Stacy Ronquillo, MSN, APRN, FNP-BC, AGACNP-BC, IFMCP, ABAAHP

Endometriosis Long-Term Care Provider

Summary: Stacy Ronquillo is a dual board-certified Family Nurse Practitioner and Adult-Gerontology Acute Care Nurse Practitioner at Remedy Functional Medicine in Portland, Oregon. As an Endometriosis Long-Term Care and Chronic Care Provider, she specializes in individualized, comprehensive care for patients managing endometriosis and persistent pelvic pain.

Stacy takes a comprehensive, patient-centered approach to endometriosis care, recognizing that every patient’s experience is unique. She addresses hormonal, inflammatory, gastrointestinal, and nervous system factors that may contribute to symptoms. Her treatment approach may include medication management, nutritional support, pelvic floor physical therapy, and collaboration with endometriosis excision specialists when appropriate.

For patients experiencing persistent pain after surgery or struggling to find lasting symptom relief, Stacy provides ongoing support, thorough evaluations, and individualized care plans. She prioritizes listening to patients’ concerns, understanding their health goals, and helping them feel heard, informed, and supported throughout their endometriosis journey.

City: Portland, Oregon, USA

Philosophy of Endometriosis Care: I approach endometriosis as multifactorial, consistent with the current literature (Giudice 2010). No single theory explains every case. Retrograde menstruation accounts for much peritoneal disease but not for cases in people who have never menstruated or for distant lesions, where Müllerian rests and coelomic metaplasia offer better explanations. Genetic, epigenetic, and immune factors shape who develops disease and how it progresses. In practice, this means I don’t treat endometriosis as a uterine or purely hormonal problem. Lesions are endometrial-like tissue that can produce their own estrogen through aromatase and often show progesterone resistance, so hormonal suppression manages symptoms but does not remove disease. I refer for excision with a specialist when appropriate, and I address the inflammatory, immune, and central sensitization components alongside it through nutrition, GI evaluation, pelvic floor therapy, and trauma-informed mental health support.

What type of surgery do you perform for endometriosis: Excision

Do you include imaging in pre-surgical planning: Yes, though imaging supports my approach rather than driving it. My diagnosis starts with the clinical picture: a detailed history of pain patterns, bowel, bladder, and sexual symptoms, cycle changes, and treatment response, built over time through a close patient-provider relationship. Because I see patients consistently and spend longer with them, I can track how symptoms evolve and respond to treatment, which often tells me more than a single study. When the clinical picture is consistent with endometriosis, I treat on that basis, rather than requiring imaging or surgical confirmation before patients get care. I offer imaging when it will change management: Transvaginal ultrasound is my first choice, ideally performed by a sonographer experienced in endometriosis using an advanced protocol. I use it to evaluate for endometriomas, deep infiltrating disease, and adenomyosis, and to monitor endometriomas over time. MRI with an endometriosis protocol is for inconclusive ultrasound, suspected deep disease, and surgical planning, so the surgeon knows in advance whether bowel, bladder, or ureteral involvement requires a multidisciplinary team. Renal ultrasound is for suspected disease near the ureters or bladder, since ureteral obstruction can progress without symptoms. I’m clear with patients that imaging cannot detect superficial peritoneal disease, so a normal result doesn’t rule out endometriosis or invalidate their symptoms. That’s where the relationship matters most: patients who have been told “your imaging is normal” for years need a provider who takes their history seriously.

Medication: I choose medications based on symptom pattern, reproductive goals, prior response, contraindications, and patient preference, and I’m clear with patients that medical therapy manages symptoms but does not remove disease. NSAIDs. First-line for dysmenorrhea, started a day or two before expected menses and taken on a schedule rather than as needed. Progestogens. These are the foundation of my hormonal management. For ovulation and symptom suppression, I primarily use progestins, including drospirenone (Slynd), norethindrone acetate, and the levonorgestrel IUD, chosen by side effect profile, bleeding pattern, and patient preference. Progestin-only options avoid estrogen-related risks, and drospirenone’s antimineralocorticoid and antiandrogenic properties make it well tolerated for many patients. I also use oral micronized progesterone for patients who don’t tolerate synthetic progestins due to mood or other side effects, or when sleep and luteal-phase symptoms are prominent, while being clear that its evidence for lesion suppression is more limited than for progestins. I reassess often, and if pain worsens or doesn’t improve, I consider progesterone resistance. Combined hormonal contraception. An option for select patients without contraindications to estrogen, used continuously. Second-line therapy. For patients who don’t respond to progestogen therapy, I coordinate with an endometriosis specialist or gynecologist for GnRH-based therapies, aromatase inhibitors, and surgical evaluation. Neuromodulators. Low-dose tricyclics or SNRIs when central sensitization is a significant contributor, alongside pelvic floor therapy and psychological support. Supportive therapies. Iron repletion for heavy bleeding, vitamin D correction, and evidence-informed anti-inflammatory support such as omega-3 fatty acids, as adjuncts rather than replacements for hormonal or surgical care. I avoid long-term opioids. For any hormonal option, I discuss fertility goals and, for gender-diverse patients, how progestogenic effects fit their goals and experience.

Approach to Persistent Pain After Surgery: I start by validating that persistent symptoms are real and common, and that they don’t mean the patient failed or the surgery was pointless. Then I work through why they’re happening, because persistent pain after surgery usually has more than one source. Timing. Healing and nerve recovery take months, so I distinguish expected recovery from true persistence, generally reassessing at three to six months against the patient’s pre-surgical baseline pain scores. Reviewing the surgery. I go back to the operative and pathology reports to understand what was found, whether lesions were excised or ablated, and whether any areas weren’t addressed. Incomplete excision, especially of deep disease, is a common reason symptoms continue. Broad differential. I evaluate for: Residual or recurrent endometriosis; adenomyosis, which excision of endometriosis does not treat; pelvic floor muscle dysfunction; central sensitization and neuropathic pain; pelvic congestion syndrome and other pelvic venous disorders, particularly when pain worsens with prolonged standing, late in the day, or after intercourse; postoperative adhesions; GI drivers such as SIBO, IBS, and food sensitivities; bladder pain syndrome; ovarian remnant in patients who had oophorectomy. Targeted management. Treatment follows what I find: pelvic floor physical therapy, neuromodulators and pain psychology for sensitization, GI evaluation and nutrition, and progestogen therapy to suppress residual or recurrent disease. When pelvic venous disease is suspected, I order transvaginal ultrasound with Doppler and refer to interventional radiology for venography and possible embolization. When residual endometriosis is likely, I refer back to an excision specialist with expert imaging, rather than toward repeated surgeries with non-specialists, which can add adhesions without resolving disease. Continuity. Because I follow patients closely over time, I can track which interventions change their symptoms and adjust accordingly, and patients have one provider coordinating care rather than navigating it alone.