In this episode of The Endometriosis Podcast, Dr. Nicholas Fogelson and Dr. Shanti Mohling take on one of the most emotionally charged and misunderstood topics in pelvic pain care: hysterectomy. Drawing on decades of surgical experience, they unpack common myths, clarify confusing terminology, and explain when hysterectomy may—or may not—be an appropriate part of endometriosis treatment. This thoughtful, nuanced conversation emphasizes individualized care, informed consent, and the importance of excision surgery alongside any uterine decision

Highlights:

• Why hysterectomy does not cure endometriosis—and why it can still be helpful for some patients with pelvic pain
• The difference between hysterectomy, ovary removal, and fallopian tube removal (and why the distinctions matter)
• Adenomyosis, fibroids, and other uterine pain sources that can influence surgical decisions
• Effects of hysterectomy on hormones, menopause timing, sexual function, and pelvic organ support
• How surgical technique, experience, and thorough excision impact long-term outcomes and recurrence risk

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Download a transcript of this episode.

In this episode, Dr. Nick Fogelson and Dr. Shanti Mohling take on one of the most persistent gray zones in gynecology: how to safely use hormone replacement therapy in patients with current or past endometriosis. Moving beyond the simplistic "estrogen bad" narrative, they explore what the data actually show about recurrence, cancer risk, and quality of life. The discussion weaves clinical insight with case studies, examining how progesterone's protective role, surgical completeness, and individualized dosing all shape outcomes.

Highlights:

• The lingering misconceptions from the Women's Health Initiative study and what modern research now shows about the safety of hormone replacement.
• Why bioidentical progesterone should often accompany estrogen—even in hysterectomized patients with prior endometriosis.
• Real-world case studies revealing how residual disease and incomplete excision affect postmenopausal pain and risk.
• The broader benefits of HRT—stronger bones, cardiovascular protection, cognitive support—and how fear-based medicine often obscures them.
• Updates from the surgical front: robotic excision of endometriosis in outpatient centers, plus a preview of the next episode on MyReceptiva's diagnostic test for endometriosis.

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Download a transcript of this episode.

In this thought-provoking episode, Dr. Nicholas Fogelson and Dr. Shanti Mohling delve into new research that challenges how we understand adenomyosis in relation to endometriosis. They break down the proposed subtypes of adenomyosis— from interna and externa to intramural and adenomyomas— and discuss how these patterns may arise from childbirth, uterine surgery, or molecular changes shared with endometriosis. Along the way, they revisit century-old theories, weigh the evidence for different pathways of disease development, and explore what this means for treatment decisions, fertility preservation, and patient pain.

Highlights:

• Defining adenomyosis and how it differs from—and overlaps with—endometriosis
• Subtypes of adenomyosis: interna, externa, intramural, and adenomyomas
• Theories of origin: tissue injury and repair, retrograde menstruation, embryonic remnants, and genetic mutations
• Why hysterectomy can sometimes relieve pain when conservative surgery cannot
• Understanding why patients with minimal disease may have severe pain while others with advanced disease experience little or none

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Download a transcript of this episode.

In this illuminating episode, Dr. Shanti Mohling and Dr. Nicholas Fogelson dive into the science behind supplements and functional medicine approaches to managing endometriosis. From NAC and curcumin to the role of Vitamin D and the gut microbiome, they explore which anti-inflammatory tools hold real promise—and which ones may not. They also tackle a listener's question about persistent post-op symptoms and break down why the term "IBS" isn't always the end of the diagnostic road.

Highlights:

• The anti-inflammatory mechanisms of NAC, alpha-lipoic acid, curcumin, and fish oil

• Why Vitamin D deficiency may worsen endometriosis—and how much to take

• Discussing the limits of zinc and resveratrol in treating symptoms

• The role of probiotics and gut health in managing "endo belly"

• Why supplement research is underfunded and how politics shapes what gets studied

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Download a transcript of this episode.

In this episode, Dr. Nicholas Fogelson and Dr. Shanti Mohling dive deep into the complex overlap between endometriosis and nerve-related pelvic pain. They discuss a pivotal paper by Dr. Marc Possover on laparoscopic treatment for endometriosis and vascular entrapment of the sacral plexus — groundbreaking work that opened new paths for addressing sciatica caused by pelvic disease. The conversation explores how nerve irritation and compression can manifest, why menstrual cycle patterns matter, and how careful patient selection guides surgical decisions. If you or someone you know has unexplained sciatic or pelvic pain that worsens cyclically, this episode is essential listening.

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Highlights:

• Why "sciatica" describes symptoms — not a standalone diagnosis — and how to trace its true source.
• The critical differences between sciatic nerve endometriosis, sacral nerve root involvement, and vascular compression.
• How menstrual cycle timing can provide vital clues to nerve-related pain origins.
• The role of neuropelveology in surgically addressing complex pelvic nerve pain
• What patients can realistically expect from surgery — and why improvement, not perfection, is the goal.

Download a transcript of this episode.

In this episode, Dr. Nicholas Fogelson and Dr. Shanti Mohling discuss a compelling new study from the Journal of Minimally Invasive Gynecology exploring spontaneous conception and live birth rates in infertility patients after endometriosis surgery. They break down what the data reveals about excision versus ablation, the role of age, and the surprising lack of correlation between disease stage and fertility outcomes. Along the way, they examine how inflammation impacts egg viability, why BMI may not matter as much as once believed, and how social media is transforming surgical education and patient advocacy.

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Highlights:

• What a retrospective cohort study reveals about spontaneous conception rates after excision surgery
• Why disease stage may not determine fertility potential in endometriosis patients
• How inflammatory environments—not just structural damage—interfere with egg survival and implantation
• What the data shows about BMI having no significant impact on post-surgical fertility outcomes
• Why surgical video sharing on social media is reshaping education, access, and accountability in the field

Download a transcript of this episode.

In this episode, Dr. Nicholas Fogelson and Dr. Shanti Mohling relaunch The Endometriosis Podcast with an in-depth look at one of the most crucial surgical decisions for patients with deep endometriosis: how aggressive should bowel surgery be? You'll hear their thoughts on recent meta-analysis comparing conservative techniques (like shave and discoid resection) to radical approaches (like segmental bowel resection). Dr. Fogelson and Dr. Mohling break down how disease severity, nerve preservation, and surgical judgment all shape patient outcomes — and why sometimes a more radical surgery is not only necessary, but life-changing. Along the way, they share real-world cases, challenge common assumptions, and invite listener questions.

For clinical consultations: contact Northwest Endometriosis and Pelvic Surgery in Portland, OR at (503) 715-1377 or email us at [email protected]

Follow us on Instagram: @Nicholasfogelson and @drshantimohling

Highlights:

• What the research reveals about constipation risks after conservative vs. radical bowel surgery
• How nerve-sparing strategies protect long-term bowel and pelvic health
• When a conservative approach succeeds — and when deeper excision is needed for lasting relief
• Why flexible decision-making during surgery leads to better outcomes than imaging alone
• How understanding the differences between superficial and deep disease leads to more effective treatment

Download a transcript of this episode.

Join surgeon Nicholas Fogelson and endometriosis researcher Libby Hopton as they answer listener questions and discuss recently published research. This episode was recorded in July 2017. Stay tuned for future episodes!

Dr. Nicholas Fogelson, MD, and Libby Hopton discuss new literature on endometriosis. Studies include a comparison of excision and ablation surgeries for superficial endometriosis, and a literature review on treating the disease with hormonal contraception. Also, a look at how endometriosis may be connected to the state of a patient's microbiome, and more.

Dr. Nicholas Fogelson, MD, and Libby Hopton discuss new literature on endometriosis and answer questions from the endometriosis patient community. Topics include removing abdominal wall endo after c-section, Visanne studies, whether to chose a surgery center or a hospital and more.

This episode was recorded in July 2017.

Fresh episodes coming soon!