Category "Treatment"


Yesterday in the New York Times endometriosis patient Sindha Agha (not my patient) wrote a thought-provoking op-ed about her adventures in pharmaceutical hormone treatment for her endometriosis. What struck me the most about her accounts was the repetitive nature of hormones the care providers she saw offered. Over and over they offered her palliative treatments to her disease, with no thought to side effects or to an effective patient outcome. While Agha rightly was careful not to demonize birth control, what we are really talking about here is not birth control but treatment options for a disease than strike as many women as diabetes in their prime years, often rendering them with chronic, debilitating pain and organ dysfunction.

As a physician who treats endometriosis patients with wide excision surgical therapy, this makes me so sad. The fact that here we are more than twenty-five years after wide excision was pioneered, numerous clinical, peer-reviewed publications demonstrate it’s effectiveness, and the successes I’ve seen in my own practice of wide excision restoring women to their original vitality – yet ob-gyns are still just offering palliative care in the form of hormones, is dismaying to say the least. If hormones get the patient to the outcome she desires – functionality and return of quality of life, then they are an effective treatment. However, if they do not, we now know that delaying effective treatment to endometriosis patients in the form of palliative care can allow the disease to get more invasive and symptomatic. While there is currently no cure for endometriosis, wide excision surgery done by someone who can effectively identify the disease can be a highly effective therapy, and even curative. In addition, many women successfully manage their symptoms with alternative modalities from dietary changes to acupuncture. In short, health and wellness is not a pharmaceutical deficiency.

We now know that delaying effective treatment to endometriosis patients in the form of palliative care can allow the disease to get more invasive and symptomatic.

There are so many factors that play into the reasons for the lack of treatment options, including the American Congress of Obstetricians and Gynecologists (ACOG) refusing to update their outdated standards of care for endometriosis, to larger structural issues our entire healthcare system now grapples with. Over and over, women who have this disease get lost in the shuffle. Fortunately there are so many amazing clinical and patient activists who fight daily for changes in standards of care from Casey Berna to Shannon Cohn.

When I see my patients, the first thing I always do is just listen. This simple but powerful tool allows me as the physician a window into a woman’s experience. I’m hoping ob-gyn’s across the country, ACOG, and the larger medical system start to listen too.

Dr. Andrew Cook

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Dr. Andrew Cook and Libby Hopton are awarded the 2014 Carlo Romanini Award by the American Association of Gynecologic Laparoscopists (AAGL) for best video on endometriosis. The winning video was presented at the 43rd AAGL Global Congress in Vancouver, Canada, 2014. The surgery demonstrated the complete excision of full-thickness bladder endometriosis.


Aromatase is an enzyme that is responsible for the production of estrogen. Although estrogen is important for our health, too much estrogen and poor elimination of old estrogen can lead to high levels of estrogen. There is strong evidence that estrogen stimulates the growth of endo, and studies have shown that aromatase inhibitors can help to reduce endo symptoms. Like all drugs and medications, there can be side effects. The good news is, you can eat foods that will help reduce aromatase activity as well as foods that will aid in metabolism of old estrogen. You can also make lifestyle changes to improve your aromatase production.


  1. Lose weight if you are overweight, especially in your mid-section. The fat around your waist, visceral adipose tissue (VAT), produces aromatase.
  2. Address hyperinsulinemia. Insulin stimulates aromatase.
  3. Decrease inflammation. Inflammation stimulates aromatase.
  4. Reduce stress. Chronic stress elevates cortisol, which leads to inflammation, which stimulates aromatase.
  5. Do daily exercise.



  1. Natural aromatase inhibitors include chrysin, naringenin, apigenin, and genistein. Include foods such as dietary fiber, lignins from flax seed, genistein and daidzein from soy (non-GMO), resveratrol as a supplement or found in red wine (particularly French Cabernet and CA Pinot Noir), grape seed extract (proanthocyanidins), white button mushrooms, brassaiopsis glomerulata, and green tea.
  2. Foods which increase the metabolism of old estrogen include cruciferous vegetables (kale, broccoli, cabbage, onions, garlic, radishes, cauliflower, and collard greens). Aim to eat 3 servings daily raw and cooked.
  3. Strong anti-inflammatory foods include ginger, curcummin, and cinnamon.

For more information please call our office for an appointment.

To your health,
Vital Health Endometriosis Center

I have been asked about the effectiveness of pre-sacral neurectomy (PSN) in providing pain relief and if it should be routinely performed as a part of endometriosis and pelvic pain surgery. For those of you not familiar with this term (PSN), it is a nerve cutting procedure done during laparoscopy in an attempt to decrease pelvic pain. This should not be confused with another similar procedure,

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