Recovery after endometriosis surgery: what to expect

Recovery after endometriosis surgery depends on what was removed. After a laparoscopy (a keyhole operation) for superficial endometriosis, most women go home the same day or the next morning, and after removal of an endometrioma (an endometriosis cyst on the ovary) after one night.

Even after these operations, many women need three to four weeks before they are ready to return to work, and I usually advise about four weeks. If you work from home and need to, light desk work after about two weeks is often possible. After surgery for deep endometriosis, particularly on the bowel, expect a few nights in hospital and four to six weeks or more before you feel back to normal.

Before your operation you receive full written information, including the recovery to expect, and I give you a personal estimate; this guide explains what each stage is usually like.

What was removed sets the pace

Almost all of my endometriosis surgery is keyhole surgery, through a cut in the navel and two or three lower down. The cuts are the same size whatever is done inside. “Keyhole” covers laparoscopic surgery, in which I hold the instruments, and robotic surgery, in which I control them from a console. What decides recovery is how much tissue was removed, and from where.

Superficial endometriosis lies on the peritoneum (the thin lining of the pelvis), and removing it leaves a raw surface that heals quickly. An endometrioma is removed from the ovary, which I then close and reconstruct with stitches. Deep endometriosis grows into the tissues and can involve the bowel, the bladder or the ureters (the tubes from the kidneys to the bladder), and removing it is major surgery.

For deep or severe disease I prefer robotic surgery, because the view is magnified up to ten times and the wrist-like instruments allow precise dissection and stitching deep in the pelvis. Since 2013, around one in a thousand of my keyhole operations has needed to be changed to open surgery (about these figures).

If you are still deciding, surgery is one choice among several, and for some women the right choice is pain relief, hormone treatment or no treatment at all. The endometriosis page sets these out, and we go through them together before you decide.

The first day is about rest and moving a little

When you wake you may have a drip (a fine tube into a vein) and, after longer operations, a catheter (a thin tube draining the bladder). Soreness around the cuts is normal. Many women also feel pain in the tip of one or both shoulders, from the carbon dioxide gas used to make space inside the abdomen. It irritates the diaphragm (the muscle beneath the lungs) and usually settles within a day or two; walking about helps it go.

You will be encouraged to eat, drink and walk the same day. Walking early helps your bowels recover and lowers the risk of blood clots, and you may also wear compression stockings or have injections to thin the blood.

The first two weeks after a laparoscopy or removal of an endometrioma

Expect to feel more tired than the size of the cuts suggests. Take the painkillers you are given regularly for the first few days, walk around the house several times a day and rest in between. The small wounds are closed with dissolvable stitches, and you can usually shower the next day. I take infection after keyhole surgery seriously, which is why my written information before the operation includes advice on washing beforehand.

Constipation is common, from the painkillers and from moving less, so drink plenty and use a gentle laxative from the pharmacy if you need one. A little vaginal bleeding for a few days is common.

I usually advise about four weeks before returning to work after a laparoscopy or removal of an endometrioma, and some women need that long even when only a small amount of endometriosis was removed. If you work from home and need to, light desk work after about two weeks is often possible. You can drive when you can wear a seatbelt comfortably, make an emergency stop without hesitating and are no longer taking painkillers that make you drowsy.

Recovery after surgery for deep endometriosis takes longer

When deep endometriosis involves the bowel, I operate alongside a colorectal (bowel) surgeon, and the stay is usually a few nights.

Depending on how deeply the bowel is involved, the endometriosis may be shaved from its surface, removed with a small disc of the bowel wall, or removed with a short segment of bowel that is then joined back together. Your bowels may take some weeks to settle into a pattern. Very occasionally a temporary stoma (an opening of the bowel onto the abdomen) protects a join while it heals; it is closed in a later, smaller operation.

After extensive surgery deep in the pelvis, the nerves to the bladder can be slow to recover, and a few women go home with a catheter for a short time until the bladder empties normally again. A physical job usually needs longer than the four to six weeks a desk job needs.

A study our team published followed women who had keyhole surgery for severe endometriosis affecting the bowel; a year after surgery they reported significant improvements in pain, sexual function and quality of life ^[2]. It was an observational study, without a comparison group.

If endometriosis was removed from the vagina

Deep endometriosis sometimes grows through to the top of the vagina, and removing it leaves a wound there that I close in two layers. That wound needs time to heal, so I ask you to use no tampons for six weeks, and to wait until about week five before swimming in a pool. Sex involving penetration should also wait for around six weeks, until the wound has healed.

Getting back to exercise and sex

After a laparoscopy or removal of an endometrioma, build up exercise gradually as you feel able. After surgery for deep endometriosis, heavy lifting and high-impact exercise should wait for around six weeks. Sex can resume when you feel comfortable, unless the vagina was operated on. For many women, pain during sex improves once endometriosis has been removed ^[2].

The weeks and months after

Soreness from the operation should ease week by week. I see you after the operation to go through what I found and the results from the laboratory, and to plan what comes next.

Endometriosis can come back. National guidance suggests considering hormone treatment after surgery, such as the contraceptive pill, to prolong the benefit of the operation ^[1]. It is not suitable while you are trying to conceive, so if you are hoping to become pregnant we plan the timing around that instead, and we decide together whether it suits you.

When to call for help

Contact the hospital ward straight away (the number is on your discharge letter), or call NHS 111, if you have:

• a fever, or feel hot and shivery
• pain that is getting worse rather than better, or is not controlled by your painkillers
• a swollen, hard abdomen, repeated vomiting, or being unable to pass wind or open your bowels
• a wound that is red, hot, swollen or leaking
• heavy vaginal bleeding, or a smelly discharge
• difficulty passing urine
• pain or swelling in one calf

After bowel surgery, increasing abdominal pain with a fever in the first two weeks needs to be seen the same day, because it can be a sign of a leak from the join. If you have chest pain or sudden breathlessness, or in any other emergency, call 999. For questions that are not urgent, my practice manager, Helen, can help.

You can read more about endometriosis and how surgery is planned on the endometriosis and ovarian cysts pages, or book an appointment.