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How to Know if an Endo Surgery Is Right for You (Again)

If you are lucky enough to get so far as to receive an endometriosis diagnosis (and studies report that, on average, it takes a woman 12 years to receive a proper diagnosis for this disease), then the nagging question often becomes "Should I get surgery?". And, if one does opt for surgery, "How long will that surgery last?".

I have had these questions on my mind for a year now, given that I had an endo surgery 14 years ago, and symptoms are slowly starting to creep up again.

I reached out to Dr. Kelly Wright, a gynecologist and an assistant professor of obstetrics and gynecology at Cedars-Sinai in Los Angeles, to ask about her thoughts about second surgeries and the ongoing nature of living with endometriosis. Here is what she said.1

How long will surgery last as a cure for endo?

"Surgery is not necessarily a cure. It reduces the disease burden. When someone has a surgery, that takes out all the endometriosis at that time. But going forward, we think we will have better results if someone is able to take some kind of hormonal management."

What do you mean by hormonal management?

"We often recommend using some kind of hormones to regulate periods, in the form of birth control. It could be in pill form. It could sometimes be in other forms, like an IUD or a contraceptive injection. This is all based on limited data. What we do know is that if patients who have chocolate cysts (aka ovarian cysts filled with old blood) are put on birth control, then that reduces the risk of forming those cysts ever again by 50 percent.

I don’t want patients to have periods at all any more in their life. Any time they have periods, it creates inflammation and potential new growth. So, we believe in surgery along with long-term management."

If someone has already had one endo surgery, how do you know when it is time to have another surgery?

"Really, that is the question isn’t it? When and if surgery is needed again. We know how cancer spreads. But we still don’t really understand how endo spreads and implants on the body in places it shouldn’t be, such as the bowel or bladder. It does something very similar to cancer, but we have very little insight in how it spreads. There are limited, small studies on the topic.

As far as knowing when it might be time to consider a second surgery, we really want to go based on someone’s symptoms. If someone had surgery and is good for 10 or even 15 years, but then things start changing, it might be time to consider surgery again. But to do so more frequently than that, and the risks might not be worth it. For example, surgery every 2 years is a ton for the body to go through.

The other thing to consider is that this is a disease that has to be managed from first period through menopause. So, that can be a 40-year timeframe. Doing surgery again and again without results is not a good option."

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