PELVIC PAIN SHOULD NOT BE TOLERATED!

Severe pain with the cycle, heavy bleeding, pelvic pressure, pain with intercourse infertility.

ONLY by Laparoscopy.  Imaging studies such as ultrasound, MRI, and CT scan CANNOT MAKE THE DIAGNOSIS since the implants are too small to be seen. The diagnosis can NOT be made by an OBGYN in the office. Surgery is needed to confirm that endometriosis is present, and determine the extent of the disease (staging).

Laparoscopic minimally invasive surgery to excise (remove) implants on ALL organs. Ablation (burning) should not be used since it will not remove all disease.   Surgical treatment allows for removal of all disease, and STAGES the disease from 1 – 4.

1. Specialists should be the FIRST option for treatment, NOT OBGYN’s. This avoids DELAY IN CARE of the disease and prevents unnecessary imaging studies, referrals to nonGYN providers, progressive disease and pain, and infertility.
2. Minimally invasive surgery is vital – the recovery is only a few days, the STAGE of the disease is diagnosed, and the endometriosis is completely removed. Birth control pills are NOT used to treat endometriosis without surgery.
3. Cash Based Endometriosis specialists should NOT be part of the treatment plan. Paying $20,000 or more for surgery does NOT provide better care that can be provided by a CIGC specialist using your insurance.

Very SEVERE pain with menstrual cycles, heavy bleeding, BACK PAIN.  Incapacitating symptoms that can severely affect normal activities.

By clinical symptoms. MRI can be used to detect the disease.  Ultrasound and CT CANNOT diagnosis adenomyosis.

The best short and long term option is PARTIAL hysterectomy in which the ovaries are preserved to maintain hormone production, and the cervix is preserved to maintain pelvic floor support and sexual function.

1. Non Diagnosis – most cases of adenomyosis are NOT diagnosed by the OBGYN since ultrasound is normal, with patients suffering from extensive pain and bleeding for long periods of time.
2. Specialists diagnosis the disease FAR MORE OFTEN than the OBGYN. Specialists have far more experience with adenomyosis, understand the symptoms, and can often make the diagnosis just be listening carefully to the patient.
3. Infertility. Adenomyosis can prevent fertility since implantation of the embryo into areas of adenomyosis can lead to miscarriage. Specialist evaluation can help to determine the extent of disease and the potential for fertility.

Pain, bleeding, frequency of urination, pelvic pressure and pain, bloating and distension.

Ultrasound is the best single method to diagnose the number and location of fibroids present.

Surgical removal by LAAM myomectomy preserves the uterus for fertility while removing all fibroids present with small incisions and a recovery of only 7 – 10 days. DualportGYN hysterectomy removes the uterus for those patients who do not want fertility with a recovery of 7 days back to work.

• Embolization or UFE. UFE should NOT be used for any patient who desires fertility since it will increase the risk of miscarriage and potentially injure the ovaries by decreasing blood supply. Embolization does NOT remove the fibroids and has a longer recovery than either LAAM or DualportGYN hysterectomy, both of which will eliminate the symptoms of fibroids in a one hour. UFE will take months or never to control symptoms.
• Accessa, MRI guided ultrasound, Sonata – all options to treat fibroids that will NOT immediately alleviate symptoms as compared to LAAM and can injure the uterus for fertility.
• LAAM is the ONLY option available to patients for fibroid removal that will control pain and bleeding and is safe for fertility. UFE, MRI Ultrasound, Sonata, Accessa, and others can decrease fertility rates and should not be used.

Gradual pain as the cyst grows, or severe pain which occurs suddenly with a torsion. Distension or swelling of the abdomen can occur.

Ultrasound is the most accurate and easiest way to make the diagnosis. An ultrasound will evaluate the size of the mass, and its characteristics.

Removal of the cyst with a laparoscopic procedure, such as DualportGYN, will allow removal of only the cyst and not the ovary. Dualport GYN allows removal of ovarian cysts of very large size while preserving the ovary.

1. It is not necessary to remove the ovaries for most younger patients with cysts. OBGYNs often remove the entire ovary when a cyst is present, such as with endometriomas. This is not the best option, as fertility may be severely affected.
2. Open surgery is NOT necessary for treatment of ovarian cysts, even of large size
3. Older patients must be evaluated for ovarian cancer. CIGC surgeons are GYN Oncology trained, and are capable of assessing and treating ovarian cysts safely and effectively.

Continuous pain with a history of prior pelvic surgery.

CANNOT BE MADE with imaging studies such as ultrasound, CT or MRI – adhesions are too thin to be diagnosed by these studies.

Surgical LYSIS OF ADHESIONS, which means surgical removal of adhesions to alleviate pain

1. Lysis of adhesions is a complicated surgical procedure that requires a specialist.  Non specialist OBGYN’s trying to remove adhesions can increase the risk of bowel injury and obstruction. Any lysis of adhesion procedure should be performed by a specialist such as a CIGC surgeon that is able to remove the adhesions and repair any structure that adhesions may involve such as bowel, bladder, and ureters.
2. CIGC surgeons are GYN Oncologists and have training and privileges to repair any structure in the pelvis such as bowel, bladder, and ureters that may require repair.

Pelvic pain, bladder pain, pain with urination, bladder pressure and pain.

Often made by clinical symptoms and by cystoscopy.  Cystoscopy with hydrodistension – filling the bladder with water and checking for petechiae (red areas consistent with defects in the bladder lining) can help make the diagnosis.

Hydrodistention can help with symptoms, and in some patients becomes a method of treatment. Avoiding certain foods such as coffee, red pepper, and others can help control symptoms.

IBS should NOT be a “wastebasket” category for pelvic pain made by any practitioner. Should you be diagnosed with IBS as a cause of pain, seek out the specialists at CIGC for more information and a diagnosis for pelvic pain that can be justified by your symptoms and history.