Understanding Endometriosis Surgery: When is it Recommended?

Endometriosis surgery isn’t a one-size-fits-all solution, it can serve different purposes depending on the individual and the severity of the condition.

For some, surgery is used to confirm a diagnosis through a closer look inside the body, while for others, it's a way to remove or reduce endometrial tissue to relieve pain or improve fertility. Understanding the types of procedures available, and when they’re typically recommended, can help you make more informed decisions about your care and feel more in control of your treatment journey.

Types of Surgery for Endometriosis

There are mainly two surgical approaches: laparoscopy and laparotomy.

Laparoscopy (Keyhole Surgery)

The most common type of surgery for endometriosis is laparoscopy, also known as keyhole surgery. It’s a minimally invasive procedure done under general anaesthetic, where the surgeon makes small cuts in your abdomen and inserts a tiny camera to look inside.

Laparoscopy is often used to diagnose endometriosis by directly seeing the endometrial tissue, but it can also be used to treat it during the same procedure by removing or destroying the problem areas. Because the incisions are small, recovery tends to be quicker and less painful compared to traditional surgery.

Laparotomy (Open Surgery)

In more complex or severe cases, doctors may recommend a laparotomy, which is open surgery involving a larger abdominal incision. This type of surgery is typically reserved for situations where endometriosis is extensive, deeply embedded, or affecting multiple organs. Unlike laparoscopy, laparotomy is generally used for treatment rather than diagnosis and usually involves a longer hospital stay and recovery period.

When Do Doctors Recommend Surgery?

Surgery isn’t usually the first option for managing endometriosis, but it may be recommended if your symptoms aren’t improving with medication or other treatments. In some cases, your doctor might suggest surgery to diagnose endometriosis, particularly if scans haven’t provided clear answers but your symptoms strongly suggest it.

Laparoscopy allows doctors to see and possibly confirm the presence of endometrial tissue. Surgery may also be recommended to treat endometriosis symptoms if:

• Your pain isn’t getting better with medication.

• You're experiencing fertility issues.

• You have cysts (known as endometriomas) that need removing.

• There's severe scarring or tissue blocking your organs.

Read More: Understanding Excision and Ablation Surgery for Endometriosis

Benefits of Surgery: Is It Worth It?

For many women, surgery can bring real, noticeable relief from the frustrating symptoms of endometriosis.

By physically removing or destroying the patches of endometrial-like tissue growing outside the womb, surgery can reduce inflammation, ease pressure on surrounding organs, and break down scar tissue that might be causing pain or interfering with fertility. This often leads to less pelvic pain, lighter periods, and in some cases, a better chance of getting pregnant.

Read More: Endometriosis Pain vs. Period Cramps: How to Tell the Difference

Surgery can also help improve your quality of life, making everyday activities more manageable, restoring energy, and reducing the mental strain that often comes with chronic pain. For those trying to conceive, removing endometrial growths around the ovaries or fallopian tubes can sometimes clear the way for natural conception.

That said, it’s important to understand that surgery isn’t a cure. Endometriosis can come back, especially if any tissue remains or if hormones continue to stimulate its growth. Some women may need more than one surgery over time, or may still need medical treatments afterwards to help keep symptoms in check.

So while surgery can be incredibly helpful, the results vary from person to person, and it’s usually part of a broader, long-term management plan rather than a one-time fix.

What to Expect After Surgery

After laparoscopy, it’s normal to feel sore, tired, and a bit uncomfortable for about a week or two. Because the procedure involves small incisions, the pain tends to be milder, but you might still notice some tenderness around the entry points and a feeling of bloating or mild cramping as your body adjusts.

Some women also experience shoulder pain, which happens because of the gas used to inflate the abdomen during surgery—it usually fades within a day or two. Recovery is generally quicker with laparoscopy, but it’s still important to take things slow and listen to your body.

If you’ve had a laparotomy, the recovery process is longer and can be more challenging. Since this surgery involves a larger incision, you may experience more pain, swelling, and fatigue for several weeks. Your doctor will likely advise you to avoid heavy lifting, strenuous activity, and intense exercise until your body has had a chance to fully heal.

During this time, gentle movement like short, slow walks can be surprisingly helpful—it encourages blood flow, reduces the risk of blood clots, and can even ease some of the stiffness and discomfort.

In both cases, wearing loose, comfortable clothing is a small but valuable way to reduce irritation around your incisions and help you feel more at ease. Plenty of rest is essential too—your body is working hard to repair itself, and pushing too hard too soon can slow down the healing process or cause setbacks.

Don’t feel pressured to jump back into your usual routine right away; recovery is a gradual journey, and giving yourself the time and space to heal will pay off in the long run. If any unusual symptoms like heavy bleeding, fever, or intense pain occur, it’s important to contact your healthcare provider promptly.

Further Reading: Coping with Hot Flashes and Hidden Symptoms of Endometriosis

Emotional Considerations: You’re Not Alone

Going through surgery can feel overwhelming or stressful, especially when dealing with chronic pain and fertility concerns. It's totally normal to feel emotional about the process. Connecting with support groups or chatting to someone who’s been through it can really help. 

Remember, talking openly with your doctor about your worries or questions can ease your mind significantly. They’re there to help you through each step.

Alternatives and Complementary Treatments

Surgery isn’t the only way to handle endometriosis. Your doctor might also suggest:

• Pain medications or hormonal treatments (like contraceptives or hormone therapy).

• Physical therapies (such as physiotherapy to ease pelvic pain).

• Lifestyle changes (like diet adjustments or gentle exercise).

Deciding if Surgery is Right for You

Choosing whether or not to have surgery can feel like a big decision. Take your time, weigh up the pros and cons, and talk it through with people you trust. Ask your medical team plenty of questions, no query is too small or silly.

Surgery as Part of Your Journey

Endometriosis surgery isn’t the end of the road, it’s often a step along your journey. Whether it’s a turning point towards better health or simply part of managing your condition, knowing what's involved makes it less intimidating.

Take comfort knowing you’re informed and prepared. Endometriosis might feel isolating at times, but you're not alone on this path. Support and treatments are available to help you live your life comfortably, surgery or not.