see your healthcare provider, preferably an expert in the treatment of endometriosis.
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).
Resources:
Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis – PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013143/
If you are suffering from Endometriosis and are considering Endometriosis Surgery, it is very important to discuss any questions or concerns you have with your doctor. That is what we doctors are there for!
We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.
