Lillian Medhus
Lillian Medhus, DNP, WHNP-BC, CNM, MSCP
Endometriosis Long Term Care Provider
Summary: Lillian Medhus, DNP, a Women’s Health Nurse Practitioner and skilled Long-Term Endometriosis Care Provider at Aspire Women’s Wellness. She specializes in comprehensive management of endometriosis, viewing it as a chronic, systemic neuroinflammatory condition and providing individualized, evidence-based care that addresses the whole person rather than focusing solely on gynecologic symptoms
Her comprehensive approach combines hormonal and non-opioid pain management, lifestyle and dietary interventions, metabolic health optimization, and treatment of coexisting conditions such as pelvic floor dysfunction, adenomyosis, migraines, IBS/IBD, hypermobility, MCAS, and mood disorders. She collaborates closely with surgeons, pelvic floor therapists, mental health providers, dietitians, and other specialists to support patients before and after surgery.
Lillian is a Menopause Society Certified Practitioner and holds certifications as a Certified Nurse Midwife, Women’s Health Nurse Practitioner, Certified Nurse Practitioner, and Registered Nurse. She earned her Doctor of Nursing Practice from Frontier Nursing University and her Master’s degree in Nurse Midwifery and Women’s Health Nurse Practitioner from Georgetown University, complemented by advanced training in trauma counseling.
City: Waxahachie, Texas, USA
Visit types: Telehealth and In-Person
Spoken languages: English
Interpreting services for other languages: No
Philosophy of Endometriosis Care: Endometriosis is a chronic, neuroinflammatory condition that affects the entire body. The origin is likely genetic and pathophysiologic in nature, with an increased risk of symptoms in patients with other neuroimmune conditions. Treatment must look at the entire body, not isolated treatment of the gynecologic organs. Interventions to reduce inflammation and improve long-term health, include treatment of insulin resistance, nutrient deficiencies, consideration of the increased cardiovascular risks of endometriosis, and treatment of chronic overlapping pain conditions and central sensitization. Patients achieve the best outcomes with interdisciplinary care among surgeons, pelvic floor therapists, mental health providers, dieticians, long-term care providers, and other complementary therapies.
Medication: Progestogens: Progesterone, Drosperinone, Norethindrone acetate, Medroxyprogesterone. Progestogens are utilized for dysmenorrhea, menorrhagia, or chronic pelvic pain. Type of progestogen is based on patient preference, medication history, and pregnancy plans. I currently practice through telehealth only, however I may encourage a patient with suspected adenomyosis to pursue levonorgestrel IUD with their local GYN provider. Low dose naltrexone is utilized as an off-label option for chronic pain & inflammation. Vaginal suppositories (typically baclofen, with or without diazepam & gabapentin) are utilized for pain flares, sciatic pain, and hypertonic pelvic floor. Tirzepatide is used on-label for patients with insulin resistance, obesity, or metabolic disease. It is used off-label in small doses for inflammation. NSAIDs are utilized for pain. GnRH analogs are only used if the patient comes to our practice stable on them or as a bridge to surgery in very rare cases, and only as a final resort. Duavee/bazedoxifene may be an emerging option for endometriosis and menopause.
Pre-surgical care plan: Patients who are awaiting surgery, or who decline surgery, receive a holistic plan of care. New intake visits include a comprehensive lab panel, looking for any other causes of inflammation, fatigue, bloating, or other chronic symptoms which can be improved. Patients are referred to pelvic floor therapy in most cases, especially if there is evidence of pelvic floor dysfunction. Patients are also offered referral to mental health providers skilled in treatment of chronic disease. Patients are offered treatments including dietary interventions (ie- anti-inflammatory diet patterns & blood sugar management), evidence based supplement regimens, and non-opioid pain relief (including vaginal suppositories & NSAIDS). Collaborative care with the surgeon is utilized to make the decision whether to employ hormonal treatment options, or to defer until after surgery.
All the above is also utilized if a patient comes to me after surgery. Additionally, we will consider the use of hormonal options, most often progestogens. We will tailor treatment to any persistent symptoms, or other chronic overlapping conditions (MCAS, hypermobility, mood disorders, migraines, pelvic floor dysfunction, IBS/IBD, etc).
