Dr. Gaby Moawad

Dr. Gaby Moawad, MD.

Dr Gaby Moawad Md – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon

Summary: Dr Gaby Moawad MD is a renowned endometriosis specialist and minimally invasive gynecologic surgeon based in McLean, VA. With a research-driven approach, Dr Gaby Moawad blends advanced surgical expertise with a deep understanding of genetic and epigenetic factors influencing endometriosis. Patients searching for expert care from Gaby Moawad MD will benefit from his commitment to holistic, personalized treatment that goes beyond surgery.

Gaby Moawad offers comprehensive management for chronic pelvic pain, combining surgical precision with hormonal therapy, pain desensitization, pelvic floor therapy, and integrative care like acupuncture and nutrition. Dr Gaby Moawad ensures each patient receives thoughtful, long-term support tailored to their fertility goals and symptom profile. His dedication to evidence-based care and whole-person healing makes him a trusted choice for those seeking lasting relief from endometriosis.

City: Mclean, VA, USA

Philosophy: Endometriosis has been considered for a century as implants of endometrial-like tissue outside the uterus either following retrograde menstruation into the peritoneal cavity or following hematological dissemination. This implantation theory is attractive as endometriosis looks histologically like the endometrium, as retrograde menstruation contains living cells that can implant, and as the fibroblasts from endometriosis or from the endometrium of women with endometriosis have an increased invasion capacity.

The implantation theory does not explain why endometriosis lesions develop in some women only, while retrograde menstruation seems to occur in most women. Some observations are difficult to explain by the implantation of endometrial cells following retrograde menstruation. The clonality of each endometriosis lesion, as described for deep and cystic and typical endometriosis, is more consistent with a G-E (genetic-epigenetic) incident related to intracellular aromatase activity resulting in intracellular estrogen production than to newly implanted endometrium. The implantation theory does not explain the occurrence of endometriosis in women without a uterus, and in men. It is more likely that deep endometriosis lesions can become symptomatic more than 10 years after menopause in the absence of increased circulating estrogen as a result of a G-E cellular incident than that implanted endometrium would suddenly start to develop. It should be realized that theories such as coelomic metaplasia, endometriosis originating from bone marrow/stem cells, Müllerian rests, tissue injury and repair, repeated tissue injury and repair, estrogen toxicity and traumatic induction are compatible with and can be considered today to require epigenetic changes.

Recently, the G-E theory of endometriosis was formulated as an update of the endometriotic disease theory. Endometriosis starts in the G-E theory, irrespective of the original cell when a cumulative combination of specific genetic and/or epigenetic cellular incidents exceeds a certain threshold. The inherited genetic and epigenetic incidents at birth explain the hereditary character of endometriosis. It remains unclear whether and how epigenetic changes are transmitted transgenerationally in endometriosis. The effects of minor G-E abnormalities remain clinically invisible because of the redundancy of molecular biological mechanisms in the cell, but they increase the risk of developing the disease when additional incidents occur. Additional incidents can occur during intra-uterine development because of the maternal environment and external factors, and during live mainly as mistakes during mitosis. Most G-E mistakes result in apoptosis of the cell if they cannot be repaired. Some minor incidents, however, do not cause cell death and are transmitted to the next generation of cells. These incidents are favored by mutagenic substances such as dioxins and other pollutants, radiation, or oxidative stress such as caused by retrograde menstruation or by infection or by the peritoneal microbiome. The dynamic and gradual aspect of these mistakes and their inheritance is important. The crosstalk between genetic and epigenetic mechanisms makes the cell vulnerable to new incidents, especially when the external circumstances are unfavorable. The cell thus becomes progressively more vulnerable to acquiring more mistakes, with some of them being cancer-associated mutations explaining the clonal expansion.

The G-E theory adds to the implantation and other theories that the onset of the disease requires a cumulative and triggering combination of G-E cellular incidents. With the G-E hypothesis, it seems logical to postulate that the specific set of G-E incidents will orient the development into clinically subtle, typical, cystic or deep lesions. A specific set of G-E incidents also explains that each type of lesion is heterogenous with variable aromatase activity, progesterone resistance, estrogen sensitivity and probably many other factors. Additional incidents occurring during further development result in endometriosis lesions which are probably also heterogeneous at the cellular level, as demonstrated for breast cancer.

After their triggered initiation, the lesions develop in an environment different from the uterus with different microbiota and different immunologic, endocrine and paracrine influences. The cyclic endocrine changes with eventual bleeding will moreover result in repetitive traumas which increase the risk of developing additional G-E incidents and ultimately fibrosis. Therefore, all theories emphasising trauma, immunology, the role of estrogen and peritoneal fluid retain their full importance for understanding the growth of endometriotic lesions.

Much of the many endometriosis-associated changes, such as changes in the endometrium and in the immunology can be viewed as a consequence of the inherited predisposition instead of being a consequence of endometriosis.

Although poorly understood, reversibility of epigenetic changes becomes more difficult when additional epigenetic incidents have occurred. When the associated genomic instability results in genetic errors, changes become irreversible.

Medication: OCP, Progestins including IUD, gabapentin, Lyrica.
OCP, Progestins are mainly used for suppression after excision
Gabapentin, Lyrica is used for central pain desensitization in preparation to or after surgical management especially for patients with chronic pelvic pain and amplified pain response

Approach to Persistent Pain After Surgery: Endometriosis excision surgery is only one part of the comprehensive approach to the management of endometriosis. Pain medicine has an important role in managing central pain and neuropathic pain, pelvic floor PT helps with myofascial pain associated with endometriosis, other ancillary services like nutrition and pain psychology, acupuncture has proven an added value in the management of endometriosis-associated conditions

4 years ago No comment

Andrea Wood, PT, DPT

Visit types: Office/Hospital

Spoken languages: English

Interpreting services for other languages: Yes

Philosophy of care and typical treatment strategies:

My philosophy includes helping individuals with endometriosis learn tools to help live a better quality of life throughout the course of treatments and lifespan. I also integrate nervous system down training through breathing techniques and manual therapy, while promoting healthy movement for overall wellness. I believe in a team relationship with my patients in working together to improve their function.

4 years ago No comment

Justine Roper, PT, DPT

Visit types: Office/Hospital

Spoken languages: English

Interpreting services for other languages: Yes

Philosophy of care and typical treatment strategies:

Our lead therapist, Dr. Justine Roper PT, DPT is a certified women’s pelvic specialist & pelvic floor therapist. She has dedicated her life to offering innovative ways to heal her patients’ bodies of pain and other dysfunction through alternative methods. From sexual dysfunction to pelvic pain, many of her patients are impacted by both physical ailments as well as mental health issues. We focus heavily on functional goals established by our patients in order to endow them with autonomy over their treatment plans. Some specific techniques that we use for our patient population affected by endometriosis include visceral mobilization, myofascial release,”breathwork”/breathing techniques, & functional training.

4 years ago No comment

Justine Payne, PT, DPT

Visit types: Office/Hospital, At home

Spoken languages: English, Español

Interpreting services for other languages: Yes

Philosophy of care and typical treatment strategies:

The appropriate care and management of individuals with endometriosis and/or adenomyosis have been a passion of mine since I first began working in pelvic health, and through all the experiences I have been so fortunate to have had patients I have learned the importance of a holistic, evidence-based, patient-centered, team approach to the management of these horrendous and all too often misunderstood disorders.

Coming from a strong neurorehabilitation background and having been trained as a yoga teacher as well, I prioritize the treatment not only of the musculoskeletal system via flexibility training, strength training (mainly via pilates and yoga), manual therapies (including myofascial release, soft tissue mobilization, and dry needling, externally and internally if needed) and functional mobility but also the nervous system as a whole. I am a firm believer that the autonomic nervous system plays an intimate role in the management of chronic pain and functional gastrointestinal disorders and use meditation, pranayama, yoga, dry needling, grounding techniques, myofascial release, and aerobic conditioning to improve the functioning of the ANS. I also utilize visceral mobilization in my practice but have not undergone the advanced trainings as of this date (i.e. Barral Institute, Herman & Wallace, etc.).

Above all, providing each and every patient with the education that they need regarding these diseases to make informed decisions along providing trauma-informed care are the two most important cornerstones of my practice. As I say to all of my patients, although you are in my clinic you are the boss of your own body and I will always be respectful of your wishes.
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Spanish

Primero en aclarar todos esos acrónimos que denotan mis credenciales: Doctor en Terapia Física, Especialista Clínico Neurológico Certificado (APTA), Especialista Certificado en Rehabilitación Pélvica (Herman & Wallace), Profesor de Yoga Registrado (Yoga Alliance 200 horas), Certificado de Punción Seca (Master Punción seca).

La atención y el manejo adecuados de las personas con endometriosis y / o adenomiosis ha sido una de mis pasiones desde que comencé a trabajar en salud pélvica. A través de todas las experiencias que he tenido la suerte de haber tenido con los pacientes, he aprendido la importancia de un enfoque de equipo holístico, basado en la evidencia y centrado en el paciente para el tratamiento de estos trastornos horrendos y, con demasiada frecuencia, incomprendidos.

Con una sólida formación en la rehabilitación neurológica y con una formación como profesora de yoga, priorizo ​​el tratamiento no solo del sistema musculoesquelético a través del entrenamiento de flexibilidad, entrenamiento de fuerza (principalmente a través de pilates y yoga), terapias manuales (incluida la liberación miofascial, masaje y punción seca, externalmente o internalmente si es necesario) y movilidad funcional, pero también el sistema nervioso en su conjunto. Creo firmemente que el sistema nervioso autónomo juega un papel íntimo en el manejo del dolor crónico y los trastornos gastrointestinales funcionales y utilizo la meditación, pranayama, yoga, punción seca, técnicas de conexión a tierra, liberación miofascial y acondicionamiento aeróbico para mejorar el funcionamiento del ANS. También utilizo la movilización visceral en mi práctica, pero no he recibido entrenamientos avanzados a esta fecha (es decir, Barral Institute, Herman & Wallace, etc.).

Sobre todo, brindar a todos y cada uno de los pacientes la educación que necesitan con respecto a estas enfermedades para tomar decisiones informadas junto con brindar atención informada sobre el trauma son los dos pilares más importantes de mi práctica. Como digo a todos mis pacientes – aunque esta en mi oficina, siempre Usted es la jefa (o jefe, dependiendo en su idendidad de género) y siempre respecto sus deseos.

5 years ago 3 comments

Dr. Andrea Vidali MD

Dr. Andrea Vidali, M.D

Endometriosis Specialist, Obstetrics & Gynecology / General Obstetrics & Gynecology, Reproductive Endocrinology

Summary: Dr Andrea Vidali MD is a highly regarded endometriosis specialist and reproductive endocrinologist based in New York, NY, USA. Known for his expertise and compassionate approach, Dr Vidali offers comprehensive care for patients dealing with complex endometriosis cases. His practice attracts individuals from both the New York City area and beyond, especially those searching for a trusted expert like Andrea Vidali NYC. What makes Dr Andrea Vidali endometriosis treatment unique is his focus on combining excision surgery with targeted medical therapies, such as progestins and IUDs. This approach not only helps control bleeding but also addresses related conditions that often go untreated. His methods are especially effective for patients who haven’t responded well to hormonal therapy alone.

In addition to his surgical skill, Dr Vidali emphasizes the importance of personalized, long-term care. Every patient receives a tailored recovery plan that may include physical therapy and collaboration with physiatrists to help manage persistent pelvic pain. This ongoing support is a key part of the experience with Dr Andrea Vidali MD, who believes that successful treatment doesn’t end in the operating room.

Many patients turn to Dr Andrea Vidali MD not just for his medical knowledge, but for his commitment to improving their overall quality of life. Whether you’re local to New York or researching providers like Andrea Vidali NYC from across the country, his integrative approach to endometriosis makes him a leading choice in the field. It’s no surprise that Dr Andrea Vidali endometriosis care is so highly sought after by those navigating this challenging condition.

City: New York, NY, USA

Philosophy: Current scientific evidence points to the coelomic theory of endometriosis

Medication: The approach to endometriosis has to be holistic and address not only the disease itself but also potentially associated conditions. At this time, since we do not have medical candidates for curing endometriosis, the first essential step in the treatment of endometriosis is excision surgery. Additionally, Dr. Vidali rely on hormonal contraception, preferably progestins either orally or in the form of IUD to control bleeding or adenomyosis-related factors, if present. He does not rely on GnRH agonists or antagonists as in my experience the risk profile and efficacy profile not better than progestins make them undesirable.

Approach to Persistent Pain: I would like to affirm that I follow all the patients I operate on until they are well. I see the patients periodically as long as necessary. I always have a plan post-operatively especially if history, lab work, and initial examination have highlighted the possibility of the coexistence of additional pain generators. I do recommend physical therapy to most if not all patients and rely on a network of physiatrists.