Endometriosis surgery is often performed to diagnose as well as treat the condition. That said, while a diagnosis can be confirmed by the presence of endometrial-like tissue found outside of the womb during surgery, full relief from endometriosis symptoms is not always guaranteed after surgery.
In this article, we discuss why endometriosis surgery is performed, the procedures used, what you can expect during recovery, and the alternative options available for managing endometriosis.
What Is Endometriosis Surgery?
With endometriosis, tissue that is similar to the endometrial lining that usually grows inside the womb is found growing outside the womb, typically on pelvic organs like the ovaries, fallopian tubes, bowel, or rectum. Sometimes it also grows in the abdomen.
This endometrium-like tissue can form on the ovaries, scar tissue on the fallopian tubes, and adhesions that bind organs together that would otherwise remain separate.
For many women, the pain and discomfort that ensues from this abnormal tissue growth can be so severe that it becomes life-altering and psychologically distressing. Endometriosis surgery is performed, first to diagnose the condition, and also to remove the unwanted tissue in an effort to relieve the pain and additional symptoms.
Types of Endometriosis Surgery
There are two initial approaches to endometriosis surgery, a laparoscopy and a laparotomy. If either is unsuccessful in alleviating symptoms, a hysterectomy may be performed as a last resort.
Laparoscopy
As far as endometriosis surgery is concerned, a laparoscopy, or keyhole surgery, is the least invasive. It is currently the only way of successfully diagnosing endometriosis and it is also commonly used to treat mild to moderate cases of endometriosis. The procedure involves a surgeon making two (or more) small incisions in the abdomen under general anesthesia.
A tiny tube with a camera is inserted through one incision to locate endometrial-like tissue growing outside of the uterus. The other incision(s) is used to insert surgical tools that can remove the tissue for testing and to alleviate endometriosis symptoms.
Laparotomy
A laparotomy is more invasive than a laparoscopy and involves the surgeon making a large incision across the abdomen under general anesthesia. Although laparotomies are not performed as often as laparoscopies, they can be required if symptoms are severe, if a patient doesn’t meet the requirements for a laparoscopy, or if there is too much endometrial-like tissue to be successfully removed with keyhole surgery.
Hysterectomy
Even though a laparoscopy and laparotomy can remove abnormally growing endometrial tissue outside of the uterus, in many cases it can grow back and women suffer the symptoms of endometriosis again. In these cases, or if a woman is nearing the end of the reproductive stage of life, a hysterectomy for endometriosis can be performed.
A hysterectomy is a surgical procedure to remove the uterus and, in some cases, the ovaries and fallopian tubes to cease the production of estrogen and the growth of endometrial tissue.
When Is Endometriosis Surgery Recommended?
Unfortunately, many women suffer from endometriosis for a long time before undergoing surgery to diagnose the condition and remove the abnormally growing tissue. This is typically due to women not seeking help, their symptoms being misdiagnosed, or the reluctance to undergo surgery as a means of diagnosis.
Endometriosis surgery is performed:
- When the pain of cysts, scar tissue, or adhesions is severe enough to adversely impact a person’s quality of life
- If medication and/or hormone therapy has not relieved symptoms
- When women prefer to avoid the risks of hormone therapy and ongoing pain medication
- When women find it difficult to become pregnant due to the side effects of endometriosis. In some cases, ovarian cysts prevent the release of eggs and scar tissue can completely block the fallopian tubes.
Recovering From Endometriosis Surgery
After a laparoscopy, patients are usually free to go home on the same day. That said, patients typically feel tender and tired for a few more days and are normally advised to rest for up to a week.
The incisions are usually healed enough for most patients to return to their normal activities like exercise and driving after two weeks, however, it can take longer for some. It is advised that women refrain from intercourse for two-four weeks after a laparoscopy to avoid infections.
Following a laparotomy, patients are required to stay in the hospital for several days so their vitals and wounds can be monitored. Pain medication and fluids are typically given intravenously and small walks are encouraged to prevent blood clots.
Once released, patients are advised to rest and recover for 3-6 weeks before returning to certain activities. They would typically return to their surgeon for a final check-up before resuming exercise, driving, or intercourse.
Recovering from a hysterectomy for endometriosis will depend on whether the patient undergoes a partial, total, or radical hysterectomy. Moderate pain, vaginal bleeding, and discharge can occur for up to six weeks, and constipation and urinary discomfort can also be expected.
Hormonal changes will typically affect women’s moods and a sense of loss is experienced by many women after a hysterectomy. Patients usually resume driving after 2-4 weeks depending on the type of hysterectomy. And Exercise & intercourse can usually recommence after the 6-week check-up.
Does Endometriosis Surgery Improve Pain?
As many as 80% of women who undergo endometriosis surgery like laparoscopy or laparotomy experience significant relief. Unfortunately, as many as 40% of those are reported to suffer recurring pain within five years due to the regrowth of endometrial-like tissue outside of the uterus.
It has also been found that 20% of women who undergo endometriosis surgery do not respond and continue to suffer from pain and additional symptoms straight after surgery.
Why Does Endometriosis Return After Surgery?
The return of pain and additional symptoms after endometriosis surgery like laparoscopy or laparotomy can be driven by how severe the condition was before surgery. It can also depend on whether the surgeon was able to remove all endometrial-like tissue outside of the uterus. In other words, the condition is capable of progressing if all tissue was not removed or returning despite all the tissue being removed.
Specialists in the field also believe that hormone therapy after surgery to suppress the production of estrogen, which stimulates the growth of endometrial tissue, can influence the alleviation of symptoms.
Can Endometriosis Surgery Improve Fertility?
Endometriosis surgery is known to improve fertility and women’s chances of becoming pregnant, but only within a certain timeframe. This process is complex and often requires different physicians and pelvic physical therapists working together to address all aspects of conception.
Alternative Options to Endometriosis Surgery
Options for alternatives will differ based on medical history, a person’s unique goals, and depending on whether a woman is hoping to get pregnant or not.
Hormone Therapy
The main difference is hormone therapy. For women with endometriosis who are not trying to get pregnant, hormone therapy in the form of birth control pills, patches, or IUDs can be prescribed to regulate the menstrual cycle and suppress the production of estrogen. By regulating hormone fluctuations, the pain associated with endometriosis often reduces.
Although women who are hoping to conceive naturally will not want to suppress their estrogen levels, they can find guidance from a fertility expert with regard to hormone therapy that could help relieve their endometriosis symptoms without altering their chances of getting pregnant.
In addition to hormone therapy, a combination of treatments is advised for all endometriosis patients to reduce pain, improve pelvic dysfunction, and alleviate discomfort during intercourse. For example:
Pelvic Health Physical Therapy
Seeking the guidance of a pelvic health physical therapist can be especially helpful when dealing with endometriosis, for example. In addition to performing supportive physical therapy in their clinic to improve pelvic health, they will also prescribe stretches and therapy that can be carried out in the privacy of your own home.
Deep breathing exercises and gentle yoga stretches to relax tension in the body as well as the pelvic area can be surprisingly soothing in a somatic way for endometriosis patients. Physical therapists can also prescribe the use of pelvic wands and dilators to alleviate pelvic pain and other symptoms of endometriosis.
Pelvic Wands for Massage
Pelvic wands, particularly those made from smooth medical-grade silicone, can help women with endometriosis to massage deep pelvic trigger points and tender spots, as well as relax scar tissue and alleviate the tension of adhesions.
Dilators for Better Intercourse
Endometriosis can also result in pelvic muscle dysfunction, which can result in pain or discomfort during sex, and often leads to women refraining from sex. For relief, a set of vaginal dilators in incrementally increasing sizes have proven incredibly helpful.
As well as relaxing tight pelvic muscles, dilators gently stretch the vaginal tissues and improve natural lubrication for more pleasurable intercourse. The smallest size (about the size of a female pinkie finger) is where most women start and progress through the set (to the average size of a penis) over the course of weeks or months, depending on the severity of their condition.
Pain Management
Over-the-counter pain medication, warm baths, and heat packs on the pelvic area are also helpful in relieving pain, especially during ovulation and menstruation.
Support Groups
The digital age has brought about a wealth of online support groups for women with endometriosis. These communities provide a space for individuals to share experiences, seek advice, offer guidance, and find solace in knowing they are not alone.
Conclusion
For some women with endometriosis, surgery can be a viable option. That said, it can be difficult to know if pain will be reduced or if fertility will improve after endometriosis surgery. Aside from surgery, alternative treatment options like physical therapy, pelvic wand massage, and dilation therapy can provide relief from endometriosis.
If you are experiencing symptoms associated with endometriosis, or a female in your family suffers from it, schedule a consultation with your healthcare provider for evaluation and treatment options.
References
Web MD - What Is Laparoscopic Surgery for Endometriosis? - https://www.webmd.com/women/endometriosis/laparoscopic-surgery
Endometriosis News - Laparotomy - https://endometriosisnews.com/laparotomy/
Endometriosis.net - Getting Back On Your Feet After a Hysterectomy - https://endometriosis.net/clinical/recovery-hysterectomy
National Library of Medicine - When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis - https://pubmed.ncbi.nlm.nih.gov/31676397/
Reproductive Facts – Endometriosis and Fertility: Can Surgery Help? - https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/endometriosis-and-infertility-can-surgery-help/
Endometriosis.net - Recurrence of Endometriosis - https://endometriosis.net/clinical/recurrence
International Journal of Gynecology and Obstetrics - Pregnancy after laparoscopic surgery for endometriosis: How long should we wait? A retrospective study involving a long-term follow up at a university endometriosis center - https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.14849