QC: Hormone Suppression After Excision? Does Endo Spread If an Endometrioma "Pops"? Artwork

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

April 08, 2025 • Alanna • Episode 126

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Dr. Abhishek Mangeshikar, leading endometriosis specialist from the Indian Center for Endometriosis, shares expert insights on post-excision medical management and endometrioma concerns. His straightforward explanations debunk common myths while providing practical guidance for patients navigating surgical recovery and ongoing treatment options.

• Medical management after excision may be appropriate for patients with adenomyosis who wish to keep their uterus
• Progesterone-containing IUDs like Mirena can help suppress adenomyosis symptoms
• Temporary hormonal suppression (3-4 months) may protect healing ovaries after large cyst removal
• Endometrioma rupture during surgery does not cause disease spread or "upstaging" as with cancer
• Virtually all endometrioma excisions involve some rupture as part of the surgical process
• Successful surgery requires complete ovary mobilization and removal of all underlying disease

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Speaker 1: 0:00

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. 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?

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. 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.