Endometriosis is a chronic gynecologic condition in which tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, pelvic peritoneum, bowel, bladder, and in some cases beyond the pelvis entirely. Each menstrual cycle, this tissue responds to hormonal changes the way the uterine lining does — it thickens, breaks down, and bleeds — but with nowhere to go, producing inflammation, scarring, adhesions, and pain that can become severely disabling over time.
Despite affecting a significant proportion of women of reproductive age, endometriosis remains one of the most underdiagnosed conditions in gynecology. The average delay between a woman’s first symptoms and an accurate diagnosis exceeds seven years. That delay is not inevitable — it is a product of pain being normalized, symptoms being attributed to other causes, and endometriosis not being considered early enough in the diagnostic process. Early evaluation and accurate diagnosis make a meaningful difference in outcomes.
At Lapeer Women’s Health, Dr. Ramona D. Andrei, MD, PhD, FACOG approaches endometriosis with both the clinical depth it requires and the surgical expertise it often demands. Evaluation, medical management, excision surgery, and robotic-assisted surgical treatment are all available — with a consistent emphasis on accurate diagnosis as the foundation of every treatment plan.
Endometriosis produces a wide range of symptoms that vary significantly from woman to woman. Some women have severe pain with relatively limited disease on imaging. Others have extensive endometriosis with surprisingly manageable symptoms. The absence of a dramatic presentation does not mean endometriosis is absent — and the presence of the following symptoms warrants evaluation.
- Severe menstrual cramping that is significantly worse than typical period pain and may begin before the period starts
- Pelvic pain that persists beyond the menstrual period — chronic, cyclical, or constant
- Pain during or after sexual intercourse, particularly with deep penetration
- Painful bowel movements or rectal pain, especially during menstruation
- Urinary urgency, frequency, or pain during urination that worsens around the menstrual period
- Heavy menstrual bleeding or irregular periods
- Spotting or bleeding between periods
- Lower back pain with a cyclical pattern linked to menstruation
- Bloating, nausea, or gastrointestinal symptoms that worsen with the menstrual cycle
- Fatigue — often severe — particularly during menstruation
- Difficulty conceiving or a history of infertility without a clear explanation
- Symptoms that have progressively worsened over months or years
Endometriosis symptoms are frequently normalized or attributed to other conditions — irritable bowel syndrome, interstitial cystitis, or simply “bad periods.” If you recognize these patterns, particularly if they have been present for more than one or two cycles and are affecting your quality of life, an evaluation with Dr. Andrei is an appropriate and important next step.
Most endometriosis symptoms develop gradually and are appropriately addressed through a scheduled appointment. Contact our office the same day if you experience:
- Sudden, severe pelvic pain unlike your usual endometriosis pain — particularly if accompanied by fever or signs of infection
- Acute pelvic pain with nausea or vomiting that may indicate a ruptured ovarian cyst
- Heavy vaginal bleeding alongside acute pelvic pain
- Pelvic pain severe enough to prevent normal function that is not responding to your usual management
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Endometriosis is not simply painful periods. It is a systemic inflammatory condition with structural consequences that extend well beyond the menstrual cycle. Understanding what it is and how it behaves is essential context for understanding why accurate diagnosis and appropriate treatment matter so significantly.
Where Endometriosis Grows
Endometriosis most commonly involves the ovaries, fallopian tubes, the lining of the pelvic cavity (peritoneum), the uterosacral ligaments, and the space between the uterus and rectum known as the cul-de-sac or pouch of Douglas. It can also involve the bladder, ureter, bowel, appendix, and in rare cases structures outside the pelvis entirely including the diaphragm. The location of endometriosis implants determines much of the symptom pattern — ovarian endometriosis produces different symptoms than deep infiltrating endometriosis of the uterosacral ligaments or bowel.
Endometriomas — Ovarian Cysts From Endometriosis
When endometriosis involves the ovaries, it can form cysts filled with old blood — called endometriomas or “chocolate cysts” because of their characteristic dark brown contents. Endometriomas are identifiable on pelvic ultrasound and are one of the most reliably detected forms of endometriosis on imaging. They can grow to significant size, cause pelvic pain and pressure, and affect ovarian function and fertility. Their presence on ultrasound is often the finding that leads to a first formal endometriosis diagnosis.
Deep Infiltrating Endometriosis
Deep infiltrating endometriosis (DIE) refers to endometriosis implants that penetrate more than five millimeters below the peritoneal surface, involving the uterosacral ligaments, rectovaginal septum, bladder wall, or bowel wall. This form of endometriosis produces some of the most severe pain symptoms — particularly deep dyspareunia, cyclical rectal pain, and painful urination — and is among the most surgically complex to treat. It is also among the most commonly missed on standard imaging because superficial ultrasound does not reliably identify deep infiltrating lesions without specific bowel preparation and technique.
Why Endometriosis Causes Pain
The pain of endometriosis is produced through several overlapping mechanisms. Endometriosis implants bleed cyclically with each menstrual period, creating local inflammation that stimulates pain-sensitive nerve fibers. Over time, repeated cycles of bleeding and inflammation produce fibrous scar tissue (adhesions) that can tether pelvic organs together, restricting their normal movement and producing chronic pain that is no longer purely cycle-dependent. Deep infiltrating endometriosis directly involves nerve-rich structures including the uterosacral ligaments, producing pain that is often severe and constant. Central sensitization — a process in which the nervous system becomes increasingly reactive to pain signals over time — further amplifies symptoms in women with long-standing disease.
Endometriosis and Fertility
Endometriosis is identified in a significant proportion of women who are evaluated for infertility. The mechanisms through which endometriosis affects fertility are multiple — including anatomical distortion from adhesions, impaired ovarian reserve from endometriomas, altered tubal function, and an inflammatory pelvic environment that may affect implantation. The relationship between endometriosis and fertility is complex and highly individual — some women with severe endometriosis conceive without difficulty, while others with minimal visible disease have significant fertility challenges. Surgical treatment of endometriosis, particularly excision, has documented benefit for fertility outcomes in appropriately selected patients.
Why Diagnosis Is So Often Delayed
The average diagnostic delay for endometriosis is among the longest of any chronic condition in medicine. Several factors contribute. Menstrual pain is normalized in many cultural and clinical contexts, delaying the recognition that pain at a particular level is not typical. Endometriosis does not reliably appear on standard pelvic ultrasound unless ovarian endometriomas are present, which means a normal ultrasound does not rule out the condition. The definitive historical diagnostic standard has been laparoscopic surgery with tissue biopsy — an invasive step that historically required sufficient clinical suspicion before it was offered. And because endometriosis symptoms overlap with those of other conditions including IBS, IC, and pelvic floor dysfunction, it is frequently attributed to those conditions first.
Understanding that a normal ultrasound does not exclude endometriosis is one of the most important things a woman can know when seeking evaluation for symptoms that fit this condition. Clinical history, symptom pattern, and a high index of suspicion are essential components of an accurate endometriosis evaluation.
Your evaluation is led by Dr. Ramona D. Andrei, MD, PhD, FACOG — with a focus on taking your symptoms seriously, building a complete clinical picture, and developing a management plan that reflects the full range of available options.
Step 1 — A Thorough Symptom History
Dr. Andrei reviews your complete symptom history — the character and location of your pain, its relationship to your menstrual cycle, how it has changed over time, what has been tried previously, and how it is affecting your daily life. This history is not a formality. In endometriosis, the clinical story is often the most diagnostically meaningful information available.
Step 2 — Targeted Imaging and Examination
A pelvic exam and transvaginal ultrasound are performed with specific attention to signs of endometriosis — including ovarian endometriomas, restricted ovarian mobility, and uterosacral tenderness. When imaging findings are ambiguous or when deep infiltrating endometriosis is suspected, MRI may be recommended for more precise anatomical characterization.
Step 3 — A Management Plan That Fits Your Goals
Treatment recommendations are built around your specific presentation, your reproductive goals, the severity of your symptoms, and your preferences. The full range of options — from medical management through excision surgery — is discussed before any recommendation is finalized. No decision is made without your full understanding of what is being proposed and why.
Endometriosis treatment is individualized based on symptom severity, disease extent, reproductive goals, and the patient’s own priorities. There is no single correct approach — and the right plan evolves as circumstances change over time.
Hormonal treatments suppress estrogen-driven endometriosis activity, reducing inflammation, pain, and bleeding. They do not eliminate endometriosis lesions but can provide meaningful symptom control, particularly for women who are not yet ready for surgery, who wish to defer surgical treatment, or who need management between surgical procedures. The right hormonal approach depends on symptom severity, reproductive goals, and tolerability.
Surgical treatment of endometriosis removes or destroys endometriosis implants directly. Excision — the complete surgical removal of endometriosis lesions — is associated with more durable symptom relief and lower recurrence rates than ablation (surface destruction) alone, and is the preferred surgical approach for most patients. Dr. Andrei performs laparoscopic and robotic-assisted excision surgery, with a strong emphasis on minimally invasive techniques that reduce recovery time and surgical impact. Ovarian endometriomas are treated by cystectomy — removal of the cyst wall — rather than simple drainage, which has a higher recurrence rate.
For women with severe endometriosis who have completed childbearing and for whom other treatments have not provided adequate relief, hysterectomy with removal of the ovaries eliminates the hormonal drive for endometriosis activity. It is not a universal solution — endometriosis implants outside the uterus must be addressed at the time of surgery, and residual disease can occasionally persist or recur even after hysterectomy. It is, however, the most definitive treatment available for women whose disease burden and symptom severity make it the appropriate choice. Dr. Andrei performs minimally invasive and robotic-assisted hysterectomy.
For patients whose endometriosis requires surgical treatment, Dr. Andrei’s training in minimally invasive and robotic-assisted gynecologic surgery provides access to the full range of surgical approaches — with a strong emphasis on excision over ablation and minimally invasive techniques over open surgery.
Excision & Robotic-Assisted Surgery
Dr. Andrei performs laparoscopic and robotic-assisted endometriosis excision surgery — the approach associated with the most durable symptom relief and the lowest recurrence rates. Robotic assistance provides enhanced visualization and precision that is particularly valuable for excising deep infiltrating endometriosis and for managing disease in anatomically complex locations.
Hospital Affiliations
Surgical procedures are performed at McLaren Lapeer Region, Beaumont Hospital Royal Oak, and Crittenton Hospital — providing access to facilities equipped for advanced minimally invasive gynecologic surgery for patients from both the Lapeer and Rochester Hills service areas.
No Referral Required
You do not need a referral to schedule an endometriosis evaluation or surgical consultation with Dr. Andrei. Contact either our Lapeer or Rochester Hills office directly. If you have prior imaging, operative reports, or records from previous evaluations, bringing them to your appointment is helpful — but not required to get started.
The most consistent theme in the experience of women with endometriosis is the length of time between first symptoms and first accurate diagnosis — and the number of times their pain was minimized, normalized, or attributed to something else in between. That experience is not inevitable, and it is not something you have to continue to accept.
Endometriosis is a real, identifiable, treatable condition. The evaluation that leads to an accurate diagnosis starts with a provider who takes the clinical history seriously, understands the limitations of standard imaging, and approaches pelvic pain with the thoroughness it deserves. That is what every appointment at Lapeer Women’s Health is designed to provide.
Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here for that evaluation — at both our Lapeer and Rochester Hills offices, without a referral required.
Endometriosis
If endometriosis has been part of your life — diagnosed or suspected — Dr. Andrei and the team at Lapeer Women’s Health are here to provide the thorough evaluation and expert surgical care you deserve. Both our Lapeer and Rochester Hills offices are available. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
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Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.