© 2015 by the Center for Endometriosis Care/Ken Sinervo MD, MSc, FRCSC. All rights reserved. No reproduction permitted without written permission. Revised since original publication and current as of 2023. No external funding was utilized in the creation of this material. The Center for Endometriosis Care neither endorses nor has affiliation with any resources cited herein. The following material is for informational purposes only and does not constitute medical advice.

We often hear “what should I ask my doctor about my endometriosis care?” Although not an exhaustive list, following are a few common questions you may want to bring to a new physician appointment and/or to your appointment discussing a pending surgery (we’ve included our own answers for reference, as well):

  • How much of your practice is dedicated to the care of endometriosis and pelvic pain patients? How much to general gyn and obstetrics? (our practice has been 100% to endometriosis and related gynepathologies since we were founded in 1991; 0% to OB)

  • Where, with whom and for how long did you undergo FMIGS training? How much of it was dedicated specifically to endometriosis surgery, and was multidisciplinary excision the method of lesion removal used throughout your Fellowship? (Our surgeons have all undergone lengthy, dedicated excisional and advanced gynecologic surgery Fellowships as outlined in their respective CVs; you can read more about excision here)

  • Do you run a training program for Fellows to learn more about endometriosis treatment and excision surgery? (Yes)

  • Do you present to peer and/or lay audiences on endometriosis and best practices? (Yes, and yes)

  • How long have you been in practice, and how much of that time has been dedicated to the best treatment of endometriosis? (More than 3 decades; we were among the very first centers of expertise founded in the United States solely for the dedicated treatment of endometriosis using an integrative, excisional approach)

  • Do you have any industry ties? (No)

  • How many cases of endometriosis do you treat annually? Medically? Surgically? Both? What are the pros and cons of each option? (We operate on nearly 500 cases of endometriosis annually in patients from every corner of the globe; we do not use GnRH analogs with very rare exception due to lack of efficacy, costs to the patient and high side effect profiles; we do use Mirena or oral contraceptives post-operatively in some patients depending on the very specific nature of their case – AFTER all endo is excised)

  • Are you Board Certified? (Yes, all of our surgeons are Board Certified)

  • Do you use pre- or post-operative medical suppression? Which one(s)? Why? For how long? What are the pros and cons of the suppressive approach? (Generally, we do not suppress pre- or post-operatively with the exceptions, and for the reasons, outlined above)

  • What kind of complex cases do you see? Thoracic, diaphragmatic, sciatic, etc.? How do you treat them? (We treat among the highest rates of thoracic endometriosis of any center annually, and routinely treat sciatic and other extrapelvic/complex cases through our multidisciplinary, integrative care approach)

  • Do you exclusively perform excision to cut out all endometriosis, or do you superficially ablate/cauterize, etc.? (We use near-contact excision to dissect all lesions from all areas; Dr Albee coined the term “LAPEX” - laparoscopic excision - in 1991)

  • What are your outcomes? How many of your patients require additional surgery with you or someone else, and what was found on pathology during such reoperative events? What are the actual endometriosis recurrence/persistence rates in your patient population on average? (Better than 85% of our patients [nearly 8,000 to date from over 60 countries] have successful, long-term outcomes both in terms of symptom relief/reduction and fertility; of those who underwent reoperation, adhesions, adenomyosis and secondary non-endometriosis pain generators have been the most common findings, with actual endometriosis found less than 10% of the time as confirmed by our own operative pathology or that provided to us by patients who undergo another surgery elsewhere)

  • Do you engage a multidisciplinary team in your OR to remove all the disease during one surgical encounter? Uro, colorectal, cardiothoracic, etc.? (Yes, we have a full OR team consisting of dedicated specialists from all disciplines)

  • Will you be performing my surgery yourself, or will your Fellow/Student? (Our surgeons perform all cases themselves; in the event a Fellow is present, they may assist under direct supervision depending on the case; patients are advised in advance of this possibility so that they can consent or decline)

  • Are you fully prepared to excise/resect all disease, no matter where it is located? (Yes, generally)

  • Is all tissue that is removed during surgery sent to pathology, so I know what was found? (Of course, yes)

  • Is my surgery intended to be organ-sparing, or will hysterectomy/oophorectomy/salpingectomy/appendectomy/etc. be performed and if so, why? (The goal is always to be organ-sparing while removing all disease and a hysterectomy is not a cure for endometriosis; however, in cases where hysterectomy may be indicated e.g. for adenomyosis and the patient has discussed the pros and cons of each aspect of their procedures, it will be performed on a minimally invasive basis during the same encounter while also excising all disease; oophorectomy/salpingectomy is of course based on the patient; appendectomy may be performed if endometriosis is suspected or it is otherwise abnormal in appearance- all procedures are discussed with the surgeon while planning the patient’s procedures)

  • Do you lyse adhesions and restore normal anatomy during surgery? (Yes, and yes)

  • Do you remove as much of the gas as possible before the end of surgery to lessen referred shoulder pain common with Laparoscopy? (Yes)

  • Do you use an adhesion barrier and/or PRP intraoperatively? (Yes and yes; we were among the first to adapt PRP use to gynecologic indications)

  • How long will I be in the hospital? (Depending on the nature of the case, -23-72+ hours generally; patients are advised in advance as to their specific expectations)

  • How can I best prepare for my surgery? Is there a nutritional approach? Should I be off – or take – any medications or supplements and if so, when should I start/stop them? (Our patients are advised on a case by case basis how to best prepare for their upcoming surgery, including meds we restrict)

  • Do you require preop bowel prep? (Yes, and it can be obtained from our office for patient convenience, for a nominal fee at preop)

  • Will your office provide assistance with completion of FMLA and/or other supporting paperwork? (Of course, for a nominal fee)

  • What tests do I need in advance of my surgery, and why (labwork, imaging, etc.)? (Each patient is advised of any additional testing or imaging we might need to help with presurgical planning; for those out of state, tests can often be done locally for the patient prior to their arrival in Atlanta)

  • Will a pelvic exam be done at my preop or in the OR prior to surgery? (This will be discussed and decided with each patient on a case-specific, consented basis)

  • What postop adjuncts will be recommended? Pelvic floor therapy, diet/nutrition, etc.? (Depending on the case, PT is often recommended as are certain nutritional approaches and more to support and enhance the ‘big picture’ approach to effectively treating the disease and any related gynepathologies)

  • What if I have complications during or after surgery? What is the expected follow-up plan? (Our surgeons and entire team stay involved in our patient’s care long after their case has been completed and they have left the hospital)

  • What is your postsurgical pain management protocol? What pain medications are used for post-op recovery and for how long? Do you work with or refer to pain management professionals if needed? (Depending on the nature of the case, we do limit our narcotic prescribing in accordance with our pain management protocol, which patients are advised of prior to surgery; we can also connect patients to pain management - and other - professionals as necessary through our collaborative network)

  • Do you provide a binder after surgery? (Yes; it can be a lifesaver during recovery!)

  • How long should I reasonably expect to be out of school/off work/on limited activity? When can I drive, shower/take a bath/have sex? (Each case is unique and this may range from 2-6 weeks; each patient will be advised individually)

  • Will I get a full set of my records from surgery, including op/path and photos? (Of course, we provide full sets, in fact, we provide the patient with 2 – one for them and one for their local doctor)

  • If I have issues post-operatively, who can I call? (Our patients are advised on how to get in touch with our team 24/7 as needed)

  • Do you have information on your website that I can refer to and review with my caregiver team when considering my treatments? (Yes, of course - check out our FAQ and all the other pages of our site)

  • Will I be treated as a partner in my own care, with the autonomy to make my own decisions about all treatments presented to me, after fully informed consent? (Absolutely!)