Endometriosis is a painful condition in which endometrial tissue grows outside the uterus, often in the pelvic area. It commonly affects women in their reproductive age.

In which patients’ surgeries are performed?
Surgery is indicated for women suffering from endometriosis with severe pain. It can also be performed if the endometriosis has affected multiple organ systems like the bowel or bladder. If a woman has severe endometriosis and decides not to get pregnant again, then surgery is a good option.

Why surgery is not the best solution?
Surgery often comes with risks. It is impossible to remove every cell of misplaced tissue and the remaining tissue can grow, this can cause recurrence of the symptoms. If endometriosis has spread to other important organs then the surgical removal of the disease on these organs can come with extra risks or complications.

Most of the times surgery can relieve the pain but won’t necessarily cure endometriosis, even after a hysterectomy. Unfortunately, in certain cases, the surgery won’t even alleviate the symptoms. 

In some cases, there are chances of recurrence of endometriosis after surgery. Reports have suggested that in 20-40% of women who had conservative surgery, symptoms resurfaced within 5 months and with the same level of pain. 

Surgery can also cause some other issues:

• Important organs like the bladder can be damaged and need to be repaired.
• Infections involving the cuts on the bladder or the womb can also occur.
• Occasionally, post-surgery patients could find it difficult to pass urine and might need a catheter.

What you should know before undergoing surgery?
There are some risks associated with surgeries that are performed to remove endometriosis. Woman undergoing surgery must have an idea about risks and complications associated with surgery, which include:

• Pelvic infection
• Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
• Scar tissue formation after surgery.
• Damage to the bowel, bladder, or ureters can happen, because of the small tubes that carry urine from the kidneys to the bladder.

What are the long-term effects of surgery on the ovaries?
Surgical removal has no beneficial effects on pregnancy rates and can reduce the ovarian output of eggs. 

• It can cause permanent damage to the ovaries.
• Risk of reduced ovarian function.
• Can lead to a reduction in the number of ovarian follicles
• Reduce ovarian reserve

Hysterectomy is a surgery used to treat severe endometriosis. It involves the removal of uterus, cervix, and ovaries. Once a woman has had a hysterectomy, she’ll no longer get her menstrual cycles and she won’t be able to get pregnant after the surgery.

Having the ovaries removed is more likely to relieve your symptoms long term because it stops the hormone swings that the tissue responds to. If a woman had her ovaries removed, she’ll have menopause due to which she may experience some effects, like:

• Hot flashes
• Vaginal dryness
• Night sweats
• Insomnia
• Bone density loss

Other approaches such as diet, other options along with medical nutrition therapies have been known to show beneficial effects in managing endometriosis. They also help to reduce the need of surgery as surgery often leads to relapse.

The growing importance of supplements like NAC, curcumin & resveratrol on the cyst
Below we list down some of the naturally occurring compounds that help to manage endometriosis. These approaches are effective and safe.

Curcumin
Curcumin has been known for its anti-inflammatory properties and is one of the most valuable agents used in the prevention and treatment of endometriosis. Inflammation plays a key role in the development of endometriosis and curcumin due to its anti-inflammatory properties can be effectively used for the management of endometriosis.

Curcumin decreases endometrial cell proliferation, increases apoptosis thus reducing size and number of endometriotic lesions. The effect of curcumin on endometriotic cells/lesions is scientifically proven.

Endometriosis can get worse because of oxidative stress due to the production of free radicals and reactive oxygen species (ROS). This leads to increasing growth and adhesion of endometrial cells in the peritoneal cavity. Curcumin has a therapeutic potential as it possesses antioxidant properties. Thus, prevents the effects of oxidative stress on endometriosis development and infertility. 

Resveratrol
Resveratrol is a natural polyphenol flavonoid. It is found in seeds and the skin of grapes, in mulberries and red wine. The antineoplastic, anti-inflammatory and antioxidant effects of resveratrol are well established. Studies have also further confirmed the anti-angiogenic properties of resveratrol that inhibit the development of endometriotic lesions.

Resveratrol has several mechanisms of action that apply to endometriosis. Its anti-inflammatory effect is achieved by:

• Inhibition of inflammatory mediators like cytokine 
• Inhibiting inflammatory reaction monocytes, macrophages, and lymphocytes. 
  Resveratrol is also recognized to have various actions, both agonist and antagonist on estrogen receptors. It also affects cell proliferation and apoptosis, so inhibits the growth of endometriosis.

N-acetylcysteine
N-acetylcysteine (NAC) is the acetylated form of cysteine which, when supplemented, has been shown to reduce the size of endometriosis. It also

• Replaces proliferative behavior with differentiating behavior, hence acts as an anti-proliferative agent.
• It also acts as an anti-inflammatory agent; decreases the inflammatory and invasive activity.

References:
https://helloclue.com/articles/cycle-a-z/managing-endometriosis-treatment-options

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14834

https://pubmed.ncbi.nlm.nih.gov/26841161-nutritional-aspects-related-to-endometriosis/

https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661