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Dr. Abhishek Mangeshkar breaks down why hormonal suppression only manages symptoms, while surgery removes endometriosis. He highlights key differences between these approaches and the serious long-term risks of hormonal treatments, including bone loss, heart disease, GI issues, mood disorders, and potential permanent ovarian damage.
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Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question, send it in and let's quickly get you the answers. I'm your host, alana, and it's time to 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.
Speaker 2:
1:07
If someone has very superficial disease, or what they call a little bit of endo. Is there a benefit over doing suppression, over surgery?
Speaker 3:
1:14
So we need to clarify that suppression is symptom management, whereas surgery is actual excision or removal of the disease. So they're two different approaches. Symptom management is by stopping the hormones which you give either plain old birth control, which is the combined pill, or you give a progestin, which is a synthetic progesterone to suppress estrogen, or you give the GNIH analogs, which act on the brain level, which then act on the ovary. So either of which one of those drugs comes with their own side effects, and we need to clarify that. It's not a treatment of the disease, it's more of a treatment of the symptoms.
Speaker 3:
1:58
Furthermore, when we talk about superficial disease or peritoneal disease or stuff that's not picked up on imaging, there is no direct correlation between stage of the disease versus how much pain someone might feel. So someone with stage one or stage two endometriosis can have far worse symptoms than someone with, you know, frozen pelvis and stage four with a big rectal nodule. So I don't know if suppression is really the right answer. It is a way to buy time if someone needs symptom management until they can get into surgery, depending on each country's constraints or waiting times or whatever those systems are, or if the availability to get to a specialist is limited for that particular patient, then suppression might help in that interim period.
Speaker 2:
2:49
In your opinion, there's no reason why you would choose suppression over surgery. Long-term use.
Speaker 3:
2:55
No, not long-term use. It's not a substitute for surgery and I've also seen it being used as a diagnostic test by some general gynecologists, which is a terrible way to do it, because they use it and they say, okay, if you respond to suppression means it's probably endometriosis, but there's no data to support that and, yeah, it has no great long-term use in treatment of the disease.
Speaker 2:
3:20
What are some of the long-term side effects of using hormonal suppression?
Speaker 3:
3:26
Hormonal suppression either creates a state of chemical pregnancy or chemical menopause, depending on which hormones you use. So the long-term effects of suppressing estrogen are going to be bone loss, which is the primary one, which is not going to trouble someone when they're young, in the 20s, 30s or 40s, but when they get into the fifth, sixth and seventh decade of their lives, that's when the osteopenia and subsequent osteoporosis is going to kick in and those problems will exacerbate as they get older. Also, estrogen is cardioprotective, so it is good for your heart and taking that away also increases the risk of cardiac disease earlier than one would normally expect it. So those are the two biggest side effects, not to mention the GI side effects that come in. So gastrointestinal disturbances, a lot of anxiety, depressive disorders come in with progestins. We know that the studies on lucron that were suppressed and david redwine had spoken widely about was long-term damage to the ovaries, which estrogen levels never return back to their original values, and loss of libido, vaginal dryness, all those other adverse reactions that come in with some of these medications.
Speaker 1:
4:50
That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.