What Kind Of Doctor Do You See For Endometriosis and Fibroids: What to Know

What Kind Of Doctor Do You See For Endometriosis and Fibroids: What to Know

Pelvic pain, heavy periods, and fertility challenges often point to two common conditions: endometriosis and uterine fibroids. Knowing which type of doctor to see can speed up diagnosis, expand your treatment options, and help you reach your goals—whether that’s pain relief, lighter periods, or preserving fertility. Here’s a clear guide, grounded in evidence from trusted sources such as the American College of Obstetricians and Gynecologists (ACOG), the National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA).

Where to Start: Primary Care and OB-GYN

For most people, a good starting point is either your primary care clinician or an obstetrician-gynecologist (OB-GYN). Primary care can evaluate symptoms, order basic tests (like a pelvic ultrasound), and refer you to the right specialist. Many patients with heavy bleeding, severe cramps, or pelvic pain go directly to an OB-GYN, who is the core specialist for both endometriosis and fibroids.

  • Go to primary care if you want an initial workup, help managing pain, or guidance on referrals.
  • Go to an OB-GYN if you have persistent heavy bleeding, painful periods, pelvic pain, or trouble conceiving.

ACOG provides patient-focused overviews of endometriosis and uterine fibroids.

Endometriosis: Which Doctors and When

  • General OB-GYN: Manages most cases. They diagnose clinically, offer first-line medical treatment (e.g., hormonal therapies), and can perform diagnostic or therapeutic laparoscopy when needed. ACOG notes that many patients can be treated based on symptoms without immediate surgery.
  • Reproductive Endocrinologist (REI): If endometriosis is affecting fertility (e.g., you’ve tried to conceive for 6–12 months without success), an REI can evaluate ovarian reserve, tubal patency, and recommend fertility-focused treatments such as ovulation induction or IVF.
  • Minimally Invasive Gynecologic Surgeon (MIGS): For severe, deep infiltrating endometriosis, or persistent pain despite medication, a gynecologist with advanced laparoscopic/robotic training can perform excision or ablation while preserving fertility when possible.
  • Multidisciplinary care: Pelvic floor physical therapists, pain specialists, gastroenterologists, urologists, or colorectal surgeons may be part of the team for bowel or bladder involvement and complex pain. NIH’s overview of endometriosis symptoms and complications is a useful reference (NICHD).

Fibroids: Which Doctors and When

  • General OB-GYN: The primary specialist for fibroids. OB-GYNs diagnose fibroids with pelvic exam and ultrasound, manage heavy bleeding and pain, and perform surgery such as myomectomy (fibroid removal) or hysterectomy.
  • Interventional Radiologist (IR): If you’re considering uterine fibroid embolization (UFE)—a minimally invasive, uterus-sparing procedure that shrinks fibroids—an IR consult can clarify candidacy, risks, and outcomes. ACOG and NIH include UFE among established options.
  • MIGS surgeon: For complex fibroids (e.g., large or numerous fibroids), a MIGS specialist may offer laparoscopic/robotic myomectomy, transcervical or laparoscopic radiofrequency ablation, or minimally invasive hysterectomy.

NIH’s overview of uterine fibroids covers causes, symptoms, and treatments (NICHD).

How Doctors Diagnose Endometriosis and Fibroids

Endometriosis

  • Clinical assessment: History and pelvic exam often guide diagnosis. ACOG emphasizes that treatment can begin based on symptoms; surgery is not always required immediately.
  • Imaging: Ultrasound can detect endometriomas (ovarian cysts from endometriosis) and sometimes deep disease; MRI helps in mapping complex cases but cannot rule out superficial disease.
  • Laparoscopy: The surgical “gold standard” for definitive diagnosis and removal of visible lesions when needed.

Fibroids

  • Ultrasound: First-line, noninvasive, and widely available to confirm fibroids and estimate size/location (ACOG).
  • MRI: Helpful for surgical planning, especially with many or large fibroids.
  • Lab tests: Blood counts to check for anemia from heavy periods; pregnancy test when appropriate.

Treatment Options by Specialty

Medications

  • Pain relief: NSAIDs can reduce cramps and pelvic pain.
  • Hormonal therapies: Combined oral contraceptives, progestin-only pills, injections, or a levonorgestrel-releasing IUD can control bleeding and pain (ACOG).
  • GnRH analogs: For endometriosis pain, the FDA has approved elagolix (Orilissa) (FDA). For fibroid-related heavy bleeding, options include elagolix with add-back therapy (Oriahnn) (FDA) and relugolix combination therapy (Myfembree) for fibroids and endometriosis (FDA).
  • Antifibrinolytics: Tranexamic acid (Lysteda) is FDA-approved to reduce heavy menstrual bleeding (FDA).

Medication selection depends on your goals (pain relief, cycle control, fertility), health history, and side effect profile.

Procedures and Surgery

  • Endometriosis surgery: Laparoscopic excision or ablation performed by an experienced gynecologic surgeon can improve pain and, in some cases, fertility (ACOG).
  • Myomectomy: Surgical removal of fibroids with uterus preservation (via hysteroscopy, laparoscopy/robotics, or open surgery). Best for those seeking future pregnancy.
  • Uterine fibroid embolization (UFE): Performed by an interventional radiologist to shrink fibroids and reduce bleeding. Uterine-sparing but may affect future fertility; discuss risks/benefits based on your plans.
  • Radiofrequency ablation (RFA): Laparoscopic or transcervical destruction of fibroids (e.g., Acessa, Sonata systems). Minimally invasive, uterus-sparing; candidacy depends on fibroid size and location.
  • MRI-guided focused ultrasound (MRgFUS): A noninvasive, uterus-sparing option available in select centers; not suitable for all fibroid types (ACOG).
  • Hysterectomy: Definitive treatment for fibroids when childbearing is complete and other options are ineffective or undesired.

Each approach has benefits and trade-offs. An OB-GYN, MIGS surgeon, or IR can outline success rates, recovery times, impact on fertility, and recurrence risks for your specific case.

Choosing the Right Specialist

  • Match expertise to your goals: If fertility is a priority, consider an OB-GYN with reproductive expertise or an REI. For complex surgery, ask about a surgeon’s minimally invasive training and case volume.
  • Board certification and experience: Look for board-certified OB-GYNs and interventional radiologists; ask how often they perform the procedure you’re considering.
  • Seek second opinions: Especially for repeat surgery, deep infiltrating endometriosis, or when you’re deciding between UFE, myomectomy, or hysterectomy.
  • Insurance and access: Confirm coverage, required referrals, and in-network specialists. Bring prior imaging and records to save time.

Smart questions to ask

  • What is the most likely diagnosis based on my symptoms and imaging?
  • Which treatments fit my goals (pain control, lighter periods, pregnancy now or later)?
  • What are the success rates, recovery time, and recurrence risk?
  • How will this affect fertility, and what are my fertility-preserving options?
  • What are the medication side effects and how long can I safely use them?

When to Seek Urgent Care

  • Severe pelvic pain with fever, vomiting, or fainting
  • Heavy bleeding soaking through a pad or tampon every hour for more than two hours
  • Rapid abdominal enlargement, severe dizziness, or signs of anemia (shortness of breath, extreme fatigue)

Trusted Sources and Further Reading

Bottom line: Start with an OB-GYN, then tailor your care team based on your goals and the complexity of your condition. With the right specialist and a plan aligned to your priorities, most people can achieve meaningful relief and protect their reproductive health. This article is informational and not a substitute for personal medical advice.

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