Endometriosis is a painful condition where tissue similar to the lining of the uterus grows outside of the uterus, most commonly on the ovaries, fallopian tubes, and tissue lining the pelvis. This tissue buildup leads to inflammation, pain, and formation of scar tissue. Some symptoms of endometriosis include painful menstrual cramps, chronic lower back and pelvic pain, pain during or after sex, excessive bleeding, infertility, and digestive issues like diarrhea and constipation.
Surgery is often recommended to remove endometriosis tissue and scar tissue. This can help relieve pain and improve fertility in some cases. However, like any surgery, it does carry risks. Understanding the pros and cons of surgery can help you decide if it’s the right option for your individual case of endometriosis.
What are the benefits of endometriosis surgery?
There are several potential benefits of having endometriosis surgery:
Pain relief
The main goal of surgery is to remove as much endometriosis and scar tissue as possible. This can significantly reduce inflammation and pain caused by the buildup of tissue. Studies show around 75% of women experience pain relief after endometriosis surgery. However, the benefits are often temporary, with pain returning within 2-5 years. Additional surgeries may be needed to continue managing pain.
Improved fertility
Surgery provides the best chance for increasing fertility in women with endometriosis, especially when combined with fertility treatments. It may be the only option for women with severe disease blocking their fallopian tubes. After surgery, around 50% of women are eventually able to become pregnant. The sooner it’s performed, the better the results.
Confirm diagnosis
Surgery with biopsy allows doctors to definitively diagnose endometriosis by examining tissue samples. This guides appropriate treatment. Without surgery, endometriosis can often be misdiagnosed.
Halts disease progression
Endometriosis can continue spreading if left untreated. Surgery removes tissue deposits and may slow its growth and spread to other areas in the pelvis.
What are the risks of endometriosis surgery?
While surgery has many potential benefits, it also carries risks:
Surgical complications
All surgeries pose a small risk of bleeding, infection, damage to surrounding organs, adverse reactions to anesthesia, blood clots, or death (about a 0.1% risk of major complications).
Pain returns
Even with successful surgery, endometriosis and associated pain returns in 30-50% of women within 5 years. Further treatment is often needed.
Menopause symptoms
Surgery to remove endometriosis tissue often also involves removing some healthy ovarian tissue. This can trigger menopause in some women, with symptoms like hot flashes, vaginal dryness, and lowered estrogen levels.
Bowel, bladder, or sexual dysfunction
Removing endometriosis lesions near sensitive pelvic structures may cause damage leading to problems like constipation, urinary incontinence, or pain during intercourse. This occurs in about 4% of surgeries.
Scar tissue and adhesions
The surgery itself causes new scar tissue and adhesions to form in the pelvis. This may cause ongoing pelvic pain after surgery.
Repeat surgeries
Due to high pain recurrence rates, multiple surgeries are often needed to continue removing new endometriosis tissue. Each carries additional surgical risks.
What types of endometriosis surgery are available?
There are several surgical options to treat endometriosis, with varying degrees of invasiveness:
Laparoscopy – This minimally invasive keyhole surgery inserts a camera and surgical tools through small abdominal incisions. It allows precise removal of endometriosis tissue with little scarring or recovery time.
Laparotomy – Also called open surgery, the abdomen is opened with one large incision to excise endometriosis. It allows access to severe disease but causes more pain and longer recovery than laparoscopy.
Hysterectomy – Removing the uterus provides a permanent cure but causes irreversible infertility. It’s generally only recommended for severe endometriosis when childbearing is not desired.
Presacral neurectomy – Severing the nerves to the uterus may help central pelvic pain when hormone therapy and conservative surgeries fail. But pain may still recur.
The type of surgery depends on your specific symptoms,plans for pregnancy, extent of disease, and surgeon’s expertise. Most procedures are laparoscopic.
Should I consider alternative treatments first?
Given the risks, surgery may not be your first choice for managing endometriosis pain and fertility issues. Some other options to try first include:
Pain medication – Over-the-counter NSAIDs like ibuprofen or naproxen can help manage pain during periods. For severe pain, opioids may be prescribed but aren’t recommended long-term due to side effects.
Hormonal birth control – Methods like the pill, patch, vaginal ring, or progesterone-only IUD can lighten periods and suppress estrogen production to shrink endometriosis tissue. This may relieve mild symptoms without surgery.
Gonadotropin-releasing hormone (GnRH) agonists – These injections temporarily suppress ovarian function, much like menopause. This starves endometriosis tissue, but symptoms recur after stopping. Risks include menopause symptoms and bone loss.
Progestins – Oral or injected progestin-only hormone medications reduce estrogen levels. They may suppress mild endometriosis when combined with NSAIDs.
Aromatase inhibitors – These estrogen blockers are sometimes prescribed off-label with progestins to combat hormone-sensitive tissue. More research is needed on their efficacy.
Pelvic physical therapy – Specialized PT can relieve muscle tension, soft tissue restriction, and nerve pain contributing to endometriosis pain. Results improve when combined with surgery.
Trying medication and conservative therapies first often allows time to research surgeons and prepare for surgery while managing acute symptoms. If these options fail to provide adequate relief, surgery may be warranted.
How do I choose an endometriosis surgeon?
Choosing an experienced, knowledgeable surgeon is key to getting good surgical results. Here’s how to find one:
– Get a referral to a specialist like an gynecologist or reproductive endocrinologist familiar with endometriosis.
– Look for surgeons who perform many endometriosis operations yearly and have training in minimally invasive techniques.
– Ask about their surgical approach – whether they prefer to cut out tissue or use ablation. Excision is associated with lower pain recurrence rates.
– Inquire about hospital privileges – competent surgeons should operate out of major medical centers.
– Check for membership in endometriosis organizations like the Endometriosis Association or Endometriosis Foundation of America.
– See if they offer a skilled multidisciplinary team including pelvic floor physical therapists, GI specialists, urologists, and fertility experts.
An experienced surgeon can maximize your chances of successful surgery. Don’t hesitate to interview several candidates before deciding.
Conclusion
Endometriosis surgery can offer substantial pain relief and improved fertility when performed by a skilled surgeon. However, it does carry risks of complications, hormone changes, ongoing pain, and repeat procedures. Timing surgery along with trying alternative options like medication or physical therapy allows for an individualized approach accounting for your symptoms, plans for pregnancy, and personal preferences. Most women with endometriosis need a combination of therapies. Discussing your full treatment plan with both your regular doctor and surgeon helps determine your best path forward.