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Health Matters: Providence St. Joseph Hospital | 11 THE COMPLEXITY OF ENDOMETRIOSIS Dr. Fee explains that endometriosis is a disorder in which tissue—similar to the tissue that lines the uterus—grows outside the uterus in places where it doesn't belong. "In advanced cases like Sarah's, it causes repeated scarring and development of cysts." When Sarah underwent her first imaging tests in June 2021, they revealed a baseball- size cyst on her left ovary. That July, Sarah had her first surgery at another hospital, which turned out to be far more complicated than anticipated, as surgeons discovered extensive endometriosis. Despite the surgery, Sarah's symptoms persisted, prompting her to seek Dr. Fee's expertise. Initially, they opted for a conservative approach, monitoring her condition and trying hormone controllers. In July 2023, Sarah underwent her second surgery, this time placing her trust in Dr. Fee's experienced hands. The procedure, intended to remove her left ovary, was unexpectedly brief due to the discovery of a large blockage in her colon. "Sarah's endometriosis was more extensive than seen on imaging, invading deeply and causing scarring," Dr. Fee says. It was in the aftermath of this surgery that Dr. Fee collaborated with Grace Hwang, MD, a colorectal surgeon at Providence St. Joseph, to unravel the complexities of Sarah's condition through a series of tests and procedures. In November 2023, Sarah underwent her third surgery, this time with both specialists working together in a comprehensive effort. "We were able to do the surgery as a tag team using robotic technology, with minimally invasive incisions," Dr. Fee says. "We're hopeful that this comprehensive approach will eliminate all traces of the disease." NEW HOPE FOR RELIEF When Sarah awoke after surgery, she was surprised to find that she felt "great," with the relief extending beyond the physical. "Endometriosis is not just hard on your body—it's hard on your mind. It affects everything you do—your relationships, work …" Sarah explains. "It's a hard disease, and it doesn't have a very quick cure." Dr. Fee echoes this, pointing out that endometriosis and chronic pain are tied to depression and anxiety. "It's tragic. There's a tremendous loss of quality of life and productivity," she says. "The most important thing is to have an advocate and a proactive approach to a treatment plan." Thankfully, there are more treatment options available than ever before, according to Dr. Fee. "The correct treatment path depends on various factors, including the patient's desire for fertility, amounts of pain and previous surgeries they 've had," she says. "The first step is to properly make a diagnosis." PRIORITIZING EARLY DETECTION AND INTERVENTION Endometriosis often presents with classic symptoms such as severe menstrual cramps, ovarian cysts and gastrointestinal issues. Early detection is crucial for less invasive treatment options, including medication management and hormonal suppression, which can mitigate the need for extensive surgeries. Additionally, lifestyle factors like maintaining a healthy weight and diet play a role in managing estrogen levels and curbing tissue growth associated with endometriosis. Ongoing research promises further advance- ments in treatment options, emphasizing the importance of comprehensive care and proac- tive management strategies. Sarah is now free from the endometriosis pain that plagued her for years and is seizing life's opportunities with renewed vigor. As she travels for work, she relishes the freedom to add extra days onto her trip "just for fun." "I can do those things now that there's nothing holding me back," she says. "I can wear what I want and sleep how I want comfortably. I'm readapting to a new life." Dr. Janis Fee Dr. Grace Hwang Providence St. Joseph Heritage Obstetrics and Gynecology (OB/Gyn) has moved to the Helen Caloggero Women's and Family Center, located on the Providence St. Joseph Hospital campus. The new clinic offers a streamlined, enhanced patient experience and the convenience of five levels of underground parking. Make an appointment by calling 714-997-9595.

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