Questions to Ask During Your Endometriosis Surgery Consultation

• Do you use excision or ablation?
• If you use both, when do you choose one over the other?

Excision means cutting the disease out at the root. Ablation means burning the surface, which can leave disease behind, particularly when it's deep infiltrating endometriosis. Research generally supports excision for longer-lasting pain relief and lower rates of recurrence.

• What percentage of your surgeries are for endometriosis?
• How many endometriosis surgeries do you do in a typical month?
• Does your practice also cover general gynecology or deliveries?
• How often do you take on complex or repeat cases?

Surgeons who specialize in this disease often describe endometriosis and pelvic pain as around 80% or more of their surgical work, and a much lower share usually means it's one part of a broader practice. Volume matters separately, since someone can do mostly endometriosis surgery and still not do very much surgery overall. A surgeon operating on this disease regularly has simply seen more of it.

• What do you do if you find disease on the bowel, bladder, or diaphragm?
• Do you treat those areas yourself, or work with colorectal, urology, and thoracic surgeons?
• Are those surgeons arranged ahead of time, or called in as needed?

Endometriosis often reaches these areas, and it's worth knowing the plan before you're under anesthesia.

For severe disease, most respected specialists bring in a colorectal surgeon, urologist, and/or thoracic surgeon rather than operating on those organs themselves. No single surgeon is an expert in endometriosis and the bowel and the bladder and the organs in the chest, and the ones who take this disease seriously tend to know that. Working with a team isn't a limitation. It's how each organ gets handled by someone who works on it constantly.

It also protects you from the alternative, which is a surgeon who finds disease they can't safely address, closes you up, and sends you elsewhere for a second surgery.

• Do you screen for adenomyosis before surgery?
• How do you identify it?
• How does it change your surgical plan if you find it?

Adenomyosis often occurs alongside endometriosis and is treated differently, so it's worth knowing whether they're looking for it rather than finding it later.

• In what situations would you remove my uterus?
• In what situations would you remove an ovary?
• Would you ever make that decision during surgery without discussing it with me first?
• How do you decide what stays and what goes?

What you're listening for is whether they'd remove an organ because there's something wrong with that organ, rather than as a general approach to treating endometriosis. Hysterectomy can be the right call for adenomyosis or other uterine disease, but endometriosis lives outside the uterus, and removing organs doesn't remove disease that's growing somewhere else.

Ovaries are worth asking about specifically. Removing them brings on surgical menopause, and that's a significant decision with long-term effects that should be made deliberately rather than in the moment.

• Do you recommend pelvic floor physical therapy, and is it part of your standard plan?
• What does your follow-up schedule look like, and how long do you stay involved?
• What do you recommend about hormonal suppression after surgery?
• What medications do you typically use for pain?
• How do you handle nerve-related pain?
• Do you support integrative or non-opioid options?

Recovery is part of treating this disease, not an afterthought, and it's worth knowing the plan before you need it. Pain management in particular should fit your comfort level and your values, so say what those are.

Work these out before you walk in, then bring them up one at a time and watch how they respond to each one. Their reaction will help you to tell if this is a good fit for you.

• Where you stand on keeping your uterus, and what would change that.
• Where you stand on your ovaries, and under what circumstances you'd accept losing one or both
• Whether fertility is something you want, now or later
• How you feel about hormonal suppression after surgery
• Any religious or personal limits that aren't negotiable for you
• Anything else you feel strongly about your surgeon should know

There aren't right answers to any of these, only yours, and "it depends" is a real answer as long as you know what it depends on.

Say each one on its own rather than listing them all at once, because you learn more from how a surgeon reacts to a single position than from a general conversation about your goals. Someone who takes a position seriously, tells you where they agree, and explains where they don't is giving you real information. Someone who brushes past it is also telling you something.

Deciding these in advance means you're not working them out under pressure, in a room where someone else has far more information than you do.