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A Q&A On Endometriosis And Adenomyosis With Dr. Rupen Baxi, MD

The difference between endometriosis and adenomyosis is important to understand. Both of these GYN conditions can cause debilitating and disruptive symptoms. It takes a highly trained surgical specialist to relieve these symptoms with minimally invasive treatment that is safe and effective. Women should know that with advanced surgical techniques at The Center for Innovative GYN Care recovery after a GYN procedure is much faster, and no hospital stay is required.

CIGC’s fellowship trained minimally invasive GYN surgeon Dr. Rupen Baxi, MD talks about the difference between endometriosis and adenomyosis, symptoms to watch for and the right minimally invasive treatment to alleviate pain. Learn more in the interview below.

Q. What is the difference between endometriosis and adenomyosis?

A. Endometriosis is a condition where the cells similar to those in the lining of the uterus (endometrium) are found in other places of the body causing inflammation and scarring, which can lead to painful sex, menstruation and bowel movements. It can be found in the pelvis and on pelvic organs such as bladder, bowel, ureter, and ends of the fallopian tube. Endometriosis can also be found in the abdomen and the diaphragm. In rare cases, endometriosis lesions have been found on the lungs and the brain.

Adenomyosis is a condition where the cells from the lining of the uterus are found in the muscle of the uterus, causing inflammation of the muscle and leading to pain, heavy bleeding and enlargement of the uterus. Adenomyosis is limited to the uterus whereas Endometriosis can be diffuse.

Q. Why is thorough endometriosis excision so important?

A. Endometriosis can be present as superficial lesions as well as deep infiltrating lesions. There is often microscopic disease adjacent to the obvious lesion and when these are left behind, more lesions will develop in time causing the vicious cycle of pain to continue. It is difficult to assess the depth of the lesions and the microscopic spread of the lesion, so by “burning” or “zapping” them, we may not reach the entire depth of the lesion. Therefore, excising (removal of) the lesions and the surrounding tissue is the key. It allows for a more complete treatment and also enables tissue sampling for pathology.

Q. How does resection of endometriosis help relieve symptoms?

A. By resecting endometriosis, you are freeing up the tissue from the inflammatory process that endometriosis causes. Your body heals any perceived injury to itself by causing inflammation and scar tissue formation. (the body does not heal endometriosis) The scar tissue (adhesions) causes “pulling” and “tearing” sensations on the inside as various organs are pulled and stretched from their normal locations. By resecting the endometriosis, and reducing the chance of further scarring using special techniques, you are relieving the organs from the attachments of the scar tissue, as well as eliminating the inflammatory process of the endometriosis. This leads to normalization of the pelvis and a pain free life.

Q. How can hysterectomy help women suffering from either condition?

A. After attempts at conservative management with medicine and minor temporizing procedures, if the symptoms continue and a woman has completed child bearing, then hysterectomy can be an option. With Adenomyosis, the problem is in the muscle of the uterus, therefore, by removing the uterus, you are eliminating the painful stimuli and the source of the bleeding, effectively curing the condition. With Endometriosis, the presence of hormones from the ovaries and the “back spill” of the menstrual blood from the uterus and tubes into the pelvis can continue to propagate the condition, therefore, given the right candidate, a hysterectomy with or without removal of the ovaries can be therapeutic. Endometriosis has no cure, but many patients find relief after a total hysterectomy.

Q. CIGC surgeons perform these procedures using the DualPortGYN technique. What makes this approach superior?

A. DualPortGYN is truly innovative and different from other procedures because the incisions are tiny and there are only two of them. Additionally, they are located in the midline of the abdomen so you are sparing all the muscles, blood vessels and the nerves. This is very important as it reduces post-operative pain, bleeding or lingering nerve pain. It is also a reason why patients that undergo DualPortGYN procedures are able to move around immediately after surgery, are able to eat and drink, and go home in just a couple of hours after surgery. The results are terrific!

The DualPortGYN approach was developed by Paul MacKoul MD and Natalya Danilyants MD and has been applied to thousands of cases for hysterectomyendometriosispelvic massesovarian cysts and prolapse procedures. The DualPortGYN technique uses only two 5 MM incisions and post-operative recovery is 1 week. Hear from our patients:

Kia’s Story: Minimally Invasive Hysterectomy For Adenomyosis

Emily’s Story: Minimally Invasive Excision of Endometriosis


The CIGC state-of-the-art specialists are available at three locations in the DC metro area. Virginia patients can visit the Reston location, and Saturday appointments are available. Maryland offices are located in Rockville and Annapolis.

GYN surgical specialists can often see women sooner because they are focused entirely on surgery. Each patient gets detailed, in depth attention from Dr. Natalya DanilyantsDr. Paul MacKoul and Dr. Rupen Baxi. This personalized care helps patients understand their condition and the recommended treatment so that they can have confidence from the very start. Our surgeons have performed over 20,000 GYN procedures and are constantly finding better ways to improve outcomes for patients.

Book a consultation today with Paul MacKoul MD, Natalya Danilyants MD or Rupen Baxi, MD.


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CIGC-Travel-Map-FBEven if you are not from the DC area, many patients travel to The Center for Innovative GYN Care for our groundbreaking procedures. We treat women from around the world who suffer from complex GYN conditions.

Learn more in our travel program.