Jon Einarsson, M.D., Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
City: Boston, MA, USA
Philosophy: The origin of endometriosis is probably multifactorial and includes coelomic metaplasia, retrograde menstruation and genetic predisposition. Complete excision is the mainstay of the surgical approach, but since endometriosis can be found in lymph nodes and elsewhere, recurrences can occur even in the best of hands since microscopic implants may continue to evolve after surgery. This is correlated with age, with a higher risk of recurrence in younger patients.
Medication: In patients who are not contemplating pregnancy after surgery, I generally recommend either continuous birth control pills, hormonal IUD, or oral progestins. This has been shown to reduce the risk of recurrence and repeat surgery. These agents are also better tolerated and equally effective to medications such as Lupron, which we generally do not use.
Approach to Persistent Pain After Surgery: A multidisciplinary approach to pain is essential. We, therefore, work closely with other disciplines such as pain experts, gastroenterology, urology, pelvic floor physical therapy, etc. The goal is to alleviate the patient’s symptoms, and sometimes the main cause of symptoms may not be endometriosis, although this is the most common etiology.