QC: Suppression vs Surgery And The Long-term Impacts

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Speaker 1
0:00

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I'm

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alana
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to

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
.

Suppression vs. Surgery Explained

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
?

Long-Term Side Effects of 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

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Episode Wrap-Up & Contact Information

Speaker 1
5:14

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