Ma Li, M.D., Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
City: Singapore, Singapore
Philosophy: Retrograde menstruation and metaplasia, hormone dependant.
Medication: Progesterone based (dienogest, depo-provers), Mirena, GnRha, oral contraceptive pills
1. I use hormonal suppression mostly for postop patients who don’t have a fertility plan, aiming to reduce the risk of recurrence.
2. young patient, low AMH, the trial of medical treatment, and monitor response.
Approach to Persistent Pain: 1. need to find out why pain persists. whether due to previous incomplete surgery, adenomyosis, or other reasons such as IBS, interstitial cystitis, myofascial pain syndrome, etc. and treat accordingly.
2. if due to incomplete surgery, depending on the location of the disease. If deep infiltrating endometriosis, I will suggest repeat surgery. if cyst recurrence, for a young patient, I will try hormonal treatment and see the response. If poor response, then repeats surgery.
If it’s due to adenomyosis, for patients with fertility requirements, I will try the hormonal treatment. For those who had completed family, and failed medical treatment, I will suggest a Total Laparoscopic Hysterectomy.
If it’s due to IBS, Interstitial Cystitis, or myofascial pain, I will refer other subspecialties accordingly.