Dr. Luky Satria, M.D., Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Jakarta, DKI Jakarta, Indonesia
Philosophy: Probably multifactorial, coelomic metaplasia and retrograde menstruation combined with genetic-epigenetic factor
Medication: I use medication/ hormonal (progestin or LNG IUS) as the first-line treatment for endometriosis-associated pain, when the hormonal failed then complete excision surgery will be done. I also give hormonal treatment to patients waiting for surgery.
Hormonal treatment is also given to post-operative patients who don’t seek fertility to reduce recurrence risk.
Approach to Persistent Pain After Surgery: Systematic mapping with ultrasound (or MRI when needed) will be done to search for residual lesions (due to incomplete surgery) or de novo lesions. Surgery will be done when we find DIE lesions, but if it is ovarian lesions (endometrioma), I will suggest hormonal treatment or ART since repeat surgery of recurrent endometrioma will give a bad prognosis in ovarian function, especially in subfertility patients.