Dr. Jurgis Vitols, Endometriosis Specialist
City: Riga, Latvia
Philosophy of Endometriosis Care: Genetic – epigenetic theory.
What type of surgery do you perform for endometriosis: Excision; Both. I may use ablation only for ovarian cysts. For ovarian endometriosis, I may use laser vaporization on the hilum of the capsule or for all of the cyst capsules in case the cyst enucleates badly and there is a high risk of damage to normal ovarian tissue. My preferred approach for ovarian cysts is cystectomy.
Medication: Depends on the patients wishes and complains. For patients who doesn’t want to have surgery, I recommend use of combined oral contraceptive pills or progesterone pills. If symptoms persist, I recommend surgical treatment. After surgery, I recommend long-term use of combined oral contraceptive pills or progesterone pills for patients who don’t wish to become pregnant and have had ovarian endometrioma – to reduce recurrence. For patients who wish to become pregnant after surgery, sometimes I recommend short use (maximum for 3-4 months) of GnRH analogs or GnRH antagonists to improve their chance of having a natural conception. I never prescribe long-term use of GnRH medication.
Approach to Persistent Pain After Surgery: Combined oral contraceptive pills or progesterone pills. Suppose this doesn’t help—pregabalin or amitryptiline. Patients with persistent pain symptoms are referred to pain specialists.