Ask The Expert: Endometriosis Treatment & Management - Part 2

Read Part 1 here.

Have you tried multiple endometriosis treatments, but are still in pain?
Are you looking for new treatment options, or considering surgery?

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 do you recommend if a patient has tried multiple treatments with little relief? How do you help patients with treatment fatigue?

“I think it really just takes an in-depth review of not only their test history on what they've tried, but also how the disease has impacted them over the course of their lifetime... Every patient's gonna have to be individual because everyone will have had different treatments.

If there's someone who has only had multiple rounds of hormone therapy, then clearly another step would be potential for surgery with the idea that we can diagnose, and then hopefully treat, in a way that's gonna improve their pain. So, at least making sure that they have been presented all options and focusing solely on endometriosis as a cause of their pain and symptoms, making sure that they are aware of all the options that are there.”

What if a patient has had multiple surgeries?

“Now, some patients will have had prior surgeries. We see that all the time in patients who have had two, three, sometimes even up into the teens of prior surgery...just making sure that a good exam is done and if there's concern for disease... that they're aware that there could be another surgical option open, but help them understand that this is a completely different approach to how it's been looked at in the past.

We do have patients who have had years and years of pain and have had prior excision surgery, and they're just exhausted regarding different hormone therapies and surgical treatments and they're really not interested. We have to look at other modalities to help them at either controlling pain or helping them to cope with pain. And we see a lot of new evidence in good quality pain clinics where patients are taught coping mechanisms. We can use neuromodulating medications to help control the neuropathic or nerve related pain, psychotherapeutic treatment options, just more coping mechanisms to allow patients to be more functional.”

What are some other ways to control symptoms and pain?

“There are some patients who achieve benefit with diet, with acupuncture, with psychotherapeutic approaches to pain, neuromodulators, even some newer nerve type work in the aspects of pelvic pain (making sure the nerves are cleaned up and function appropriately). It probably comes down to more just making sure that we've reviewed everything that they've tried, everything that's been done, and then helping them know what other realms we need to start looking at, whether it's continued focus on endometriosis, or we have to change our thought process and look at what other aspects could be contributing to their pain.”

What complementary and alternative treatments do you recommend?

“Clearly, we don't know everything related to endometriosis, or for that matter, to pain. And when we look at diet, we look at acupuncture, we look at massage therapy, we look at chiropractic... there are some patients that benefit from those and some patients that don't. I don't feel there's any harm in trying some of those. For a patient, if it works, even though I may not be able to explain it, by all means, go after and use what helps you.”

How can we get more young doctors interested in endometriosis?

“First of all, you have to convince them, or help them realize, that there's an interest even in OB/GYN in general... It's just appropriate exposure to treatment of the disease to understanding it, being taught appropriately, being shown that there are more advanced ways of treating that disease as opposed to just a diagnostic laparoscopy.

Certainly, us docs in the community that do a lot of excision that primarily focus on endometriosis, getting out and teaching and showing. I'm not just saying that my outcomes are better than yours, but showing them the appearance of lesions, doing grand rounds, or having docs come in and watch or assisting them on cases.”

Click here to learn more about Dr. Arrington and The Center for Endometriosis Care.

This article is for educational purposes only and is not sponsored in any way. For questions, please email contact@endometriosis.net.