Dr. Devin D. Namaky, MD

What does it mean to be “cured”?

A “cure” generally refers to a treatment that eliminates a disease (endometriosis) or condition (pelvic pain). It implies eradication of the disease from the body and complete or lasting recovery or relief.

For many endometriosis patients, a cure is possible. By completely cutting out endometriosis, many patients experience long-term or permanent pain relief without recurrence. Not all patients will achieve this result, but many do.

What is endometriosis?

Endometriosis is an abnormal tissue that can cause pain. It can be found anywhere in the body, but is usually found within the pelvis. A leading theory supported by clinical observation is that endometriosis originates during embryologic development, meaning patients are generally born with their endometriosis predetermined at birth.

Endometriosis myths

There are many persistent myths about endometriosis:

Endometriosis grow back.

Endometriosis spreads.

Endometriosis comes from the uterus.

Hysterectomy is a cure for endometriosis.

Hysterectomy is required to cure endometriosis.

Removal of the ovaries cures endometriosis.

Removal of the ovaries is required to cure endometriosis.

Endometriosis needs to be periodically and repeatedly removed or treated.

The same endometriosis surgery is needed more than once.

Endometriosis cannot be cured.

The myth that is perhaps the most damaging to patients is that “endometriosis cannot be cured.” This belief can be deeply harmful, leaving many women without hope or leading them to believe that they’ll need repeated surgeries over the course of their life. Many patients who come to see me are surprised to learn that in many cases endometriosis can be cured.

THE LIMITATIONS OF THE ORIGIN THEORY: REFLUX MENSTRUATION

In the early 20th century, John Sampson proposed that endometriosis comes from the uterus. He postulated that when a woman has a period, the period flows backward, through the fallopian tubes into the pelvis, and then implants and grows as endometriosis.

In the early 20th century, John Sampson proposed that endometriosis originates from menstrual blood flowing backward through the fallopian tubes into the pelvis, where it implants and grows.

This is called Sampson’s theory of reflux (or retrograde) menstruation.

Sampson’s theory has been debunked for a long time. There are many reasons that his theory is categorically untrue. Nevertheless, the medical community, physicians, and the majority of gynecologists, still reinforce and perpetuate this myth.

While historically influential, this theory does not adequately explain many observed features of endometriosis. Endometriosis is physically not the same as the endometrium (lining) of the uterus. Endometriosis has differences in enzyme activity, hormone receptors, hormone responsiveness, microscopic appearance, visual appearance, and genetic differences when compared to the lining of the uterus.

Sampson’s theory cannot explain several other observations about endometriosis. Endometriosis can live in remote parts of the body, such as the lungs. Men get endometriosis. Women still have endometriosis after hysterectomy. Stage of endometriosis generally does not increase with age. And once endometriosis is physically removed it generally does not come back in that area. These observations suggest the cause of endometriosis to be embryologic in origin, and not from reflux menstruation.

“… the continuing lack of what should be easily obtainable evidence is taken as an indication that the theory of reflux menstruation as the origin of endometriosis is wrong.”
Dr. David Redwine, MD

The truth: A Clinical Perspective

Based on my extensive clinical experience, the following principles guide my approach:

Endometriosis can be cured.

You are born with all of your endometriosis predetermined.

When endometriosis is physically cut out completely it does not recur.

Endometriosis does not “spread.”

Many patients have their endometriosis cured with just one surgery.

Treatments that attempt to “burn” endometriosis often provide incomplete treatment and are inferior to excision, which is where endometriosis is actually cut out of the body.

You generally should not need repeated identical surgeries. A surgeon offering the same surgery that they already performed for you before would be a reason to seek a second opinion.

What’s happening to patients?

Many patients are getting unnecessary and inadequate medical treatments, delaying both the diagnosis of, and the potential cure of, their endometriosis.

Many patients have the same surgery over and over unnecessarily.

Many patients have the disease burned, but falsely believe it was cut out.

Many patients have surgery that provided no treatment for their endometriosis.

Some patients have undergone multiple surgeries for endometriosis despite not having endometriosis, and never even had it in the first place.

Pelvic pain is too often ignored

Patients often tell me they feel like they might be “crazy.” Or worse, someone has made them feel, or even told them, that they’re “crazy.” The truth is that I do find endometriosis in the vast majority of patients with pelvic pain who come to see me for evaluation. After treating hundreds of patients per year for several years, I can confidently say that patients with pelvic pain are not crazy.

The “diagnostic laparoscopy” should go the way of the dinosaur

Endometriosis can have many appearances. It’s often not seen by the surgeon, especially the inexperienced surgeon. If anyone offers you a diagnostic surgery that does not include cutting out the disease, you should get a second opinion.

Endometriosis treatment with a laser is often inadequate for removal of the disease and in some cases constitutes essentially a “sham” treatment.

Endometriosis also can have a nonspecific appearance. Scar tissue and adhesions can be confused with endometriosis. Some patients who’ve had multiple surgeries for endometriosis don’t actually have it at all, and never did.

At laparoscopy, the pelvic lining may appear normal even when endometriosis is present. Generally, if a biopsy is taken of the normal appearing lining, the pathologist may find endometriosis in the specimen approximately 30% of the time. While more experienced surgeons may be more likely to see subtle changes from endometriosis, biopsy of, or even excision of, the lining is necessary and prudent in most cases, since visual inspection alone is not always reliable.

A laparoscopy that is purely diagnostic without removing any tissue may delay diagnosis and effective treatment.

My experience

By operating on hundreds of endometriosis patients per year I see the true character and nature of this disease. My clinical experiences are consistent with the theory of Embryonically Patterned Metaplasia (EPM) and mulleriosis. The theory of EPM / mulleriosis essentially describes the origin of endometriosis as arising during fetal development before birth. The physicians performing hundreds of excision cases per year often report similar observations.

Are You Dealing with Pain or Anxiety from Endometriosis?

If you are suffering from pelvic pain or endometriosis and your physician offers you laser ablation, diagnostic laparoscopy, hysterectomy alone, ovarian removal, or the same surgery repeatedly, then I encourage you to seek a second opinion.

I am an endometriosis surgeon—a specialist who offers comprehensive treatment options for endometriosis and pelvic pain, including laparoscopic excision surgery.