The Hidden Struggle: Adhesions, Scar Tissue, and the Surgery Dilemma Facing Women with Endometriosis and Adenomyosis

By Our Daughters Foundation

What are Adhesions? Adhesions are internal bands of scar tissue that form between organs and tissues, often after inflammation, infection, or surgery. Instead of healing cleanly, the body’s natural repair process sometimes causes tissues to stick together—like a web of internal glue. For women with endometriosis or adenomyosis, adhesions are more than just a medical term—they’re an often invisible, persistent source of pain.

Why Do They Form? Any pelvic or abdominal surgery can trigger adhesion formation. During healing, the body releases fibrin, a protein that acts like a sealant. Ideally, this dissolves after healing. But in some women, especially those with endometriosis or a history of inflammation, fibrin turns into permanent scar tissue—resulting in adhesions. Studies suggest that 55–100% of women undergoing pelvic surgeries form adhesions, and this rate increases with repeat procedures.

The Dilemma: Surgery Can Help… But Also Hurt Here lies the painful paradox: the most effective treatment for endometriosis-related pain is excision surgery. For adenomyosis, hysterectomy is often the only lasting relief. Yet these same surgeries often result in new adhesions—which can cause ongoing or even worsening pain.

Some women experience significant symptom relief after surgery. Others are left feeling frustrated, wondering why the pain persists. It’s not always due to the disease returning. Sometimes, the culprit is scar tissue itself.

Do Some Women Form More Adhesions Than Others? Yes. Risk factors for developing adhesions include: - Multiple prior surgeries - Endometriosis or chronic pelvic inflammation - Diabetes or poor wound healing - Longer or more invasive surgeries - Surgical techniques that involve more tissue handling or foreign materials

Unfortunately, there’s no test to predict who will develop adhesions. Some women are simply more prone due to individual biology and inflammatory response.

Are There Ways to Prevent Adhesions? There’s no guaranteed prevention, but surgeons can reduce risk by: - Using minimally invasive techniques (like laparoscopy) - Gentle tissue handling and reduced bleeding - Applying adhesion barriers (gels or membranes like Seprafilm, Hyalobarrier, or 4DryField®)

While promising, these barriers are not foolproof. Some studies report modest benefits, while others show significant reductions in adhesion formation when combined with expert surgical techniques.

The Cycle of Surgery and Scar Tissue This creates a cruel cycle for many women: 1. Disease causes pain 2. Surgery offers hope 3. Surgery causes scar tissue 4. Scar tissue causes pain 5. Repeat surgery may be needed

It’s no wonder women often feel stuck. Do they pursue another surgery and risk more adhesions? Or live with pain that doesn’t go away?

What About Non-Surgical Options? While no medication currently reverses endometriosis or adhesions, some women find relief through: - Physical therapy focused on pelvic floor and scar tissue mobilization - Anti-inflammatory diets - Nerve modulators for pain management - Gentle movement therapies like yoga

Still, these are supportive—not curative.

So What Is the Choice? There is no one-size-fits-all answer. For some, surgery brings significant relief. For others, it leads to more pain. This is why informed, compassionate, and expert care is critical. Women should expect: - Honest conversations about the risks of adhesions - Skilled excision surgeons who understand and minimize trauma - Follow-up care that addresses the whole body, not just the disease. Ultimately, we need better understanding of why endometriosis lesions and adenomyosis forms to begin with and a way to treat it before it causes the complications of chronic pain, infertility, & systemic inflammation. We need to get to the origin of disease.

References for Further Reading: - Liakakos T. et al., Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Digestive Surgery. 2001. - Oboh A., Trehan AK. Pelvic adhesion formation at second-look laparoscopy. Gynecol Surg. 2007. - Cochrane Review: Barrier agents for adhesion prevention in gynaecologic surgery. - Korell M. et al., Adhesion formation after endometriosis surgery. J Minim Invasive Gynecol. 2006. - Humaidan P. et al., Efficacy of starch-based adhesion barrier in gynecologic surgery. 2021.