Kathy Kates, MSN, FNP-BC
Endometriosis Long Term Care Provider
Summary: Kathy Kates, MSN, FNP-BC, is an Endometriosis Long-Term Care Provider and founder of Pelvic Health Support in Brookline, Massachusetts, a clinical practice focused on restoring quality of life through integrative, evidence-based care for pelvic pain, sexual dysfunction, menopause, and endometriosis. She previously co-founded the Institute for Pelvic Health, where she developed continuing education programs to expand comprehensive pelvic health training for clinicians. Kathy holds a Master of Science in Nursing as a Family Nurse Practitioner from MGH Institute of Health Professions.
Kathy takes a multifactorial, whole-person approach to endometriosis, recognizing that the disease involves hormonal, inflammatory, immune, tissue, and nervous-system mechanisms. Her care may include individualized hormonal and pain management, pelvic floor physical therapy, myofascial and visceral therapies, and treatment of associated conditions such as mast cell activation, dysautonomia, and connective tissue disorders. She works closely with excision surgeons to prepare patients before surgery and provides structured postoperative care focused on healing, pelvic floor rehabilitation, bowel and bladder function, sexual health, symptom management, and long-term recurrence prevention.
Her philosophy is that endometriosis care extends beyond treating lesions alone. By addressing hormones, inflammation, tissue, muscle, and nervous-system sensitization together, Kathy aims to help patients reduce pain, restore function, and improve quality of life over the long term.
City: Brookline, Massachusetts, USA
Visit types: In-Person and Telehealth
Spoken languages: English
Interpreting services for other languages: No
Philosophy of Endometriosis Care: My approach reflects the current consensus that endometriosis is multifactorial. I regard Sampson’s retrograde menstruation theory as the foundational mechanism of lesion formation, but incomplete on its own: refluxed endometrial cells are found in the majority of menstruating women, yet only a subset develop disease. I therefore also ground my approach in the complementary theories – impaired immune clearance and chronic peritoneal inflammation, coelomic metaplasia, stem cell origin (including bone marrow-derived cells, which help explain recurrence after excision), and genetic/epigenetic predisposition. Because the disease is estrogen-dependent, inflammatory, and neuroimmunologic, my treatment model addresses hormones, tissue, and muscle together rather than treating the lesion alone.
Medication: My medication approach is layered to match the layered pathophysiology. Hormonal: continuous combined oral contraceptives or progestins for suppression; GnRH antagonists with add-back therapy for moderate-to-severe or refractory cases; and, in carefully selected refractory cases, aromatase inhibition. Pain and nervous system: NSAIDs for inflammatory flares, neuromodulators (gabapentin, low-dose amitriptyline) for sensitized pain, and low-dose naltrexone for its anti inflammatory and central sensitization effects. When MCAS overlaps, I use mast cell-directed therapy (H1/H2 blockade, cromolyn, ketotifen, microdosing of GLP/GIP). Locally: compounded topical hormones for tissue health: including vaginal estrogen +/- testosterone, neuropathic agents and vestibular or intravaginal onobotulinintoxinA for refractory high-tone dysfunction. For patients with metabolic or weight related comorbidity that is worsening their inflammatory burden and pain, I incorporate microdosed GLP-1/GIP receptor agonists – using low, titrated doses to capture the anti-inflammatory and metabolic benefits while minimizing GI side effects. Medication is always paired with bodywork and PT – drugs quiet the fire; they do not release the tissue.
Pre-surgical care plan: Before surgery, my goals are to decrease inflammation, calm the nervous system and optimize the tissue environment so the patient gets the most from the operation. I treat high-tone pelvic floor dysfunction and central sensitization preoperatively (pelvic floor therapy with myofascial release, visceral manipulation and – when indicated vestibular or intravaginal onobotulinintoxinA) so that postoperative pain is not layered onto a guarded, sensitized pelvis. I optimize the hormonal and inflammatory milieu, stabilize any comorbid mast cell activation, connective tissue disorder, dysautonomia, address bowel and bladder function, and coordinate timing and preoperative instructions with the excision surgeon. Just as importantly, I set expectations: surgery removes tissue, but it does not resolve muscle guarding, fascial restriction, or sensitization – so patients understand pre-surgical work is a crucial part of the overall treatment plan.
Post-surgical care plan: Postoperatively, I see patients early to support healing and prevent the pain cycle from restarting. The plan includes: (1) early hormonal suppression to reduce recurrence, given the estrogen dependent nature of lesions and the stem cell mechanism behind regrowth; (2) graded pelvic floor therapy once the surgeon clears it, to prevent guarding from becoming chronic high-tone dysfunction; (3) myofascial release and visceral mobilization after adequate healing to address adhesions, scar tissue, and fascial restriction, and restore visceral mobility; (4) bowel, bladder, and sexual function rehabilitation; and (5) structured follow-up to catch persistent symptoms early. I integrate the surgeon’s operative findings (disease extent, locations, complications) directly into the ongoing plan.