QC: Does Birth Control Actually Shrink Endo Lesions? (Spoiler: Probably Not), Timing Surgery with Your Cycle, & Cyclical Nose Bleeds

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Expert endometriosis surgeon Dr. Abhishek Mangeshikar debunks common myths and provides clear answers to pressing questions about endometriosis management. Drawing from his extensive experience at the Indian Center for Endometriosis, he offers evidence-based insights on treatments, surgical approaches, and unusual symptoms.

• No conclusive data supports the claim that birth control or Lupron causes regression of endometriosis lesions
• Shrinking endometriomas may actually indicate worsening disease as contents leak into the pelvis causing adhesions
• The timing of surgery relative to menstrual cycle generally doesn't matter for experienced excision specialists
• Operating during a patient's period may require additional cleaning of the surgical field but doesn't affect excision outcomes
• Cyclical nosebleeds might be connected to thoracic endometriosis, but medical data remains limited
• Hysteroscopy procedures are the main exception where avoiding menstruation is beneficial for visualization

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Episode Transcript

Speaker 1 (00:00):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:20):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.
Today we're honored to have DrAbhishek Mingashigar join us.

(00:44):
Today we're honored to have DrAbhishek Mingashigar join us.
Dr Ming's is a leadingendometriosis specialist and
minimally invasive gynecologicalsurgeon, known for his
groundbreaking work at IndianCenter for Endometriosis in
Mumbai.
With expertise in advancedlaparoscopic and robotic
surgeries, he's dedicated toimproving care for those
battling this complex disease.
Let's dive in and get answersto the questions that matter

(01:05):
most to you.
Does taking birth control orLupron drugs stop the endolesion
stimulation, therefore reducingthe amount of lesions created,
or shrink endolesions?

Speaker 2 (01:16):
That's really a good question.
So there's no data to supportthat.
There is some circumstantialevidence which I don't really
believe too much, that there issome circumstantial evidence
which I don't really believe toomuch could be
industry-sponsored papers.
But there is no conclusive datato say that any medication
causes regression of the lesionsor the disease magically

(01:36):
vaporizes or disappears.
So I always tell patients theywould tell me okay, I had a cyst
diagnosed and the doctor put meon progesterone or something.
My cyst went from eightcentimeters to six centimeters.
And I said, first of all, thereis no protocol to measure
disease progression orregression by measuring just the

(01:56):
size of the cyst.
And a cyst decreasing in sizeis worse than it's increasing in
size, which just means thatit's linking into the pelvis and
making things more stuck andworse than they already are.
There's not a good sign, it's abad sign.

Speaker 1 (02:12):
I can be a testament to the fact that it doesn't do
that.
After being on it for so long,the disease definitely
progressed.
Is it better or worse to be onyour period before surgery or
during surgery?

Speaker 2 (02:25):
It doesn't matter.
I think an experienced surgeonwho can identify all subtypes of
the disease can kind of pick itup.
So most women have retrogrademenstruation, believe it or not.
Not all of them haveendometriosis.
So usually if you will operateon someone during that period,

(02:48):
there will be blood in thepelvis.
Now if somebody has a lot ofmenstrual blood for whatever
reason it could be adenomyosisor whatnot then you're going to
have a lot of blood in thepelvis and then you have to
spend that extra couple ofminutes washing and sucking that
out.
It's not a deal breaker.
I still operate on patientsduring their period, before

(03:12):
their period, after their period.
It doesn't really make adifference to the excision of
the endometriosis part of it.
You only try to avoid it.
If you're doing a hysteroscopy,which is where you put a
telescope into the uterus tolook at the cavity, when you're
doing an evaluation forfertility, or if you're looking
for a fibroid or a polyp orsomething inside the uterine

(03:33):
cavity that may be causing goodliver, then obviously you don't
want her to be on a period.
Then you do it post-menstrual.

Speaker 1 (03:40):
Okay, and then if they don't ever go
post-menstrual?

Speaker 2 (03:44):
You give them medication to stop it.

Speaker 1 (03:47):
How do endo-excision specialists address cyclical
nosebleeds?

Speaker 2 (03:51):
That's a tough one, yeah.
Yeah, I've had a couple ofpatients with cyclical
nosebleeds.
One of them had thoracicendometriosis, but we also did a
bronchoscopy.
We had the pulmonology teamcome in and they looked through
the nasal passages and throughthe respiratory system to look
for any endometriosis there.

(04:12):
They did biopsies but theydidn't come up with anything
specific.
So I'm not sure on how toproceed with that, because the
data is very limited.
So you have to kind ofinvestigate what's causing it
and then come up with a plan onhow to treat it.

Speaker 1 (04:30):
Can cyclical nosebleeds occur, even if it's
not necessarily endometriosis inthe nasal passages, because you
know that's been found.
But I for one have not had anosebleed since my excision
surgery and hysterectomy, whichI used to have all the time.

Speaker 2 (04:45):
I don't know.
There are many causes fornosebleeds.
I'm not exactly sure if it'sspecifically endometriosis in
the nasal tract that would causeit.
It could be a matter of things.
We don't have enoughinformation about that kind of
endometriosis.
I would assume some kind ofthoracic endometriosis could

(05:05):
also present that way, becauseit is linked to coughing up
blood so it can easily get intothe nasal passages that way too.

Speaker 1 (05:13):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming, send them inand I'll bring you the expert
answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(05:37):
Until next time, keep feelingempowered through knowledge.