Facing these symptoms, a hysterectomy might seem like the only option for relief. However, before making this irreversible decision, it’s vital to explore all avenues, including the expertise of excision specialists. Far too often in my practice, I see the tragedy, yes tragedy, of young women in their 20s and 30s who have never had children OR never had intercourse before falling to a provider who jumped to a hysterectomy. I have so many ethical concerns on this topic, but I will save that for a different day.  


When faced with the debilitating pain and discomfort of conditions like endometriosis and adenomyosis, many women are presented with a hysterectomy as a definitive solution. However, this is a significant, life-altering decision, and understanding all your options before proceeding is crucial. Endometriosis and adenomyosis, while related, are distinct conditions, each with its own set of challenges and treatment pathways. Knowing the difference between these conditions, recognizing their symptoms, and understanding the value of specialized care can make a world of difference in your treatment outcome.

Endometriosis occurs when tissue similar to the lining inside the uterus (endometrium) starts to grow outside the uterus, leading to pain, irregular bleeding, and potentially infertility. Adenomyosis, on the other hand, happens when endometrial tissue grows into the muscular wall of the uterus, causing severe cramps, heavy bleeding, and enlarged uterus.

Both conditions share common symptoms such as:

  • Severe menstrual cramps
  • Heavy menstrual periods
  • Pain during intercourse
  • Chronic pelvic pain
  • Low back pain
  • Uncommon Symptoms

Each condition also has unique, less common symptoms:

  • Endometriosis: Pain with bowel movements or urination, gastrointestinal issues, fatigue
  • Adenomyosis: Chronic lower abdominal pressure and bloating, pain throughout the menstrual cycle, not just during periods

The Surgical Dilemma and the Role of Specialists

Diagnosing endometriosis in teens is challenging. The symptoms can mimic other conditions, and there’s a pervasive myth that teenagers are too young to develop endometriosis. A combination of a thorough medical history, female family history, physical exams, and sometimes laparoscopy with a trained excision surgeon is used to diagnose the condition. It’s crucial for teens and their guardians to advocate for a thorough evaluation if endometriosis is suspected, especially if family members have a known diagnosis.

Excision Specialists vs. Regular OB/GYNs or General Surgeons

An excision specialist is a surgeon with advanced training in removing endometriosis lesions. This is all they do all day everyday, no more delivering babies or treating other GYN conditions. Unlike general gynecologists or surgeons, excision specialists use precise techniques to meticulously remove all endometriosis tissue, which can potentially offer long-term relief from symptoms. This contrasts with more common surgical methods like ablation, which merely burns the surface of the endometriosis lesions, often leaving underlying disease and leading to symptom recurrence

Regular OB/GYNs are crucial for routine reproductive health care, but they may not have the specialized training or experience to effectively manage and surgically treat endometriosis or adenomyosis. Similarly, general surgeons may not understand these conditions to offer alternative treatments or preserve fertility, if desired.

A Team Approach: Beyond a Single Provider

Endometriosis and adenomyosis are complex conditions that can affect every aspect of your life, from fertility and sexuality to mental health and overall well-being. Managing them often requires more than just surgical intervention. A multidisciplinary team can provide a comprehensive treatment plan tailored to your specific needs and goals. Before considering a hysterectomy, advocate for a thorough evaluation by a team of specialists who understand the intricacies of endometriosis and adenomyosis. Such a team can offer a range of treatments that preserve the uterus and especially fertility. They can also provide support for the emotional and psychological impacts of living with chronic pain and fertility concerns.


If you’re considering a hysterectomy, take a moment to pause and explore all your options. The decision to undergo such a significant surgical procedure should not be made in haste. I know I know, the bleeding and pain is awful. I have this too! BUT you can’t undo this decision. With the right team who understands the full scope of treatment possibilities, traditional and none, you may find a path that offers relief while preserving your fertility and long-term health. Remember, a well-informed decision is a powerful step toward reclaiming your life from chronic pain and symptoms.