Endometriosis & Pelvic Pain

No. Many people are treated without surgery. Options include pain relief medicines, hormonal treatments, and monitoring. Hormonal treatments reduce or stop periods, or lower the hormones that fuel endometriosis. Surgery is usually discussed when medicines have not helped enough, cause side effects, or are not suitable. It may also be discussed when there is an ovarian cyst (endometrioma), deep disease involving the bowel, bladder or ureters, or fertility concerns. The right choice depends on your symptoms, examination findings, fertility plans, and preferences.

Your doctor will ask about your symptoms and medical history and may do a pelvic examination. Ultrasound or MRI can often show endometriosis, especially cysts or deeper disease. A normal scan does not rule it out. Keyhole surgery (laparoscopy) is no longer always needed to make the diagnosis, and treatment can sometimes begin based on symptoms and imaging. The tests that are right for you will vary.

It can for some people, but many people with endometriosis conceive naturally or with treatment. Hormonal treatments for pain do not improve fertility and are not suitable if you are trying to conceive. If you want a pregnancy now or in the future, tell your doctor early, because this affects which treatments are suitable.

• Why surgery is being recommended and what you can realistically expect from it. It may reduce pain, but symptoms can return.
• Alternatives, including continuing or changing medicines.
• Possible risks and complications, which your surgeon can explain for your specific procedure.
• How surgery may affect fertility. For example, surgery on ovarian cysts can reduce egg reserve, so ask about this if you plan to conceive.
• What the surgeon plans to do and whether any procedure may need to be extended, for example if bowel, bladder, or ovarian involvement is found. Ask what you are being asked to consent to.
• Whether removal of the womb or ovaries is being considered. This is not a first-line treatment. In someone who has not already reached menopause, removing both ovaries causes surgical menopause.

Follow the instructions from your surgical and anaesthesia teams. Do not stop prescribed medicines, or follow a general fasting schedule from the internet, in place of your own instructions. Tell the team about all medicines, supplements, and allergies, including any blood thinners, diabetes medicines, or herbal products.

• Bring a list of your medicines, allergies, and previous anaesthetic problems to your pre-operative visit.
• If you smoke, stopping before surgery, even for a short time, lowers the risk of breathing and wound problems.
• Do any tests your team asks for (for example blood tests or a pregnancy test). If you have heavy periods or feel unusually tired, mention it, as anaemia is worth treating before surgery.
• Some operations, especially those involving the bowel, need special preparation. Follow the instructions exactly if you are given any.
• Arrange a lift home and someone to stay with you for the first day or two.
• Plan time off work and help with household tasks, children, or other caring duties.
• Prepare at home: loose comfortable clothes, sanitary pads (not tampons), easy-to-prepare food, and your prescribed pain relief.
• On the day, follow the team's instructions on what to wear and what to leave at home.

Many keyhole procedures are day-case, but it depends on the procedure, the anaesthesia, and your recovery. More extensive surgery usually needs a hospital stay. The team should explain the expected plan before surgery.

Symptoms vary by procedure and patient. After keyhole surgery, common and usually temporary effects include:

• Soreness around the incisions and lower abdomen
• Bloating
• Shoulder-tip pain, caused by the gas used during surgery, which usually settles within a few days
• Tiredness
• Light vaginal bleeding or discharge

Your discharge instructions should explain what to expect and how to look after yourself.

• Take pain relief regularly as prescribed rather than waiting for severe pain.
• Walk gently soon after surgery, as advised. Early movement helps recovery and reduces the risk of blood clots.
• Rest when you need to, and increase activity gradually.
• Drink fluids and eat fibre-rich foods unless your surgical team gives you different instructions, particularly after bowel surgery. Constipation is common after surgery and some pain medicines, and straining can be uncomfortable. Ask your team before using laxatives.
• Keep wounds clean and dry as instructed.
• Ask your surgical team before using a heat pack. If they advise that it is suitable, avoid placing it over incisions or directly on the skin.
• Look after your emotional health. Feeling low or anxious after surgery or a long illness is common, and it is fine to ask for support.
• Attend follow-up visits. Ask whether a long-term plan, such as hormonal treatment, is recommended to reduce the chance of symptoms returning. This depends on whether you are trying to conceive.

There is no single timeline suitable for everyone. It depends on your procedure, your job, and how you recover. Ask your team when to return to work, exercise, lifting, intercourse, and driving. Follow their advice about when it is safe to drive. Do not drive while taking medicines that cause drowsiness, or until you can drive comfortably, including making an emergency stop. Check your insurance conditions.

Your clinical team should give you specific warning signs and a contact number. In general, contact them promptly if you have:

• Fever or chills
• Pain that is getting worse or not controlled by your medicines
• Heavy vaginal bleeding, or a foul-smelling discharge
• Redness, swelling, pus, or opening of a wound
• Repeated vomiting, or a swollen, hard abdomen
• Difficulty passing urine, or new bowel or urinary problems

If you have painful swelling of one calf, seek urgent medical assessment.

Seek urgent medical care straight away for chest pain, difficulty breathing, fainting, or severe or rapidly worsening symptoms.