Dr. Nicholas Hazen, M.D., Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Washington DC, USA
Philosophy: I believe there is still more that is unknown than known about the disease process of endometriosis. Quality scientific evidence supports multiple current etiologies, suggesting that endometriosis is not a simple process with a simple solution. My approach to surgical treatment is based on my most up to date understanding of the disease process, in combination with my personal experience caring for patients along their unique health journeys. When surgery is warranted, I favor an excisional approach with wide margins to include both visible and surrounding microscopic disease. In my experience, this leads to the best outcomes for patients.
Medication: The choice of medication for management of endometriosis is an extremely individual one. Finding the best fit for a patient requires reviewing both their current status and past history very thoroughly, including their previous experiences, the evolution of their symptoms, and their individual management goals. In my practice, I most commonly proscribe progestational agents, but often recommend GnRH antagonists. The current literature shows that suppression results in decreased return of pain and symptoms following endometriosis surgery, and I often recommend and manage post-surgical resection hormonal suppression. I use non-narcotic medications such as NSAIDS for treatment of pain and gabapentinoids and SNRI/SSRIs for central sensitization. I believe that diet and mental health also play an important role in the body’s pain response to endometriosis.
Approach to Persistent Pain After Surgery: I believe there no single “right” approach to addressing continued pain after surgery. Every patient is different and so is each surgery, so it is critical to individualize treatment plans based on a patient’s unique needs. It has been widely shown that for the majority of patients, the pain relief experienced from surgery is unfortunately only temporary. In the continued care of my patients, my goal is always to work together to extend pain relief as long as possible, and minimize impacts and disruptions to the patient’s life going forward.