Dr. Joseph Chen, Gynecology & Minimal Invasive Surgery, Endometriosis Specialist.
City: Oakland, California
Philosophy:
As a provider who sees and addresses extra-pelvic endometriosis on a consistent basis, I am a believer that many of the origin theories including retrograde menstruation, Mullerian and colemic transformation, as well as dysregulation of lymphatic transportation are all relevant causes for this chronic condition. We know that premenstrual, postmenopausal as well as non-female cases for endometriosis do occur, and thus need to be cognizant of the challenges regarding current understanding of this disease.
Medication:
I will routinely use progestin components for systemic suppression, as well as localized progestin protection for pain control. I routinely encourage patients to consider the use of systemic progestin suppression to prevent recurrence following excisional surgery – an approach that I have seen tremendous success in.
In addition to hormonal suppression, I will always screen for common pain triggers (i.e. other syndromes that exist with endometriosis) such as neuropathic pain disorders, IBS, painful bladder syndromes, pelvic floor dysfunction, etc.) and am comfortable treating basic pain pathology with other important medication therapy.
Approach to Persistent Pain After Surgery:
Similar to my pre-surgical approach, I will often reevaluate to determine if the other pain triggers following surgery have been addressed. With patients who desire future fertility, repeating imaging and further systemic suppression is important to prevent worsening symptoms. with careful counseling and detailed discussion about the risks, benefits and alternatives for reoperation can we consider repeating the excision surgery.