Dr. Fadel Azer, Endometriosis Specialist
City: Lisle, IL, USA
Philosophy of Endometriosis Care: I believe that the etiology of endometriosis is complex and multifactorial involving genetic, hormonal, immune, and environmental components. For most patients, I find a positive family history of the disease or one of its symptoms. While retrograde menstruation may initiate superficial endometriosis, deep endometriosis appears to have different mechanisms. Unlike superficial lesions, deep nodular lesions are not typically shed during menstruation, suggesting alternative theories such as coelomic metaplasia, induction of cellular transformation, and the embryonic remnant theory may better explain their origin. Genetic, hormonal, and environmental influences also contribute to the progression of both superficial and deep
What type of surgery do you perform for endometriosis?: Excision
Medication: Given the unique circumstances of each patient, I customize my treatment strategy accordingly. I offer a range of hormonal contraceptive options, including the Mirena IUD, oral contraceptive pills (OCPs), and Depo-Provera. Medications are provided before, during (such as inserting a Mirena or Kyleena IUD post-excision surgery while the patient is still under anesthesia, particularly for younger patients or those aiming for fertility), and after surgery. While I typically refrain from routinely suggesting GnRH agonists or antagonists, I may contemplate their use in certain instances, particularly for addressing persistent postoperative pain.
Approach to Persistent Pain After Surgery: Preparation for managing postoperative persistent pain begins during preoperative consultations. I conduct thorough assessments, including detailed medical histories and comprehensive physical exams, along with pelvic pain evaluations to explore potential conditions like spastic pelvic floor syndrome, interstitial cystitis, and irritable bowel syndrome. When central sensitization is suspected, I collaborate with a team comprising pelvic floor physical therapists, pelvic pain specialists, sex therapists, and behavioral therapists. I prescribe muscle relaxants to address pelvic floor spasms and provide treatment for interstitial cystitis or IBS through medications and lifestyle adjustments. In cases of suspected central sensitization, SSRIs may be prescribed. Additionally, I may consider GnRH agonists or antagonists for persistent postoperative pain management in specific scenarios.
Dr. Azer gave me my life back, and I am so thankful. I am 44 and struggled for way too many years with pain, very heavy bleeding all the time, and other awful symptoms. Dr. Azer recently performed my Davinci Robot-Assisted Total Hysterectomy and found deep endometriosis in multiple areas, rare endometriosis on both ureters, adhesions, ovarian cyst, ovarian endometrioma, cervicitis, and adenomyosis. Also, the endometriosis would’ve eventually caused kidney problems later down the road or possibly renal failure if this surgery wasn’t done. I really believe that he saved my life. As for my recovery, it was extremely fast with minimal pain, and my incisions were tiny with no scarring. I would recommend Dr. Azer to everyone I know, as I’m extremely grateful to have found such a skilled, kind, and knowledgeable doctor. He genuinely cares about his patients’ outcomes. Thank you so much Dr. Azer!