I first discovered that I have endometriosis in 2019 when my NaProTechnology doctor performed the laparoscopic surgery necessary to definitively diagnose it. Because she was also trained in endometriosis excision, she was able to remove the endometriosis in the same surgery. At the time, I thought all gynecologists were similarly trained to remove endometriosis, and I was fortunate that my doctor was so well-trained. But, as I have since found out, not everyone is as lucky. Not all gynecologists are equally well-trained to spot and effectively remove endometrial lesions, and if you’re considering endometriosis surgery, you’ll first need to do your due diligence in finding a good doctor. If you’re currently searching for a good endometriosis surgeon and wondering where to begin, this guide is for you.
Endometriosis surgery: Excision vs ablation
Endometriosis is an illness in which tissue similar to the endometrium (the lining of the uterus) grows in places where it shouldn’t, such as on the ovaries or the fallopian tubes—even on the rectum. In the same way as the endometrium, this tissue breaks down and bleeds during menstruation (your period), but it can’t leave your body, so it stays where it is, eventually turning into scar tissue, adhesions, and bands of tissue. This tissue causes inflammation, with symptoms such as mild to severe pain, and infertility, among other issues.
For many doctors, the standard treatment for endometriosis is the birth control pill, but the pill is a band-aid at best, treating the symptoms without solving the problem. More effective treatments include physical therapy, diet changes, and exercise, but the only way to eliminate endometriosis is through surgery (and even then, it can return).
There are two types of endometriosis surgery: excision and ablation. Both are laparoscopic, meaning the surgeon makes tiny holes in the patient’s skin and can enter through those holes to perform the surgery, rather than needing to make large incisions. Ablation uses heat to destroy tissue, while excision uses heat to actually remove it. Ablation can only remove tissue on the surface, while excision can dig deeper to remove all of it. A 2017 meta-analysis found that excision is a more effective technique—better at reducing dysmenorrhea (period pain), dyschezia (constipation), and chronic pelvic pain—so it’s a good idea to look for a surgeon who does excision rather than ablation.
Assessing your endo surgeon’s qualifications
Of course, as Mary Bruno, FCP, co-founder and executive director of FAbM Base, points out, “not all women’s health surgeons are capable of providing the same surgical care.” She recommends looking for an Advanced FertilityCare Medical and Surgical Consultant (AFCMSC) who completed his or her NaProTechnology and surgical fellowship at the St. Paul VI Institute (search this list for a physician with “AFCMSC” next to his or her name) or searching the directory at Nancy’s Nook, an online endometriosis resource.
NaProTechnology is an approach to gynecological medical and surgical treatments that cooperates with and restores a woman’s reproductive system rather than attempting to shut it down. It’s used in conjunction with the Creighton method of fertility awareness and works to “correct the condition, maintain the human ecology, and sustain the procreative potential,” according to the NaProTechnoloy website. One of its most revolutionary applications is in endometriosis diagnosis and excision.
According to a blog post by Bruno, most OB/GYNs do not receive extensive training in treating endometriosis with surgery; rather, they turn to the birth control pill to manage symptoms. Unfortunately, the pill only alleviates symptoms with varying degrees of effectiveness, but does not eliminate endometrial lesions or even keep them from growing. This lack of adequate training in standard OB/GYN programs makes it critical to look for a surgeon with the right training in endometriosis. The fellowship at the St. Paul VI Institute is one avenue for physicians to receive this level of education.
Another, according to Nancy’s Nook, is a two-year fellowship in minimally invasive gynecologic surgery (MIGS for FMIGS). Nancy’s Nook, created by a registered nurse with personal and professional experience with endometriosis, also recommends asking any surgeon you’re considering about his or her experience, team members, thoughts on excision versus ablation, and use of hormonal suppression drugs (or lack thereof).
The importance of self-advocacy
Finally, it’s important to remember that you are your own best advocate. If a doctor dismisses any of your symptoms, tries to push a treatment on you that you don’t want, or otherwise disrespects you and your health, find someone else. It’s difficult to find a well-trained endometriosis surgeon, but the good ones are worth looking for. In fact, they’re even worth traveling for. I went out of town for my surgery, staying at a nearby hotel the night before and night after my surgery. As strange as it may sound to most (healthy) people to travel for a medical procedure, I would do it again in a heartbeat.
