Cindy Mosbrucker, M.D., Endometriosis Specialist, UroGynecologist.
City: Gig Harbor, Washington, USA
Philosophy: Peritoneal metaplasia which is genetically influenced
Medication: I do not use any GnRH agonists or antagonists. I will use progestins (either norethindrone or Prometrium) for suppression when necessary, either while waiting for surgery or for those recurrent pain typically from ovarian cysts. I am not opposed to OCPs or progestin containing IUD s however their utility is not as good as progestins alone. I use multimodal pain management postop with tap blocks, On Q pump, gabapentin, tramadol, Sprix (ketorolac nasal spray), antiemetics, and minimal narcotics.
Approach to Persistent Pain: Figure out what is causing their pain. At least 75% of the time it is myofascial usually related to pelvic floor spasm. Most of my patients are referred to PT postop. IC patients are taught installations usually before surgery but sometimes postop. Those prone to adhesion formation are referred to visceral mob PTs around 6-8 wks postop. For those with pain after these interventions, we consider repeat surgery and my reoperation rate is somewhere between 5-10%.