Endometriosis Adhesions Surgery and Fibroids: What to Know

September 13, 2025

Endometriosis Adhesions Surgery and Fibroids: What to Know

Endometriosis and uterine fibroids are two of the most common causes of pelvic pain and heavy menstrual bleeding. Many people live with both conditions, and some eventually consider surgery—either to relieve pain, control bleeding, improve fertility, or all three. If you’ve been told you have endometriosis adhesions and fibroids, understanding how these conditions interact and what modern surgery can and cannot do will help you make informed decisions.

What are endometriosis adhesions?

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, triggering inflammation and scar tissue. Adhesions are bands of fibrous tissue that can make organs stick together—such as the ovaries and fallopian tubes binding to the pelvic sidewall, or the uterus adhering to the bowel or bladder. Adhesions can cause pain with periods, sex, bowel movements, or urination, and may interfere with fertility by limiting the mobility of the ovaries and tubes.

Diagnosis typically starts with a thorough history and pelvic exam, followed by imaging. Transvaginal ultrasound can identify fibroids and ovarian endometriomas; MRI can help map deep infiltrating endometriosis and complex anatomy before surgery. Laparoscopy (minimally invasive surgery) remains the gold standard for confirming endometriosis and treating it in the same setting.

When is surgery recommended?

Surgery is individualized. It may be considered when:

Pain persists despite medications (NSAIDs; hormonal options such as combined oral contraceptives, progestins, or GnRH analogs/antagonists).
There is bowel, bladder, or ureter involvement, or dense adhesions causing organ dysfunction.
Infertility is present and imaging suggests surgically correctable factors (e.g., endometriomas, occluded tubes, severe adhesions).
Fibroids cause heavy bleeding, anemia, bulk symptoms, or fertility issues that don’t respond to medical therapy.

Medical therapies can help many patients avoid or delay surgery. For endometriosis pain, FDA‑approved options include elagolix (Orilissa) and relugolix‑estradiol‑norethindrone (Myfembree). For heavy menstrual bleeding due to fibroids, options include tranexamic acid, hormonal IUDs, combined hormonal contraception, GnRH agonists (e.g., leuprolide), and FDA‑approved combinations such as elagolix‑estradiol‑norethindrone (Oriahnn) or relugolix‑estradiol‑norethindrone (Myfembree). Your clinician will review benefits, side effects, and bone health monitoring where applicable.

How fibroids change the surgical plan

Fibroids (leiomyomas) are benign uterine tumors that can enlarge and distort the uterus. When endometriosis and fibroids coexist, surgery is more complex for three reasons:

Anatomy: Fibroids can obscure surgical landmarks, while adhesions tether organs, raising the risk of injury to the bowel, bladder, or ureters.
Bleeding: Myomectomy (fibroid removal) can increase blood loss; surgeons plan strategies to minimize it (e.g., vasopressin injection, tourniquets, or temporary uterine artery occlusion).
Adhesions: Both endometriosis and uterine surgery predispose to new adhesions, which can affect future fertility and pain.

Because of these factors, combined surgery is best performed by a high‑volume, minimally invasive gynecologic surgeon—often with a multidisciplinary team if bowel or urinary tract disease is suspected.

Surgical options: what they address—and what they don’t

For endometriosis and adhesions:

Laparoscopic excision of endometriosis and lysis of adhesions aims to remove disease and restore anatomy. Excision is generally preferred over superficial ablation for deep lesions.
Special techniques (e.g., ureterolysis, nerve‑sparing approaches) lower complication risks when disease involves critical structures.
Adhesion‑reduction strategies include gentle tissue handling, minimizing cautery, copious irrigation, and selective use of adhesion barriers (e.g., oxidized regenerated cellulose or hyaluronic acid–based sheets/gels). Evidence suggests barriers can reduce adhesions, although impact on pain and fertility outcomes varies.

For fibroids:

Myomectomy removes fibroids while preserving the uterus; it can be hysteroscopic (for submucosal fibroids), laparoscopic/robotic, or open, depending on size, number, and location.
Uterine artery embolization (UAE/UFE) shrinks fibroids by blocking blood flow. It treats bleeding and bulk symptoms but does not treat endometriosis and may not be ideal for those seeking pregnancy.
Radiofrequency ablation (laparoscopic Acessa or transcervical Sonata) thermally treats fibroids with typically quick recovery; fertility data are evolving.
MRI‑guided focused ultrasound (MRgFUS) is noninvasive and shrinks eligible fibroids; access and candidacy are limited.
Hysterectomy definitively treats fibroids but is not appropriate for those desiring future fertility. It does not treat extra‑uterine endometriosis; excision of endometriosis at the same time may still be needed.

Combined procedures are feasible and often beneficial when both conditions drive symptoms. Preoperative hormonal suppression (e.g., GnRH agonists/antagonists) may reduce fibroid size and correct anemia; some surgeons avoid prolonged suppression right before endometriosis excision so disease remains visible. Discuss this balance with your team.

Fertility and family‑building

Both endometriosis and fibroids can affect fertility. Adhesions can impair egg pickup, and endometriomas can alter ovarian reserve. Submucosal fibroids reduce implantation rates; large intramural fibroids may also affect outcomes. Key points:

Excision of deep endometriosis and lysis of adhesions can improve spontaneous conception rates in selected patients.
Endometrioma cystectomy can relieve pain and improve access to follicles for IVF but may reduce ovarian reserve; preoperative AMH testing and fertility counseling are important.
Myomectomy can improve fertility when submucosal or cavity‑distorting fibroids are present.
If assisted reproduction is planned, coordinate timing with your surgeon and reproductive endocrinologist.

Recovery, risks, and recurrence

Most laparoscopic procedures allow home the same day with light activity in 1–2 weeks and full recovery in 2–4 weeks (longer after open surgery). Typical risks include bleeding, infection, and injury to adjacent organs; risks are higher in reoperative abdomens and with deep disease. Even with excellent surgery, recurrence can occur. Pain from endometriosis may recur in up to 40–50% within five years after conservative surgery; using postoperative suppression (e.g., combined hormonal contraception, progestins, LNG‑IUD, or GnRH analogs/antagonists as appropriate) lowers recurrence risk.

Because any pelvic surgery can cause adhesions, your surgeon will use preventive strategies. If you are trying to conceive soon, discuss whether to avoid certain barriers that could interfere with embryo implantation in the immediate cycle.

Preparing for surgery: questions to ask

Experience: How many combined endometriosis–fibroid surgeries do you perform annually? What are your complication and conversion rates?
Approach: Will you excise (not just burn) deep endometriosis? Will a colorectal or urologic surgeon be available if needed?
Fertility: How will this plan protect my ovarian reserve and future pregnancy goals? Should I consider egg freezing before surgery?
Fibroid plan: Which fibroids will be addressed (hysteroscopic vs laparoscopic vs open), and why?
Recovery: Expected downtime, pain plan, and warning signs (fever, heavy bleeding, worsening pain, chest pain, calf swelling).
Aftercare: Do you recommend postoperative hormonal suppression? For how long?

The bottom line

When endometriosis adhesions and fibroids coexist, a tailored plan that integrates your pain, bleeding, and fertility goals is essential. High‑quality laparoscopic surgery can relieve symptoms and restore anatomy, and modern medical therapies can reduce recurrence and control bleeding. Partner with an experienced team, ask detailed questions, and align choices with your priorities.

Trusted resources

NIH NICHD: Endometriosis – https://www.nichd.nih.gov/health/topics/endometriosis
ACOG Patient FAQ: Endometriosis – https://www.acog.org/womens-health/faqs/endometriosis
ACOG Patient FAQ: Uterine Fibroids – https://www.acog.org/womens-health/faqs/uterine-fibroids
FDA: Orilissa (elagolix) for endometriosis pain – prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210450s000lbl.pdf
FDA: Oriahnn (elagolix/estradiol/norethindrone) for fibroid heavy bleeding – prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213382s000lbl.pdf
FDA: Myfembree (relugolix/estradiol/norethindrone) for fibroid heavy bleeding and endometriosis pain – prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/214846s005lbl.pdf
NIH MedlinePlus: Uterine fibroids – https://medlineplus.gov/uterinefibroids.html

This article is for educational purposes and does not replace personalized medical advice. Consult your healthcare professional for recommendations tailored to your situation.