Skip to main content

Improving the Lives of Endometriosis Patients

UH Endometriosis-Pelvic Pain Center of Excellence advances patient care and clinical research

Innovations in Obstetrics & Gynecology - Spring 2018

Megan Billow, DO


Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center; Assistant Professor, Obstetrics and Gynecology, Case Western Reserve University School of Medicine

Angelina Gangstead, MD


Director, Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center; Associate Professor, Reproductive Biology, Case Western Reserve University School of Medicine

University Hospitals Cleveland Medical Center is tackling the complex issue of endometriosis by launching a center of excellence that provides comprehensive patient care and conducts clinical research on the latest treatments.

“Endometriosis is a challenging, chronic condition that greatly affects patients’ overall quality of life,” says Megan Billow, DO, a minimally invasive gynecologic surgery specialist at UH Cleveland Medical Center and Assistant Professor of Obstetrics and Gynecology at Case Western Reserve University School of Medicine. “Involving a multispecialty physician team to address the complex problems posed by endometriosis is the best approach for patient care.” Endometriosis Illustration

Led by a team of fellowship-trained physicians, the UH Endometriosis-Pelvic Pain Center of Excellence focuses on individualized care plans for endometriosis patients. The initial intake process involves taking the patient’s history and performing a general physical exam. From there, physicians can determine referral sources to support a patient’s overall care.

Through the center, patients can access medication therapy for all stages of endometriosis as well as minimally invasive surgical services for advanced stage endometriosis. The center guides endometriosis patients through the treatment process by offering preoperative imaging services and collaborative care from pelvic floor physical therapists, urogynecologists, colorectal surgeons, reproductive endocrinologists, infertility specialists, behavioral medicine specialists and nutritionists.

Patients also have the option to join support groups and take advantage of educational resources provided through the UH Endometriosis-Pelvic Pain Center of Excellence.

Clinical research will be another core focus of the Endometriosis-Pelvic Pain Center of Excellence, Dr. Billow says. The center has plans to start a database of its patients to support future clinical research initiatives, and it is already involved in testing a new drug treatment with the pharmaceutical company, AbbVie Inc.

Angelina Gangestad, MD, Director of the General Obstetrics and Gynecology Division at UH Cleveland Medical Center and Associate Professor of Reproductive Biology at the School of Medicine, is the principal investigator of the Phase III clinical study examining the safety and efficacy of Elagolix, an oral medication, as a treatment for moderate to severe endometriosis. Researchers are investigating the ability of Elagolix, a GnRH antagonist, to suppress endometriosis and decrease pain.

Elagolix is an investigational drug that has not yet been approved as a treatment for endometriosis in the United States. The study is combining Elagolix with Estradiol/Norethindrone Acetate. These two hormonal therapies are being included to suppress hot flashes and protect against bone loss, a symptom of GnRH antagonists. “This medication is oral, and it can be titrated for symptom relief,” Dr. Gangestad says.

The Phase III study is in the process of recruiting patients. For the first six months of the 12-month treatment period, randomized groups will receive either treatment or a placebo, Dr. Gangestad says. In the second half of the study, all subjects will be randomized into a treatment arm – either Elagolix alone or Elagolix with the Estradiol/Norethindrone Acetate add-back therapy.

“We want to be able to offer our patients cutting-edge surgical and medical therapies,” she says. “Clinical research helps us get our patients access to this kind of cutting-edge care faster.”

Current treatment strategies for endometriosis include medications designed for contraception, GnRH suppression injections and surgical intervention. Dr. Gangestad expects that positive results from the Elagolix study and studies of other new drugs could contribute to big changes to the endometriosis standard of care.

“I think we will see a significant shift in the way we treat endometriosis,” she says. “Elagolix is just one of these drugs in development. We will move more toward oral agents and away from injections and surgical therapy.”

UH is committed to offering cutting-edge care, as well as playing an active role in trailblazing new, innovative treatments for conditions such as endometriosis.

“As a major academic medical institution, we must continue to do what is best for the patient,” Dr. Billow says. “A multidisciplinary approach to this challenging condition will significantly improve our patients’ lives.”

The multidisciplinary Endometriosis-Pelvic Pain Center of Excellence demonstrates this focus by offering patients comprehensive care that covers multiple specialties, providing a support network for people struggling with endometriosis and conducting important research on treatments that could change the way the medical field approaches endometriosis care.

To make a referral, call 440- 720-3250.

Contact Dr. Billow or Dr. Gangestad at