Patrick Yeung Jr, M.D., Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon.
City: St. Louis, MO, USA
Philosophy: Metaplasia or maybe stem cells. I agree with Dr. Redwine that the retrograde menstruation theory is probably one of the most problematic areas in our understanding of endometriosis, and leads people to make statements or hold ideas that just biologically are not true (like hysterectomy or inducing amenorrhea will somehow treat endometriosis).
Medication: I rarely, if ever, use or recommend hormonal suppression, which at best is symptomatic relief; I think that hormonal suppression does nothing to the actual disease (it certainly does not dissolve it or get rid of it), has not been shown or proven to prevent progression, does NOT help (later) fertility, and can have serious side effects.
I do NOT recommend postoperative hormonal suppression for the sake of preventing progression or recurrence if I think that optimal excision has been achieved, and so am committed to achieving optimal excision at the time of surgery.
Approach to Persistent Pain: If a patient has had optimal excision, then endometriosis as a source of pain should be at the bottom of the list of potential sources of symptoms, though not off the list. Other sources of pain should be investigated first before revisiting the issue of endometriosis-associated pain, or at least in thinking that another surgery would be helpful. The uterus itself could also be a source of pain.
Our rate of repeat surgery for endometriosis, since incorporating a more global or comprehensive approach to pain, has gone from 40% to 6%.
If surgery is to be repeated, I like to try to do something different than what was done the first time, in the hopes of a different outcome.