The pain caused by endometriosis can have a significant effect on your quality of life. This can be especially frustrating if medications don’t appear to be helping.
For some people with endometriosis, surgery may be an option. 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.
Endometriosis is a chronic, noncancerous condition where cells that resemble the uterus lining, called endometrial cells, grow outside the uterus. The endometrium-like tissue appears in areas like the ovaries, abdomen, and bowel.
This 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.
When it comes to treating your endometriosis, your doctor might recommend surgery if:
- You have severe pain: Because the endometrium is growing where it doesn’t belong, endometriosis can impact surrounding tissues, leading to pain and inflammation. Sometimes pain can be severe and significantly interfere with your daily activities.
- Medications haven’t helped: Hormone therapy and pain medications can often help to relieve symptoms in some stages of endometriosis. However, some stages of endometriosis don’t respond well to medications.
- You’ve been trying to get pregnant: Endometriosis can cause damage to sperm and eggs. In severe cases, scar tissue from endometriosis can block the fallopian tubes. This can make it harder for someone with endometriosis to conceive.
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.
Doctors use two main treatments for endometriosis: medicine and surgery. Your doctor will first try to treat your endometriosis with medications.
For someone with mild symptoms, pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) are enough to control symptoms of pain, but won’t slow the growth of cells.
For others, birth control pills or gonadotropin-releasing hormone agonists can prevent endometrium-like tissue from growing outside the uterus.
Surgery usually isn’t a first response, unless symptoms merit it. When surgery is recommended, doctors perform three main types of surgery to treat endometriosis. We’ll examine each of these in more detail below.
Prior to your surgery, your doctor will give you specific guidelines about when to stop eating and drinking. You may also need to stop taking some types of medication.
Be sure to follow your doctor’s guidelines carefully so that your procedure can proceed as scheduled.
Laparoscopy surgery for endometriosis
Laparoscopy is a type of minimally-invasive surgery. It uses a small, slender camera called a laparoscope and only requires small incisions to see into the abdomen.
Laparoscopy is performed under general anesthesia. That means that you’ll be asleep while the procedure is being performed and won’t feel anything.
During laparoscopy, the following things will happen:
- 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 laparoscope 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 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 the above organs.
- Lastly, the surgeon will close up your incisions.
You should be able to go home on the same day as your surgery.
Laparotomy surgery for endometriosis
Laparotomy is also called open surgery. This is considered a major abdominal surgery and uses larger incisions than laparoscopy.
As with laparoscopy, laparotomy is done under general anesthesia, meaning that you’ll be asleep and won’t feel pain during your surgery.
Using a laparotomy for endometriosis is rare. However, it’s possible that it may be used when endometriosis is extensive or your doctor needs to remove patches of endometriosis that can’t be seen well using laparoscopy.
During laparotomy, the following things will happen:
- The surgeon will make an incision in your lower abdomen.
- The surgeon will use surgical tools to remove endometrial or scar tissue from organs such as ovaries, bladder, fallopian tubes, and rectum.
- At the end of the procedure the surgeon will close up your incision.
Because of the more intensive nature of the surgery, the recovery time for a laparotomy is longer than that of a laparoscopy. It’s also likely that you’ll need to stay in the hospital overnight after your surgery has been completed.
Hysterectomy for endometriosis
Hysterectomy is a procedure that can be used to treat more severe endometriosis when preserving fertility isn’t an issue.
In contrast to conservative surgery, the surgeon will remove your uterus, and possibly your cervix, ovaries (oophorectomy), and fallopian tubes (salpingectomy).
If you have this surgery, you’ll no longer be able to carry a pregnancy yourself. But if your ovaries are preserved, the eggs could still be used with a gestational carrier.
It’s important to discuss your surgical options carefully with your doctor before deciding to have a hysterectomy.
Hysterectomy surgery can be done in a few different ways:
- Laparoscopic: In this minimally-invasive surgery, the surgeon makes a few small incisions in your abdomen. Your uterus and possibly your cervix and ovaries are removed through these incisions. This procedure can sometimes use robotic surgery, assisted by computer-assisted technologies.
- By laparotomy: Also called an abdominal hysterectomy, the surgeon makes an incision in your lower abdomen and removes your uterus and other reproductive organs through this incision.
- Vaginally: The surgeon removes your uterus and cervix through a small cut in your vagina. There isn’t an abdominal incision. If you have a large uterus or scarring from a previous surgery, you may not be able to have a vaginal hysterectomy.
It’s possible that you might be able to go home on the same day as a vaginal or laparoscopic hysterectomy. However, an abdominal hysterectomy typically requires an overnight hospital stay.
Now, let’s go over what you can expect following a surgery for endometriosis:
How long will my recovery take?
You’ll recover faster after laparoscopic surgery than after a laparotomy. Regardless of the type of procedure you’ve had, your activities will be limited for the first couple of days or weeks after your procedure.
You may feel well recovered following a laparoscopy (without hysterectomy) in 1 to 2 days but may need more time before resuming normal activities.
Meanwhile, recovery from a laparoscopic or vaginal hysterectomy can take 3 to 4 weeks. A full recovery from an abdominal hysterectomy can take 4 to 6 weeks.
It’s very important to talk with your doctor about when you can go back to activities such as driving, working, and exercising. Carefully following their directions can help to promote a smooth recovery.
What might I feel after recovery?
Pain or discomfort is common following any surgery. Your doctor will prescribe you medications to help manage this in the days after your procedure.
Additionally, your doctor may prescribe hormone medications to help prevent endometriosis pain from recurring in the future.
After a laparoscopic procedure, you may have shoulder or back pain. This is caused by gas trapped in your belly. The pain should go away within a few hours or days.
After a hysterectomy
Once you’ve had a hysterectomy, you’ll no longer get a period.
If you had your ovaries removed, you might begin menopause if you don’t start hormone replacement therapy. This means you may experience the effects of menopause, like hot flashes, vaginal dryness, and bone density loss.
It’s also not uncommon for some who’ve had a hysterectomy to feel depressed or have a sense of loss at not being able to have children.
It’s important to talk to your doctor about how to manage the physical and emotional symptoms that can follow a hysterectomy.
The exact cost of endometriosis surgery can depend on many different factors, including:
- your insurance
- the specific type of procedure that you’re having
- the surgeon performing the surgery
- the facility where the surgery is being done
- your geographical location
Generally speaking, a more invasive type of surgery, such as an abdominal hysterectomy, will be more expensive than a laparoscopy.
One European study from 2012 found that the average cost of endometriosis surgery in general was 899.3 Euros (a little over $1,000) across 10 countries.
Most insurance companies will cover surgeries if they’re considered medically necessary to diagnose or treat a condition. If you’re unsure if your insurance will cover endometriosis surgery, contact them before scheduling your procedure.
Most types of surgery for endometriosis use some kind of incision. Because of this, you may have concerns about scarring.
Because the incisions are smaller, you have a lower risk of noticeable scarring after having a laparoscopic procedure. Laparotomy uses larger incisions that can potentially lead to a noticeable presence of scars.
In many cases, a scar from an incision will fade or flatten over time. This process may take a period of months to years, depending on the size and location of the incision.
Aftercare of your incision following your surgery is also very important in minimizing scarring. Because of this, always follow the instructions that your surgeon provides detailing proper wound care.
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
- not being able to empty your bladder
There’s currently no cure for endometriosis, though a hysterectomy with oophorectomy (removal of the ovaries) is
However, surgery can help to relieve pain, and laparoscopic surgery can potentially help you get pregnant.
If any endometrium-like tissue is left in your abdomen, you may still have symptoms. Remaining tissue can grow, and it’s impossible to remove every cell of misplaced tissue.
Endometriosis can also come back after surgery. ACOG estimates that endometriosis symptoms like pain return in 40 to 80 percent of people within 2 years of surgery.
Your likelihood of having a recurrence depends on the severity of your endometriosis and whether your surgeon is able to remove most of the endometrium-like tissue during the procedure.
Having both ovaries removed may help with long-term relief. This is because it lowers the levels of the hormone that the tissue is responding to.
However, once the ovaries are removed, you’ll be in menopause, and that is likely to lead to menopausal symptoms unless treated with hormone replacement therapy.
Weigh these pros and cons when making your decision to have surgery for endometriosis.