How often does endometriosis come back after surgery?
An estimated 20-30% of patients have a recurrence within two years of surgery, and the rate keeps rising with longer follow-up (Masferrer-Ferragutcasas et al., 2026). Individual studies report between 6% and 67%. It depends what counts as recurrence. Some studies count pain recurrence, while others count endometriosis seen again on a scan or at a second operation (Selçuk and Bozdağ, 2013).
In some cases, pain recurs without surgical evidence of endometriosis recurrence. Symptoms recurrence may be due to other reasons, such as adhesion formation of nerve damage.
Why does endometriosis come back?
Endometriosis may return from disease that was left behind or from new growth. Estrogen from your ovaries stimulates both.
- Persistent disease. Deposits too small to see, or deep lesions treated only at the surface, keep growing. Excision removes the lesion including tissue below the surface; ablation burns the visible surface and can leave deeper tissue in place.
- New growth (de novo lesions). Surgery removes the lesions you have but does not stop new ones forming, sometimes on organs that were clear at your first operation.
Your risk is higher if you had:
- Extensive or deep disease at your first operation
- Large ovarian cysts (endometriomas)
- Adenomyosis alongside endometriosis
- Dense adhesions or earlier pelvic surgery
- Surgery at a younger age
- Severe pain during periods or pelvic pain before surgery
What are the signs that endometriosis has come back?
The usual sign is the return of the symptoms you had before surgery, in the same pattern around your cycle. Some recurrences cause no symptoms at all and show up on a routine scan.
- Severe period pain that over-the-counter pain relievers do not relieve
- Deep pain during sex
- Pelvic or low back pain between periods
- Pain with bowel movements or urination, worse around your period
- Bloating or bowel changes that follow your cycle
- A new endometrioma (ovarian cyst) on ultrasound
How quickly can endometriosis grow back after surgery?
Endometriosis left behind at surgery can cause pain again within months, while new endometriosis more often appears after a year or more. Pain in the first weeks after an operation is usually part of healing.
| When the pain appears | Most likely cause | What happens next |
|---|---|---|
| The first days after surgery | Gas used during laparoscopy, your incisions, internal healing | Shoulder pain from the gas eases within days; soreness fades over the following weeks |
| Your first periods or ovulations after surgery | Healing tissue responding to your cycle | Often heavier and more painful than usual |
| The same pain, returning within months | Persistent disease | Ultrasound, MRI and a review of your operative report |
| Pain after a year or more of relief | New growth, or slow regrowth of persistent disease | Hormone treatment, surgery or both, depending on what is found |
| Pain that never improved, or feels different | Persistent disease, or one of the other causes below | Assessment for each possible cause |
If it is not endometriosis, what else causes pain after surgery?
Several conditions cause pain that can feel like endometriosis, and more than one is often present at the same time.
| Cause | What the pain feels like | Treatment |
|---|---|---|
| Adhesions (internal scar tissue) | Pulling or stabbing pain with movement or sex | Adhesiolysis, surgery to release them; they can re-form |
| Adenomyosis (endometrial tissue in the wall of your uterus) | Heavy, painful periods; a tender uterus | Hormone treatment, or hysterectomy if you do not plan a pregnancy |
| Pelvic floor muscle spasm | Deep aching; pain with sex, tampons or sitting | Pelvic floor physical therapy |
| Nerve sensitization (central sensitization) | Burning, shooting or widespread pain | Pain management, including nerve-targeted medication |
| Bladder or bowel conditions (bladder pain syndrome, irritable bowel syndrome) | Pain as your bladder fills, urgency, bloating | Care from a urologist or gastroenterologist |
| Ovarian cyst from ovulation | One-sided pain, sometimes sudden | Usually resolves on its own; sudden severe pain needs same-day care |
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How does Dr. Meyer find the cause of pain after a previous surgery?
Dr. Meyer reads the operative report and pathology from your earlier surgery, compares them with new ultrasound and MRI, and examines you before recommending any treatment.
- Operative report: where endometriosis was found, what was removed, and whether it was excised or ablated. On your new imaging, Dr. Meyer looks for disease in places the report does not describe.
- Pathology: whether the tissue removed was confirmed as endometriosis. You can still have endometriosis when an earlier laparoscopy or pathology report found none.
- Ultrasound and MRI: these show deep nodules, endometriomas and adenomyosis, and distinguish an endometrioma from an ovulation cyst. They often miss adhesions and small surface deposits.
- Examination: tender points and tight pelvic floor muscles that match the pain you describe.
If imaging shows endometriosis on your bowel, Dr. Meyer and our colorectal surgeons, Dr. Yosef Nasseri and Dr. Moshe Barnajian, review your scans side by side at a joint case conference and plan one operation.
Can you have endometriosis surgery again?
A repeat operation is possible, and it often takes longer than the first because adhesions from earlier surgery can bind your bowel, ovaries and uterus together. Dr. Meyer frees those adhesions, then excises the remaining endometriosis in the same operation.
Another operation is more likely to help when:
- Imaging shows deep nodules, endometriomas, or disease on your bowel, bladder or diaphragm
- The repeat operation is more extensive, with complete endometriosis excision, and sometimes a hysterectomy
- Adhesions are located where you feel the pain
It is less likely to help when your symptoms are no longer related to periods and become chronic.
What a repeat operation can involve:
- Excising all visible endometriosis
- Release of adhesions and restoration of the normal anatomy
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How can you lower the chance of endometriosis coming back?
Removing all visible endometriosis lowers the risk as disease left behind is the main cause of early recurrence. Hormone treatment after surgery further lowers recurrence rate. In studies comparing hormone treatment after surgery with surgery alone, the risk of endometriosis returning was 59 to 70% lower, and the risk of symptoms returning about 30% lower, at 12 months of follow-up (Masferrer-Ferragutcasas et al., 2026).
- Hormonal IUD or combined pill: the 2022 European Society of Human Reproduction and Embryology (ESHRE) guideline recommends that doctors consider a 52 mg levonorgestrel IUD or a combined hormonal contraceptive for at least 18 to 24 months after surgery, to keep painful periods from returning..
- Long-term treatment after endometrioma surgery, if you are not trying to conceive right away.
The benefit fades after treatment stops. Patients treated for less than 12 months have recurrence rates within one to two years similar to patients who had no treatment (Masferrer-Ferragutcasas et al., 2026).
Pregnancy and breastfeeding pause ovulation and are linked to lower recurrence. If you are trying to conceive, ESHRE advises against hormone treatment after surgery for the sole purpose of improving your chance of pregnancy. Read more about hormonal treatment for endometriosis.
Why patients with pain after surgery choose the Comprehensive Endometriosis Center
- Dr. Raanan Meyer: fellowship-trained in minimally invasive gynecologic surgery at Cedars-Sinai, and Director of the Comprehensive Endometriosis Center.
- Research: Dr. Meyer directs the MIGS Research Program at Cedars-Sinai and publishes on deep endometriosis and surgical outcomes.
- Dr. Yosef Nasseri and Dr. Moshe Barnajian: double board-certified general and colorectal surgeons and leaders in robotic surgery, who have operated with Dr. Meyer for years.
- Adenomyosis: Dr. Meyer treats it as well as endometriosis, so one surgeon plans your care if you have both.
Recurrent endometriosis surgery in Los Angeles
Dr. Raanan Meyer, an advanced minimally invasive gynecologic surgeon in Los Angeles, performs repeat endometriosis surgery laparoscopically or robotically. He frees adhesions and removes the remaining endometriosis down to healthy tissue in one operation, treating both surgical causes of returning pain together, and when the disease reaches your bowel, bladder or diaphragm, the colorectal, urologic or thoracic surgeon for that organ operates with him. Wherever it is safe, he preserves your uterus and ovaries to protect your fertility.
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Frequently asked questions
How many times can you have endometriosis surgery?
There is no fixed limit, but each operation can form new adhesions and, on an ovary, remove healthy tissue. Dr. Meyer recommends another operation when surgery is likely to improve your symptoms.
Can endometriosis come back after a hysterectomy?
Yes, though, less often. Symptoms return in about 10% of patients after hysterectomy. With removal of both ovaries, recurrence rate is even lower. (Selçuk and Bozdağ, 2013). However, removing both ovaries causes menopause if you have not yet reached it and is associated with negative long term effects. A hysterectomy on its own does not remove endometriosis on other organs, which has to be excised in the same operation.
Would a different surgeon find more endometriosis?
Possibly. Dr. Meyer evaluates your ultrasound and MRI scan and looks for signs of deep endometriosis. Superficial endometriosis may not be seen on these images. During surgery, he performs a thorough evaluation for the presence of endometriosis lesions.
Sources
- Masferrer-Ferragutcasas C, et al. Rethinking endometriosis recurrence: from clinical challenge to biological opportunity. npj Women’s Health, 2026. https://www.nature.com/articles/s44294-026-00128-9 (review; also the source for Vignali et al., 2005, J Minim Invasive Gynecol 12:508–513, and Muzii et al., 2015, Fertil Steril 103:738–743)
- ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Human Reproduction Open, 2022(2):hoac009. https://pmc.ncbi.nlm.nih.gov/articles/PMC8951218/
- Selçuk İ, Bozdağ G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. Journal of the Turkish-German Gynecological Association, 2013;14(2):98–103. https://pmc.ncbi.nlm.nih.gov/articles/PMC3881735/
- Cleveland Clinic. Endometriosis Surgery: Procedures, Recovery & Results. https://my.clevelandclinic.org/health/treatments/4620-endometriosis-surgery