William Kondo M.D., Endometriosis Specialist, Gynecologist, and Laparoscopic Surgeon.
City: Parana, Brazil.
Philosophy: Endometriosis is a multifactorial disease. Hereditary predisposition (immune dysfunction apoptosis suppression), genetics, and epigenetics associated with hormones, menstruation, ovulation, dioxines, oxidative stress and inflammation are important factors that contribute to the pathophysiology and pathogenesis of endometriosis.
Medication: Usually I use combined oral contraceptives and progestins for the treatment of most women with endometriosis not desiring pregnancy. In some specific cases, we may use GnRH analogues or gestrinone, especially for those women who are not responsive to conventional treatment.
Approach to Persistent Pain: For persistent pain after surgery, if the surgery was complete we try to start clinical treatment for those women not desiring pregnancy (oral contraceptives or progestins in order to try do induce amenorrhea and ovulation suppression). In those cases of persistent pain, it is very important to have physical therapy to treat myofascial pain, and also some other treatments may play an important role (pain medications, physical activity, acupuncture, nutrition, etc).