Endometriosis

Endometriosis care in Miami.

The average delay between first symptom and diagnosis is measured in years, largely because painful periods get normalised. We treat that delay as the problem.

The options

How this is approached here

  1. 01

    Diagnosis starts with a history taken

    Seriously and an examination, not with a laparoscopy.

  2. 02

    Imaging can support the diagnosis but a normal scan does not rule endometriosis out, and we say so rather than discharging you.

  3. 03

    Medical management first where it is appropriate

    Hormonal suppression, and obstetrics and gynecology that is not only NSAIDs.

  4. 04

    Where surgery is indicated

    Excision rather than ablation for deep disease — the distinction matters for recurrence.

  5. 05

    Referral to a specialist centre for bowel or bladder involvement, arranged by us.

Symptoms

What to tell us about

Period pain that stops you working

Studying or sleeping, and that paracetamol and ibuprofen do not touch.

Pain that starts a day or two before bleeding and is different in character from cramps.

Deep pain during or after sex

Pain opening your bowels or passing urine

Especially around your period.

Bleeding from the bowel or in urine at the time of a period — uncommon, and important.

Difficulty conceiving after a year of trying

Or six months if you are over thirty-five.

Why it takes years to diagnose

What goes wrong, and what we do differently

  • Severe period pain gets normalised, often from adolescence, by family and by clinicians alike.
  • A normal ultrasound is read as ruling it out. It does not — superficial disease is invisible on a scan.
  • The pill masks the symptoms without addressing the disease, and the clock keeps running.
  • We treat a clinical diagnosis as a diagnosis. Treatment can reasonably start before a laparoscopy, and for many people it should.

Excision or ablation

Why the distinction is not a technicality

Ablation burns the surface of a lesion

Excision cuts it out with a margin of normal tissue beneath.

For deep infiltrating disease

The evidence favours excision for symptom relief and for how long that relief lasts.

For superficial peritoneal disease the difference

Is smaller and either is reasonable.

Which you have is not known until someone looks

Which is why the consent conversation covers both.

Endometriosis: common questions

Do I need surgery to be diagnosed?
No. Laparoscopy confirms it, but treatment can reasonably start on a clinical diagnosis, and for many patients it should.
Is excision better than ablation?
For deep infiltrating disease the evidence favours excision. For superficial disease the difference is smaller. Which applies to you depends on what is found.
Can it affect fertility?
It can. If you are trying to conceive or may want to, say so at the first visit — it changes the order in which we do things.
Does pregnancy cure endometriosis?
No. Symptoms often quieten during pregnancy and while breastfeeding because of the hormonal state, and usually return afterwards. It is not a treatment.
Will a hysterectomy cure it?
Not by itself. Endometriosis is tissue outside the uterus, so removing the uterus without excising the disease frequently leaves the pain behind. This is one of the most common reasons for a second opinion.
Can it affect my fertility?
It can, and the degree varies enormously. If conception is a goal, say so at the first visit — it changes whether we operate, when, and what we remove.

Know before you book.

Vireo opens in 2027. Until then the plan list, panel status and first-available wait for every office are published on this site and kept current. Questions can go to the practice office on (305) 555-0180.

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