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 does every woman with endometriosis have to have surgery?
If a healthcare provider suspects that your pelvic pain or fertility problems might be caused by endometriosis, there’s a good chance that they will eventually recommend a laparoscopy to confirm the diagnosis. There are preliminary procedures like magnetic resonance imaging (MRI) that can help rule out other conditions, but the only way to confirm an endometriosis diagnosis is for a doctor to get in there and look around using a laparoscopy.
Laparoscopies, when they’re just exploratory, are minimally invasive surgeries, and generally outpatient procedures. A small incision at the belly button lets a thin scope down into the pelvic area through the abdominal cavity to look for lesions or scar tissue from endometriosis. If a doctor thinks it’s likely that you have endometriosis, there’s a good chance this surgery will be recommended as a way to confirm the diagnosis and determine the right course of treatment.
While surgery is the definitive way to diagnose endometriosis, it’s not the only way to treat it. There are two different possible surgical treatments for endometriosis, and there are also medical treatment options, and your healthcare provider will be able to discuss which method or combination of methods will be the right course of treatment for your particular case.
- Laparoscopy: if this one sounds familiar, that’s because it is – the same kind of incision, instrument, and operation that’s used to diagnose endometriosis can also be used to treat it. In fact, in some cases, this surgery can both diagnose and begin treatment for endometriosis, if the surgeon is prepared ahead of time, and the endometriosis diagnosis is confirmed. In a laparoscopic surgery to treat endometriosis, the endometriosis tissue and lesions are removed from the uterus and pelvic area physically. 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 naturally. A laparoscopy to remove endometrial tissue is significantly more invasive than an exploratory laparoscopy.
- Hysterectomy and oophorectomy: the other 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, and only in women who aren’t planning on getting pregnant. Hysterectomies and oophorectomies are very invasive surgeries with serious potential complications, and they can take some time to recover from, but they’re successful for getting rid of endometriosis in about 85% of cases. Endometriosis only usually ends with menopause, but by removing the uterus and ovaries, the hormonal changes that happen during menopause can be set into motion early. However, since it turns what’s generally a more gradual process of menopause into something that happens all at once, it can cause more severe menopause symptoms.
- Hormonal treatment: not every treatment for endometriosis is surgical, however. Hormonal treatments ranging from a continuous dose of hormonal birth control to a medication that induces a synthetic 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 aren’t compatible with trying to conceive. For women 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.
“Endometriosis: Frequently Asked Questions.” youngwomenshealth. Boston Children’s Hospital, August 1 2014. Web.
“Endometriosis: Should I Have a Hysterectomy and Oophorectomy?” UofMHealth. Health System University of Michigan, February 20 2015. Web.
- “Surgical Treatment for Endometriosis.” my.clevelandclinic. The Cleveland Clinic Foundation, 1995-2014. Web.