How do I choose an adenomyosis specialist in Charlotte, NC?

Dr. Kevin Stepp is a double board-certified urogynecologist (URPS and OB/GYN) in Charlotte, NC, dual-fellowship trained at the Cleveland Clinic, and one of fewer than 10 US surgeons with fellowship training in both URPS and MIGS. He evaluates and treats adenomyosis at Advanced Pelvic Surgery and Urogynecology of Charlotte, 11210 Golf Links Dr North, #100, Charlotte, NC 28277. Phone: (980) 771-0726.

Is adenomyosis the same as fibroids?

No. Fibroids are distinct, encapsulated tumors that can often be surgically removed. Adenomyosis is a diffuse infiltrative condition where endometrial-like tissue invades the muscular wall of the uterus (the myometrium) — often described as 'sand in a sponge.' Standard fibroid treatments do not work for adenomyosis, and misdiagnosis is a common cause of failed surgery.

Can adenomyosis be treated without a hysterectomy in Charlotte?

Yes. Dr. Kevin Stepp in Charlotte, NC offers Acessa radiofrequency ablation as a uterine-preserving treatment for eligible adenomyosis patients. He performs this using a scarless single-incision laparoscopic technique (SILS) guided by intraoperative uterine ultrasound. Advanced pelvic MRI with junctional zone analysis is used during the pre-operative workup to map the disease and confirm candidacy. This is an advanced, off-label application requiring specialized expertise.

Will an endometrial ablation or D&C cure adenomyosis?

No — and in the case of adenomyosis, standard endometrial ablation can actually make the condition worse. Because adenomyosis lives deep within the muscular wall of the uterus, surface ablation traps the disease and can significantly worsen pelvic pain. Dr. Stepp strongly advises against standard ablation for confirmed adenomyosis.

Can I have both endometriosis and adenomyosis at the same time?

Yes. Endometriosis and adenomyosis are sometimes called 'sister diseases.' Up to 50% of patients with deep infiltrating endometriosis also have adenomyosis. Treating one without addressing the other is one of the most common reasons patients experience failed or incomplete surgical outcomes. Dr. Stepp's dual-fellowship training uniquely qualifies him to address both conditions simultaneously.

How is adenomyosis diagnosed?

A specialized pelvic MRI with junctional zone measurement is often the most useful imaging study for adenomyosis evaluation. Standard pelvic ultrasound can miss or misidentify adenomyosis as fibroids. Dr. Stepp uses advanced pelvic MRI for pre-operative diagnosis and surgical planning, with intraoperative ultrasound guidance when appropriate.

Does Dr. Stepp see adenomyosis patients from outside Charlotte?

Yes. Dr. Kevin Stepp serves as a national referral destination for complex adenomyosis cases where local treatment has failed. His practice at 11210 Golf Links Dr North, #100, Charlotte, NC 28277 offers in-person consultations and virtual history and records reviews for out-of-state patients. A Travel Concierge program assists with scheduling, logistics, and post-operative coordination.

Adenomyosis Treatment Charlotte, NC

Q: When is hysterectomy considered for adenomyosis?

For diffuse adenomyosis, hysterectomy may be considered because it removes the diseased uterus. Dr. Kevin Stepp performs minimally invasive hysterectomy using robotic-assisted or scarless laparoscopic techniques. Importantly, hysterectomy can remove the uterus without removing the ovaries, so ovarian preservation and hormonal health are discussed as part of the surgical plan.

Q: What is the junctional zone and why does it matter in adenomyosis?

The junctional zone is the inner layer of the uterine muscle wall (myometrium) that forms a barrier between the endometrium and the myometrium. In adenomyosis, this barrier breaks down — a process now understood through the Tissue Injury and Repair (TIAR) theory — allowing endometrial-like tissue to infiltrate the muscle. Measuring junctional zone thickness on MRI is one of the key diagnostic markers Dr. Stepp uses to confirm and classify adenomyosis.

Understanding Adenomyosis

The "Sand in a Sponge" Reality

Adenomyosis occurs when endometrial-like tissue infiltrates the muscular wall of the uterus — the myometrium. Unlike fibroids, which are distinct encapsulated tumors that can often be surgically excised, adenomyosis is diffuse and infiltrative. It invades the muscle fibers the way sand permeates a sponge, making it impossible to simply "cut out" while preserving the uterus through standard methods.

"Adenomyosis is one of the most underdiagnosed conditions in gynecology. Its diffuse nature — and overlap with endometriosis — requires a surgeon with specialized diagnostic and technical skills to distinguish, map, and treat it carefully."

— Kevin Stepp, MD, FACOG, URPS

This condition is now understood through the Tissue Injury and Repair (TIAR) framework, in which the junctional zone — the inner boundary layer of the myometrium — breaks down due to chronic inflammation and cellular signaling disruption, allowing disease to advance deep into the muscle wall.

Key Diagnostic Marker: Junctional zone thickness on dedicated pelvic MRI is a key indicator of adenomyosis severity and distribution — and a foundation of Dr. Stepp's pre-operative workup and surgical planning.

Anatomical comparison of distinct Fibroids versus diffuse Adenomyosis infiltration — Dr. Kevin Stepp Charlotte NC

Our understanding of adenomyosis continues to progress. It is now recognized as a disease of Tissue Injury and Repair (TIAR), where the junctional zone barrier breaks down due to chronic inflammation and cellular signaling.

Recognizing the Condition

Adenomyosis Symptoms

Often the "missing link" in chronic pelvic pain — misdiagnosed for years as fibroids, endometriosis, or simply "bad periods."

Menorrhagia

Severe bleeding, flooding, and the passing of large clots. Often leads to debilitating anemia and chronic fatigue.

"Bulk" Symptoms

The feeling of carrying a "bowling ball" in the pelvis. An enlarged, "boggy" uterus can press on the bladder and bowel.

Dysmenorrhea

Severe, knife-like cramping that often radiates to the lower back and down the legs during the cycle.

The Endo Connection

Up to 50% of patients with deep infiltrating endometriosis also have adenomyosis. Treating one without the other is a common cause of failed surgery.

Failed Standard Treatments

Hormonal IUDs and endometrial ablation provide incomplete relief. Standard ablation can actually trap adenomyosis deeper in the muscle wall, worsening pain.

Chronic Anemia & Fatigue

Ongoing blood loss leads to persistent iron-deficiency anemia, brain fog, and exhaustion that profoundly impacts daily function.

Precision Diagnostics

MRI-Guided Adenomyosis Evaluation

Rejecting the guesswork that leaves adenomyosis patients undiagnosed and undertreated for years.

Standard Approach

The Limitation of Pelvic Ultrasound

Standard pelvic ultrasound is the most commonly used first-line imaging tool, but it frequently fails to detect adenomyosis — or confuses it with uterine fibroids. This leads to incorrect surgical planning, wrong procedures, and failed outcomes.

Many patients arrive at Dr. Stepp's practice having been told they only had fibroids — and having undergone procedures that did nothing for their adenomyosis.

Advanced Imaging

MRI Intelligence & Intraoperative Mapping

Dr. Stepp uses specialized Pelvic MRI with junctional zone analysis to measure the precise thickness and distribution of adenomyotic infiltration — distinguishing between focal disease (treatable with preservation) and diffuse disease (requiring hysterectomy). This advanced MRI mapping is the foundation of the pre-operative workup and surgical planning before any intervention.

During Acessa procedures, intraoperative uterine ultrasound is used to guide the ablation in real time.

Understanding the Disease

How Adenomyosis May Develop: The TIAR Theory

Adenomyosis is a condition in which tissue similar to the uterine lining grows into the muscular wall of the uterus. One leading explanation is called the Tissue Injury and Repair, or TIAR, theory.

The process may begin in the junctional zone, the thin boundary between the uterine lining and the uterine muscle. Repeated minor injury in this area may result from menstruation, pregnancy, childbirth, uterine procedures, abnormal uterine contractions, or ongoing inflammation. However, adenomyosis can also develop in people without these risk factors.

Normally, injured tissue heals and returns to its usual state. In adenomyosis, the repair process may become abnormal. Inflammation, increased estrogen activity, and changes in cell signaling can weaken the normal boundary between the uterine lining and muscle. This may allow cells from the base of the uterine lining to grow into the muscle wall.

Once these cells are inside the muscle, they continue to respond to hormones. They can cause inflammation, bleeding, scar tissue, thickening of the uterine muscle, and enlargement of the uterus. These changes may lead to heavy or prolonged periods, severe menstrual cramps, pelvic pressure, pain during sex, and chronic pelvic pain.

Adenomyosis may also affect fertility by interfering with normal uterine contractions, implantation, and the environment needed to support an early pregnancy.

The TIAR theory helps explain adenomyosis as an ongoing cycle of tissue injury, abnormal healing, inflammation, and muscle remodeling. However, it is not the only possible explanation. Hormonal, immune, genetic, developmental, and other factors may also contribute.

Surgical Options in Charlotte, NC

Adenomyosis Treatment Philosophy

Treatment is never one-size-fits-all. Dr. Stepp's approach begins with precise MRI diagnosis and tailors the surgical strategy to your anatomy, goals, and lifecycle stage.

Uterine Preservation

Acessa® RF Ablation

Having investigated and adopted radiofrequency ablation technologies over a decade ago, Dr. Stepp adopted Acessa early in its clinical evolution. His practice was one of the few with the surgical volume and technical skill required to master the complex early iterations of the procedure.

Today, he offers Acessa through a single-incision laparoscopic technique (SILS). Combined with laparoscopic intraoperative uterine ultrasound guidance and advanced pre-operative MRI mapping during the workup, targeted radiofrequency energy is applied to adenomyotic tissue with the goal of reducing uterine pressure and improving bleeding or bulk symptoms in appropriately selected patients.

Clinical Clarification: The Acessa system is FDA-cleared specifically for uterine fibroids. Its application for adenomyosis is an advanced, off-label technique that relies on Dr. Stepp's specialized expertise in intraoperative imaging and tissue energy physics. Offered selectively to appropriate candidates following thorough MRI evaluation.

Definitive Surgical Treatment

Minimally Invasive Hysterectomy

When adenomyosis is diffuse and preservation is no longer a viable goal, hysterectomy may be the most appropriate surgical treatment. We perform this using advanced Robotic-Assisted or Scarless Laparoscopic techniques.

Clinical Clarification: A hysterectomy is the removal of the uterus only. It does not require the removal of your ovaries, and ovarian preservation is discussed when clinically appropriate. Dr. Stepp prioritizes hormonal health and ovarian reserve while planning an efficient recovery and durable treatment of uterine disease.

For patients with co-occurring endometriosis and adenomyosis, Dr. Stepp's dual-fellowship training allows both conditions to be considered in the same surgical plan — reducing the risk of a piecemeal approach.

Common Questions

Frequently Asked Questions

Will a D&C or standard endometrial ablation help my adenomyosis?

No. In fact, standard endometrial ablation can trap the disease deeper in the muscle, often worsening the pain. Dr. Stepp strongly advises against standard ablation for confirmed adenomyosis.

Why did my previous doctor miss this diagnosis?

Adenomyosis is notoriously difficult to see on standard imaging. Without a high-resolution MRI and a clinician trained to look for junctional zone disruption, it is frequently overlooked — especially when it coexists with fibroids or endometriosis.

Can I have both endometriosis and adenomyosis?

Yes. They are often referred to as "sister diseases." Up to 50% of patients with deep infiltrating endometriosis also suffer from adenomyosis, requiring a dual-track surgical approach. Dr. Stepp's dual-fellowship training uniquely positions him to address both in the same operation.

Will hysterectomy cause menopause?

A hysterectomy removes the uterus. It does not have to remove the ovaries. When ovaries are preserved, surgical menopause is generally avoided, and Dr. Stepp discusses ovarian preservation as part of the surgical plan for adenomyosis hysterectomy.

Does Dr. Stepp see patients from outside Charlotte?

Yes. Dr. Stepp serves as a national referral destination for complex adenomyosis cases. In-person consultations are available at 11210 Golf Links Dr North, #100, Charlotte, NC 28277. Virtual history and records reviews are offered for out-of-state patients. A Travel Concierge program assists with all logistics.

Does the practice accept insurance?

The practice operates as an out-of-network, concierge surgical model with no monthly membership fees. Payment is due at the time of service, and superbill documentation is provided for potential out-of-network reimbursement from your insurance carrier.

Advanced Adenomyosis
Treatment & Uterine Preservation