Medically reviewed by: Melissa A. Delgado, MD, FACOG
Melissa A. Delgado, MD, FACOG is the founder and owner of The Chronic Pelvic Pain Center of Northern Virginia. Dr. Delgado is an experienced, board-certified OB/GYN and has spent the past 10 years dedicating her time to understanding complex and persistent pelvic pain.
Endometriosis is a chronic, painful condition that impacts the daily lives of millions of women worldwide. When the tissue that lines the uterus, called the endometrium, begins to grow outside of the uterus, it can cause numerous problems.
Women with endometriosis often experience painful periods, pain during intercourse, and infertility. While endometriosis is incurable, the condition can be treated through medications, conventional management (e.g., hormone therapies), and/or surgery.
However, even with successful treatment, endometriosis can come back.
Let’s explore how quickly endometriosis can grow back after surgery, who it could happen to, and what you can do to prevent a recurrence.
Understanding Why Endometriosis Comes Back
One of the major reasons endometriosis can recur is related to the etiology (or causes) of the condition. While the exact reason some women develop endometriosis is unknown, it’s believed to be related to hormonal imbalances and genetics.
It’s also important to understand that there’s a big difference between eliminating the symptoms of endometriosis—like lower back pain, pelvic pain, or pain during intercourse—and getting rid of what causes the pain: endometrial-like tissue growing outside of the uterus where it doesn’t belong.
To treat and manage the symptoms of endometriosis, medications such as pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) and hormone therapies such as birth control pills are usually adequate. These treatments can relieve pain, reduce inflammation, and regulate hormones to inhibit the growth of more endometrial tissue.
But the only way to really remove outgrowths of endometrial tissue is through surgery.
How Surgery Can Treat Endometriosis
Surgery is one of the most effective treatments for endometriosis. In severe cases of endometriosis, laparoscopic or robot surgery may be necessary to remove excess endometrial tissue and any scar tissue that has formed.
Robotic surgery is the same thing as laparoscopic surgery, except the surgeon remotely controls robotic instruments that perform the surgery. Whatever the laparoscopy reveals is projected onto a screen before the surgeon remotely removes any excess tissue by manipulating robotic ‘arms.’
Robotic surgery isn't as scary as it sounds — and can result in better outcomes. (Source)
Either type of surgery can be very effective in treating endometriosis, especially if surgery is performed earlier rather than later after diagnosis. However, it is not a cure for the condition.
Endometriosis can and often does come back after surgery, especially if the surgeon did not remove all of the endometrial tissue. In some cases, the tissue may be too small to see or may be located in a hard-to-reach area, which increases the risk of recurrence.
Factors That May Affect Endometriosis Recurrence
Several factors can affect the likelihood of endometriosis recurring after surgery:
Severity of the condition: Women with severe endometriosis are more likely to experience recurrence than those with mild or moderate endometriosis.
Skill of the surgeon: An experienced surgeon trained in laparoscopic or robotic surgery is more likely to remove all excess endometrial tissue, reducing the risk of recurrence.
Type of surgery performed: In some severe cases of endometriosis, a surgeon may perform a hysterectomy, which involves removing the uterus. This can be an effective treatment for endometriosis, but it’s not always necessary.
Keep in mind that any irreversible surgery, like a hysterectomy, can have long-term effects on a patient's mental health and well-being. It’s super important to discuss all treatment options with your doctor before deciding on surgery.
Signs of Endometriosis After Surgery
Some of the signs of endometriosis returning after surgery may include:
Painful periods (dysmenorrhea)
Pain during intercourse (dyspareunia)
Pelvic pain or pressure
Lower back pain or pressure
Chronic fatigue
Difficulty urinating or having a bowel movement
Infertility (if it had not been an issue prior)
Note that this is not an exhaustive list. Endometriosis presents differently in different women. These are just the most common symptoms.
If you experience any of these symptoms after surgery, it’s important to talk to your doctor about it as soon as possible. Your doctor may recommend further testing, such as an ultrasound or MRI, to determine if endometriosis has indeed returned.
How Quickly Can Endometriosis Grow Back After Surgery?
The timing of endometriosis recurrence after surgery can vary from patient to patient. Some people may experience recurrence just a few months after surgery, while others may not experience it for several years.
In general, women with severe endometriosis are more likely to experience recurrence after surgery, although this is not always the case. The likelihood of recurrence depends on several factors, including the severity of the initial condition, the skill of the surgeon, and the type of surgery performed.
Other factors may include genetic predispositions or even childhood trauma, although these potential causes of endometriosis are not as well understood.
Can Endometriosis Come Back After a Hysterectomy?
A hysterectomy is a surgical procedure in which the uterus is removed for health reasons. In some cases, it may also involve removing the ovaries, fallopian tubes, and cervix.
Hysterectomy is often recommended as a last resort for women with severe or recurring endometriosis. However, even after a hysterectomy, endometriosis can still come back.
Remember—endometriosis can grow back if any endometrial tissue was left behind after surgery. This is known as residual endometriosis.
Preventing Endometriosis Recurrence
The best way to prevent endometriosis recurrence is to have a comprehensive treatment plan. This includes a combination of surgery, medication, and lifestyle changes. Here are some tips to prevent endometriosis recurrence:
1. Follow your doctor's advice
It is important to follow your doctor's advice after surgery to prevent endometriosis recurrence. This may include taking new or different medications, changing your diet, and avoiding certain activities that could be triggering.
2. Take medication as prescribed
Your doctor may prescribe medication(s) to control the growth of endometrial tissue. It is important for anyone living with endometriosis to take their prescribed medication to increase their odds of preventing recurrence.
3. Make healthy lifestyle changes
Half the battle with conditions like endometriosis is maintaining a positive attitude. That’s why making and committing to healthy lifestyle changes—such as reducing stress, getting regular exercise, and eating a healthy diet—can help prevent endometriosis recurrence.
The best way to prevent endometriosis recurrence is to have a comprehensive treatment plan that includes medication, lifestyle changes, and follow-up care. If you are experiencing signs of endometriosis returning, seek medical help as soon as possible.
How to Test for Recurring Endometriosis
If you believe you might be experiencing endometriosis again (or for the first time), the first step should always be to seek advice from a medical expert, like an endometriosis specialist, who can help guide you in the right direction.
While there isn't a single conclusive test for endometriosis—which is often misdiagnosed as a more common condition with similar symptoms, like irritable bowel syndrome (IBS)—there are a few key tests that can help your healthcare provider reach a conclusion:
Pelvic examination: Your healthcare provider may perform a manual pelvic exam to feel for any abnormalities, such as cysts or scars, that may suggest endometriosis.
Ultrasound imaging: This imaging method, which is gentle and non-invasive, uses sound waves to create pictures of your reproductive organs.
Magnetic resonance imaging: An MRI can provide a more detailed view of your reproductive organs, which can help your healthcare provider identify endometriosis.
As with all forms of endometriosis, however, the only way to conclusively diagnose the condition is via a biopsy of any suspicious tissue, usually obtained via laparoscopy.
Coping With Endometriosis Recurrence
If you’re experiencing residual or recurring endometriosis, it can be incredibly frustrating, disheartening, and overwhelming. Here are some tips for coping with an endometriosis recurrence diagnosis:
1. Seek peer support
Talking to friends, family members, or a therapist about your feelings can help you cope with endometriosis recurrence. There are many endometriosis support groups out there.
2. Manage your symptoms
There are many ways to manage endometriosis symptoms, including pain medication, heating pads, warm baths, and other relaxation techniques.
3. Stay informed about developments
Stay informed about the latest treatments and research on endometriosis using sites like scholar.google.com. This can help you make informed decisions about your treatment.
Getting Back on Your Feet
Being diagnosed with endometriosis can be challenging and daunting. But it’s so important to remember that you're not alone in this journey. With appropriate assistance and the right tools, you can start on a path toward healing and wellness.
If you suspect endometriosis has recurred, seek medical advice from your healthcare professional. Timely intervention and appropriate management can significantly enhance your outlook and quality of life, empowering you to handle your symptoms more effectively.
Join us on a healing journey at The Chronic Pain Center, where Dr. Delgado offers specialized care for endometriosis and its associated conditions and symptoms. Dr. Delgado is an expert in robot-assisted excisional surgery and can produce excellent results with minimal downtime.
If you're ready to start your journey toward healing from endo, reach out to The CPP Center today.