Endometriosis

Surgery

Although surgery does not cure endometriosis, it does offer short-term results for most women and long-term relief for a few.

• Pain. Removing endometriosis growths (implants) and scar tissue relieves pain for most women. Between 70% and 100% of women report pain relief in the first months after surgery.¹ However, about 45% of women have symptoms that return within the first year after surgery.¹⁰ This number increases over time.¹
• Infertility. Removing moderate to severe endometriosis may improve your chances for pregnancy.¹⁵
• Removing the uterus and ovaries (hysterectomy and oophorectomy) is considered a last-resort measure to relieve endometriosis pain. But pain does return for up to 15% of women.¹⁰ You cannot ever become pregnant after this surgery.

Surgery is generally recommended for endometriosis when:

• Treatment with hormone therapy has not controlled symptoms, and symptoms interfere with daily living.
• Endometrial implants or scar tissue (adhesions) interferes with the functions of other abdominal organs.
• Endometriosis causes infertility.

Surgery Choices

• Laparoscopy is the most common procedure used to diagnose and treat endometriosis. If your doctor recommends a laparoscopy, it will be used to look for and possibly to remove or destroy implants and scar tissue. During the same procedure, the doctor can:
  • Examine the internal organs for signs of endometriosis and other possible problems. This is the only way that endometriosis can be diagnosed with certainty. But a "no endometriosis" diagnosis is never certain—growths (implants) can be tiny or hidden from the surgeon's view.
  • Remove any visible endometriosis implants and scar tissue that may be causing pain or infertility. A surgeon uses one or more techniques, including cutting and removing the growths (excision) or destroying them with a laser beam or an electric current (electrocautery). If the doctor finds an endometriosis cyst on an ovary (endometrioma), he or she will likely remove the cyst.
• Hysterectomy with oophorectomy offers the chance of long-term pain relief for women who have no future childbearing plans. But hysterectomy with oophorectomy is a major surgery that has risks of complications from the surgery and anesthesia. After having your ovaries removed, low-estrogen side effects can be more sudden and severe than low-estrogen symptoms at natural menopause. And, when you start menopause early, your risk of future osteoporosis increases unless you take measures to protect your bones. Talk to your health professional about whether estrogen replacement therapy or nonhormonal treatment (bisphosphonates) might be best for you.

Should I have a hysterectomy with oophorectomy to treat endometriosis?

Should I use estrogen replacement therapy after having a hysterectomy or oophorectomy?

What To Think About

Women who do not become pregnant after surgery can consider trying fertility drugs with insemination or in vitro fertilization. For more information, see the topic Fertility Problems.

Some studies suggest that using hormone therapy after surgery can make the pain-free period longer by preventing the growth of new or returning endometriosis.⁷

When laparoscopy may not be needed

Surgery is the only way to be sure that you have endometriosis. Usually, this can be done with a tiny viewing instrument that is inserted through a small incision (laparoscopy). But laparoscopy is not always needed. Doctors commonly try anti-inflammatory and/or hormonal treatment for suspected endometriosis. If this works, endometriosis is a more likely diagnosis.

Endometriosis symptoms will stop naturally after you reach menopause. If you are nearing age 50, controlling symptoms with home treatment and hormone therapy until you reach menopause may be a more reasonable choice for you than surgery. But if scar tissue is causing pain, hormone therapy will not be effective.

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Author:	Kathe Gallagher, MSW Ralph Poore Monica Rhodes	Last Updated: August 1, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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