Written by Dr. Merritt Jones, LAc, DAIM, FABORM
So You’ve Had Endo Surgery — Now What?
If you’ve just had excision surgery for endometriosis, you’re probably feeling a lot of things. Relief, exhaustion, hope for the first time in a while, uncertainty about what comes next. Getting to this point likely took years of symptoms, being dismissed, doing your own research, and fighting to be believed. That road is long, and it takes a toll.
But here’s what nobody always tells you: surgery is a critical step, not the finish line.
Excision surgery is the gold standard for removing endometriosis lesions, and for many people it’s life-changing. But endo is a whole-body, chronic inflammatory condition. The immune dysfunction, the nervous system sensitization, the hormonal imbalances, the pelvic floor tension, the gut issues. Those don’t resolve on the operating table. They need their own attention.
That’s where your post-surgical village comes in.
Why “Post-Op Care” Is Bigger Than You Think
After surgery, your body is doing a lot: healing tissue, resolving inflammation, recalibrating. This is actually one of the most powerful windows to intervene. Your lesions have been removed, and now you have an opportunity to address the underlying patterns that contributed to your symptoms (and that may contribute to recurrence if left unchecked).
Think of surgery as clearing the field. What you do next determines what grows there.
So let’s talk about who belongs on your post-op team, when to bring them in, and what to expect.
Acupuncture & Integrative Medicine
When to start: Many people benefit from starting acupuncture before surgery to optimize their body’s readiness to heal, reduce inflammation, and calm the nervous system. If that wasn’t part of your plan, no worries. Starting in the weeks after surgery is a great time too. Most people can safely begin acupuncture within 1–2 weeks post-op, depending on the procedure and your surgeon’s guidance.
What it does post-surgery: Acupuncture supports post-op recovery by reducing pain and inflammation, improving pelvic circulation and tissue healing, calming the nervous system (which is often in overdrive after years of chronic pain), and helping regulate your hormones and cycle as your body recalibrates. Herbal medicine and targeted supplements can further support hormone metabolism, gut repair, and immune balance, all of which matter for long-term endo management.
What to expect: Weekly sessions are typical in the first phase of recovery, gradually spacing out as you stabilize. Many people notice meaningful shifts within 3–6 weeks of consistent treatment.
Pelvic Floor Physical Therapy
When to start: Your surgeon will likely give you the green light for pelvic floor PT around 4–6 weeks post-op, once initial healing is underway. Some pelvic PTs will do a gentle intake earlier to assess your baseline and start with breathwork, nervous system regulation, and external work before progressing to internal techniques.
Why it matters: If you’ve lived with endo for years, your pelvic floor has been through a lot. Chronic pain leads to guarding, tension, and compensatory movement patterns. Surgery itself can also create scar tissue and adhesions. Pelvic floor PT helps release that tension, restore mobility, improve bladder and bowel function, and reduce pain with penetration or intercourse. It’s also essential for people who are planning to conceive. A pelvic floor that can relax and coordinate well supports fertility and pregnancy.
What to expect: Sessions typically involve a combination of internal and external manual therapy, breathwork, movement retraining, and home exercises. Progress is usually gradual and cumulative.
Nutrition Therapy
When to start: Ideally, nutritional support begins before surgery, but it’s never too late. The post-op period is an excellent time to focus on anti-inflammatory, nutrient-dense eating because your body is actively rebuilding tissue, processing residual inflammation, and re-establishing hormonal rhythms.
Why it matters: Nutrition is foundational to endo management. The right dietary approach can help reduce inflammatory markers, support estrogen metabolism and detoxification, heal the gut lining (especially important if you deal with endo belly, bloating, or dysbiosis), stabilize blood sugar (which in turn supports hormone balance), and provide the building blocks for tissue repair. This doesn’t mean a rigid elimination diet forever. It means finding a sustainable, nourishing way of eating that supports your body’s unique needs and that actually fits into your real life.
What to expect: Working with a provider who understands endo-specific nutrition (not just general “eat healthy” advice) makes a real difference. Your plan might include targeted supplementation, gut-healing protocols, and practical strategies for meals and snacks that reduce inflammation without feeling restrictive.
Mental Health Support
When to start: Honestly? Whenever you’re ready, and ideally sooner rather than later. Many people feel a complex mix of emotions after surgery: relief, grief, frustration, hope, anxiety about recurrence, anger about how long it took to get diagnosed. All of it is valid. Some people also experience a post-surgical emotional dip as the body heals and hormones shift.
Why it matters: Endometriosis is not just a physical condition. Years of pain, medical gaslighting, lost time, strained relationships, fertility fears. These leave real marks. A therapist who understands chronic illness (and ideally endo specifically) can help you process that history, develop coping tools, and build a relationship with your body that isn’t defined by pain. Nervous system regulation is also deeply connected to pain perception and inflammation, so mental health care isn’t separate from your physical recovery. It’s part of it.
What to look for: Therapists experienced with chronic pain, chronic illness, health-related trauma, or somatic-based approaches (like EMDR or somatic experiencing) are often a particularly good fit. Support groups, whether in person or online, can also be incredibly validating.
Building Your Village: Who’s on the Team?
Putting your post-op team together can feel overwhelming, especially when you’re recovering from surgery and already exhausted. But you don’t have to do everything at once. Here’s who to consider and when they typically come into the picture.
Your excision surgeon is your anchor. Even after surgery, you’ll likely have follow-up appointments to monitor healing, discuss pathology results, and plan for long-term management. Keep that relationship active. If you don’t yet have an excision specialist (as opposed to a general gynecologist) this is worth looking into for any future surgical needs.
A pelvic floor physical therapist is one of the first providers to bring on board post-op, usually around 4–6 weeks after surgery. Years of endo pain create deeply held tension and guarding patterns in the pelvic floor that don’t just disappear once lesions are removed. A pelvic PT helps your body relearn how to move, relax, and function without bracing against pain.
An acupuncturist (ideally one with experience in endo and reproductive health) can begin working with you within 1–2 weeks post-op in most cases. Acupuncture supports surgical recovery by reducing inflammation, improving pelvic circulation, calming the nervous system, and helping your hormones and cycle recalibrate. This is also where herbal medicine, supplements, and functional lab work often come in.
A nutritionist who understands endometriosis can help you build an anti-inflammatory, gut-supportive way of eating that’s sustainable, not punishing. This is especially important if you deal with endo belly, bloating, or digestive issues. Nutrition work can start at any point, but the post-op window is a particularly powerful time to focus on it.
A gastroenterologist is worth having on your team if you experience significant GI symptoms, whether that’s chronic bloating, IBS-like patterns, constipation, diarrhea, or pain with bowel movements. Endo and gut issues are deeply intertwined, and it helps to have someone who can rule out overlapping conditions and coordinate with the rest of your team.
A mental health therapist, particularly one experienced with chronic illness, chronic pain, or health-related trauma, can help you process the emotional weight of living with endo. The grief, the anger, the medical gaslighting, the fertility fears. These are real, and they deserve real support. Somatic-based approaches like EMDR or somatic experiencing can be especially helpful. This is a provider you can bring in at any point, whenever you’re ready.
A reproductive endocrinologist (RE) is an important team member if you’re trying to conceive or thinking about fertility down the road. Look for an RE with specific experience treating endometriosis, as the disease presents unique challenges around egg quality, ovarian reserve, tubal function, and implantation that not every RE approaches the same way. Even if pregnancy isn’t on your radar right now, a baseline fertility assessment after surgery can give you valuable information for future planning.
A few more things to keep in mind:
Start with what feels most urgent or accessible. For many people, that’s acupuncture and pelvic PT in the first few weeks, with nutrition, mental health and other support layered in as capacity + need allows.
Ask your providers for referrals. A good endo specialist will have network of trusted colleagues. Don’t be afraid to ask who they recommend.
Look for providers who “get” endo. Not every therapist, nutritionist, GI doc, or PT has experience with endometriosis. It makes a difference when your provider understands the complexity of this disease and doesn’t minimize your experience.
Make sure your team communicates. The best outcomes happen when your providers are coordinated and aware of each other’s treatment plans. At Natural Harmony, collaboration with your full care team is built into how we practice.
Give yourself grace. Recovery is not linear. There will be great weeks and hard weeks. Having a team around you means you don’t have to figure it all out alone.
You’ve Done the Hard Part
Getting to surgery is a massive milestone. What comes next is your chance to truly invest in long-term wellness. Not just surviving endo, but building a life where you feel strong, supported, and heard.
If you’re navigating post-surgical recovery and wondering where to start, we’d love to be part of your village. Book a complimentary 10-minute call to talk through your situation and figure out the right next steps for you.
Medically reviewed by the author 4/14/26
Dr. Merritt Jones is a board-certified reproductive acupuncturist (FABORM) and the founder of Natural Harmony Reproductive Health in San Diego. She has lived with stage 4 endometriosis and adenomyosis and has been helping others navigate this disease with integrative, whole-person care since 2015.