Endometriosis is a condition that can range from having a pretty minimal impact on day-to-day life, to causing debilitating pain and being a major problem. It’s also a disease that can be diagnosed at many different points and can have many different treatment options. One thing many women at any stage or level of impact of endometriosis have in common, though, is wondering how to best manage it, and if this course of treatment involves surgery. But Endometriosis is a condition that can range from having a pretty minimal impact on day-to-day life, to causing debilitating pain and being a major problem. It’s also a disease that has many different management and treatment options. One thing many at any stage or level of impact of endometriosis have in common, though, is wondering how to best manage it, and if this course of treatment involves surgery. But does everyone with endometriosis need to have surgery?
Diagnosis
If you’ve worked with a healthcare provider to confirm a diagnosis of endometriosis, there’s a good chance that they will list laparoscopy or other surgery as a potential treatment option. This is especially true if other options have failed or pain or infertility persist.
Laparoscopies, when they’re just exploratory, are minimally invasive surgeries, and generally outpatient procedures. This means a small incision at the belly button lets a thin scope (camera) down into the pelvic area to look for lesions or scar tissue from endometriosis. If extensive disease and scarring is found, additional surgery can be a way forward.
Treatment
There are different possible surgical treatments for endometriosis, and there are also medical treatment options, and your healthcare provider will be able to discuss risks and benefits of all of your options.
- Laparoscopy: if this one sounds familiar, that’s because it is – the same kind of incision, instrument, and operation that’s used to explore your endometriosis can also be used to treat it. In fact, in some cases, initial exploratory surgery can both diagnose and begin treatment for endometriosis, if the surgeon is prepared ahead of time. In a laparoscopic surgery to treat endometriosis, the endometriosis tissue and scar tissue it has caused are removed from the uterus, ovaries, fallopian tubes and other areas of the pelvis and abdomen either by cutting it out, or burning it off (ablation). This isn’t a cure, since the endometriosis can and often does grow back, but it can provide relief from pain and can increase the chances of conceiving unassisted, if that’s a goal. A laparoscopy to remove endometrial tissue is much more invasive than an exploratory laparoscopy and may need a specialty surgeon.
- Hysterectomy and oophorectomy: another surgery sometimes used to treat endometriosis is the removal of the uterus (hysterectomy) and ovaries (oophorectomy), which is usually considered to be the last-resort treatment for cases of endometriosis that cause severe pain or other debilitating symptoms. Hysterectomies and oophorectomies are major surgeries. They are not advised for anyone who wants to preserve their fertility. While the recovery is significant, and the risks important to understand, these surgeries are successful in getting rid of endometriosis in about 85% of cases. Removing the ovaries causes immediate surgical menopause, which has risks of its own when done early in life and requires thorough discussion and management. But leaving the ovaries increases the risk six-fold that endometriosis symptoms will return.
- Hormonal treatment: not every treatment for endometriosis is surgical. Hormonal treatments ranging from a continuous dose of hormonal birth control to a medication that prevents the release of estrogen and causes early menopause can control symptoms and halt the spread of endometriosis in many cases. Not every treatment works for every woman, and it may take some trial and error to find the right one, but many women with endometriosis find some relief from hormonal treatments. Unfortunately, hormonal treatments conflict with trying to conceive. So you’d have to temporarily stop treatment when trying to conceive and through pregnancy. For those who think they might like to try to conceive later on, though, this treatment may be the best option to preserve fertility in the meantime.
Reviewed by the Ovia Health by Labcorp Clinical Team
Sources
- Rizk B, Fischer AS, Lotfy HA, Turki R, Zahed HA, Malik R, Holliday CP, Glass A, Fishel H, Soliman MY, Herrera D. Recurrence of endometriosis after hysterectomy. Facts Views Vis Obgyn. 2014;6(4):219-27. PMID: 25593697; PMCID: PMC4286861.
- “Endometriosis: Frequently Asked Questions.” youngwomenshealth. Boston Children’s Hospital, November 22, 2023 Web.
- Wisely, R. “Is a hysterectomy right for you??” UofMHealth. Health System University of Michigan, August 11, 2023. Web.
- “Endometriosis Surgery.” my.clevelandclinic. The Cleveland Clinic Foundation, Sept. 13, 2022Web.
