Are we disturbing the weed!

Hi…

I want to talk today about something that’s been playing on my mind, something I’ve been noticing not just in my own experience with endometriosis, but in conversations with other women too.

It’s about excision surgery, which is often called the “gold standard” for endometriosis treatment.

Now, don’t get me wrong, I fully respect the skill and precision that some surgeons bring to this work.

But I’ve also noticed a pattern that I think we’re not talking about enough.

Many women go in for this so-called routine laparoscopic excision surgery, and they come out… not better, but worse.

Months later, they’re still in pain, sometimes even more pain than before. And when you speak to them, they’re often told, “The surgery was successful,” or, “Everything looked fine.” But if the woman is still in agony, then clearly something isn’t adding up.

So here’s my theory.

What if operating on active endometriosis that red, inflamed, hormonally reactive tissue is like disturbing a weed while it’s still thriving in fertile soil?

Anyone who’s ever done a bit of gardening knows, if you cut a weed at the wrong time, or pull it up without fully removing the root, what happens? It doesn’t just come back, it comes back faster, stronger, and deeper.

And maybe that’s exactly what’s happening here. These “active” lesions are alive, they’ve got blood supply, inflammation, hormonal sensitivity, immune activity and we’re cutting into them during their most aggressive phase. Isn’t it possible that this trauma actually stimulates the disease to become more entrenched?

Surgery itself is trauma. It activates inflammation, and if you already have a dysregulated immune system which so many endometriosis sufferers do then that inflammation could actually fuel recurrence or worsen nerve sensitivity.

And let’s not forget,

not all pain is from lesions!

Sometimes it’s adhesions, sometimes it’s nerve dysfunction, sometimes it’s deep central sensitisation where the nervous system itself becomes hypersensitive. So even if the surgery technically removes the tissue, it might not address the pain and might even make it worse.

So here’s the big question I think we need to start asking:

Should we be operating on active endo at all?

Would outcomes improve if surgeons waited until the disease was less inflamed?

maybe after a period of hormonal or immune modulation?

Should we be developing more advanced ways to time surgery and not just blindly perform it?

Because right now, the system feels backwards: we’re being sent for surgery without truly understanding the hormonal, immune, and neurological environment it’s happening in. It’s like fighting a fire with a knife.

This isn’t about blaming surgeons, many are doing their best with the tools and knowledge they’ve got. But if we’re going to truly treat endometriosis in all its complexity, we’ve got to start thinking bigger than the scalpel.

Surgery isn’t a quick fix — especially not when the garden is still overgrown and hostile. Maybe it’s time we stop cutting weeds in fertile soil… and start listening to what the soil is telling us first.

Thanks for listening.