We spoke with two specialists from The Center for Innovative GYN Care — Rupen Baxi, M.D., and Natalya Danilyants, M.D. — about the most important things women should keep in mind when speaking to their doctor about endometriosis.

Why is endometriosis so hard to treat?

Rupen Baxi: Every woman who suffers from endometriosis experiences symptoms differently. There may be similarities, but how the disease presents can be perplexing. Mild cases can cause intense pain if the lesions are sitting on or near nerve endings, while more severe cases may pass unnoticed by the patient.

The inverse is also true. This lack of consistency creates barriers for many physicians to effectively treat endometriosis and, to date, there is no cure. Many cases are discovered because a woman has struggled with trying to conceive or carry a child to term.

Proper diagnosis can only be achieved through a laparoscopic procedure, and once identified, ensuring correct removal of the disease and corresponding trauma to the surrounding organs is essential. Thorough removal of endometriotic lesions, endometriomas (ovarian cysts caused by endometriosis), and scar tissue that often forms from years of inflammation due to the disease, require extensive skill and experience to minimize the risk of relapse or of the condition worsening. In minimally invasive endometriosis excision, specialists in endometriosis can ensure the patient has the best chance for recovery.

What do women with endometriosis need to know about choosing a specialist?

Natalya Danilyants: Women should educate themselves on what having a minimally invasive procedure entails. It is not simply a keyhole version of an open surgery. There are few physicians in the world who are true specialists in laparoscopy, and have also mastered the additional techniques required to ensure a safe procedure. The skills of a minimally invasive surgeon should be examined by the patient extensively.

How can minimally invasive surgery help with a woman’s recovery?

ND: Just as important as choosing the right specialist is choosing the right procedure. Not all minimally invasive procedures are created equal. Knowing the difference between a standard laparoscopic surgery, a robotic surgery and a DualPortGYN surgery, including the amount of time the procedure requires, the number of incisions, average recovery times, and overall safety are all important for patients to understand before committing to any GYN procedure. All options for the procedure should be made available for the patient to make an educated decision.

What questions should patients come prepared with to ask their physician on the day of surgery?

RB: Never be afraid to ask your surgeon questions. This is your health, and while the surgeon is an expert, you need to decide if he or she is the right expert for you. The most important questions a woman can ask her surgeon are:

  • How will the surgery be performed? Some procedures take weeks to recover, while others take just days. It is the skill of the surgeon and not the extent of the patient’s condition that determines which procedure will be performed, which is why it’s important to choose the right specialist.
  • If a hysterectomy is recommended, ask about more conservative options including excision? Hysterectomy may be appropriate for treating adenomyosis, a form of endometriosis that affects the walls of the uterus. However, hysterectomy will not cure endometriosis. Removal of the ovaries may help with symptoms, but is not a blanket treatment for endometriosis. Each patient must be evaluated, and future plans for fertility discussed with a specialist.
  • If excision is offered, how many surgeries of this kind has he or she performed? Experience and training of a surgeon is essential to a patient’s overall recovery. The physician should be devoted to GYN surgery and specialize in minimally invasive endometriosis excision (removal of endometriosis lesions), pelvic adhesion removal, as well as bowel and ureter repair. Endometriosis can cause “frozen pelvis,” where the delicate structures in the pelvic cavity are stuck together. Depending on the severity of the condition, a surgeon may need to do extensive repairs on the surrounding organs.