Will I Need Surgery for Endometriosis?

Understanding surgery such as laparoscopy and whether it might be a viable option for your endometriosis.

Medically reviewed in April 2022

Endometriosis is a condition in which tissue that is similar to the tissue that lines the inside of the uterus (this tissue is called "endometrium") grows outside the uterus (this tissue is called "endometriosis"). The most common spots for endometriosis are the ovaries, the fallopian tubes, the bowel, and the areas around the uterus. This endometrium growth can result in pelvic pain, excessive bleeding, and, in some cases, difficulty getting pregnant.

Types of treatment options
Although there is no known cure for endometriosis, there are many treatment options available—from nonsteroidal anti-inflammatory drugs (NSAIDs) to birth control to other types of hormone treatment—that may help reduce symptoms, slow disease progression, and prevent complications.

In some cases, surgery may be recommended. Endometriosis is different for everyone, though. Just as symptoms will vary from person to person, so will treatment options. Some women will require surgery, while others will not.

Surgery as a recommendation
Your healthcare provider might recommend surgery if you have severe endometriosis that’s causing you a lot of pain, and if medication hasn’t helped. Or if you’re having trouble getting pregnant, surgery may be recommended to determine if endometriosis is the cause, as a surgical biopsy is the only definitive way to diagnose endometriosis. In most cases, if endometriosis is diagnosed during surgery, it can be treated at that time as well.

Laparoscopy: a minimally invasive surgical option
One type of surgery used to diagnose and treat endometriosis is laparoscopic surgery. This minimally invasive approach is also known as keyhole surgery because during the surgery, a thin viewing tube (called a laparoscope) is passed through a small incision (like a keyhole) in the abdomen. The laparoscope has a light source and a lens that project a magnified image of the pelvic cavity onto a screen. This way, the surgical team can have a clear view of the organs in the pelvis and any endometriosis present. One or two additional incisions may be made on the lower abdomen to provide more openings for surgical instruments. This laparoscopic approach is less invasive than open surgery, in which a large abdominal incision must be made.

The laparoscopic surgery may involve removing endometriosis growths, adhesions, and/or scar tissue. The type of surgery will depend on a number of different factors, including the location and size of the endometriosis. There is no treatment option that is best, only one that is best for a particular person. Because these procedures involve operating on and around delicate organs, it’s important to have an experienced and qualified surgeon on your healthcare team.

Other types of surgeries
In some cases, more traditional abdominal surgery using a larger incision may be performed to remove widespread endometriosis. And in cases of advanced endometriosis, surgery to remove organs affected or damaged by endometriosis may be necessary. But as with all other treatment options, it depends on your particular situation and requires conversations with your healthcare team.

It’s different for everyone
Remember that no two cases of endometriosis are the same. Working with doctors you feel comfortable with, seeking out a second opinion if necessary, and having a trusted surgeon on your healthcare team can help you feel confident in making informed decisions about your health.

Sources:
Mayo Clinic. "Endometriosis."
UpToDate. "Patient education: Endometriosis (Beyond the Basics)."
Office on Women's Health. "Endometriosis."
Eunice Kennedy Shiver National Institute of Child Health and Human Development. "What are the treatments for endometriosis?"
endometriosis.org. "Surgery."
Brigham Health. "Surgical Treatment of Endometriosis: Excision and Destruction."
NHS. Overview: Laproscopy (keyhole surgery)."
HealthLinkBC. "Laparoscopic Surgery for Endometriosis."
Johns Hopkins Medicine. "Endometriosis."

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