Endometriosis Specialist Maryland and Fibroids: What to Know

Endometriosis Specialist Maryland and Fibroids: What to Know

Endometriosis and uterine fibroids are among the most common gynecologic conditions, yet they are frequently misunderstood and underdiagnosed. If you live in Maryland and are seeking help for pelvic pain, heavy periods, or fertility concerns, seeing a specialist can make a meaningful difference in diagnosis, treatment options, and long-term outcomes. Below, you’ll find a clear, evidence-based guide to how these conditions differ, how they’re diagnosed and treated, and how to choose the right endometriosis specialist in Maryland.

Endometriosis vs. Fibroids: Key Differences

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, pelvic peritoneum, and other sites. It can trigger inflammation and scarring that lead to chronic pelvic pain, painful periods, pain with sex, bowel or bladder symptoms, and sometimes infertility. Symptoms do not always correlate with disease severity, and routine imaging may be normal. Trusted overviews: NIH/NICHD, ACOG.

Uterine fibroids (leiomyomas) are benign muscle tumors of the uterus. They are very common and can cause heavy or prolonged menstrual bleeding, pelvic pressure or pain, bulk symptoms (bloating, urinary frequency), anemia, and pregnancy complications in some cases. Black women are disproportionately affected and tend to develop fibroids at younger ages. Trusted overviews: NIH/NICHD, ACOG.

It’s also possible to have both conditions at once. Because symptoms overlap (pain, heavy bleeding, fatigue from anemia), a careful evaluation is crucial.

When to See an Endometriosis Specialist in Maryland

Consider consulting a specialist if you have:

  • Pelvic pain that interferes with school, work, or daily life (especially >6 months).
  • Severe menstrual cramps unrelieved by over-the-counter pain relievers.
  • Pain with sex, bowel movements, or urination around your period.
  • Heavy menstrual bleeding (soaking pads/tampons every 1–2 hours, passing clots) or iron-deficiency anemia.
  • Difficulty getting pregnant or recurrent pregnancy loss.
  • Fibroid symptoms such as pelvic pressure, urinary frequency, or abdominal distension.

Maryland is home to high-volume gynecology and minimally invasive surgery programs where multidisciplinary care is available. Large academic centers and hospital-affiliated practices can coordinate imaging, medical therapy, interventional radiology, and surgery when needed.

How Specialists Diagnose Endometriosis and Fibroids

  • History and pelvic exam: A detailed symptom timeline, menstrual history, prior treatments, and pain mapping help narrow possibilities. Pelvic exam can identify tender points, nodularity, enlarged uterus, or masses.
  • Imaging: Transvaginal ultrasound is first-line to assess fibroids and ovarian cysts. MRI may be used for surgical planning or when deep endometriosis is suspected. Note: imaging can miss endometriosis that involves only superficial peritoneal disease (ACOG, NIH).
  • Diagnostic laparoscopy: While not always required, surgical visualization with biopsy is the gold standard for definitive endometriosis diagnosis. Many specialists aim to treat (excision/ablation) during the same procedure when appropriate.
  • Labs: Blood tests may assess anemia or rule out other conditions; there is no reliable blood test that diagnoses endometriosis.

Treatment Options: Individualized, Stepwise Care

Care is tailored to your symptoms, goals (pain relief, controlling bleeding, fertility), age, and other health factors. Many plans combine medical therapy, lifestyle measures, and, when needed, procedures.

Endometriosis management

  • Pain relief: NSAIDs for cramps and inflammation.
  • Hormonal suppression: Combined oral contraceptives, progestin-only pills, depot medroxyprogesterone, etonogestrel implant, or levonorgestrel IUD to reduce pain and bleeding (ACOG).
  • GnRH antagonists: Elagolix (brand Orilissa) is FDA-approved for moderate-to-severe endometriosis pain; add-back therapy may reduce bone loss and hypoestrogenic side effects. See FDA labeling for indications and duration limits.
  • Relugolix/estradiol/norethindrone acetate: Myfembree is FDA-approved for moderate-to-severe endometriosis pain with specified duration limits; monitoring for bone density is important (FDA).
  • Surgery: Laparoscopic excision or ablation can relieve pain and improve fertility in selected cases. Choose surgeons experienced in endometriosis excision, especially for disease involving bowel, bladder, or diaphragm.
  • Fertility: When pregnancy is the goal, a specialist may coordinate surgery, ovulation induction, or referral to reproductive endocrinology. Early involvement can optimize outcomes (NIH/ACOG).

Fibroid management

  • Expectant management: If fibroids are small and asymptomatic, observation is reasonable.
  • Medical therapies: NSAIDs for cramps; tranexamic acid for heavy menstrual bleeding; hormonal options such as combined oral contraceptives or levonorgestrel IUD to reduce bleeding (ACOG).
  • GnRH agonists/antagonists: Short-term use can shrink fibroids or reduce bleeding. FDA-approved options include Oriahnn (elagolix + estradiol + norethindrone acetate) and Myfembree (relugolix combination) for heavy menstrual bleeding due to fibroids, with defined treatment durations and bone health monitoring (FDA).
  • Uterine-sparing procedures: Myomectomy (hysteroscopic, laparoscopic/robotic, or open) removes fibroids while preserving the uterus; choice depends on size, number, and location. Uterine fibroid embolization (UFE), performed by interventional radiologists, blocks blood flow to fibroids to reduce size and bleeding. MRI-guided focused ultrasound may be available in select centers (ACOG/NIH).
  • Hysterectomy: A definitive option for those finished with childbearing who have persistent, severe symptoms.

All treatments have benefits and risks. A specialist can explain side effects (for example, hypoestrogenic symptoms or bone density effects with GnRH therapies) and discuss how choices may affect fertility and recovery time.

Fertility and Pregnancy Planning

Endometriosis can impair fertility by causing inflammation, scarring, or distorted anatomy. Submucosal fibroids and some intramural fibroids can also affect conception and miscarriage risk. If you are trying to conceive:

  • Ask whether fibroid removal (e.g., hysteroscopic myomectomy) could improve outcomes.
  • Discuss timing of conception after surgery and any needed recovery intervals.
  • Consider early referral to reproductive endocrinology if age or other factors suggest lower ovarian reserve.

Choosing the Right Specialist in Maryland

Look for:

  • Training and volume: Board-certified OB-GYN with fellowship training in minimally invasive gynecologic surgery (MIGS) or significant experience in endometriosis excision and complex fibroid surgery.
  • Comprehensive services: Access to pelvic floor physical therapy, interventional radiology (for UFE), reproductive endocrinology, and pain management.
  • Transparent approach: Willingness to discuss excision versus ablation for endometriosis, uterine-sparing options for fibroids, and complication rates.
  • Hospital affiliation: Centers with advanced imaging and multidisciplinary care—Maryland hosts several such programs at academic medical centers and large hospital systems.

Preparing for Your Appointment

  • Bring prior records: imaging, operative reports, pathology, and lab results (including iron studies).
  • Keep a 2–3 month symptom diary: cycle dates, pain scores, bleeding volume, triggers, and medication response.
  • List all medications and supplements tried, including side effects.
  • Clarify goals: pain relief, cycle control, fertility, or avoiding major surgery.
  • Questions to ask: What is my working diagnosis? What tests do I need? What are the pros/cons of each treatment, including impact on fertility and recovery time? How many similar surgeries do you perform annually?

Insurance, Costs, and Access

Most insurers cover evaluation and evidence-based treatments for endometriosis and fibroids, but prior authorization may be required for advanced imaging, specialty medications (e.g., GnRH antagonists), or surgery. Ask your clinic about documentation needed and available financial counseling. Telehealth may be useful for initial consultations and follow-up.

When to Seek Urgent Care

  • Heavy bleeding soaking a pad or tampon every hour for more than two consecutive hours.
  • Signs of anemia or hemodynamic instability: dizziness, fainting, chest pain, shortness of breath, or paleness.
  • Severe, sudden pelvic pain with fever, nausea/vomiting, or positive pregnancy test.

If you experience any of the above, seek emergency care or call 911.

Trusted Resources

Bottom line: With the right specialist—particularly one experienced in complex endometriosis and fibroid care—most people can find a plan that controls symptoms, protects fertility when desired, and supports long-term health. If you’re in Maryland and struggling with pain or heavy bleeding, don’t wait: schedule a consultation and bring your questions. You deserve individualized, evidence-based care.

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