Endometriosis can be very tiny lesions (a few millimeters in size). These small lesions are impossible to be detected by imaging studies and therefore most MRIs, CT scans or ultrasounds come back as “normal” or “negative for endometriosis.” This is why the gold standard for diagnosing and treating endometriosis is with surgery. 

Endometriosis is a chronic and progressive disease. The only treatment for endometriosis is removal of the disease. Hormonal suppression with birth control pills or progesterone-only medication can often manage the symptoms of the disease, but does not treat the disease. 

There is always the chance that you may need another surgery after your initial surgery for endometriosis, should symptoms reoccur. It is impossible to predict the progression of disease. However, a big factor is the thoroughness and completeness of your initial surgery. If not performed by a surgeon who specializes in endometriosis, disease can be either missed, not completely excised, or ablated – which can cause even more inflammation and scar tissue. This can cause either a recurrence or only a reduction in symptoms, which then can lead to another surgery a couple of years later. This is not necessarily because the endometriosis “grew back;” it is because it was never removed in the first place. Studies have shown that recurrence rate in the hands of an experienced excision surgeon is about 20-30%. 

The first surgery that you get for endometriosis is the most important one. Complete excision surgery by an expert will give you the greatest chance of removal of all disease, as well as having long-term relief. It is also important to have endometriosis diagnosed and treated to prevent disease progression and preserve fertility. Early intervention is key!

The first 2-3 days are rough. You will feel bloated, distended and sore. It is imperative that you take ibuprofen and acetaminophen every 6 hours (alternating the two, so you are taking something every 3 hours — per your post-operative instructions) for the first 72 hours after surgery. After the first 72 hours, you can start cutting back the dosage and/or frequency of the medication and take it as needed, but most will still continue the regimen for the first 5-7 days. 

Many patients benefit from setting their alarm to not miss a dose. Once you pass gas out the bottom, you will start feeling better. Once you have your first bowel movement after surgery, you will feel even better! The most important thing is to not get constipated after surgery. You will be instructed to take a stool softener and magnesium to help keep your stools soft and your bowels awake. Many times, additional medication may be needed to further “wake up” your bowels. 

However, the best thing you can do to expedite your recovery is to walk around. This helps your body absorb the gas and helps “wake up” your body. 

By the end of the first week, most patients report feeling about 60% back to normal. By the end of the second week, most patients report feeling 70% back to normal. 

The only physical restriction that you have after surgery is that you should not lift anything heavier than 10 pounds until 4-6 weeks after surgery. 

This is entirely up to you. The general recommendation is to take at least 2 weeks off from work, but there have been patients who have gone back to work as early as 72 hours after surgery. 

If you work from home, take at least one full week off after surgery before resuming work. 

If you commute into the office, take at least 2 weeks off after surgery before resuming work.

It’s always better to ask for more time off than you think you will need and can always go back earlier if you feel good. For example, arrange for 4 weeks off and then go back after 2 weeks. The only restriction is that you can’t lift anything heavier than 10 pounds for 4-6 weeks post-operatively. 

Generally, no. Being on your period will not negatively affect surgery. However, if you’re scheduled for a hysteroscopy (camera that looks inside your uterus), please let Dr. Liu that you may be on your period at the time of your surgery.

Stop all herbal supplements and aspirin one week prior to surgery, including GLP-1 agonists (Mounjaro, Ozempic, etc). You may continue to take ibuprofen, acetaminophen, multivitamins, magnesium, and regular prescription medication up until the day of surgery. 

You may resume all supplements and medications one week after surgery. 

It is completely normal to not have much of an appetite for a couple of days after surgery. Unless instructed otherwise, you can eat whatever you want. It may be wise to start with easy- to-digest foods, such as soups, crackers, etc. The most important thing is to stay hydrated. 

You can shower the day after your surgery. Let the water run over your incisions and pat dry afterwards. You may use soap around your incisions on your abdomen, but do not scrub or use soap/lotion directly on your incisions. 

Your period may be “thrown off” from the stress of surgery. Do not be surprised if it arrives a couple days/weeks earlier or later than expected. Your cycles will normalize after a couple of months. Also, be prepared for your first 2-4 cycles to be very heavy and/or very painful after surgery. This is very common. If you are on birth control pills prior to surgery, continue taking them even if you have unpredictable bleeding. 

Because you are under general anesthesia, there is a breathing tube that goes down your throat during surgery. You will be asleep when it is placed and when it is removed, but your throat may be scratchy or sore when you wake up. Throat lozenges or cough drops can help with the discomfort. Ice pops or popsicles can also help. This should resolve within a few days. 

This is because of the gas that is used to inflate your abdomen during the surgery. This is called “referred pain” and is due to the trapped gas under your diaphragm. The best thing you can do to help with this pain is to get up and move around to help your body absorb the gas. Sometimes, taking Gas-X (simethicone) can also help alleviate some of the gas pain. 

You will have a catheter in your bladder during the surgery. This will be placed after you are asleep and the majority of the time, will be removed before you wake up. On the rare occasion, your bladder may still be “sleepy” after the surgery and will not want to work right away. If you are unable to urinate on your own, the catheter may have to be reinserted and will be removed the following day. This does not happen often (but does happen). 

If you have significant amounts of endometriosis over your bladder, or if you had a long surgery, you may wake up with the catheter still in your bladder just to let it rest overnight or for a few days.

You may have been given a patch behind your ear for nausea by the anesthesiologist before your surgery. If you were, be careful not to rub or touch your eyes after touching the patch. There is medication on the patch that can be transferred to your eyes, which will make your vision blurry. This will improve over time. Be sure to wash your hands after every time you touch the patch. 

When it is time to remove the patch (generally 48-72 hours after surgery), make sure to thoroughly wash your hands after you throw the patch away. 

If you are doing well after surgery, there is no need to schedule an in-person post-operative visit unless you are told otherwise. When your pathology results are finalized, usually 7-14 days after your surgery, you will receive a phone call from Dr. Liu and she will go over the results with you. 

You are always welcome to schedule an in-person post-operative visit if you wish! Dr. Liu ALWAYS loves to see her post-op patients, but does not make it mandatory.

You should be up walking the same day of your surgery and every day thereafter. Movement and light activity is encouraged; however, any activity that is high-impact, engages the abdominal muscles, and/or elevates your heartrate or blood pressure is discouraged for the first 4 weeks after surgery. This includes running, pilates, power yoga, etc. You should also not be lifting anything heavier than 10 pounds for 4-6 weeks after surgery. 

If you are already in pelvic floor physical therapy, you can resume as soon as you feel up to it! Most patients resume their physical therapy 2-4 weeks after surgery. Unless you are told otherwise, you may also resume internal pelvic floor physical therapy at that time. If you have never had pelvic floor physical therapy, Dr. Liu highly encourages it to help with the recovery process and will be more than happy to give you recommendations and a referral.  

Surgical technique with excision of lesions, rather than ablation will lead to less scar tissue formation. Ensuring meticulous hemostasis (ie, having negligible bleeding) at the end of the surgery will also decrease the risk of scar tissue. However, there is no way that scar tissue can be eliminated completely. This is how your body heals itself. However, there are some techniques that most physical therapists can do that will help mobilize the scar tissue, which can help aid in the healing process and prevent excessive formation.

Do not put anything on your incisions until at least 8 weeks after surgery. After that, you can start to apply vitamin E oil, coconut oil, and/or Mederma cream to help lighten the appearance of your scars. Also, avoid any sunlight exposure to your incisions/scars. 

Pathology results are usually back within 7-14 days after your surgery. Once the report is finalized, Dr. Liu will give you a call to go over the results. 

You can start driving again as long as you are not taking any pain medication stronger than Tylenol or advil and when you feel like you can safely “hit the brakes.” For most patients, this generally is about 5-7 days after surgery. 

You can start swimming, soaking in bath or jacuzzi 2 weeks after your surgery.

You can use your heating pad on your lower back and upper shoulders/neck immediately after surgery. Please do not use heat on your abdomen until 5-7 days after your surgery. You may use ice packs on your abdomen immediately after surgery. 

Immediately after surgery or whenever you feel up to it (unless you are told otherwise). If you’ve had a hysterectomy, nothing in the vagina for 8 weeks post-op.

Dr. Liu does not recommend routine imaging surveillance after surgery (e.g., ultrasounds every 6 months). She truly wants you to go live your life!