Endometriosis surgery in Nigeria: when it helps, what it involves, and what it cannot do

Endometriosis in brief

Endometriosis is when tissue similar to the lining of the womb grows outside the womb, on the ovaries, the pelvic lining, the bowel or the bladder. It can cause painful periods that painkillers do not control, pain during or after sex, pain opening the bowels during periods, long-term pelvic pain, and difficulty getting pregnant.

In Nigeria, period pain is often dismissed as normal, and many women spend years being told to endure it. Pain that stops you working or studying is not normal and deserves proper assessment.

Before surgery: what is usually tried first

If the scan and examination suggest endometriosis, your gynaecologist will often start with painkillers and hormone treatment, such as the contraceptive pill, progestogen tablets, injections or a hormone-releasing coil. These can control symptoms for many women without an operation. A normal scan does not rule out endometriosis, because small patches do not show.

When surgery is advised

• Pain that has not improved with medicines, or you cannot take hormones
• An ovarian endometrioma (chocolate cyst), especially if large or painful
• Endometriosis affecting the bowel, bladder or ureters
• Difficulty getting pregnant where surgery may help, decided together with a fertility specialist
• Uncertainty about the diagnosis

What the operation involves

Most endometriosis surgery is laparoscopy: a camera and instruments through a few small cuts in the tummy, under general anaesthetic. The surgeon looks, takes samples, and removes or destroys the patches they find. Chocolate cysts are removed from the ovary while keeping as much healthy ovary as possible. Most women go home the same day or the next, and return to normal activities within a couple of weeks, longer if extensive surgery was done.

Deep endometriosis involving the bowel or bladder is complex and is best done by a specialist team. Ask your surgeon how much of this kind of surgery they do.

Fertility, honestly

Surgery may improve the chance of natural pregnancy in some women, but it cannot guarantee it. Removing chocolate cysts can also reduce the number of eggs left in the ovary, so if you want children, ask about an egg reserve blood test (AMH) and see a fertility specialist before surgery on your ovaries. Your plan for pregnancy should shape the plan for surgery, not the other way round.

After surgery: why it can come back

Endometriosis is a long-term condition. Pain often improves after surgery, but symptoms can return over time. Hormone treatment after surgery may help keep them away if you are not trying to conceive. A hysterectomy, sometimes with removal of the ovaries, is an option for women who have finished having children and have severe symptoms, but even then pain does not always go completely.

Common questions