Is Your Current Treatment Approach Working?

If you have been under a general gynecologist’s care in Mumbai for months or years and you are still experiencing severe pelvic pain, bowel or bladder symptoms, or you have had surgery with incomplete relief, it may be time to consider an endometriosis surgery specialist rather than another medication trial.

This is a question of scope of expertise, not competence. Complex, deep infiltrating endometriosis, especially involving the bowel, bladder, ureters, or nerves, requires advanced excision surgery that lies beyond routine general gynecology practice.

Studies on women with endometriosis in India report diagnostic delays of around 6 years on average, with many patients seeing three to five doctors before receiving a clear diagnosis and appropriate management. Many do not realise they meet criteria for specialist care until years have passed and disease severity has progressed.

General Gynecologist vs Endometriosis Surgery Specialist

A general gynecologist typically manages:

• Routine women’s health and preventive care
• Pregnancy and delivery
• Standard gynecologic procedures and minor surgery
• Early-stage endometriosis treated with medication

An endometriosis surgery specialist in Mumbai typically focuses on:

• Deep infiltrating endometriosis excision
• Bowel disc excision or segmental resection
• Bladder and ureteric endometriosis surgery
• Nerve-sparing dissection in complex pelvic anatomy
• Revision surgery after incomplete or unsuccessful procedures
• 3D laparoscopic surgery for advanced and multi-organ disease

If your symptoms or imaging suggest complex disease, remaining only in the general gynecology pathway can delay the definitive surgical treatment that is actually required.

8 Signs You Need an Endometriosis Surgery Specialist in Mumbai

If any one of these scenarios describes you, a specialist evaluation becomes important.

1. Severe Pain That Disrupts Your Life

• You regularly miss work, family responsibilities, or social events because of pain.
• Period pain remains intense despite multiple medication changes.
• You experience pain during intercourse, bowel movements, or urination that is clearly linked to your menstrual cycle.

When disease is causing structural damage to pelvic organs, medication alone cannot address the underlying problem; surgical removal may be needed.

2. Bowel Symptoms During Your Period

• Painful bowel movements during menstruation
• Cyclical rectal bleeding
• Severe constipation or diarrhea that worsens around your period
• A persistent feeling of incomplete bowel evacuation during menstruation

These patterns are classic for bowel endometriosis and usually require a surgical team that includes colorectal expertise and experience in bowel endometriosis surgery.

3. Bladder or Urinary Symptoms Linked to Your Cycle

• Painful urination during periods
• Blood in urine that appears cyclically
• Marked urinary urgency or frequency specifically during the menstrual phase
• Imaging showing ureteric involvement or early kidney changes

Bladder and ureteric endometriosis can lead to progressive kidney damage if not properly identified and surgically treated. This is a clear indication for specialist assessment.

4. Previous Surgery, Pain Still Present

• You had endometriosis or “chocolate cyst” surgery 6 to 24 months ago.
• Pain returned after a brief interval or never fully resolved.
• Reports state that disease was “removed” but your symptoms do not match that picture.

In many of these cases, the issue is not true recurrence but incomplete excision or ablation of surface disease instead of full removal. Clinical data show that revision surgery after incomplete procedures has significantly lower pregnancy rates (around 20 to 26%) compared with approximately 41% after properly performed first-time excision, underlining the importance of complete initial surgery.

5. Imaging Shows Deep or Complex Disease

• MRI reports mention rectovaginal disease, bowel nodules, bladder lesions, or ureteric endometriosis.
• Reports use terms such as “deep infiltrating endometriosis (DIE)” or “Stage 3 to 4 endometriosis.”
• You have multiple or large endometriomas with distortion of the normal pelvic anatomy.

Deep excision surgery for this level of disease requires specific advanced laparoscopic training and experience.

6. Fertility is Affected or IVF is Planned

• You have been unable to conceive after 12 months (or 6 months if over 35).
• You are planning IVF but also have significant pelvic pain or imaging-confirmed endometriosis.
• You have had failed IVF cycles in the setting of endometriosis.

Evidence shows that in selected women with moderate to severe endometriosis, surgical treatment before IVF can improve outcomes. Published data report cumulative live birth rates of around 43.6% within 12 months in women treated surgically before IVF, versus approximately 27.7% in women who proceeded directly to IVF without addressing endometriosis. Fertilization rates can also improve (around 60 to 64% vs 46.24%), and time to live birth can reduce from roughly 23 months to 14 to 18 months in treated groups. These benefits depend on appropriate and complete excision, not partial or superficial surgery.

7. Medical Treatment for 6+ Months Without Improvement

• You have tried multiple hormone therapies, injections, or pain protocols.
• Symptoms are unchanged or worsening despite compliance with treatment.
• You are frequently told to “try one more medication” but your daily life remains limited.

When comprehensive medical management over 6 months fails to improve symptoms, it often indicates structural disease that requires surgical removal rather than further medication changes.

8. Multiple Doctors, No Clear Plan

• You have consulted three or more gynecologists with differing opinions.
• You feel your symptoms are minimized or labelled as “normal period pain” despite their impact on your life.
• You still lack a clear, long-term management plan.

In such situations, a specialist who regularly manages complex endometriosis can reassess the full picture (symptoms, imaging, previous surgery and fertility goals) and propose a coherent strategy.

What Endometriosis Surgery Specialists in Mumbai Offer

When you move from general gynecology to a specialist centre, the care model changes in several ways.

Advanced Surgical Capabilities

• Complete excision surgery removing disease with clear margins, rather than surface ablation
• 3D laparoscopic systems that enhance depth perception and precision in complex anatomy
• Nerve-sparing dissection techniques to preserve function while removing deep disease
• Bowel, bladder, and ureteric endometriosis surgery in collaboration with colorectal and urology teams

Revision Surgery Expertise

• Management of incomplete previous surgeries and dense post-surgical adhesions
• Identification and removal of residual endometriotic disease left behind during earlier operations

High-Volume Complex Case Experience

• Surgeons who perform large numbers of complex endometriosis procedures each year
• Familiarity with extensive bowel involvement, nerve entrapment, and “frozen pelvis” scenarios

These features are particularly relevant in a city like Mumbai, where tertiary centres offer advanced endometriosis surgery and multidisciplinary support.

Frequently Asked Questions

Do I need a referral to see an endometriosis surgery specialist in Mumbai?
Not always. Many specialist centres accept direct consultations. If you recognise complex features in your own case, you can request an appointment directly.

How do I know if my case is “complex”?
Indicators include bowel or bladder symptoms linked to your cycle, previous surgery with persistent pain, deep disease on MRI, or severe symptoms unresponsive to medical management. Any combination of these signs should prompt a specialist opinion.

What is the difference between ablation and excision surgery?
Ablation uses energy (such as cautery or laser) to destroy visible lesions on the surface. Excision involves surgically cutting out the disease with surrounding healthy tissue. Excision is associated with significantly lower recurrence rates and is generally preferred for advanced and deep disease.

My surgery was 2 years ago and pain returned. What should I do?
Pain returning within 1 to 2 years often points to incomplete initial excision or superficial treatment. A specialist experienced in revision endometriosis surgery can review your operative notes and imaging to determine whether residual disease is present and whether re-operation is advisable.

Should I discuss specialist referral with my current gynecologist?
Yes. Many gynecologists appreciate involving a specialist when disease complexity increases. This can become a collaborative approach where your local gynecologist continues routine care while the specialist handles complex surgical planning and execution.

Your Next Steps

If you recognise yourself in the scenarios above, consider the following:

• Schedule a consultation with an endometriosis surgery specialist in Mumbai who routinely performs complex excision, bowel and bladder procedures, and revision surgery.
• Bring all previous imaging and surgical reports (ultrasound, MRI, operative notes, discharge summaries) to your appointment so the specialist can review your full history.
• Ask specific questions during the consultation, such as:
  • “Is my disease pattern suitable for complete excision?”
  • “How often do you perform surgery for cases similar to mine?”
  • “Do you work with colorectal or urology teams when necessary?”
  • “What is your approach to revision surgery after previous operations?”

Dr. Vivek Salunke focuses on complex endometriosis cases, including deep infiltrating disease, bowel and bladder involvement, nerve-sparing excision, and revision surgery after incomplete procedures. With extensive experience in advanced laparoscopic surgery at leading Mumbai hospitals such as Lilavati Hospital, Nanavati Hospital, and P.D. Hinduja Hospital, his practice is structured to manage tertiary-level endometriosis surgery.

Complex endometriosis usually progresses over time. Accessing appropriate surgical expertise earlier in the course of disease can meaningfully influence pain control, organ function and future fertility.

[SCHEDULE CONSULTATION TODAY: ENDOMETRIOSIS SURGERY SPECIALIST IN MUMBAI]

About Dr. Vivek Salunke
Dr. Vivek Salunke is a senior laparoscopic surgeon based in Mumbai, India, with over 20 years of experience in endometriosis and fertility-preserving surgery.
He leads the Endometriosis & Pelvic Pain Centre and is known for his ethical, patient-centered care and advanced excision techniques.