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 it’s the right decision for you.

Endometriosis is a chronic, noncancerous condition where cells that resemble the uterus lining, called endometrial cells, grow outside the uterus. The endometrial-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.

Surgery is necessary to confirm an endometriosis diagnosis. Your doctor might recommend surgery if:

  • You have severe pain. Because endometrial-like tissue grows where it doesn’t belong, endometriosis can impact surrounding tissues. This leads 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 eggs and sperm. 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.

Here are some answers to questions you may have about surgery for endometriosis.

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) can be enough to control symptoms of pain. But these medications won’t slow the growth of cells.

For others, birth control pills or gonadotropin-releasing hormone agonists can prevent endometrial-like tissue from growing outside the uterus.

When surgery is recommended, doctors perform two main types 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 pain.

The surgeon may use one of the following surgical techniques to remove endometrial-like tissue:

  • Excision. During an excision, the tissue is cut out.
  • Ablation. During an ablation, the tissue is destroyed using freezing, heating, electricity, or laser beams.

During laparoscopy, the following things will happen:

  1. Your belly will be filled with gas to help the surgeon see inside your abdomen.
  2. 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.
  3. The surgeon will 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.
  4. The surgeon will also remove any scar tissue in the above organs.
  5. 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 a laparotomy, the following things will happen:

  1. The surgeon will make an incision in your lower abdomen.
  2. The surgeon will use surgical tools to remove endometrial or scar tissue from organs, such as ovaries, bladder, fallopian tubes, and rectum.
  3. 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.

Now, let’s go over what you can expect following 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.

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.

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 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 (about $1,000) across 10 countries.

According to another study from 2016, the average cost of laparoscopy in the United States as of 2013 was about $21,268.

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:

  • bleeding
  • infection
  • damage to nearby nerves and blood vessels
  • an abnormal connection between two organs in the abdomen (fistula)

Talk with 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’s severe or that gets more intense
  • fainting
  • not being able to empty your bladder

Surgery’s effect on fertility

According to the American College of Obstetricians and Gynecologists (ACOG), approximately 40 percent of people with infertility also have endometriosis.

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.

There’s currently no cure for endometriosis. However, surgery can help to relieve pain, and laparoscopic surgery can potentially help you get pregnant.

If any endometrial-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 up 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 endometrial-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. Studies show a lower rate of recurrence when all endometrial-like tissue is removed during a hysterectomy.

However, your healthcare professional will likely not remove your ovaries if possible because they’re important for your overall health.

Once the ovaries are removed, you’ll be in menopause, and that’s 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.