Dr. Gina Ranieri, Endometriosis Specialist
City: Princeton, New Jersey, USA
Philosophy of Endometriosis Care: The theory of endometriosis that I believe makes the most sense is that endometriosis likely originates during embryologic development either through coelomic metaplasia or embryonic cell remnants. This explains how endometriosis can be seen in non-menstruating patients and areas outside the abdominopelvic cavity.
What type of surgery do you perform for endometriosis: Excision
Medication: I will use hormonal medications such as the levonorgestrel IUD, combined oral contraceptive pills, Depo-Provera, or norethindrone for patients who are not interested in surgical treatment or to prevent recurrence after surgical excision in select patients.
Approach to Persistent Pain After Surgery: For patients who have undergone complete surgical excision of endometriosis and continue to report symptoms, I will often explore other pain generators. I do refer patients to pelvic floor physical therapy and perform pelvic floor trigger point and Botox injections as well as abdominal wall injections to treat myofascial pain. I will also prescribe non-opioid centrally acting pain medications for patients with very challenging to treat pain. If I suspect that the patient’s endometriosis has returned, I will often order imaging in the form of an MRI and potentially offer repeat surgery in appropriate and select patients.