© 2015 by the Center for Endometriosis Care/Ken Sinervo MD, MSc, FRCSC. All rights reserved. No reproduction permitted without written permission. Revised since original publication and current as of 2026. No external funding was utilized in the creation of this material. The Center for Endometriosis Care neither endorses nor has affiliation with any resources cited herein. The following material is for informational purposes only and does not constitute medical advice.

The Center for Endometriosis Care is a pioneering leader in endometriosis and surgical gynepathologies that often appear alongside the disease. We understand the complexities and have provided the following questions to help you evaluate whether your practitioner does as well. Our own responses are included for reference. While not exhaustive, these questions can highlight key considerations and help guide more informed discussions when selecting your care team. While these questions were originally developed and shared in early 2015, they are continuously updated and we are glad to see them being widely reused by many others elsewhere. Education is key! Please also note: We will always freely provide the most current information to our patients and visitors here about endometriosis, related comorbidities, our surgical approaches, and, most importantly, our surgeons and their capabilities. We strongly encourage patients not to rely on unaffiliated third parties who charge the community for such information (e.g., ‘surgeon reports,’ ‘what to ask your doctor’ lists, etc.), as such data scraping may not be current, complete, or accurate, and there should be absolutely no need to ever pay for access to information about the team you are choosing for your care or for accurate details about the diseases and conditions you are being treated for.

Questions to Ask About Your Endometriosis Care

Will I be treated as a partner in my care, with full autonomy and informed consent?
(Of course. This is always the standard.)

What are your views on endometriosis (pathophysiology, diagnosis, and treatment)?
(You can review our philosophy and approach to endometriosis care here: https://www.centerforendo.com/about-endo)

How do you balance symptom management with long-term disease management?
(While care is always individualized, short-term symptom relief should not come at the expense of long-term outcomes - for example, relying solely on medical suppression for pain control versus addressing disease through surgical excision when appropriate.)

Experience, Training & Practice Focus
What percentage of your practice is dedicated specifically to endometriosis and surgical gynepathologies?
(Our practice is and has always been exclusively dedicated to endometriosis and surgical gynecology since our founding in 1991.)

What formal training have you completed in advanced gynecologic surgery, specifically for endometriosis?
(Both Dr Sinervo (https://www.centerforendo.com/dr-ken-sinervo) and Dr Eugenio (https://www.centerforendo.com/drcolon) have completed extensive, dedicated surgical Fellowships in excisional and advanced gynecologic surgery over the course of their lengthy careers and routinely train other physicians in these techniques. Likewise, Dr Eugenio has earned the Master Surgeon designation in an unprecedented five categories.)

Do you teach, publish, or present on endometriosis and its management?
(Of course. Our surgeons regularly teach, publish, and present on endometriosis and best practices in its management all over the world and via many publications.)

How long have you been in practice, and how much of that time has focused on endometriosis care?
(We have been dedicated exclusively to endometriosis care for over three decades.)

Do you have any financial or industry affiliations that may influence treatment recommendations?
(No. We do not have any financial or industry relationships that influence our clinical decision-making; recommendations are made independently and in the patient’s best interest.)

Diagnosis & Clinical Approach
How do you approach diagnosis in the absence of visible disease on imaging?
(While we are leaders and early pioneers in dynamic imaging for endometriosis, the disease is still sometimes not reliably detected via imaging; clinical judgment remains critical.)

How do you differentiate endometriosis from other contributors to pain (e.g., pelvic floor dysfunction, central sensitization, GI or urologic conditions)?
(A comprehensive evaluation of each patient is essential to avoid incomplete treatment.)

How do you assess and manage central sensitization or chronic pain syndromes when present?
(These may coexist and require a different therapeutic approach. Again, all care is personalized and specific.)

Surgical Approach & Capabilities
How many endometriosis cases do you manage annually (medical and surgical), and how do you approach each?
(We treat a high volume of complex cases, performing nearly 500 surgeries each year. Surgical excision is the standard of care; non-GnRH medical therapies may be used selectively in the course of a patient’s care depending on the individual.)

Do you perform complete excision of disease, or do you use ablation/cauterization?
(We perform excision to remove disease at its root. Ablation is ineffective at removing the disease from its roots, leading to high recurrence.)

What types of complex or extrapelvic endometriosis do you treat (e.g., bowel, bladder, thoracic, sciatic)?
(We routinely treat complex and extrapelvic disease using a multidisciplinary, team approach; we perform among the highest numbers of thoracic and other extrapelvic surgical cases in the world each year.)

Do you work with a multidisciplinary surgical team when needed?
(Yes. Colorectal, urologic, thoracic, and other specialists as indicated is routine for us.)

Who will perform my surgery?
(Our surgeons perform all procedures themselves; any involvement of Fellows is disclosed and consented.)

Is your goal to preserve organs whenever possible?
(Yes. Organ-sparing approaches are prioritized; while appropriate in certain cases for an individual’s situation, a hysterectomy is not a cure for endometriosis.)

Will adhesions be addressed and normal anatomy restored?
(Yes, of course. Adhesiolysis is routinely performed, along with the goal of restoring normal anatomy. Adjunctive measures also are employed, such as but not limited to ovarian suspension, adhesion barriers, and platelet-rich plasma (https://www.centerforendo.com/platelet-rich-plasma-therapy) to support healing and reduce additional adhesion formation.)

Is all removed tissue sent for pathology?
(Yes, of course. You have the comfort of knowing exactly what was found.)

Medical Management & Treatment Planning
Do you use pre- or post-operative hormonal suppression? Why or why not?
(We do not use preoperative suppression as it is counter-intuitive to ensuring full disease detection; non-GnRH postoperative management is individualized.)

What is your philosophy on repeat surgeries, and how do you determine when they are appropriate?
(Not all recurrence or persistent symptoms are due to endometriosis, nor do they require immediate reoperation. Careful evaluation is essential to distinguish between residual or recurrent disease and other potential contributors, and decisions are made with the patient on a case-by-case basis.)

What is your approach when pathology does not confirm endometriosis despite visual findings?
(Clinical context and surgical findings must be interpreted together for appropriate next steps.)

Complex & Reoperative Cases
What is your approach to patients with persistent pain after prior surgery?
(Again, reoperative cases require careful evaluation of both disease- and non-disease pain generators, including residual or recurrent endometriosis, pelvic floor dysfunction, and other comorbid conditions. Management is individualized, and surgery is considered only when clearly indicated.)

How do you address less common or more complex presentations (e.g., diaphragmatic, thoracic, hepatic or nerve involvement)?
(Cases are always managed through an interdisciplinary team approach, incorporating the necessary surgical specialties. Our Center was among the first in the world to formalize this type of collaborative operative model for endometriosis treatment.)

Fertility & Long-Term Considerations
What is your approach to fertility preservation and counseling in patients with endometriosis?
(Individualized planning is important, particularly in surgical decision-making.)

Recovery, Support & Continuity of Care
What is the expected hospital stay and recovery timeline?
(Varies by case; individualized guidance is provided. Check out our FAQs for more information: https://www.centerforendo.com/faq)

How should I prepare for surgery? Are there specific nutritional or medication considerations?
(Preparation is tailored to each patient. You will be guided specifically; however, this resource can also help: https://tinyurl.com/bdduk2pk)

What preoperative testing is required, and why?
(Determined based on individual clinical needs and may range from dynamic imaging to blood work to lab tests.)

What postoperative care is recommended (e.g., pelvic floor therapy, nutrition)?
(Adjunctive therapies are often part of our comprehensive plan. View our full library at https://www.centerforendo.com/news-education for additional resources and information as well as our pre- and post-op guide linked above.)

What is your approach to postoperative pain management?
(We use a structured, multimodal approach and collaborate with additional specialists as needed, i.e., pain management, Physical Therapy, etc.)

How long should I expect to be out of work or limited in activity?
(Typically 2–6 weeks, depending on the case; you will be advised accordingly.)

How do you ensure continuity of care for patients traveling from out of state or internationally?
(Follow-up and communication are critical components of outcomes. As a tertiary referral Center of Expertise in Endometriosis Care since 1991, we have long-standing experience supporting patients who travel for treatment and coordinating continuity before and after their procedures - and built the very foundation for this model of care as it is widely practiced today by specialists around the world.)

What is the follow-up plan, and how are complications managed?
(Ongoing, accessible care is essential. Patients will have a defined follow-up plan, direct access to our care team, and clear protocols for managing postoperative concerns or complications.)

Will I have access to my operative report, pathology, and images?
(Yes, of course. Transparency is standard.)

Outcomes & Expectations
What data do you collect on patient outcomes, and how is that used to inform care?
(Ongoing data collection reflects a commitment to quality improvement.)

What if I need surgery elsewhere or at the Center again?
(We support patients with records and communication when care occurs elsewhere and reassess on a case-by-case basis if additional treatment at our Center is indicated.)