Chris Kliethermes, M.D., Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
City: Detroit, MI, USA
Philosophy: At this point I take all theories into consideration as possible origins for endometriosis. I inform my patient about the mullerianosis, stem cell/retrograde flow or vascular dissemination theories. My goal is to best treat my patients and until we learn more about the disease, try to look at aspects of research being conducted for origins. Training with Dr. Patrick Yeung in residency, I fully agree with his teachings of optimal excision and restoration of normal anatomy as essential to properly treat the disease surgically.
Medication: Medication does not treat endometriosis, but more masks symptoms. I do offer patients that are not interested in pregnancy hormonal suppression following surgery pending their post-operative pain as I have seen decreased pelvic pain in patients with a levonorgestrel IUD. For patients that are absolutely adamant they want to avoid surgery (which is extremely rare) the IUD is again my preferred method. I often will educate pre and post op patients regarding the GnRH analogs and give them the autonomy to choose these methods if desired, although I do believe the benefits of these medications do not outweigh the cons.
Approach to Persistent Pain: For patients with persistent symptoms after surgery, I have multiple options, assuming optimal excision. Our hospital system has access to pain specialists, physical therapy, other surgical specialties, and nutritionists. Thus far I have only had to utilize them sparingly, but am lucky to have their services accessible. There are also local sex therapists. I work closely and often get referrals from our REI department, who I consult with frequently for fertility concerns.