One of the most frustrating things to encounter is unexplained menstrual pain, which can also often lead to unexplained infertility.
According to Endowhat.com, endometriosis is tissue similar, but not identical, to the lining of the uterus that is found elsewhere in the body. Endometriosis occurs in at least 7-15% of people assigned female at birth, with some experts believing it could be more like 25%. The reason that these statistics and many others aren’t fully confirmed is that the only way to confirm if someone has endometriosis is through a surgery called laparoscopy.
We spoke with Melissa Montes, MD, Minimally Invasive Gynecologic Surgeon, and Fertility Specialist at the Kofinas Fertility Group, about the surgery, its implications, and what it can potentially do for chronic, unexplained pelvic pain and infertility.
What is a laparoscopy?
A laparoscopy is an abdominal surgery often used to diagnose endometriosis and remove any endometriosis if it is found. The surgery gets its name from the telescope video camera used to look at the abdomen and pelvic organs. Dr. Montes explained that usually, 2-3 incisions are made in the abdomen to place the instruments, and each incision is about 1 cm long.
“The length of the procedure depends on the type of surgery performed,” adds Dr. Montes. “It can last anywhere between 1 hour to 3 hours. Typically, laparoscopy is an outpatient/ambulatory procedure so patients walk out of the OR, can have dinner, and stay in their homes that same night.”
How do you know if you need a laparoscopy for endometriosis?
According to Dr. Montes, those who usually get a laparoscopy are patients who have ovarian endometriotic cysts, have fertility issues that have been narrowed down to potential endometriosis, or have chronic pelvic pain.
The best way to know if you would benefit from the surgery is to go directly to the source.
“Ask [your] doctor if surgery is necessary,” explains Dr. Montes. “It is possible surgery may not be necessary, but if the patient is still interested in surgery, always ask for a second opinion.”
What happens after a laparoscopy?
The answer to this question is two-fold. In the immediate weeks after a laparoscopy, healing is the name of the game. According to Dr. Montes, patients can usually walk out of the hospital on their own on the same day as their surgery. Once home, according to Dr. Montes, you should be able to tolerate a regular diet. Over the coming month, what is restricted is when you should return to work and how much daily exercise you can practice.
Dr. Montes adds:
“I typically tell my patients they may go back to work as early as one week after surgery. Some patients may want two weeks. I feel comfortable with patients walking briskly around a track or walking on a treadmill two weeks after laparoscopy but no core exercises. One month after most laparoscopies I feel comfortable with a patient returning back to normal activity as tolerated including core exercises and weights.”
Once you’ve recovered from the surgery’s immediate toll, the bigger questions rest on when endometriosis may return and what you can do in the meantime.
“As long as a patient is still menstruating every month there is always a chance of new implants developing with every menstrual cycle,” explains Dr. Montes. “However, if a patient gets pregnant within the year after a laparoscopic surgery or is placed on maintenance medications like birth control pills after a laparoscopic procedure to remove endometriosis then it is very slow for endometriosis to return. Without pregnancy or birth control pills a patient may become symptomatic for endometriosis and see regrowth after 2-3 years of her initial surgery. After surgery to remove endometriosis (if pregnancy is not desired) medical management with birth control pills or any medication that can suppress ovarian function like norethindrone can be used to keep endometriosis away until that patient is ready to conceive a pregnancy or cryopreserve her oocytes.”
The journey to a laparoscopy is usually a long one. It’s not uncommon for women to have to advocate for themselves in the process. But, once you’ve booked your surgery, it seems like there is a light at the end of the tunnel.