Posted on May 4th, 2020by Dr. Leigh Rosenin Women's Health

Considering Surgery for Endometriosis? Here’s What You Should Know

Endometriosis is a disease that impact 90 million women worldwide. It is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside of the uterus. It impacts 6-10% of reproductive age women and roughly 40% of women who suffer from infertility. Women with endometriosis often experience pelvic pain, heavy menses, painful intercourse, and infertility.

Treatment is generally a combination of medical therapy and surgical therapy. The goal of medical therapy is to prevent estrogen stimulating the growth of endometriotic implants. The implants respond to estrogen and can grow and bleed during menstruation. The nearby structures can become inflamed, irritated, and scarred. Surgery can be diagnostic and therapeutic; it can relieve pain and might improve fertility.

Surgery is generally performed by utilizing a minimally invasive approach: laparoscopic or robotic. The goal of surgical intervention is to remove the areas of endometriosis. Endometriosis can be found in the peritoneum, the ovaries, the fallopian tubes, outer surfaces of the uterus, bladder, ureters, intestines, rectum and cul de sac (the space behind the uterus). If an endometriosis cyst (endometrioma) is present, the general recommendation may be to surgically excise the cyst.

Multiple randomized control trials have demonstrated that surgical treatment of endometriosis leads to significant improvement in symptoms. It is important to note however that this improvement in symptoms is often short lived as the pain sometimes can recur and require subsequent surgeries. In general, the younger a woman is when she undergoes surgery for endometriosis, the more likely she is to need another operation later in life.

Some studies have shown an improvement in pregnancy rates for women with early stage endometriosis-related infertility, however, the magnitude of this improvement is not clear. The risks of surgical intervention for endometriosis include but are not limited to: bleeding, infection, and damage to surrounding organs. The more advanced the endometriosis and the higher number of surgical procedures, the greater the risk of surgical complications.

It is recommended that post surgery medical suppressive therapy (i.e. birth control pills) is utilized to help extend a pain free interval post procedure.

Some women who cannot find relief after treatment will opt to undergo a hysterectomy (removal of the uterus) and possibly the ovaries as a last resort option.

It is imperative to seek care from a provider with experience in endometriosisso that the treatment plan can be not only optimal but also individualized.

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