QC: Hormone Suppression After Excision? Does Endo Spread If an Endometrioma “Pops”?

Introduction to Quick Connect

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0:00

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Meet Dr. Abhishek Mangeshkar

Speaker 1
0:37

connect
.

Today

we're

honored

to

have

Dr

Abhishek

Mangeshkar

join

us
.

Dr

Mings

is

a

leading

endometriosis

specialist

and

minimally

invasive

gynecological

surgeon

known

for

his

groundbreaking

work

at

Indian

Center

for

Endometriosis

in

Mumbai
.

With

expertise

in

advanced

laparoscopic

and

robotic

surgeries
,

he's

dedicated

to

improving

care

for

those

battling

this

complex

disease
.

Let's

dive

in

and

get

answers

to

the

questions

that

matter

most

to

you

Medical Management After Excision Surgery

Speaker 1
1:07

.

Would

there

be

a

reason

for

medical

management

after

excision

surgery
?

Speaker 2
1:11

There

is

a

mild

role

of

it

in

some

cases
.

So

I'll

tell

you

what

I

personally

use

it

for

is

in

case

I

have

treated

the

endometriosis

and

the

patient

has

an

accompanying

adenomyosis

and

wishes

to

retain

their

uterus
.

So

in

those

cases

they

may

opt

to

have

the

Mirena

IUD
,

which

is

a

progesterone

containing

IUD
,

to

hopefully

suppress

some

of

the

adenomyosis-related

symptoms
.

Again
,

none

of

this

is

mandatory
,

so

I

discuss

these

options

with

the

patient

and

the

potential

adverse

reactions

and

what

it

looks

like

for

them
.

In

some

cases

if

I

remove

large

cysts

from

the

ovary
,

so

while

the

ovary

is

recuperating

from

the

surgery
,

we

don't

want

ovulation

to

happen

for

a

couple

of

months
.

So

then

we

put

them

on

hormonal

suppression

for

maybe

three

to

four

months

post-surgery

just

to

allow

the

ovaries

some

time
,

you

know
,

to

prevent

formation

of

hemorrhagic

cysts

if

the

ovulation

happens

into

the

dead

space

while

the

ovary

is

returning

back

to

normal

size
.

Speaker 1
2:17

If

you

have

an

endometrioma
,

if

you're

having

excision

on

the

endometrioma
,

if

the

blood

spreads

say

they

pop

the

cyst
,

does

that

create

more

of

a

chance

for

adhesions

and

more

endometriosis

to

spread
,

like

the

cells

to

spread
?

Endometrioma Rupture Concerns Addressed

Speaker 2
2:33

That's

not

how

it

works

necessarily
,

because

you

obviously
,

when

you

pop

the

cyst
,

you

do

suck

out

and

wash

out

all

the

chocolate

fluid

that

comes

out

of

it
.

So

that's

not

how

the

disease

spreads
.

It's

not

spread

by

upstaging
,

so

to

say
.

So
,

if

you

have

an

ovarian

tumor

which

is

cancerous
,

of

course
,

if

you

pop

the

cyst

during

the

surgery
,

you

are

upstaging

it

and

that

has

also

changed
.

So

in

ovarian

cancer
,

what

was

initially

thought

if

you

popped

it

during

surgery
,

it

went

from

stage

one

to

stage

three
.

Now

it's

just

changed

from

1A

to

1C

or

1C3
,

if

you

pop

it

intraoperatively
.

So

it's

still

not

a

massive

upstage

in

terms

of

bleeding
,

but

I

digress

a

little

bit
.

So
,

coming

back

to

endometriosis
,

it's

not

not

a

massive

upstage

in

terms

of

bleeding
,

but

I

digress

a

little

bit
.

Speaker 2
3:25

So
,

coming

back

to

endometriosis
,

it's

not

a

cardinal

sin
.

Of

course
,

when

you

are

releasing

the

endometrioma

from

where

it's

attached

to

the

pelvic

sidewall
,

there

is

an

invariable

rupture
.

I

don't

think

I've

ever

seen

an

endometrioma

being

excised

without

rupture
.

So

it's

almost

mandatory

as

part

of

the

surgery
.

So

that's

not

how

the

disease

is

spread
,

so

we

have

no

worries

about

that
.

What's

important

is

to

be

able

to

not

just

remove

the

cyst
,

but

you

have

to

mobilize

the

ovary

completely

from

where

it's

stuck

and

take

out

the

disease

underneath

where

it

was

stuck

to
,

which

is

the

peritoneal

disease

and

obviously

all

the

other

deep

endometriosis

lesions

that

are

accompanying

that
.

Speaker 1
4:09

That's

a

wrap

for

this

Quick

Connect

Conclusion and Contact Information

Speaker 1
4:11

.

I

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