Dr. Stylianos Kogeorgos, M.D., Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Athens, Greece
Philosophy: Endometriosis is an estrogen-dependent disease but its exact etiology remains unclear but several regulatory factors are known to support the development or maintenance of the disease.
There are many theories also like, Uterine Peristalsis, Hormones, Lymphatic System, Immune System, Oxidative Stress, Apoptosis genetic and epigenetic factors.
These theories should be taken as hypotheses that need further research to be validated. This is why it is so crucial to keeping investing and funding in endometriosis research within the medical community.
We will be working to support increased research funding, awareness, and advance policy around endometriosis.
Medication: There is no single option that is clearly superior to others, when it comes to symptomatic endometriosis.
Progestogens cause changes in the micro-environment of the deep endometriosis lesion and brings positive results.
The combined hormonal contraceptive (OCP) and the Gnrh agonists are not inferior to progestogens in symptom control.
The intra-uterine Levonorgestrel device (Mirena) is also associated with improved symptoms and reduction in the size of deep endometriosis lesions.
We present all options with the appropriate explanation of the goal and risks of therapy and we start with the commonly used options of a combined hormonal contraceptive or progestogen pill.
Approach to Persistent Pain After Surgery: I liberally use and encourage pelvic floor therapy and pain specialist consultation and follow-up pre and post-operatively.
Patients are followed up closely after operations routinely followed up at 6 months, 12 months, and yearly after that regarding pain, fertility outcomes, gastrointestinal complaints, etc.
The feeling of pain in endometriosis appears to be associated with complex changes in the peripheral as well as central nervous systems, for persistent pain after surgery, if the surgery was complete we try to start clinical treatment for those women not desiring pregnancy in order to induce ovulation suppression.
Treatments as physical therapy to treat myofascial pain, physical activity, acupuncture and nutrition may play an important role.