Kathy Kates
Kathy Kates, MSN, FNP-BC
Endometriosis Long Term Care Provider
Summary: Kathy Kates, MSN, FNP-BC, is an Endometriosis Long-Term Care Provider and founder of Pelvic Health Support in Brookline, Massachusetts, a clinical practice focused on restoring quality of life through integrative, evidence-based care for pelvic pain, sexual dysfunction, menopause, and endometriosis. She previously co-founded the Institute for Pelvic Health, where she developed continuing education programs to expand comprehensive pelvic health training for clinicians. Kathy holds a Master of Science in Nursing as a Family Nurse Practitioner from MGH Institute of Health Professions.
Kathy takes a multifactorial, whole-person approach to endometriosis, recognizing that the disease involves hormonal, inflammatory, immune, tissue, and nervous-system mechanisms. Her care may include individualized hormonal and pain management, pelvic floor therapy, myofascial and visceral therapies, and treatment of associated conditions such as mast cell activation, dysautonomia, and connective tissue disorders. She works closely with excision surgeons to prepare patients before surgery and provides structured postoperative care focused on healing, pelvic floor rehabilitation, bowel and bladder function, sexual health, symptom management, and long-term recurrence prevention.
Her philosophy is that endometriosis care extends beyond treating lesions alone. By addressing hormones, inflammation, tissue, muscle, and nervous-system sensitization together, Kathy aims to help patients reduce pain, restore function, and improve quality of life over the long term.
City: Brookline, Massachusetts, USA
Visit types: In-Person and Telehealth
Spoken languages: English
Interpreting services for other languages: No
Philosophy of Endometriosis Care: My approach reflects the current consensus that endometriosis is multifactorial. I regard Sampson’s retrograde menstruation theory as the foundational mechanism of lesion formation, but incomplete on its own: refluxed endometrial cells are found in the majority of menstruating women, yet only a subset develop disease. I therefore also ground my approach in the complementary theories – impaired immune clearance and chronic peritoneal inflammation, coelomic metaplasia, stem cell origin (including bone marrow-derived cells, which help explain recurrence after excision), and genetic/epigenetic predisposition. Because the disease is estrogen-dependent, inflammatory, and neuroimmunologic, my treatment model addresses hormones, tissue, and muscle together rather than treating the lesion alone.
Medication: My medication approach is layered to match the layered pathophysiology. Hormonal: continuous combined oral contraceptives or progestins for suppression; GnRH antagonists with add-back therapy for moderate-to-severe or refractory cases; and, in carefully selected refractory cases, aromatase inhibition. Pain and nervous system: NSAIDs for inflammatory flares, neuromodulators (gabapentin, low-dose amitriptyline) for sensitized pain, and low-dose naltrexone for its anti inflammatory and central sensitization effects. When MCAS overlaps, I use mast cell-directed therapy (H1/H2 blockade, cromolyn, ketotifen, microdosing of GLP/GIP). Locally: compounded topical hormones for tissue health: including vaginal estrogen +/- testosterone, neuropathic agents and vestibular or intravaginal onobotulinintoxinA for refractory high-tone dysfunction. For patients with metabolic or weight related comorbidity that is worsening their inflammatory burden and pain, I incorporate microdosed GLP-1/GIP receptor agonists – using low, titrated doses to capture the anti-inflammatory and metabolic benefits while minimizing GI side effects. Medication is always paired with bodywork and PT – drugs quiet the fire; they do not release the tissue.
Pre-surgical care plan: Before surgery, my goals are to decrease inflammation, calm the nervous system and optimize the tissue environment so the patient gets the most from the operation. I treat high-tone pelvic floor dysfunction and central sensitization preoperatively (pelvic floor therapy with myofascial release, visceral manipulation and – when indicated vestibular or intravaginal onobotulinintoxinA) so that postoperative pain is not layered onto a guarded, sensitized pelvis. I optimize the hormonal and inflammatory milieu, stabilize any comorbid mast cell activation, connective tissue disorder, dysautonomia, address bowel and bladder function, and coordinate timing and preoperative instructions with the excision surgeon. Just as importantly, I set expectations: surgery removes tissue, but it does not resolve muscle guarding, fascial restriction, or sensitization – so patients understand pre-surgical work is a crucial part of the overall treatment plan.
Post-surgical care plan: Postoperatively, I see patients early to support healing and prevent the pain cycle from restarting. The plan includes: (1) early hormonal suppression to reduce recurrence, given the estrogen dependent nature of lesions and the stem cell mechanism behind regrowth; (2) graded pelvic floor therapy once the surgeon clears it, to prevent guarding from becoming chronic high-tone dysfunction; (3) myofascial release and visceral mobilization after adequate healing to address adhesions, scar tissue, and fascial restriction, and restore visceral mobility; (4) bowel, bladder, and sexual function rehabilitation; and (5) structured follow-up to catch persistent symptoms early. I integrate the surgeon’s operative findings (disease extent, locations, complications) directly into the ongoing plan.
Imaging: When I have a high clinical suspicion for endometriosis—particularly with history or examination findings suggestive of deep infiltrating disease, such as uterosacral ligament nodularity, thickening of the posterior vaginal fornix, or dyspareunia, dysmenorrhea, and dyschezia—I refer directly to a trusted endometriosis excision surgeon rather than pursuing imaging myself. My reasoning is that a normal ultrasound or MRI does not rule out endometriosis: both modalities can reliably identify endometriomas and deep disease but frequently miss superficial peritoneal implants, and even expert readers can miss lesions because of their variable appearance and location. Any needed imaging is best obtained and interpreted as part of the surgeon’s preoperative planning. Consistent with the ACOG (2026) guideline, a clinical diagnosis based on symptoms and examination is sufficient to act on, so I also offer symptomatic patients empiric medical therapy in parallel while awaiting surgical evaluation— treatment is never delayed.
Approach to the persistent symptoms after surgery: Persistent postoperative symptoms mean it is time to reassess systematically, not to assume failure orreflexively repeat surgery. I work through a differential: residual or recurrent disease (targeted re-imaging or surgeon re-evaluation when indicated), myofascial dysfunction and fascial restriction from adhesions and scarring, persistent high-tone pelvic floor, central sensitization, and overlooked comorbidities such as MCAS, hEDS, bladder or bowel dysfunction. Treatment is matched to the finding: myofascial release and visceral mobilization for tissue restriction, pelvic floor rehabilitation for muscle guarding, hormonal adjustment for recurrent disease, LDN or neuromodulators for sensitization, and coordination with the surgeon for reoperation only when there is a clear target. Most persistent pain after excision is a muscle, fascia, or nervous system problem – and that is treatable.
Learn more: https://www.pelvichealthsupport.com/
Magen Price
Magen Price, FNP-BC, MSCP, CSC
Endometriosis Long Term Care Provider
Summary: Magen Price, is a Family Nurse Practitioner and skilled Long-Term Endometriosis Care Provider at Mystic Valley Sexual Wellness in Melrose, Massachusetts. She specializes in individualized, comprehensive care for endometriosis, with particular expertise in hormonal health, menopause, and sexual health. Her approach is evidence-informed and patient-centered, incorporating progestogens and oral contraceptives for endometriosis, as well as individualized hormonal therapy during the menopause transition, including oral micronized progesterone, estradiol, and, when appropriate, testosterone guided by ISSWSH recommendations. Pain management may also include analgesics, vaginal suppositories, and non-pharmacologic modalities.
Magen emphasizes comprehensive support throughout the surgical journey. Before surgery, she focuses on patient education, anticipatory guidance, and ensuring that patients have the appropriate emotional and practical supports in place. When possible, she collaborates closely with surgeons and values established relationships with excision specialists. Following surgery, she takes a hands-on approach to recovery, with particular attention to pain management during the first six months, monitoring for postoperative complications, and supporting patients as they begin pelvic floor physical therapy when appropriate. She also helps manage coexisting conditions, including mast cell activation syndrome and autoimmune disease, which may flare during the postoperative period.
Magen earned her Master of Science in Nursing (MSN) as a Family Nurse Practitioner from Simmons College in Boston in 2013 and her Bachelor of Arts in Biology and Psychology from Boston University in 2009. She is a Certified Family Nurse Practitioner through the American Nurses Credentialing Center (ANCC), a Registered Nurse in Massachusetts, a Menopause Society Certified Practitioner (MSCP), and an AASECT Certified Sex Counselor (CSC) and Approved Continuing Education Provider. Her professional affiliations include the International Society for the Study of Women’s Sexual Health (ISSWSH), where she serves on the Education Committee, as well as AASECT, The Menopause Society, the International Society for Mast Cell Activation Syndromes (ISMCAS), and the American Association of Nurse Practitioners (AANP).
City: Melrose, Massachusetts, USA
Visit types: In-Person and Telehealth
Spoken languages: English
Interpreting services for other languages: No
Philosophy of Endometriosis Care: While we aren’t married to any one theory, the polypotential germ-cell is probably at the forefront of our mind and dictates much of how we approach our patients.
Medication: Our practice is most focused on midlife care (though we have plenty of younger patients as well), so our expertise is really in hormonal treatments. For endometriosis we use progestogens and oral contraceptives, we use oral micronized progesterone, estradiol, and testosterone in the menopause transition (thoughtfully, per ISSWSH guidelines, and depending on the case). We have never needed to prescribe GnRH analogues in our practice. Pain management includes analgesics and vaginal suppositories, as well on non-pharmacologic modalities.
Pre-surgical care plan: Pre-surgery much of our focus is on patient support and anticipatory guidance. We work closely with surgeons (if possible). It is much easier when we have a relationship with their excision specialist. We help ensure supports are in place and all questions are answered.
Post-surgical care plan: Post-surgery we are much more hands-on. We focus on pain management for the first 6 months post-op, help with PFPT support when ready, and monitor for any post-surgical complications. We manage coexisting conditions such as MCAS or autoimmune disease which can flare post-surgery.
Lillian Medhus
Lillian Medhus, DNP, WHNP-BC, CNM, MSCP
Endometriosis Long Term Care Provider
Summary: Lillian Medhus, DNP, a Women’s Health Nurse Practitioner and skilled Long-Term Endometriosis Care Provider at Aspire Women’s Wellness. She specializes in comprehensive management of endometriosis, viewing it as a chronic, systemic neuroinflammatory condition and providing individualized, evidence-based care that addresses the whole person rather than focusing solely on gynecologic symptoms
Her comprehensive approach combines hormonal and non-opioid pain management, lifestyle and dietary interventions, metabolic health optimization, and treatment of coexisting conditions such as pelvic floor dysfunction, adenomyosis, migraines, IBS/IBD, hypermobility, MCAS, and mood disorders. She collaborates closely with surgeons, pelvic floor therapists, mental health providers, dietitians, and other specialists to support patients before and after surgery.
Lillian is a Menopause Society Certified Practitioner and holds certifications as a Certified Nurse Midwife, Women’s Health Nurse Practitioner, Certified Nurse Practitioner, and Registered Nurse. She earned her Doctor of Nursing Practice from Frontier Nursing University and her Master’s degree in Nurse Midwifery and Women’s Health Nurse Practitioner from Georgetown University, complemented by advanced training in trauma counseling.
City: Northfield, Minnesotta, USA
Visit types: In-Person (MN only) and Telehealth (throughout MN, TX, OK, and KS)
Spoken languages: English
Interpreting services for other languages: No
Philosophy of Endometriosis Care: Endometriosis is a chronic, neuroinflammatory condition that affects the entire body. The origin is likely genetic and pathophysiologic in nature, with an increased risk of symptoms in patients with other neuroimmune conditions. Treatment must look at the entire body, not isolated treatment of the gynecologic organs. Interventions to reduce inflammation and improve long-term health, include treatment of insulin resistance, nutrient deficiencies, consideration of the increased cardiovascular risks of endometriosis, and treatment of chronic overlapping pain conditions and central sensitization. Patients achieve the best outcomes with interdisciplinary care among surgeons, pelvic floor therapists, mental health providers, dieticians, long-term care providers, and other complementary therapies.
Medication: Progestogens: Progesterone, Drosperinone, Norethindrone acetate, Medroxyprogesterone. Progestogens are utilized for dysmenorrhea, menorrhagia, or chronic pelvic pain. Type of progestogen is based on patient preference, medication history, and pregnancy plans. I currently practice through telehealth only, however I may encourage a patient with suspected adenomyosis to pursue levonorgestrel IUD with their local GYN provider. Low dose naltrexone is utilized as an off-label option for chronic pain & inflammation. Vaginal suppositories (typically baclofen, with or without diazepam & gabapentin) are utilized for pain flares, sciatic pain, and hypertonic pelvic floor. Tirzepatide is used on-label for patients with insulin resistance, obesity, or metabolic disease. It is used off-label in small doses for inflammation. NSAIDs are utilized for pain. GnRH analogs are only used if the patient comes to our practice stable on them or as a bridge to surgery in very rare cases, and only as a final resort. Duavee/bazedoxifene may be an emerging option for endometriosis and menopause.
Pre-surgical care plan: Patients who are awaiting surgery, or who decline surgery, receive a holistic plan of care. New intake visits include a comprehensive lab panel, looking for any other causes of inflammation, fatigue, bloating, or other chronic symptoms which can be improved. Patients are referred to pelvic floor therapy in most cases, especially if there is evidence of pelvic floor dysfunction. Patients are also offered referral to mental health providers skilled in treatment of chronic disease. Patients are offered treatments including dietary interventions (ie- anti-inflammatory diet patterns & blood sugar management), evidence based supplement regimens, and non-opioid pain relief (including vaginal suppositories & NSAIDS). Collaborative care with the surgeon is utilized to make the decision whether to employ hormonal treatment options, or to defer until after surgery.
All the above is also utilized if a patient comes to me after surgery. Additionally, we will consider the use of hormonal options, most often progestogens. We will tailor treatment to any persistent symptoms, or other chronic overlapping conditions (MCAS, hypermobility, mood disorders, migraines, pelvic floor dysfunction, IBS/IBD, etc).
