Endometriosis - Surgery

SYMPTOMS & TREATMENTS

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

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 isthe most common procedure used todiagnose and treat endometriosis. If your doctorrecommends a laparoscopy, it will be used to look for and possibly to remove ordestroy 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 offersthe chance of long-term pain relief for women who have no future childbearingplans. But hysterectomy with oophorectomy is a major surgery that has risks ofcomplications from the surgery and anesthesia. After having your ovariesremoved, low-estrogen side effects can be more sudden and severe thanlow-estrogen symptoms at naturalmenopause. And, when you start menopause early, yourrisk of futureosteoporosis increases unless you take measures toprotect your bones. Talk to your doctor about whetherestrogen replacement therapy or nonhormone treatment(bisphosphonates) might be best for you.
Click here to view a Decision Point.Should I have a hysterectomy with oophorectomy to treat endometriosis?
Click here to view a Decision Point.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.5

When laparoscopy may not be needed

Surgery isthe only way to be sure that you have endometriosis. Usually, this can be donewith 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 hormone treatment for suspectedendometriosis. 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.

Author: Sandy Jocoy, RNLast Updated: July 28, 2009
Medical Review: Sarah Marshall, MD - Family Medicine
Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology

1995-2009 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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