Diagnosis & Therapy

The first-time patient: a surgical approach or medical management?

The first-time patient: a surgical approach or medical management?

Arnold P. Advincula, MD, with Hye-Chun Hur, MD, and Douglas Brown, MD

Endometriosis is a condition associated with the presence of estrogen-sensitive endometrial-like glands and stroma outside of the uterus. The inflammatory response and resultant scarring lead to the many symptoms seen in women.1 Women with endometriosis often experience progressively worsening menstrual pain, dyspareunia and infertility. Other complaints include bowel and bladder symptoms, abnormal uterine bleeding, fatigue, tiredness, bloating, and sleep disturbances due to pain.2 Although laparoscopy provides definitive endometriosis diagnosis, medical management often precedes surgical treatment with a presumptive diagnosis.Are there any points, however, in the evaluation of a first-time patient in which it is appropriate to start right away with a surgical approach vs medical management? I asked this question of experts Hye-Chun Hur, MD, Director, Minimally Invasive Gynecologic Surgery Beth Israel Deaconess Medical Center, and Douglas Brown, MD, Chief, Minimally Invasive Gynecologic Surgery and Director, Center for Minimally Invasive Gynecologic Surgery in the Department of Obstetrics & Gynecology at Massachusetts General Hospital. Here is what they said:


  1. Falcone T, Lebovic DI. Clinical management of endometriosis. Obstet Gynecol. 2011;118(3):691-705.
  2. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: a qualitative study. BMC Womens Health. 2014;14:123.


Dr. Advincula is Vice Chair and Levine Family Professor of Women’s Health, Department of Obstetrics and Gynecology, Columbia University Medical Center; Chief of Gynecology, Sloane Hospital for Women, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York. He serves on the OBG Management Board of Editors.

Dr. Advincula reports that he serves as a consultant to ConMed, CooperSurgical, Intuitive Surgical, and Titan Medical, and receives royalties from CooperSurgical.