Laparoscopy for Endometriosis: Recovery Time, What to Expect Each Week, and When to Call

What the operation is

Laparoscopy is keyhole surgery under general anesthesia. The surgeon makes a cut of about half an inch below the navel, fills the abdomen with carbon dioxide gas, and passes in a camera and thin instruments through one to three more small cuts. In a diagnostic laparoscopy the surgeon only looks. In excision the lesions are cut out and sent to pathology; in ablation they are burned on the surface and left in place. The differences are set out in our guide to excision versus ablation.

Recovery from the cuts is similar for all three. Recovery from what was done inside depends on how much was done, and your surgeon's timeline should say so. The ranges below come from NHS and RCOG patient information.

The first 48 hours

RCOG says most people go home the same day after a diagnostic laparoscopy, once they have recovered from the anesthetic, and that someone should stay with you the first night. The NHS advises no driving, alcohol or flying for 48 hours.

Expect three kinds of discomfort. The wounds ache. The abdomen feels bloated from the gas, which MedlinePlus says usually settles in one to two days. And many people feel pain in one or both shoulders. That is shoulder-tip pain: gas left under the diaphragm irritates a nerve that is also felt in the shoulder. The 2019 Cochrane review on the subject reports that it affects up to 80 percent of women after laparoscopy. It fades within a few days.

Light vaginal bleeding for 24 to 48 hours is common. Acetaminophen (paracetamol) and ibuprofen are the usual painkillers.

Wound care and showering

• Keep the dressings dry for the first 24 hours. After that, the NHS and RCOG both say you can remove them and shower. Have someone at home for the first shower in case you feel faint.
• Pat the wounds dry. Avoid very hot water, which the NHS says can make the wounds bleed.
• The NHS advises no baths for about two weeks, or until the wounds have healed; RCOG allows a shower or bath after 24 hours, so follow the advice of your own surgical team.

Week one to two: driving, work and walking

Driving: RCOG says not within 24 hours of a general anesthetic, and the NHS says 48 hours. After that, you can drive once you are no longer sedated by painkillers and can sit comfortably, wear a seatbelt, check over your shoulder and make an emergency stop without pain.

Walking: RCOG suggests two walks of 10 to 15 minutes on day one, building to 30 to 60 minutes by the middle of the first week. Early walking lowers the risk of blood clots.

Work: RCOG says most women return within one to three weeks, about one week after a diagnostic or simple procedure and two to three weeks after an operative one. The NHS allows up to three weeks. Desk work from home may start earlier for some people, with shorter days at first.

Weeks two to eight: exercise, lifting and sex

Exercise: RCOG says most women are back to their previous activity level by the second week after a simple laparoscopy. After a longer operation, avoid contact sports and heavy gym work for a few more weeks and let pain, not the calendar, set the pace.

Lifting: MedlinePlus advises not lifting anything over 10 pounds (4.5 kilograms) for 3 weeks after surgery, to lower the risk of a hernia at the incisions.

Sex: RCOG says resume when you feel ready, and MedlinePlus says once any bleeding has stopped. If deep disease was excised near the vagina or bowel, your surgeon may ask you to wait longer.

Full recovery: the NHS gives 6 to 8 weeks after surgery that treats endometriosis. Bowel surgery usually means a longer recovery; ask your surgeon for the expected timeline.

What pain relief and recurrence to expect

Surgery helps many women, but the trial evidence is thin. The 2020 Cochrane review of laparoscopic surgery for endometriosis pooled 14 randomized trials with 1,563 women. For overall pain compared with a diagnostic laparoscopy alone, it found one trial of 16 women, which showed improvement at 6 and 12 months, and rated the evidence very low quality. It was more confident that treatment raises the chance of a viable pregnancy (odds ratio 1.89, 3 trials, 528 women).

Endometriosis can return. A 2009 review in Human Reproduction Update estimated recurrence at 21.5 percent at 2 years and 40 to 50 percent at 5 years. NICE NG73 advises considering hormonal treatment after laparoscopic excision or ablation to prolong the benefits of surgery. The ESHRE 2022 guideline recommends offering hormone treatment after surgery, such as a combined hormonal contraceptive or a hormonal coil, to women who are not trying to conceive, to reduce the return of painful periods.

Pain that persists after a clean operation does not always mean disease was left behind. Tight pelvic floor muscles and sensitized nerves are common after years of pain. Our guides to pelvic floor dysfunction and pelvic nerve pain explain what is done about it.

Red flags after surgery

The NHS and RCOG list the same warning signs. Call your surgical team the same day for any of these.

Call the same day

• A high temperature, or feeling hot, cold or shivery.
• Spreading redness, heat, swelling, pus or bleeding around a wound.
• Pain, swelling, redness or heat in one leg. These can be signs of a blood clot.
• Abdominal pain that is getting worse rather than better, or a swollen abdomen.
• Severe or continuous vomiting.
• Heavy vaginal bleeding, or any unusual bleeding or discharge.
• Being unable to pass urine, or burning and frequency when you do.
• Call emergency services for shortness of breath, chest pain, coughing up blood or a very fast heartbeat. These can be signs of a clot in the lung.

Questions to ask before and after surgery

• Before: will this be diagnostic only, or will you treat what you find at the same operation?
• Before: will lesions be excised or ablated, and will removed tissue go to pathology?
• Before: if you find deep disease in the bowel, bladder or ureter, will it be treated now, and with whom?
• After: what did you find, was all of it treated, and can I have the photographs and pathology report?
• After: should I start hormonal treatment to lower the chance of recurrence, and would pelvic floor physical therapy help?

How to track your recovery day by day

A short daily record turns "I think I am better" into something your surgeon can read. Each evening, note your pain out of 10, your temperature if you felt feverish, what you managed to do, bowel and bladder function, bleeding and which painkillers you took. Keep it going for two or three cycles; the real test of surgery is your next periods.

The free PelviQuest app has a daily symptom tracker that records pain, bloating, fatigue, mood and notes on a calendar, with the medications you took that day. It is a screening and tracking aid, not a diagnosis. Our guide to how endometriosis is diagnosed explains where surgery fits in the wider picture.