Indian Centre for Endometriosis - ICE

Indian Centre for Endometriosis - ICE ICE is an educational resource created to increase recognition about endometriosis and bridge the de

Not all “meta-analyses” are automatically high-quality science.A recent paper comparing Dienogest vs combined oral contr...
03/06/2026

Not all “meta-analyses” are automatically high-quality science.

A recent paper comparing Dienogest vs combined oral contraceptive pills in deep endometriosis concludes that Dienogest performs better for pain suppression. While the direction of the findings may align with existing literature, the methodology behind the paper deserves closer scrutiny.

Some important concerns:
• Extremely high heterogeneity (I² approaching 80–90%)
• Mixing randomized trials with observational and retrospective studies
• Several studies classified as high risk of bias
• Poor standardization of surgery prior to postoperative medical therapy

Perhaps the biggest issue?

The paper does not adequately define the quality or completeness of surgery performed before hormonal suppression.

In advanced endometriosis, this changes everything.

A patient with:
• residual bowel disease,
• untreated parametrial disease,
• fibrosis around nerves,
• or incomplete excision

cannot be scientifically compared with someone who underwent complete multidisciplinary excision surgery.

Pain suppression does not equal disease eradication.

Dienogest absolutely has a role in carefully selected patients:
• symptom suppression,
• postoperative management,
• delaying surgery in selected cases,
• adenomyosis symptom control,
• fertility preservation strategies.

But no medical therapy should be interpreted as a replacement for proper excision surgery in advanced disease.

Scientific literacy matters.

Not all:
• guidelines,
• publications,
• or meta-analyses

carry the same scientific weight.

In endometriosis research, methodology matters just as much as conclusions.

ExcisionSurgery Gynecology WomensHealth EvidenceBasedMedicine MedicalEducation

Bangkok bound 🇹🇭 Honored to be part of the international faculty for the Thai-German Multidisciplinary Endoscopic Works...
16/05/2026

Bangkok bound 🇹🇭

Honored to be part of the international faculty for the Thai-German Multidisciplinary Endoscopic Workshop and RTCOG-SGMIS Joint Meeting 2026.

This week I’ll be teaching advanced cadaveric dissection focused on:
• Deep endometriosis surgery
• Bowel preparation
• Pelvic nerve identification
• Pelvic neurosurgery
• Vascular entrapments of the pelvic nerves

Also privileged to be delivering a keynote lecture on:

“Surgery for Deep Endometriosis and Vascular Entrapments of the Pelvic Nerves.”

Excited to share the stage with pioneers in minimally invasive gynecologic surgery from around the world.

MIGS CadaverWorkshop Bangkok GynecologicSurgery PelvicPain ICE

25/03/2026

When cyclical shoulder pain, period-linked pneumothorax, and diaphragmatic lesions appear together, they’re not three separate problems... they’re often one diagnosis hiding in plain sight.

Recognising the pattern is what prevents years of missed calls, repeat interventions, and unnecessary morbidity.

Have questions? Drop them in the comments.

Some cases remind you just how far this disease can travel before it is finally identified.Deep-infiltrating endometrios...
23/03/2026

Some cases remind you just how far this disease can travel before it is finally identified.

Deep-infiltrating endometriosis does not stay confined to the uterus. In advanced stages, it can extend into the organs that share the same pelvic space, quietly disrupting anatomy and function over the years. By the time many patients reach a specialist centre, the condition has already rewritten the body’s internal landscape.

What this case ultimately reinforces is a simple truth: the earlier endometriosis is recognised and referred to specialised care, the more options patients have.

Have questions about the case, our approach, or anything else? Drop them in the comments.

18/03/2026

For years, endometriosis has been treated like a single condition with varying severity. What the research is starting to show is that we’ve been grouping unlike cases under the same label, and that has real consequences.

It explains why two patients with similar scans can have completely different pain patterns, treatment responses, and outcomes. It also explains why so many people feel like they’re “failing” treatments that were never designed for their specific biology in the first place.

This opens up a shift from standardised protocols to more personalised pathways. Not overnight, but directionally, it is where the science is heading. And that's a good thing.

It took me over a decade to be diagnosed, largely through my own rigorous research, using the limited credible informati...
16/03/2026

It took me over a decade to be diagnosed, largely through my own rigorous research, using the limited credible information available while navigating the persistent taboo surrounding women's health.

Now, as a 41-year-old woman with a teenage daughter, I can see that, as a society, we have much to be thankful for in terms of changing attitudes and advocacy. However, we need medical professionals, researchers, and the broader community to meet in the same space so that the progress we have made can truly take effect.

We can no longer maintain an "us and them" mentality.

In Australia, policy makers still fail to fully recognise endometriosis and the range of conditions that commonly coexist with it, such as EDS, hEDS, and POTS. As a result, those living with these conditions are forced to navigate an invisible, incurable illness while also remaining largely invisible within government and public health systems.

Today, I have also lost my business, my athletic career, and, for the past three years, my financial autonomy following serious spinal complications that left me significantly disabled. At an age where pain has become part of me, years of suffering and dismissal have led to a radical realisation: I can endure the pain, but the lack of empathy and meaningful policy hurts far more.

Image credit: Marilyn Tuna, Fremantle West Australia

13/03/2026

GLP-1 drugs have quickly become one of the most talked-about medications in medicine right now. With the way they impact weight loss, metabolic health, and inflammation, it’s only natural that patients with different conditions start asking: Could this help me too?

If you’ve been hearing about GLP-1 drugs and wondering whether they apply to endometriosis, this breakdown will help you understand where the research actually stands today.

Follow-up questions are welcome below.

09/03/2026

One of the biggest frustrations with endometriosis is how long it takes to arrive at a clear diagnosis. For many women, symptoms begin years before the condition is finally confirmed.

That’s why the idea of a reliable blood test has generated so much interest in research circles. If scientists can identify a consistent biological signature for endometriosis in the bloodstream, it could make earlier detection far more accessible and reduce the long diagnostic journey many patients face.

Right now, the focus is shifting from single markers to patterns in the body’s inflammatory and genetic signals. It’s a more complex approach, but also a far more promising one.

The science is moving in that direction. But like all good science, it needs careful validation before it becomes part of routine clinical care.

So, for now, we watch the research closely and continue to rely on the diagnostic tools we know work.

If you have questions about how endometriosis is diagnosed today, or what new research might change in the future, drop them below.

...this would happen every month during my period. I couldn’t eat, drink, or function. The cramps were intense, and the ...
06/03/2026

...this would happen every month during my period. I couldn’t eat, drink, or function. The cramps were intense, and the episodes kept getting longer with each cycle.

The pain and vomiting became so overwhelming that I couldn’t manage my daily life. I had to take a sick day from work every month, and any trips or plans had to be rearranged around my cycle. I would end up cancelling important commitments simply because it was “that time of the month.”

My quality of life kept shrinking.

After seeing a couple of doctors, I was finally diagnosed with endometriosis. Medication to stop my periods didn’t feel right, so I made the decision not to take them, and although nutrition changes helped slightly, the symptoms continued to worsen.

Then I found (thanks to my mother’s relentless research). He correctly diagnosed my case and identified all the endometrial lesions on MRI, which had previously gone undetected. He advised me to go for an excision surgery.

After the surgery, I now have completely normal periods with very little to minimal pain. It truly has been life-changing.

A drug that changes how we treat endometriosis without suppressing hormones or resorting to surgery would be a genuine s...
05/03/2026

A drug that changes how we treat endometriosis without suppressing hormones or resorting to surgery would be a genuine shift. That’s why dichloroacetate (DCA) is getting attention in research circles right now.

DCA isn’t new. It has been used for decades to treat rare metabolic disorders. What’s new is the idea that it may affect a metabolic pathway implicated in endometriosis.

If it works, it could shift the paradigm. If it fails, we still learn something important about the biology of the disease. Either way, the science moves forward.

That said, it’s important to note that dichloroacetate is still in the investigational phase. It is not approved as a treatment for endometriosis, so it should not be used for self-medication.

Drop any questions you have in the comments.

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