Dr. Amanda Chu
Dr. Amanda Chu, Endometriosis Specialist
City: New York City, USA
Philosophy of Endometriosis Care: No single theory adequately explains all presentations of endometriosis, but I believe that certain theories play more of a role in individual patients.Older theories have merit, e.g., retrograde menstruation and coelomic metaplasia, but we are constantly increasing our knowledge of endometriosis, & I think that epigenetics and immune dysregulation will become increasingly important.
What type of surgery do you perform for endometriosis?: Excision
Medication: Currently, hormonal medications are a useful and, at times, necessary adjunctive for cyclic symptoms and ovarian cyst prevention. Typically, I utilize continuous progesterone-only medications with the goal of amenorrhea/anovulation. I prefer to avoid GnRH agonists/antagonists for long-term use given their severe side effect profile.
Approach to Persistent Pain After Surgery: Postoperatively, I prefer to focus on finding less invasive ways to decrease inflammatory, musculoskeletal, & neuropathic pain rather than repetitive procedures. I believe in treating all etiologies of pain, including often coexisting comorbidities, and well as being receptive to approaches that expand beyond traditional Western medicine. Finally, the mental & social impact of endometriosis cannot be overstated, and a multidisciplinary team is essential.
Dr. Jurgis Vitols
Dr. Jurgis Vitols, Endometriosis Specialist
City: Riga, Latvia
Philosophy of Endometriosis Care: Genetic – epigenetic theory.
What type of surgery do you perform for endometriosis: Excision; Both. I may use ablation only for ovarian cysts. For ovarian endometriosis, I may use laser vaporization on the hilum of the capsule or for all of the cyst capsules in case the cyst enucleates badly and there is a high risk of damage to normal ovarian tissue. My preferred approach for ovarian cysts is cystectomy.
Medication: Depends on the patients wishes and complains. For patients who doesn’t want to have surgery, I recommend use of combined oral contraceptive pills or progesterone pills. If symptoms persist, I recommend surgical treatment. After surgery, I recommend long-term use of combined oral contraceptive pills or progesterone pills for patients who don’t wish to become pregnant and have had ovarian endometrioma – to reduce recurrence. For patients who wish to become pregnant after surgery, sometimes I recommend short use (maximum for 3-4 months) of GnRH analogs or GnRH antagonists to improve their chance of having a natural conception. I never prescribe long-term use of GnRH medication.
Approach to Persistent Pain After Surgery: Combined oral contraceptive pills or progesterone pills. Suppose this doesn’t help—pregabalin or amitryptiline. Patients with persistent pain symptoms are referred to pain specialists.
Dr. Liliana Puycan
Dr. Liliana Puycan
Endometriosis Specialist
City: Lima, Peru
Philosophy of Endometriosis Care: The theories of endometriosis that focus my treatment are the theory of coelomic metaplasia and the immunological theory since I think that the disease grows or proliferates in an inflammatory-immune environment, originating in certain patients susceptible to the disease.
What type of surgery do you perform for endometriosis: Excision
Medication: I begin treatment with the use of progestins and/or bioidentical progesterone, in addition to changes in nutrition and lifestyle to reduce the inflammatory effect of the disease.
Approach to Persistent Pain After Surgery: Before the surgical treatment, I made sure that the patient had already started a complete diet and physical activity regimen, which would continue postoperatively. Understanding the importance of reducing the intake of endocrine disruptors and reducing the percentage of visceral fat that leads to hyperestrogenism is essential for the long-term management of this type of patient.
Dr. Marco Antonio Lopez Zepeda
Dr. Marco Antonio Lopez Zepeda, Endometriosis Specialist
City: Guadalajara, Jalisco, Mexico
Philosophy of Endometriosis Care: Retrograde Menstruation (Sampson Theory), Celomic Metaplasie (Iwanoff and Meyer Theory), Linfatic or Vascular Dissemination, and Embryonic Remains Theory.
What type of surgery do you perform for endometriosis?: Excision
Medication: Dianogest, GnRh Analogs, Anovulatories, Progestins
Approach to Persistent Pain After Surgery: Depends on the patient´s symptoms, desire for childbearing, and the results of the IDEA Protocol.
Dr. Sadikah Behbehani
Dr. Sadikah Behbehani, Endometriosis Specialist
City: Costa Mesa, California
Philosophy of Endometriosis Care: It doesn’t matter where it came from; what matters is that it’s removed. Endometriosis, like cancer, can spread via multiple channels. Also, pleuripotent stem cells in the pleura and peritoneum can lead to its development. Most endometriosis patients are born with these cells that differentiate into endometriosis with hormone stimulation. It’s nothing that women did that led to their development. We have to understand embryologic origin to understand endometriosis growth because endometriosis can be associated with congenital anomalies in the genitourinary and reproductive organs.
What type of surgery do you perform for endometriosis: I perform endometriosis excision surgery to remove the endo from its roots, but I also focus on preserving fertility. I remove endometriosis from around the fallopian tubes and ovaries routinely. My surgical strategies focus on minimizing damage to the ovaries to help preserve ovarian reserve and help with future fertility. I also perform tubal surgery when necessary. It’s important to appropriately excise the disease while minimizing damage to reproductive organs. I also excise endometriosis from the bowel, bladder, and diaphragm and perform an appendectomy when necessary.
Medication: I only recommend medication after surgery after we’ve ensured that all endometriosis has been appropriately excised. For bladder or muscular spasms, I prescribe cyclobenzaprine. For nerve pain, I prescribe gabapentin. I have a good referral team and, when necessary, will refer to pain management to take care of residual pain from endometriosis nerve, and muscle damage. I never prescribe narcotics, and I don’t send my patients to anyone who will.
Approach to Persistent Pain After Surgery: I work with them until their pain reaches a tolerable level. I refer them to specialists as needed (pain management, GI, PT), but I continue to oversee their treatment plan with visits q3-6 months.
Dr. Juan Carlos Canton Romero, PhD MD
Dr. Juan Carlos Canton Romero, PhD MD, Laparoscopic Surgeon, Endometriosis Specialist
City: Guadalajara, Jalisco, Mexico
Philosophy of Endometriosis Care: Mullerianosis
What type of surgery do you perform for endometriosis?:
Ovarian ablation in young patients to preserve hormonal function and uterine in those who wish to preserve fertility; ovarian resection in postmenopausal patients. Uterine resection is for those who do not wish to preserve fertility. In patients with early-stage cancer with a good prognosis of the ovary and cervix and a desire to preserve fertility, conservative surgery was performed.
Medication: Oral analgesics, antispasmodics, prostaglandin inhibitors AINES, continuous oral contraceptives with Dienogest (Qlaira), continuous dienogest, GnRH inhibitors for 3–6 months, and Levonorgestrel IUD.
Approach to Persistent Pain After Surgery: Physiotherapy, rehabilitation, exercise like yoga, continuous contraceptives, and/or dienogest.
Dr. Luis Fernando García
Dr. Luis Fernando García, M.D.
Dr Fernando Garcia – Endometriosis Specialist
Summary: Dr Fernando Garcia is a trusted endometriosis specialist based in San Pedro Garza García, Nuevo León. Known for his compassionate care and clinical expertise, Dr Fernando Garcia offers a comprehensive, patient-first approach to managing endometriosis. With a deep understanding of the condition’s multifactorial origins—including Sampson’s theory, coelomic metaplasia, and lymphatic dissemination—Dr Fernando Garcia combines medical and surgical options tailored to each patient’s unique needs.
He specializes in excision surgery and often recommends oral contraceptives, progestins, and nonsteroidal anti-inflammatory medications as part of a well-rounded treatment plan. For patients experiencing persistent symptoms after surgery, Dr Fernando Garcia collaborates with a multidisciplinary team, including pain management experts and pelvic floor physiotherapists, to provide lasting relief and improve quality of life. Patients benefit from his warm, personalized approach and commitment to evidence-based care at every stage of their journey.
City: Nuevo León, San Pedro Garza García NL
Philosophy: Multifactorial. Sampson´s theory, chelomic methaplasia, hematologic and linfatic disseminatio
What type of surgery do you perform for endometriosis? Excision
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. 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. Manuel Lopez
Dr. Manuel Antonio Lopez de la Torre, M.D.
Dr Manuel Lopez – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: If you’re looking for expert care in endometriosis, Dr Manuel Lopez is a trusted and compassionate specialist dedicated to helping women live healthier, more comfortable lives. Many patients first discover Dr. Manuel Lopez while searching for top gynecologists under names like Manuel Lopez MD San Antonio or Doctor Manuel Lopez, drawn by his excellent reputation. Though based in Guadalajara, Jalisco, Mexico, Dr. Manuel A Lopez MD San Antonio TX is well known to U.S. patients who travel for his expert care in minimally invasive gynecologic surgery.
Dr. Lopez takes a thoughtful, individualized approach to endometriosis, grounded in both medical science and empathy. He draws on a range of theories, including celomic metaplasia, retrograde menstruation, lymphatic and vascular dissemination, and embryonic origins, as well as genetic and immunological factors, to inform his care.
For treatment, Dr. Lopez typically begins with combined progestins, followed by pure progestins if needed, and rarely, GNRH analogues with add-back therapy. Pain is managed with COX inhibitors, NSAIDs, smooth muscle relaxants, and supportive treatments like multivitamins.
What truly sets Dr. Manuel Lopez apart is his conservative and holistic approach to surgery, which is only recommended for about 30% of patients. His multidisciplinary team includes experts in colorectal surgery, fertility, urology, physical therapy, psychology, nutrition, pain management, and sexology to ensure patients receive well-rounded care.
City: Guadalajara, Jalisco, Mexico
Philosophy:
Medication:
Approach to Persistent Pain After Surgery:
When needed, the treatment always starts BEFORE the surgery, and SURGERY is indicated only in approximately 30% of our total amount of patients. Generally, most of the indications for surgical procedures depend on adhesions, anatomical changes due to nodules or adhesions, deep infiltrating nodules affecting the organs functional tissue(Muscular layers), adenomyosis. We always perform an integral follow-up on patients. Our clinic is constituted by multiple specialties, and we derive before surgery to the affected areas to deep study. When the symptoms continue, depending on the area, they get treated by whoever is demanded (Colo- proctology, Fertility, Urology, Physical Therapy, Psychology/Psychiatry, Nutrition, Pain specialist, Sexology).
Dr. Luky Satria
Dr. Luky Satria, M.D.
Jakarta Doctor, Dr Luky Satria – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Dr. Luky Satria is a highly respected Jakarta doctor specializing in endometriosis care and minimally invasive gynecologic surgery. Patients seeking expert, compassionate care often turn to Dr. Luky Satria for a personalized treatment plan that balances medication, surgery, and fertility considerations. His approach begins with hormonal therapy to manage endometriosis-related pain, reserving surgery for cases where medication is ineffective or when fertility outcomes can be improved.
Known for his thoughtful and evidence-based methods, Dr. Satria carefully evaluates each patient’s condition using imaging tools like ultrasound or MRI to guide the next steps. Postoperative care often includes continued hormonal treatment to reduce recurrence and support long-term well-being. As a trusted Jakarta doctor, Dr. Luky Satria is committed to delivering thorough, respectful care to every patient, tailoring his approach to meet their individual health and fertility goals.
City: Jakarta, DKI Jakarta, Indonesia
Philosophy: Probably multifactorial, coelomic metaplasia and retrograde menstruation combined with genetic-epigenetic factor
Medication: I use medication/ hormonal (progestin or LNG IUS) as the first-line treatment for endometriosis-associated pain, when the hormonal failed then complete excision surgery will be done. I also give hormonal treatment to patients waiting for surgery.
Hormonal treatment is also given to post-operative patients who don’t seek fertility to reduce recurrence risk.
Approach to Persistent Pain After Surgery: Systematic mapping with ultrasound (or MRI when needed) will be done to search for residual lesions (due to incomplete surgery) or de novo lesions. Surgery will be done when we find DIE lesions, but if it is ovarian lesions (endometrioma), I will suggest hormonal treatment or ART since repeat surgery of recurrent endometrioma will give a bad prognosis in ovarian function, especially in subfertility patients.
Dr. Anna Reinert
Dr Anna Reinert, M.D.
Dr Anna Reinert – Endometriosis Specialist, Gynecologist, Minimally Invasive Gynecologic Surgeon
Summary: Anna Reinert is a Los Angeles-based gynecologist and endometriosis specialist with advanced expertise in minimally invasive surgery. Patients seeking compassionate, individualized care often turn to Dr Anna Reinert for her thoughtful, science-driven approach to managing complex pelvic pain. Known for integrating surgery with long-term symptom support, Dr. Anna Reinert emphasizes hormonal suppression, lifestyle strategies, and collaboration with physical therapists and pain specialists to promote lasting relief.
Dr Reinert is deeply committed to understanding each patient’s unique presentation of endometriosis, tailoring treatment to include thorough preoperative evaluations, targeted surgical care, and ongoing pain management. She frequently uses non-opioid medications and custom therapies to support healing and improve quality of life. Patients consistently praise Dr. Anna Reinert for her warm, thorough care and for being a trusted partner through every stage of their endometriosis journey. Learn more by reading Dr. Anna Reinert reviews and discovering how she helps patients find real, sustainable relief.
City: Los Angeles, CA, USA
Philosophy: Endometriosis is such a varied disease. I think that the relative contributions of different pathogenic mechanisms vary between patients. For most patients, I find that the greatest burden of disease is present at initial surgery, with much less recurrence over time, which suggests an in situ disease theory. I have seen more aggressive forms of the disease where recurrence happens quickly and in areas where peritoneal resection was recently performed, suggestive of a retrograde menstruation mechanism. In patients seeking surgery who are done with childbearing, I recommend hysterectomy – but if a patient does not desire hysterectomy, I recommend bilateral salpingectomy to try to minimize the risk of retrograde menstruation. I also recommend hormonal menstrual suppression as part of symptom control in women desiring future fertility.
I am hopeful that over time, the inflammatory cytokine cascades involved in endometriosis pathogenesis will be elucidated, and that we will be able to treat women with a small molecule inhibitor medication, similar to what is being used to prevent ovarian cancer recurrence, as part of post-surgical medical management of endometriosis.
Medication: I frequently recommend the use of hormonal contraceptive medications to suppress menstruation in women not seeking immediate fertility (combined OCPs, Depo-Provera, Kyleena IUD placement), both pre-operatively and post-operatively. I do not routinely recommend GnRH agonists or antagonists but may consider these for refractory pain after surgery in specific patients, or for temporary symptom management if surgery needs to be delayed and symptoms have persisted despite the use of hormonal contraception and other non-hormonal pain medications. I also take a multimodal approach to pain management, including the use of oral and vaginal muscle relaxants, lidocaine patches, NSAIDs, and Tylenol.
Approach to Persistent Pain After Surgery: Prior to surgery, I perform a comprehensive pelvic pain evaluation to assess for overlapping conditions such as spastic pelvic floor syndrome, interstitial cystitis, irritable bowel syndrome, or vulvodynia, and I look for evidence of central sensitization. Patients identified as having pelvic floor spasms pre-operatively will be referred to pelvic PT as part of their management of chronic pelvic pain, so many patients are referred to work with pelvic PT post-operatively. I prescribe oral and vaginal muscle relaxants for the management of pelvic floor spasms and perform Botox trigger point injections into the pelvic floor muscles when applicable. I will treat interstitial cystitis or IBS with medications and elimination diets. I use topical compounded ointments for vulvodynia, including topical gabapentin and hormones.
In patients who have persistent symptoms after surgery that are not specifically related to muscle spasms, IC, or IBS, I will assess for central sensitization and consider the use of duloxetine or a tricyclic antidepressant. I may recommend the use of ketamine, either in the vaginal suppository that I prescribe or as an oral agent prescribed by one of the pain management specialists with whom I collaborate. In specific patients, I may consider the use of GnRH agonists or antagonists as part of post-op pain management.
In addition to physical therapists, I collaborate with occupational therapists who specialize in lifestyle redesign for chronic pain, pain management specialists who understand pelvic pain and offer a variety of interventional procedures, and pain psychologists – and will refer patients to this team of providers as part of managing persistent pain symptoms.
