Terri Sullivan, PT, DPT
Terri Sullivan, PT, DPT
Terri Sullivan – Endometriosis Specialist
Summary: Terri Sullivan, PT, brings over 20 years of diverse physical therapy expertise with a special focus on women’s pelvic floor health. Combining her strong orthopedic background with specialized pelvic care, Terri Sullivan, PT, provides comprehensive treatment that addresses the whole musculoskeletal system, recognizing how interconnected the body truly is.
Sullivan PT carefully to each patient’s concerns to develop personalized, multimodal treatment plans. Her approach to managing endometriosis and pelvic floor issues includes manual therapy techniques such as myofascial release, soft tissue and visceral mobilization, alongside postural education, movement retraining, exercise, pain management, and nutritional guidance. Terri’s warm, upbeat personality makes each session both effective and enjoyable, creating a supportive environment where patients feel empowered throughout their healing journey. Whether you’re dealing with pelvic pain or other related conditions, Terri Sullivan’s expert care is focused on helping you regain function and improve quality of life.
Visit types: Office/Hospital
Spoken languages: English
Interpreting services for other languages: No
Philosophy of care and typical treatment strategies:
I would probably call myself a ‘Jane of all Trades’ as I have learned several different specialties to help a variety of patients. Now, as a physical therapist with 20+ years’ experience, I have settled into devoting my skills to helping women with pelvic floor issues. I also have a very strong background in orthopedic physical therapy, which not only helps in women’s health but makes me versatile and able to assess a multitude of injuries and conditions. When caring for my clients, I listen closely to formulate the most effective way to address their concerns and improve their function. I like to address the whole musculoskeletal system during treatment. Everything is connected and can be a cause of source of a patient’s problem. Lastly, I am an exuberantly happy person, and I will try to make your session not only beneficial, but fun. Regarding treatment of endometriosis, I use a multimodal approach to help my patient with their issues. After performing a thorough examination, I design a plan of care that is discussed with the patient. Sessions can include manual therapy (myofascial release, soft tissue mobilization and visceral mobilization), postural education, functional and movement retraining, exercises, pain management, and nutritional considerations.
Mary Hughes-Johnson, PT, DPT
Mary Hughes-Johnson, PT, DPT
Mary Hughes Johnson – Endometriosis Physical Therapist
Summary: Mary Hughes Johnson is a dedicated manual therapist who specializes in myofascial release techniques to help improve tissue mobility and support gradual strengthening. With a patient-centered approach, Mary Hughes Johnson works closely with individuals to ease pain, enhance movement, and promote overall healing. Her expertise in manual therapy allows her to tailor treatments that address soft tissue restrictions while respecting each patient’s tolerance and progress.
By focusing on restoring mobility through gentle, targeted techniques, Mary Hughes Johnson helps patients regain function and improve quality of life. Her compassionate care prioritizes listening to patients’ needs and adapting therapy to support their unique healing journey. Whether you are recovering from injury or managing chronic conditions, Mary Hughes Johnson’s approach offers effective, hands-on support designed to empower you every step of the way.
Visit types: Office/Hospital, At Home
Spoken languages: English
Interpreting services for other languages: No
Philosophy of care and typical treatment strategies:
I am a manual therapist who focuses mainly on myofascial release techniques in order to improve tissue mobility and progress with strengthening when tolerated.
Susan Clinton, PT, DScPT
Susan Clinton, PT, DScPT
Susan Clinton – Endometriosis Physical Therapist
Summary: Susan Clinton is a highly experienced and respected physical therapist who provides individualized, whole-body care for those navigating complex pelvic health conditions. Offering both in-person and virtual visits, Susan Clinton, PT uses a holistic, biopsychosocial approach that addresses the full movement system, rather than focusing on isolated areas of pain. Patients seeking Susan Clinton’s physical therapist services benefit from an evidence-based, integrative model that supports long-term healing and resilience.
As a leader in the field, Susan Clinton, PT, considers every aspect of your health—neurological, cardiovascular, endocrine, musculoskeletal, and visceral—to design treatment strategies that restore function and well-being. Her work incorporates mindfulness, breathwork, movement science, and soft tissue techniques to optimize both body and mind. Susan Clinton’s physical therapist care is always patient-centered, with a strong focus on self-efficacy and collaboration with your broader healthcare team to ensure comprehensive, empowering support.
Visit types: Office/Hospital, Virtual
Spoken languages: English
Interpreting services for other languages: No
Philosophy of care and typical treatment strategies:
I take an integrated, holistic biopsychosocial approach for individualized care for the client. I keep up to date with the current literature of movement science and employ a full-body approach to the movement system, and NOT a regional approach. Considerations for my clients are within the biology of the person including cardiovascular (optimizing HR, HRV), neurology (HPA axis, gut-brain connections, Autonomic NS and motor planning/brain protection and neuroscience of pain application, mindfulness/meditation, neural tension, and the peripheral NS), Endocrine (Nutrition, Life-style as medicine, sleep optimization and other factors to help with endocrine optimization), Musculoskeletal (Movement system optimization, exercise balance, loading/strengthening and soft tissue techniques for tissue changes, scar) and Visceral System (optimization of the urinary and GI system functioning, respiratory with breath/voice optimization and CV/ANS as above – including visceral mobilization). My practice is patient-centered with the goal to facilitate my clients’ return to self-efficacy and care with facilitated communication with the entire health care team.
Andrea Wood, PT, DPT
Andrea Wood, PT, DPT
Andrea Wood – Endometriosis Physical Therapist
Summary: Andrea Wood is a compassionate provider specializing in pelvic health and endometriosis care in Miami. With a patient-centered approach, Andrea Wood empowers individuals to manage endometriosis by offering practical tools and personalized strategies to enhance quality of life. Her care is delivered in an office or hospital setting, with interpreting services available for non-English speakers, ensuring inclusive and accessible support.
As a leading voice in endometriosis Miami care, Andrea integrates nervous system down training through guided breathing and hands-on manual therapy. She also promotes healthy movement to support long-term wellness and pain relief. Her approach centers on collaboration, fostering a team-based relationship where patients feel seen, heard, and actively involved in their healing journey. Whether you’re newly diagnosed or navigating ongoing symptoms, Andrea Wood brings empathy, expertise, and a holistic mindset to every step of your care.
Visit types: Office/Hospital
Spoken languages: English
Interpreting services for other languages: Yes
Philosophy of care and typical treatment strategies:
My philosophy includes helping individuals with endometriosis learn tools to help live a better quality of life throughout the course of treatments and lifespan. I also integrate nervous system down training through breathing techniques and manual therapy while promoting healthy movement for overall wellness. I believe in a team relationship with my patients in working together to improve their function.
Justine Roper, PT, DPT
Justine Roper, PT, DPT
Justine Roper – Endometriosis Physical Therapist
Summary: Justine Roper, founder of InHer Physique, is a certified women’s pelvic health specialist and experienced pelvic floor therapist dedicated to helping individuals overcome pelvic pain, sexual dysfunction, and the challenges of endometriosis. At InHer Physique, Justine Roper offers holistic, evidence-based care in a welcoming clinical environment, with interpreting services available for non-English speakers.
Justine Roper takes a deeply patient-centered approach, empowering each individual to set functional goals and take an active role in their healing journey. Her therapies are both physical and restorative, incorporating visceral mobilization, myofascial release, breathwork, and functional training. With her blend of clinical expertise and compassionate care, Justine Roper helps patients manage both the physical and emotional impacts of pelvic health conditions. If you’re seeking expert support with endometriosis, Justine Roper and the team at InHer Physique are here to guide you with respect, empathy, and innovation.
Visit types: Office/Hospital
Spoken languages: English
Interpreting services for other languages: Yes
Philosophy of care and typical treatment strategies:
Our lead therapist, Dr. Justine Roper PT, DPT is a certified women’s pelvic specialist & pelvic floor therapist. She has dedicated her life to offering innovative ways to heal her patients’ bodies of pain and other dysfunction through alternative methods. From sexual dysfunction to pelvic pain, many of her patients are impacted by both physical ailments as well as mental health issues. We focus heavily on functional goals established by our patients in order to endow them with autonomy over their treatment plans. Some specific techniques that we use for our patient population affected by endometriosis include visceral mobilization, myofascial release,”breathwork”/breathing techniques, & functional training.
Justine Payne, PT, DPT
Justine Payne, PT, DPT
Justine Payne – Endometriosis Physical Therapist
Summary: Justine Payne is a compassionate and highly skilled pelvic physical therapist with a deep commitment to supporting individuals living with endometriosis and adenomyosis. Fluent in both English and Spanish and offering interpreting services for other languages, Justine provides inclusive care in office, hospital, and even home settings. As a dedicated clinician, Justine Payne, pelvic physical therapist, combines evidence-based treatment with a holistic, patient-centered approach to restore function and reduce pain.
With a strong foundation in neurorehabilitation and training as a yoga instructor, Justine uses techniques like myofascial release, soft tissue mobilization, dry needling, and functional mobility work. She incorporates Pilates, yoga, meditation, and breathwork to address both the body and nervous system. Justine Payne, a pelvic physical therapist, empowers patients through trauma-informed care, education, and shared decision-making, ensuring every person feels heard, safe, and in control of their healing journey.
Visit types: Office/Hospital, At home
Spoken languages: English, Español
Interpreting services for other languages: Yes
Philosophy of care and typical treatment strategies:
The appropriate care and management of individuals with endometriosis and/or adenomyosis have been a passion of mine since I first began working in pelvic health, and through all the experiences I have been so fortunate to have had patients I have learned the importance of a holistic, evidence-based, patient-centered, team approach to the management of these horrendous and all too often misunderstood disorders.
Coming from a strong neurorehabilitation background and having been trained as a yoga teacher as well, I prioritize the treatment not only of the musculoskeletal system via flexibility training, strength training (mainly via pilates and yoga), manual therapies (including myofascial release, soft tissue mobilization, and dry needling, externally and internally if needed) and functional mobility but also the nervous system as a whole. I am a firm believer that the autonomic nervous system plays an intimate role in the management of chronic pain and functional gastrointestinal disorders and use meditation, pranayama, yoga, dry needling, grounding techniques, myofascial release, and aerobic conditioning to improve the functioning of the ANS. I also utilize visceral mobilization in my practice but have not undergone the advanced trainings as of this date (i.e. Barral Institute, Herman & Wallace, etc.).
Above all, providing each and every patient with the education that they need regarding these diseases to make informed decisions, along with providing trauma-informed care, are the two most important cornerstones of my practice. As I say to all of my patients, although you are in my clinic, you are the boss of your own body, and I will always be respectful of your wishes.
————–
Spanish
Primero en aclarar todos esos acrónimos que denotan mis credenciales: Doctor en Terapia Física, Especialista Clínico Neurológico Certificado (APTA), Especialista Certificado en Rehabilitación Pélvica (Herman & Wallace), Profesor de Yoga Registrado (Yoga Alliance 200 horas), Certificado de Punción Seca (Master Punción Seca).
La atención y el manejo adecuados de las personas con endometriosis y/o adenomiosis ha sido una de mis pasiones desde que comencé a trabajar en salud pélvica. A través de todas las experiencias que he tenido la suerte de haber tenido con los pacientes, he aprendido la importancia de un enfoque de equipo holístico, basado en la evidencia y centrado en el paciente para el tratamiento de estos trastornos horrendos y, con demasiada frecuencia, incomprendidos.
Con una sólida formación en la rehabilitación neurológica y con una formación como profesora de yoga, priorizo el tratamiento no solo del sistema musculoesquelético a través del entrenamiento de flexibilidad, entrenamiento de fuerza (principalmente a través de pilates y yoga), terapias manuales (incluida la liberación miofascial, masaje y punción seca, externalmente o internalmente si es necesario) y movilidad funcional, pero también el sistema nervioso en su conjunto. Creo firmemente que el sistema nervioso autónomo juega un papel íntimo en el manejo del dolor crónico y los trastornos gastrointestinales funcionales y utilizo la meditación, pranayama, yoga, punción seca, técnicas de conexión a tierra, liberación miofascial y acondicionamiento aeróbico para mejorar el funcionamiento del ANS. También utilizo la movilización visceral en mi práctica, pero no he recibido entrenamientos avanzados a esta fecha (es decir, Barral Institute, Herman & Wallace, etc.).
Sobre todo, brindar a todos y cada uno de los pacientes la educación que necesitan con respecto a estas enfermedades para tomar decisiones informadas junto con brindar atención informada sobre el trauma son los dos pilares más importantes de mi práctica. Como digo a todos mis pacientes – aunque esta en mi oficina, siempre Usted es la jefa (o jefe, dependiendo en su idendidad de género) y siempre respecto sus deseos.
Dr. Steven Vasilev
Dr. Steven Vasilev MD, MBA FACOG FACS FACN ABIHM ABOIM
Dr Steven Vasilev – Endometriosis Specialist, Oncology & Minimally Invasive Robotic Surgery| Medical Director, GO Institute.
Summary: Dr Steven Vasilev is a highly respected endometriosis specialist serving patients in Santa Monica, Beverly Hills, and San Luis Obispo. With over 30 years of experience, Dr Vasilev is known for his expertise in complex gynecologic surgery, including minimally invasive and robotic techniques. Steven Vasilev MD is the only physician in the U.S. triple board-certified in OB-GYN, oncology, and integrative medicine—bringing a comprehensive, personalized approach to each patient’s care.
Patients who choose Dr Steven Vasilev benefit from a philosophy that combines precision excision surgery with holistic healing strategies. From preoperative imaging to pelvic floor therapy and integrative recovery plans, Dr Vasilev offers thoughtful, multidisciplinary care tailored to long-term wellness. Steven Vasilev MD is not only a skilled surgeon but also a compassionate listener dedicated to improving outcomes for those living with endometriosis.
City: Santa Monica, Beverly Hills & San Luis Obispo, CA, USA.
Please watch the short informative video in the upper left corner of this profile.
Philosophy:
In addition to being a doctor and surgeon, I am a clinical researcher and translational scientist. We are studying the molecular behavior of endometriosis in our laboratories. Endometriosis theories suggest multiple causes, and each thesis
contributes to factors likely tied together at the molecular genetic level. Identification of endometriosis molecular and immunomodulatory pathway biomarkers will soon lead to better non-invasive diagnostics, accurate monitoring, and effective therapies beyond the baseline of expert excisional surgery and hormonal manipulation. I focus on this and the uncommon but clear overlap with malignancy in older endo patients or those with a family history.
Surgical excision is a critical cornerstone for endo diagnosis, initial treatment, and re-excision of recurrence or pain-producing fibrosis. My philosophy is to be fully informed and prepared, no matter the findings, through optimal preoperative imaging and testing. Fortunately, my unique training and board certifications permit surgery on all abdominal or pelvic organs, including small and large bowel, ureters, bladder, liver, and diaphragm. If disease is suspected beyond these organs, such as the chest, we have expert cardiothoracic and neurosurgeons ready to join a multidisciplinary surgery. Having used both laparoscopy and robotics in thousands of surgeries over three decades, including the hardest of the complicated surgeries, I firmly believe that the far superior 3-D camera optics and articulating or wristed “tiny hands” instruments used in robotics are better than traditional laparoscopy for all but the simplest of cases. When complicated anatomy or scarring from endo and fibrosis is unexpectedly found, which is not uncommon because endo is intensely inflammatory, the ability to see better and use finesse instruments makes all the difference, especially in highly experienced hands.
Medication:
During the perioperative period, we use holistic ERAS-modified care, combined with integrative modalities such as acupuncture and acupressure, to allow faster recovery with lower narcotic use. We individually construct and coordinate a multidisciplinary consulting team of experts to manage pain, intestinal manifestations such as SIBO and pelvic floor dysfunction. We work with referring gynecologists regarding hormonal support but discourage using GnRH-based therapies. My board certification in Integrative Medicine uniquely injects additional options involving holistic care. An example is proactive estrobolome management to lower systemic estrogen levels naturally.
Approach to Persistent Pain:
Both pre- and post-operatively, I strongly encourage pelvic floor therapy and pain specialist consultation and follow-up. The genesis of endo-induced pain can be due to endometriosis implants and peripheral visceral and parietal peritoneal nociception, fibrosis, direct nerve impingement, pelvic floor dysesthesia, or central sensitization. A very individual approach is vital to the best management plan. In primary and persistent pain situations, each of these “medicalese” terms is discussed in detail to craft the best possible personalized plan. Finally, as noted above, I am a board-certified integrative medicine practitioner and thus apply Eastern thought such as acupuncture, mind-body strategies, and personal nutritional counseling and interventions.
Dr. Steve’s Articles:
Dr. Nadim Hawa
Dr. Nadim Hawa, M.D.
Dr Nadim Hawa – Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Nadim Hawa is an experienced endometriosis specialist and minimally invasive gynecologic surgeon based in Leesburg, VA. Known for his compassionate and individualized care, Dr. Hawa is committed to helping patients find lasting relief from endometriosis. Whether you’re searching for Dr Hawa OBGYN or learning more about Dr Hawa endometriosis expertise, his approach combines surgical precision with long-term support.
Dr Hawa believes endometriosis has diverse origins, which is why he tailors treatment plans to each patient’s specific condition. While medications may ease symptoms, he emphasizes that they don’t address the root of the disease. Instead, he focuses on complete excision surgery and often integrates pelvic floor therapy to improve outcomes. As both a skilled surgeon and dedicated partner in care, Dr Nadim Hawa offers a comprehensive approach to managing endometriosis with the goal of restoring quality of life.
City: Leesburg, VA, USA
Philosophy: Multiple factors. Combination of in Sito development and endometrial transplantation. I do not believe there is only one type of endometriosis. Different origins hence different differentiation, behavior, and clinical impact. Same as fibroid. Why you have one solitary fibroid vs the bag of marbles of a uterus. Different gene expression and different behavior.
Medication: Medication and hormonal suppression serve only to relieve symptoms but not treat the disease. By stopping the dynamic motion of the uterus with suppression, you limit the superficial peritoneal inflammation and cause symptomatic relief, but you will not affect the deep lesions. since they produce their own estrogen and pro-inflammatory mediators. .I use IUD and usually insert intraoperatively after the excision surgery if the patient e desires birth control. GnRH agonist/antagonist are harmful and I do not use them
Approach to Persistent Pain: Surgery alone is not enough. Pelvic floor therapy is as important as surgery, for long term recovery.
A second excision is usually advised.
Dr. Patrick Yeung Jr
Dr Patrick Yeung Jr, M.D.
Dr Patrick Yeung – Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Patrick Yeung is a renowned endometriosis specialist and minimally invasive gynecologic surgeon based in St. Louis. Known for his deep commitment to individualized care, Dr Patrick Yeung takes a comprehensive and evidence-based approach to treating endometriosis. Patients seeking answers about complex pelvic pain or surgery often find lasting relief through his expertise. Whether you’re researching Dr Patrick Yeung St Louis, exploring options for Patrick Young endometriosis treatment, or looking for the right specialist, Dr Yeung offers trusted, compassionate care.
With a philosophy rooted in achieving optimal excision over hormonal suppression, Dr Yeung believes real healing begins by treating the disease at its core—not just its symptoms. As a thought leader challenging outdated theories like retrograde menstruation, Dr Patrick Yeung focuses on precision surgery and comprehensive post-op support. Patients nationwide turn to Dr Patrick Yeung St Louis for relief from persistent endometriosis pain and personalized, long-term care.
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 to prevent progression or recurrence if I think that optimal excision has been achieved. So I 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 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.
Since incorporating a more global or comprehensive approach to pain, our rate of repeat surgery for endometriosis 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.
Dr. Lora Liu
Dr. Lora Liu, M.D.
Dr Lora Liu – Endometriosis Specialist, Minimally Invasive Gynecologic Surgeon.
Summary: Dr Lora Liu, a highly respected endometriosis specialist and minimally invasive gynecologic surgeon, is based in New York City. Known for her skill and compassionate care, Dr Liu NYC is a trusted name among patients seeking expert treatment for complex pelvic pain. At the core of Dr Liu Endometriosis care is a comprehensive understanding of the disease’s multifactorial origins, including inflammation, immune dysfunction, and hormonal influences. Patients turn to Lora Liu MD for individualized care that blends evidence-based medicine with a human-centered approach.
Dr Lora Liu believes in treating each patient uniquely. She often combines advanced excision surgery with hormonal therapy, non-opioid pain relief, and pelvic floor rehabilitation. At Dr Liu NYC, her multidisciplinary team supports long-term healing, even for those with persistent symptoms. Dr Liu Endometriosis care reflects a deep commitment to improving quality of life, and Lora Liu MD remains a leading voice in delivering compassionate, specialized care for women with endometriosis.
City: New York, NY, USA.
Philosophy: I believe that the etiology of endometriosis is complex and multifactorial. I support the Mullerianosis theory. However, there are other contributing factors such as oxidative stress and inflammation, impaired immune response, genetics, and hormones – both endogenous and exogenous that play a role in the pathogenesis and proliferation of endometriosis.
Medication: I incorporate medications into my practice for the management of symptoms. For hormonal suppression, I incorporate combined OCPs, progesterone-only pills, or progesterone IUD. I do not prescribe GnRH agonists or antagonists. Depending on the patient’s pain generators, I may also recommend non-opioid pain medication, such as NSAIDs, gabapentin, SNRIs, and compounded suppositories.
Approach to Persistent Pain: I am committed to closely following my post-operative patients to ensure that their persistent pain is managed and overall quality of life is improved. Patients with a long history of pelvic pain due to endometriosis will often require additional support following surgery. I am fortunate to work in a multi-disciplinary practice with Physical Medicine and Rehabilitation physicians who specialize in pelvic pain, as well as with pelvic floor physical therapists and pain management physicians. However, my approach depends on the individual patient and her history and current symptoms. Some patients may find that their symptoms are adequately managed with hormonal suppression alone, whereas others may need a second look if symptoms start to recur after their initial surgery. By integrating a multifaceted approach, I find that patient outcomes are overwhelmingly more positive.
Dr. Nicholas Fogelson
Nicholas Fogelson, M.D., FACOG,
Dr Nicholas Fogelson – Endometriosis Specialist, Advanced Pelvic Surgeon, Minimally Invasive Gynecologic Surgeon.
Summary: Dr Fogelson is a leading endometriosis specialist and advanced pelvic surgeon based in Portland, Oregon. Patients from across the country trust Dr Nicholas Fogelson and his clinic, Northwest Endometriosis, also known as NW Endometriosis, for expert, compassionate care. With a strong foundation in the latest research, Dr Fogelson approaches each case with precision and empathy, offering tailored treatments that prioritize long-term relief. Thanks to his reputation for surgical excellence and individualized care, NW Endometriosis has become a top destination for patients seeking advanced support for this complex condition.
At Northwest Endometriosis, Dr Nicholas Fogelson provides excision surgery backed by a deep understanding of the varied presentations of endometriosis. His treatment plans often include pelvic floor therapy, lifestyle guidance, and selective use of hormonal therapy. Whether patients are local or traveling for care, Dr Fogelson and the NW Endometriosis team are committed to delivering ongoing support and expertise every step of the way.
City: Portland, Oregon.
Philosophy: I strongly believe that endometriosis is not one disease, but rather are a constellation of states of similar but not identical disease states. This concept is strongly supported by the very large number of genes that are tightly bound to the disease state, which is more characteristic of a multifactorial and multiorigin disease than a single disease entity. Ie. calling endometriosis one thing is like calling cancer one thing.
Right now the predominant theory is that of mullerianosis, suggesting that endometriosis is a defect of embryogenesis. This theory is supported by a variety of data. At the same time, we also have evidence of environmental factors that seem to promote endometriosis, either through actual genesis of disease or through worsening of the already existent disease and therefore making diagnosis more likely.
The variable response to various therapies among different patients is also suggestive that there is more than one underlying disease state. Ie some patients respond completely to surgical excision and have very little benefit from medical therapies, while some other patients have near-complete cessation of symptoms while on progesterone suppression. Some patients have severe pain, others have no pain, and may only present with infertility. Furthermore, the variability of the appearance of endo surgically also suggests more than one underlying origin. For example, there is a clearly a subtype of endometriosis that presents with high grade rectovaginal deep infiltrating endometriosis, while sparing the ovaries and other peritoneal surfaces. Other patients may have endometriotic implants studded throughout their pelvis, many superficial with perhaps some small deeper areas, without advanced deep disease in any particular area. Again, this suggests a different origin of disease rather than a clinical variation of an identical disease state.
At this point, our understanding of the disease is incomplete. My approach is to individualize care to each particular patient in efforts to improve her quality of life to the maximum. Most patients seek me out for excision surgery, which I do a great deal of. And at this point, excision surgery is the optimal treatment we have available. At the same time, it is critical that we keep an eye out to a better future understanding of the underlying disease that may open up other effective treatment modalities.
Medication: Most of my patients have already been on medical therapies with other physicians and have not found relief, leading them to seek out endometriosis surgery. My primary treatment modality is excisional therapy, but we may augment that with hormonal suppression postoperatively in some cases. Usually, this is only for 3-6 months postoperatively, but in some cases, patients may choose to be on suppression for longer. While in theory, a patient who has had full excision of disease should not benefit from medical therapy, there are some data that do suggest a decreased frequency of recurrent pain in patients who do use progesterone suppression after surgery. These data may be biased by the inclusion of surgery that is not as complete as what is typical in my practice and other expert-level surgeons’ practices, and this may explain this result.
I typically do not use GnRH modulators such as Lupron or Orilissa, as their side effect profile is often worse than the benefit gained, and a minority of women may experience long term harm from their use.
Approach to Persistent Pain: Every case is different, so there can be no one specific approach. Most patients have thorough excision of endometriosis as part of their treatment. Most experience substantial relief from this, but over time some may have recurrent pain.
All patients should be evaluated by a skilled pelvic PT and get support for pelvic floor pains. When this is severe pelvic floor botox may be appropriate. We also have to consider urinary tract sources of pain such as interstitial cystitis. When appropriate, some patients may have repeat laparoscopy if we believe there may be recurrent or residual disease (particularly if a patient comes in after surgery from an outside surgeon. We also must evaluate other neurologic sources of pain, such as vascular or ligamentous entrapment of pelvic nerves (ie nerve roots, sciatic, femoral, obturator, pudendal, etc.). In limited cases, direct neurolysis of affected nerves may lead to relief. When a persistent pain can be neurologically localized but is not addressable surgically, or surgery has failed to relieve the pain, direct neurostimulation of affected nerves can have substantial efficacy in decreasing or even eliminating pain. We also encourage all patients to eat a healthy anti-inflammatory diet and to get regular exercise.
While some patients travel to see us, many patients come from our local area and continue to work with our practice ongoing for their routine care as well as any issues of recurrent pain. We are committed to continuing to care for all of our patients, as long as it is practical for them. While many patients do travel for surgery, we think that the best care comes with an ongoing relationship with a physician who not only can operate but has a wide base of knowledge in pelvic pain, and can help manage care actively.
Dr. Antonio Rosario Gargiulo
Dr Antonio Gargiulo MD
Dr Antonio Gargiulo – Endometriosis Specialist, Gynecologist
Summary: Dr Antonio Gargiulo is a leading endometriosis specialist Boston patients trust for expert, compassionate care. As a highly respected gynecologic surgeon based in Boston, MA, Dr Antonio Gargiulo is known for his advanced techniques and individualized approach to treatment. Patients from across the U.S. seek Antonio Gargiulo MD endometriosis care for its innovation, depth, and dedication to whole-person health. Whether you’re searching for a highly experienced endometriosis specialist in Boston or have been referred to Doctor Gargiulo by another provider, his reputation for excellence and holistic, evidence-based care sets him apart.
While the exact causes of endometriosis are still under investigation, Dr Antonio Gargiulo supports the theory of a polypotential germ-cell origin. In clinical settings, Doctor Gargiulo often begins treatment with FDA-approved progestins and NSAIDs, reserving GnRHa primarily for patients with adenomyosis preparing for IVF. His thoughtful, personalized strategies help patients manage symptoms while minimizing unnecessary interventions.
When facing chronic or complex pelvic pain, Antonio Gargiulo MD endometriosis care expands well beyond standard gynecological evaluations. Doctor Gargiulo integrates comprehensive assessments across specialties, including urology, gastrointestinal, neuro-orthopedic, rheumatology, and mental health domains. His approach ensures coexisting or overlooked conditions are addressed, and that issues such as adhesions or hernias are not missed. Physical therapy and regular follow-ups are also central to his long-term treatment plans.
With unmatched expertise and a commitment to multidisciplinary, compassionate care, Dr Antonio Gargiulo remains a leading name in the field. As a trusted endometriosis specialist Boston patients rely on, Doctor Gargiulo continues to provide clarity, relief, and lasting solutions in the often misunderstood world of endometriosis.
City: Boston, MA, USA
Philosophy: Etiology is yet unclear. Polypotential germ-cell origin is a promising hypothesis.
Medication: My first line is FDA-approved progestins and NSAIDs. I use GnRHa exclusively for adenomyosis patients in the setting of IVF.
Approach to Persistent Pain: Expanding diagnostic approach (uro, GI, neuro/ortho, rheumatology, psyche). Expanding physical therapy approach. Clinical reevaluation for possible residual disease or iatrogenic disease (hernia, adhesions). Pain service.
