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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Gynecology

Building Your Care Team and First Visit Prep

At a Glance

Endometriosis is a complex systemic disease that requires a multidisciplinary care team. The most critical step is finding a specialist who performs laparoscopic excision to completely remove the disease, supported by pelvic floor physical therapists and specialized radiologists.

Managing endometriosis is not just about finding a doctor; it is about hiring a team. Because endometriosis is a systemic, whole-body disease, one person rarely has all the tools needed to manage it. Your goal is to build a multidisciplinary team that focuses on shared decision-making—where your priorities and quality of life are at the center of every choice [1][2].

The Multidisciplinary “Dream Team”

A complex case of endometriosis often requires several different types of experts working together:

  • The Excision Specialist: This is usually a gynecological surgeon who has pursued advanced training specifically in laparoscopic excision. Unlike general OB/GYNs, these specialists focus on cutting out the disease rather than burning it [3][4]. Finding a true specialist can be challenging; patient advocacy directories like iCareBetter or Nancy’s Nook are often helpful starting points for finding vetted excision surgeons.
  • Pelvic Floor Physical Therapist (PFPT): Chronic pain causes the muscles of the pelvis to “guard” or tighten. A PFPT is essential for treating this myofascial pain, which often persists even after surgery [5][6].
  • Specialized Radiologist: You need someone who uses an “endometriosis protocol” for MRIs or ultrasounds to accurately map deep disease before you ever enter an operating room [7][8].
  • Other Specialists: For deep disease, your team may include a colorectal surgeon (for bowel involvement), a urologist (for bladder/ureter involvement), and a pain management specialist [3][2].

Vetting Your Surgeon: Red Flags and Green Flags

Not all “endometriosis specialists” are the same. Use these indicators to determine if a surgeon has the expertise required for complex cases:

Feature Green Flags Red Flags
Technique Performs laparoscopic excision (cutting out tissue) [4]. Only offers ablation or “cautery” (burning tissue) [4].
Volume Performs hundreds of endometriosis-specific surgeries per year [9]. Performs mostly general obstetrics and only occasional endometriosis cases [9].
Approach Works with a multidisciplinary team for bowel/bladder disease [3]. Claims they can “do it all” alone or dismisses the need for other specialists.
View of Cure Views surgery as one part of a long-term management plan [1]. Claims a hysterectomy or pregnancy will “cure” the disease (Note: While a hysterectomy is the definitive cure for adenomyosis, it does not cure endometriosis because the lesions exist outside the uterus) [10].

First Visit Preparation Checklist

Specialists often have long wait times, so making the most of your first visit is critical. Bring the following items to help your specialist “see” the full picture of your disease:

  • Raw Imaging Files: Bring your MRI or ultrasound images on a physical disc or USB drive. Specialists often want to see the images themselves, as routine reports can miss deep lesions [11][12].
  • Pathology Reports: If you have had surgery before, the pathology report is the only way to know for sure what was found and what was removed [13][14].
  • Symptom Log: Bring a 2–3 month diary of your pain, tracking its location, intensity, and how it aligns with your menstrual cycle [15].
  • Surgical Logs: If possible, get the “Operative Note” from any previous surgeries, which describes exactly what the surgeon saw inside your abdomen.

Why Specialized Centers Matter

Research shows that patients have better outcomes—including less pain and fewer complications—when they are treated at tertiary centers (specialized hospitals) that handle a high volume of complex endometriosis cases [9][16]. These centers are equipped to perform “nerve-sparing” surgeries that protect your bladder and sexual function while still removing all visible disease [17][4].

Common questions in this guide

Why do I need an excision specialist instead of a regular OB/GYN?
General OB/GYNs often use ablation, which only burns the surface of the disease. An excision specialist is specifically trained to cut out the disease completely from its root, which provides much better long-term symptom relief.
Will a hysterectomy cure my endometriosis?
No, a hysterectomy does not cure endometriosis because the disease lesions exist outside the uterus. While a hysterectomy can cure a related condition called adenomyosis, endometriosis requires complete excision of the lesions in the pelvis and surrounding organs.
What should I bring to my first appointment with an endometriosis specialist?
You should bring physical copies of your raw MRI or ultrasound images on a disc or USB drive, past pathology reports, operative notes from previous surgeries, and a detailed symptom log. This helps the specialist see the full picture of your disease.
Why is pelvic floor physical therapy recommended for endometriosis?
Chronic pelvic pain often causes the pelvic muscles to tighten or 'guard,' creating ongoing myofascial pain. A pelvic floor physical therapist helps treat this muscle dysfunction, which can persist even after successful endometriosis surgery.
What is a multidisciplinary team for endometriosis?
Because endometriosis is a whole-body disease, complex cases may involve the bowel, bladder, or ureters. A multidisciplinary team includes an excision specialist, pelvic floor physical therapist, specialized radiologist, and sometimes colorectal surgeons or urologists working together during surgery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How many laparoscopic excision (not ablation) procedures do you perform specifically for deep infiltrating endometriosis each year?
  2. 2.If you find endometriosis on my bowel, bladder, or ureters, do you have a multidisciplinary team (like a colorectal surgeon) ready to assist during the same surgery?
  3. 3.Do you use a 'nerve-sparing' technique to protect my bladder and sexual function during deep excision?
  4. 4.What is your plan for addressing my non-surgical pain, such as referring me to a pelvic floor physical therapist or a pain management specialist?
  5. 5.Can you review the raw images from my MRI/ultrasound during this visit rather than just reading the radiologist's summary report?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (17)
  1. 1

    Guideline No. 445: Management of Chronic Pelvic Pain.

    Allaire C, Yong PJ, Bajzak K, et al.

    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2024; (46(1)):102283 doi:10.1016/j.jogc.2023.102283.

    PMID: 38341225
  2. 2

    Advances in the Treatment of Chronic Pelvic Pain: A Multidisciplinary Approach to Treatment.

    Hwang SK

    Missouri medicine 2017; (114(1)):47-51.

    PMID: 30233101
  3. 3

    Intra-operative and post-operative complications of endometriosis excision using the SOSURE approach - A single- surgeon retrospective series of 1116 procedures over 8 years.

    Khazali S, Bachi A, Mondelli B, et al.

    Facts, views & vision in ObGyn 2024; (16(3)):325-336 doi:10.52054/FVVO.16.3.030.

    PMID: 39357864
  4. 4

    Comparison of complete and incomplete excision of deep infiltrating endometriosis.

    Cao Q, Lu F, Feng WW, et al.

    International journal of clinical and experimental medicine 2015; (8(11)):21497-506.

    PMID: 26885098
  5. 5

    Physiotherapeutic assessment and management of chronic pelvic pain syndrome: A case report.

    Burzynski B, Jurys T, Burzynski K, et al.

    Medicine 2021; (100(15)):e25525 doi:10.1097/MD.0000000000025525.

    PMID: 33847674
  6. 6

    Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study.

    Till SR, Schrepf A, As-Sanie S

    Sexual health 2024; (21()) doi:10.1071/SH24144.

    PMID: 39374209
  7. 7

    Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis.

    Guerriero S, Ajossa S, Minguez JA, et al.

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2015; (46(5)):534-45 doi:10.1002/uog.15667.

    PMID: 26250349
  8. 8

    Endometriosis: clinical features, MR imaging findings and pathologic correlation.

    Foti PV, Farina R, Palmucci S, et al.

    Insights into imaging 2018; (9(2)):149-172 doi:10.1007/s13244-017-0591-0.

    PMID: 29450853
  9. 9

    Multidisciplinary laparoscopic management of deep infiltrating endometriosis from 2010 to 2017: A retrospective cohort study.

    Larraín D, Buckel H, Prado J, et al.

    Medwave 2019; (19(11)):e7750 doi:10.5867/medwave.2019.11.7750.

    PMID: 31999675
  10. 10

    Current Status and Future Potential of Machine Learning in Diagnostic Imaging of Endometriosis : A Literature Review.

    Shrestha P, Shrestha B, Sherestha J, Chen J

    JNMA; journal of the Nepal Medical Association 2025; (63(283)):205-211 doi:10.31729/jnma.8897.

    PMID: 40656926
  11. 11

    The Role of MRI in Diagnosis and Pre-Surgical Mapping of Endometriosis.

    Shenoy-Bhangle AS, Movilla PR, Joyce S, et al.

    Journal of magnetic resonance imaging : JMRI 2026; (63(1)):39-59 doi:10.1002/jmri.70039.

    PMID: 40720193
  12. 12

    Relevance of Imaging Examinations in the Surgical Planning of Patients with Bowel Endometriosis.

    Trippia CH, Zomer MT, Terazaki CR, et al.

    Clinical medicine insights. Reproductive health 2016; (10()):1-8 doi:10.4137/CMRH.S29472.

    PMID: 26917983
  13. 13

    Acute Appendicitis Secondary to Appendiceal Endometriosis.

    Drumond JPN, de Melo ALA, Germini DE, Morrell AC

    Case reports in surgery 2020; (2020()):8813184 doi:10.1155/2020/8813184.

    PMID: 33101752
  14. 14

    Acute appendicitis due to appendiceal endometriosis: Two case report and literature review.

    Bolcatto A, Erina M, Mandojana FI, et al.

    International journal of surgery case reports 2025; (126()):110743 doi:10.1016/j.ijscr.2024.110743.

    PMID: 39700583
  15. 15

    RETRACTED: Case-control study to develop and validate a questionnaire for the secondary prevention of endometriosis.

    Ricci G, Castelpietra E, Romano F, et al.

    PloS one 2020; (15(3)):e0230828 doi:10.1371/journal.pone.0230828.

    PMID: 32226031
  16. 16

    [Early postoperative complications in a multidisciplinary surgical center exclusively dedicated to endometriosis: A 491-patients series].

    Roman H, Chanavaz-Lacheray I, Forestier D, et al.

    Gynecologie, obstetrique, fertilite & senologie 2020; (48(6)):484-490 doi:10.1016/j.gofs.2020.03.009.

    PMID: 32173597
  17. 17

    Nerve Sparing and Surgery for Deep Infiltrating Endometriosis: Pessimism of the Intellect or Optimism of the Will.

    Darwish B, Roman H

    Seminars in reproductive medicine 2017; (35(1)):72-80 doi:10.1055/s-0036-1597305.

    PMID: 27951614

This page provides educational guidance on finding an endometriosis specialist and building a care team. It is not a substitute for professional medical advice, and you should always consult specialized healthcare providers regarding your treatment options.

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