Ask The Expert: Endometriosis Treatment & Management - Part 1
Do you have questions about treating or managing your endometriosis?
Are you satisfied with your current endometriosis treatment plan?
To learn more about the complexities of endometriosis, we spoke to Dr. Jeff Arrington, board-certified gynecologist with the The Center for Endometriosis Care (CEC) in Atlanta, Georgia. Dr. Arrington is a renowned expert in the field of endometriosis and minimally invasive gynecology, and specializes in the surgical excision of endometriosis. Dr. Arrington is also involved with endometriosis education and advocacy.
In this two-part series, hear from Dr. Arrington as he addresses the treatment and management of this complex condition:
What are patients' biggest misconceptions about endometriosis?
“The pain they feel with [endometriosis] is just normal... Especially when they're younger and they're having pain with their periods, even if it's significant enough to keep them out of school, that they assume they're normal... Either their sisters have painful periods, their moms and grandmas had painful periods... That's probably the main misconception- that pain that significant is just ‘part of the deal’.”
What are common misconceptions about treatment?
“I think most of the other misconceptions come from what they're told by providers... what their options are, what the roles of those treatment options are, how it's controlled or treated with hormone therapy.... Misconceptions about what the treatment options are actually supposed to do.”
What are common misconceptions about surgical treatment?
“Number one, surgery for endometriosis in the general OB/GYN community is thought to be, I think, too risky. It's very much looked at as a last priority or last option, so we should exhaust all the medical options before we ever consider surgery for endometriosis... Most doctors do not understand the difference between full excision and just superficial treatment that knowingly leaves the disease behind.
And that some areas of endometriosis are just "too risky to treat". When we look at endo over the bowel or ureters or bladder, they're flat out just told that they got everything they could, but those other areas are too risky to treat, and then there really are no other options other than trying to treat it with hormone therapy.”
When should a patient consider switching endometriosis specialists? What are the biggest red flags?
“A good doctor should present all options that are on the table. Clearly, there are some that we will feel are more appropriate (based on the patient's needs and wants and disease presentation), but I still feel that all options should be presented to the patient. So, if a patient goes in for a painful period for suspected endometriosis, and they're only told that, “your option is birth control pills”, or “your option is Lupron” or “an IUD, that's your only option”, that should be to me, the first red flag.
Something that we see often in endometriosis patients is what we call "pill shopping" or "hormone shopping" by the doctor... if one birth control pill doesn't work, well, let's just switch you to another one and see what happens or then switch you to a progesterone pill and see what happens. Well, that's not working so let's go to Lupron and see what happens... Most of [these medications] have been tested head-to-head, and none of them is any better than the other... That's where we see that 8-10 year delays in diagnosis, mostly because of hormone and pill shopping, and doctors being very hesitant to move towards surgery to diagnose and actually treat the disease.”
What % of endo warriors from our In America survey have both migraines and endo?