Dr. Paul Tyan
Dr. Paul Tyan, M.D.
Dr Paul Tyan – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Paul Tyan is a leading endometriosis specialist and minimally invasive gynecologic surgeon based in Arlington, VA. Known for his patient-centered approach and deep expertise, Dr. Tyan brings clarity and compassion to those navigating the complexities of endometriosis. Patients searching for experienced care often turn to Paul Tyan, or Dr Paul Tyan, for his commitment to evidence-based, individualized treatment plans. With a strong foundation in the latest research, including genetic and epigenetic insights, Dr Tyan endometriosis care emphasizes early intervention and holistic pain management.
He specializes in excision surgery and integrates hormonal therapies, physical therapy, and medication tailored to each patient’s needs. Whether you’re exploring treatment for deeply infiltrative endometriosis or managing persistent pain after surgery, Dr. Paul Tyan offers thoughtful, comprehensive support. With Dr Tyan endometriosis care, patients receive both advanced clinical knowledge and the compassionate guidance they deserve.
City: Arlington, VA, USA
Philosophy: In its most basic definition, endometriosis is the presence of endometrial cells (that form the inner lining of the uterus) outside the uterus. In some patients, those ectopic cells can produce an inflammatory response that is at the origin of various cascades that can lead to pain or scarring. There are multiple proposed theories about the origin of endometriosis. The only certainty is that the origin of endometriosis is multifactorial.
The retrograde menstruation or implantation theory is one of the initial principles of the pathogenesis of endometriosis;however, it has been challenged as the single cause for several years, as evidenced by the occurrence of symptomatic endometriosis in premenarchal and postmenopausal women. Also, by the fact that nearly all patients will have retrograde menstruation, but not everyone has endometriosis.
Most recently, we have had significant advances in the genetic and epigenetic theory of endometriosis. The clonality of endometriosis lesions and the cancer-driver genes that have been identified in deeply infiltrative endometriosis lesions shed light on the genetic component of the disease. Recent work on the epigenetic factors linked to external conditions affecting pluripotent cell behavior in the setting of endometriosis is a promising field set to unveil exciting information.
Keeping up to date with the intricacies of the pathogenesis of endometriosis is crucial to my clinical practice. Many patients will be counseled over the years that surgery is unnecessary at that blocking the menstrual cycle or hormonal suppression is sufficient for “curing” endometriosis. Explaining to patients the complex nature of the disease and the necessity of early intervention, especially in the deeply infiltrative endometriosis subtype, could be a crucial factor in decreasing morbidity and improving the quality of life of my patients.
What type of surgery do you perform for endometriosis?:
Excision
Medication: I recommend a combination hormonal contraceptive (birth control) for post-surgical suppression. In cases where a combination option is contraindicated, I recommend a progesterone-only option.
I recommend treatment with an SSRI, SNRI, or GABA-Analog for patients with central sensitization due to chronic pain secondary to endometriosis.
For patients with pelvic floor tension myalgia, I recommend physical therapy, various muscle relaxers, and trigger point injections or nerve blocks in warranted conditions.
Treatment plans tend to be individualized based on the patients’ presenting symptoms, surgical management, and postoperative course.
Approach to Persistent Pain After Surgery: For some patients, endometriosis excision is sufficient for complete symptomatic relief. However, some patients will still have symptoms after surgery. It is crucial to counsel patients before surgery that endometriosis excision is only one aspect of a comprehensive management plan that should involve central and peripheral pain management, pelvic floor physical therapy, and dietary modification.
Dr. Miguel Luna Russo
Dr. Miguel Luna Russo, Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Cleveland, Ohio, United States
Dr. Elvira Bratila
Prof. Dr. Elvira Bratila, MD, Ph.D., Endometriosis Specialist, Gynecologist
City: Bucharest, Romania
Dr. Lawrence Sullivan
Dr. Lawrence Sullivan, Endometriosis Specialist, Gynecologist
City: Enosburg Falls, Vermont, USA
Dr. Benjamin Beran
Dr. Benjamin Beran, Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Milwaukee, Wisconsin, USA
Dr. Stephanie Delgado
Dr. Stephanie Delgado, Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
City: Miami, Florida, USA
Dr. Nicholas Hazen
Dr. Nicholas Hazen, M.D.
Dr Nicholas Hazen – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Nicholas Hazen MD, a renowned endometriosis specialist and gynecologist based in Washington DC, USA, is dedicated to providing personalized care for women dealing with endometriosis. Dr Hazen understands that the disease process is still not fully understood, and he combines scientific evidence with personal experience to tailor treatment for each patient. When surgery is required, he favors an excisional approach with wide margins to ensure the best possible outcomes.
In managing endometriosis, Dr Nicholas Hazen MD uses a range of treatments, including progestational agents, GnRH antagonists, NSAIDs, and gabapentinoids. He emphasizes a holistic approach, recognizing the importance of diet and mental health in managing pain. For patients experiencing persistent pain after surgery, Dr. Hazen customizes treatment plans to meet each individual’s needs, working closely with them to extend pain relief and improve quality of life.
City: Washington DC, USA
Philosophy: I believe there is still more that is unknown than known about the disease process of endometriosis. Quality scientific evidence supports multiple current etiologies, suggesting that endometriosis is not a simple process with a simple solution. My approach to surgical treatment is based on my most up to date understanding of the disease process, in combination with my personal experience caring for patients along their unique health journeys. When surgery is warranted, I favor an excisional approach with wide margins to include both visible and surrounding microscopic disease. In my experience, this leads to the best outcomes for patients.
Medication: The choice of medication for the management of endometriosis is an extremely individual one. Finding the best fit for a patient requires reviewing both their current status and past history very thoroughly, including their previous experiences, the evolution of their symptoms, and their individual management goals. In my practice, I most commonly prescribe progestational agents but often recommend GnRH antagonists. The current literature shows that suppression results in decreased return of pain and symptoms following endometriosis surgery, and I often recommend and manage post-surgical resection hormonal suppression. I use non-narcotic medications such as NSAIDS for the treatment of pain and gabapentinoids and SNRI/SSRIs for central sensitization. I believe that diet and mental health also play an important role in the body’s pain response to endometriosis.
Approach to Persistent Pain After Surgery: I believe there is no single “right” approach to addressing continued pain after surgery. Every patient is different, and so is each surgery, so it is critical to individualize treatment plans based on a patient’s unique needs. It has been widely shown that for the majority of patients, the pain relief experienced from surgery is unfortunately only temporary. In the continued care of my patients, my goal is always to work together to extend pain relief as long as possible and minimize impacts and disruptions to the patient’s life going forward.
Dr. Ulises Armando Menocal Tavernier
Dr Ulises Armando Menocal Tavernier
Dr Ulises Armando Menocal Tavernier – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Menocal is a highly skilled endometriosis specialist and gynecologist based in Morelia, Michoacán, Mexico. As a minimally invasive gynecologic surgeon, Dr Menocal provides personalized and compassionate care to women suffering from endometriosis. His approach to the condition is grounded in the coelomic metaplasia theory and the endometrial stem cell recruitment theory, which helps inform his treatment strategy.
Dr Ulises Armando Menocal Tavernier utilizes a range of treatments, including combined oral contraceptives for young women and Dienogest following surgery, to manage symptoms and improve quality of life. For patients with persistent pain after surgery, Dr. Menocal follows a multidisciplinary approach, collaborating with nutritionists, psychologists, and pelvic rehabilitation specialists. In some cases, he may recommend a second-look laparoscopy to assess the effectiveness of treatment.
City: Morelia, Michoacan, Mexico
Philosophy: Coelomic metaplasia
Medication: Combined oral contraceptives in young women for a period of 6 months up to 5 years
Approach to Persistent Pain After Surgery: Patients will remain in a multidisciplinary approach with a nutritionist, psychologist, and pelvic rehabilitation. And in some patients, we will perform a second-look laparoscopy.
Dr. David Rosen
Dr. David Rosen, M.B., B.S.,
Dr. David Rosen – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr David Rosen gynaecologist is a highly skilled endometriosis specialist based in Kogarah, NSW, Australia. With extensive experience in treating endometriosis, Dr. David Rosen gynaecologist, provides individualized care, focusing on excision surgery to remove all deposits rather than relying on less effective treatments like diathermy. His approach is designed to address the unique needs of each patient, ensuring the best possible outcomes.
For treatment, Dr David Rosen utilizes a range of therapies including OCP, progesterone IUDs (Mirena), and GnRH analogs (Zoladex), along with laparoscopy when necessary. He collaborates with pelvic floor physiotherapists and pain specialists to help manage chronic pain, offering a multidisciplinary approach to care.
As a dedicated gynaecologist, Dr David Rosen provides ongoing support through regular follow-ups and personalized pain management plans to improve quality of life for his patients.
City: Kogarah, NSW, Australia
Philosophy: The cause of endometriosis is unknown – deep infiltrating disease arising from the uterosacral ligaments and incorporating the ovaries and bowel shows a very different natural history to peritoneal gunpowder or vesicular deposits yet both can cause severe symptoms in women. Accordingly, each patient is approached individually however the overarching philosophy is extensional surgery to remove all deposits (versus “diathermy to endometriosis” which can often leave deep deposits of endometriosis especially in the Pouch of Douglas)
Medication:
Approach to Persistent Pain After Surgery: Endometriosis represents a chronic disease and I believe that pain pathways are laid down over years, like a highway of stimuli from the source in the pelvis, to the sensory cortex and back to the pelvis. As such, it is not unusual to experience recureent symptoms in the same areas as the initial presentation, even if the stimulus is minor. Whilst all physicians hope that their patients experience rapid and permanent relief from excising disease, I am aware of the concept of visceral sensitization and the strategies needed to reduce chronic pain symptoms for this group of women. Accordingly all endometriosis patients are reviewed annually until they feel they no longer need to be seen, offered hormonal therapy following surgery if fertility is not immediately desired and then work as a team to strategize the best plan for chronic pain sufferers, often involving clinicians listed below..
Dr. Stylianos Kogeorgos
Dr. Stylianos Kogeorgos, M.D.
Dr Stylianos Kogeorgos – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr Stylianos Kogeorgos is a dedicated endometriosis doctor in Athens, Greece, specializing in the diagnosis and treatment of endometriosis. As a highly skilled gynecologist and minimally invasive surgeon, Dr Kogeorgos offers personalized care to women affected by this complex condition. He recognizes that while the exact cause of endometriosis is still unclear, factors like hormones, immune system responses, and genetic influences play a significant role in its development.
Dr. Kogeorgos uses a range of treatments to manage symptoms, including progestogens, hormonal contraceptives, and intra-uterine devices (IUDs), with a focus on improving quality of life. His approach also includes extensive follow-up care for patients post-surgery, emphasizing pelvic floor therapy and collaboration with pain specialists to manage persistent pain.
For women seeking support from an experienced endometriosis doctor in Athens Greece, Dr Kogeorgos combines evidence-based treatments with compassionate, patient-centered care.
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.
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.
Mr Waseem Kamran
Mr Waseem Kamran
Mr Waseem Kamran – Consultant Surgical Gynecologist, Endometriosis Specialist
Summary: Mr Waseem Kamran is a highly skilled consultant surgical gynecologist and endometriosis specialist based in Dublin, Ireland. With a deep understanding of the genetic and embryonic origins of endometriosis, Mr. Waseem Kamran brings a comprehensive approach to diagnosis and treatment. His approach to endometriosis is based on the principles of radical cytoreduction, similar to that used in metastatic disease processes, ensuring the best possible outcomes for his patients.
With a focus on excision surgery (performed in 99% of cases), Mr. Waseem Kamran specializes in removing endometrial tissue to improve quality of life. He also uses hormonal treatments like progestogens and GNRH analogues, both before and after surgery, to manage symptoms.
For patients dealing with persistent pain post-surgery, Mr. Waseem Kamran often recommends hormone treatment and medications like pregabalin, particularly when deep nerve surgery has been performed. His care is tailored to each patient’s needs, ensuring a compassionate and effective approach.
City: Dublin, Ireland
Philosophy: Genetic- Embryonic origin and hence disease distribution can occasionally pose diagnostic dilemma
Treatment approach is the one used for metastatic disease process- radical cytoreduction
Surgery technique:
99% excision
1% ablation in certain cases- ovarian/spleen
Medication: progestogens- pre and post-op
GNRH analogues- pre-op in a select number of cases
Approach to Persistent Pain After Surgery: Hormone treatment
Pregabalin especially if deep nerve surgery is done
Dr. Aoife O Neill
Dr. Aoife O Neill, Minimally Invasive Gynecologic Surgeon, Endometriosis Specialist
City: Dublin, Ireland
