Dr. Agustina Larrea, Endometriosis Specialist
City: Ciudad Autonoma de Buenos Aires, Argentina
Philosophy of Endometriosis Care:
-Retrograde Menstruation Theory
-Genetics: as it often runs in families and also is linked to nutrition habits in families.
-Nutrition: inflamed intestines because of flour, sugar, alcohol, and dairy, among others, lead to an an inflamated body and trigger an autoimmune system. It fails to recognize and eliminate endometrial cells growing outside the uterus, allowing the disease to progress. Besides, the metabolism of sugar is linked to the metabolism of estrogen. And we know this disease is estrogen-dependent.
I believe all these theories work together and are the key factors of treatment.
What type of surgery do you perform for endometriosis: Excision
Medication: I first apply together an anti-inflammatory diet + supplements such as magnesium and dienogest. If the patient can´t afford dienogest (I live in a low-income country), then I can rotate dienogest to drospirenone 4 mg without using placebos. I met the patient after 4 months to see how she was doing.
NSAIDs can complement treatment to manage pain. If I believe the patient has a Central Sensitization Syndrome, because of chronic pelvic pain, despite of all treatments applied, I work with a pain treatment team that usually gives amitriptiline to modulate central pain.
Approach to Persistent Pain After Surgery: I explain to the patient that surgery can not always relieve pain in 100%. Definitely, we should continue with an anti-inflammatory diet and dienogest (if the patient does not desire pregnancy), regardless of the surgical treatment.
Depending on the pain, I can work with pelvic floor physiotherapists, a pain treatment team to treat central sensitization syndrome, and a psychologist in order to give emotional support and, if needed, antidepressants.