[00:00:00] It's Wednesday of my birthday week. You know, I have to talk about my birthday night cuz I like my birthday. I really don't actually even love my birthday. I actually really don't love my birthday. I say that every year and I'm always like, I don't even like making anything. I really wanna celebrate my birthday.

And then I actually always have so much fun on my birthday. I used my birthday week this week, particularly since I now get to enjoy the fruits of the social media, um, as I'm approaching the 30,000 followers because now I get to use this platform to get attention, um, and teach you guys. Today's topic, people is endometriosis because we've discussed the miscarriages, we've discussed the big love, your surgeon and the jangles.

We're still gonna talk about the ovarian cancer. That's a big one coming down the pike this week. Uh, but we need to talk about. The endometriosis cause that is a huge part of my life and health journey, [00:01:00] and that began way before I became a doctor. I don't wanna make this a very clinical discussion about endometriosis, but for the purposes of just understanding endometriosis in a nutshell, which is not actually so well understood.

So I'm gonna make it. As brief as I can because I don't even as a physician fully understand it because physicians don't even fully understand it. We'll talk about it into these terms. This is my model of the uterus. This is actually an IUDs model of the uterus. This is the uterus. This is where an I U D would sit.

By the way, the inside part of the uterus is the end endometrium. End domains, inside endometrium, the uterus. Okay, so the endometrial cells are different than. Muscle, which is the my endometrial cells. Somehow we don't know how is it from embryological times when we were born? We don't know these cells, the endometrial cells can get into other parts of our pelvis, and so you can get endometriosis.

Those parts of the uterine lining can get into other parts of our pelvis, including in our ovary, and that means that every month when the uterine lining cells [00:02:00] should thicken and shed out of your cervix as your period, I. Those little endometriotic plants, the little implants, I didn't mean to say plants, implants can actually thicken imagine, and they don't have a place to shed.

So if they're in your ovary, they grow in your ovary, and if there are other parts of your pelvis, they have nowhere to go. So they just grow and they cause pain. Now here's the confusion. This is where I will talk about the polarizing aspect of endometriosis. Let's say every month you have pelvic. And it's very obvious.

Every month I have debilitating pain where I am lying in bed with a heating pad, and it's coupled with horrible noxious gas bloating. If that is your discomfort level and you're taking like four Advil or Motrin every six hours and you can't go to school or work, you really might have endometriosis. And if you go to your doctor and your doctor says, well, your ultrasound looks.

There's [00:03:00] nothing or they imply, well, your ultrasound looks fine, and you interpret that to mean you don't have endometriosis and they don't explain this. Then unfortunately, the patriarchy, again, I will label it as the patriarchy. It doesn't mean men. It just means like our system has done, we as women or we as humans who have uteruses wrong because endometriosis cannot be discovered only by ultrasound.

In fact, it will not be discovered by an ultrasound unless you have it in your. So if it's in your ovary, they will see it as a collection in the ovary. But if it's in any other part of your body or pelvis, it will not be seen. Patients will say to me all the time, well, the doctor did an ultrasound and I didn't have endometriosis.

The doctor did a uterine biopsy. They didn't do see any endometriosis. That is not how you will diagnose it. You will only diagnose it definitively by doing a laparoscopy where we look inside your pelvis to see it. Indirectly, if we happen to see it on an ultrasound where there are fairly [00:04:00] definitive features on an ultrasound, I say that not concretely, because it's not definitive.

You can suspect it on an ultrasound or. by indirect measures, like your story is fairly significant with dysmenorrhea, which means pelvic pain during your period, but to the level of which we suspect you might have endometriosis. Now, many women are not diagnosed, and I don't think this is the fault of.

The medical system because let's say you came to me and said, I have really bad periods, like I'm laying in bed. All the things I just said, and I would say to you, okay, here's the deal. You might have this word, and I try to dip my tone, educate my patients, even when they're younger with their moms in a non-car way and say, you might have heard of this entity.

Please don't look it up because you'll freak out. You'll think you're gonna have infertility and all these issues that you may end up having, but you all very frequently will not. It does not always lead to. In fact, very often it doesn't. Millions of women have endometriosis and don't have fertility issues.

I had [00:05:00] miscarriages, but they were very likely not because of my endometriosis. And so I'll say we might not diagnose it cause the only way to definitively diagnose it is a laparoscopy. I will do an ultrasound in the absence of a finding, like an end endometrioma, which is the mass in your ovary. I won't be able to say you have it or not.

I might tell you, you still might have it, but if you'd like us to try to cause less pain, here are the things we can do. In the Western world, we would put you on the birth control pill or use the progesterone i u D. If we're talking more, more eastern influences, we can do a bevy of things like change what you're eating, acupuncture, pelvic floor, physical therapy, and we can do both together.

That's the beauty of it. You don't have to do one or the other. Are any of them perfect? No. Is the PE perfect? . Anyway, that's all I wanna say about that cuz I don't wanna discuss, I just said I don't wanna discuss it clinically and there I just did. There's so much more to say about it. Um, the polarizing aspects I find are that there are certainly women who have [00:06:00] truly debilitating life altering endometriosis who absolutely need to be seen by very specific subspecialists, who absolutely do meticulous surgery.

But that is a subset of women. There are millions of women who. Endometriosis that is either undetected or very strongly suspected but not confirmed on, on a surgery like a laparoscopy who will be able to manage their lives with either birth control pills or i u d. Sadly, they are now maligned by many influencers, many women who are making documentaries about this, and now these women who are taking birth control pills are being inflicted with fear about the fact that they're taking birth control pills and being told that they have done wrong or harmed their body when in fact they've.

Help themselves in so many ways by not only stopping their pain but decreasing certain cancer risks. I get really upset and hot and bothered when we talk about that. And, um, and they are gonna go on to have long and healthy lives [00:07:00] with children should they want them. Because the concern with endometriosis is that directly it might scar your tubes and indirectly we don't really know, does it secrete certain co-factors or other things that might.

infertility or fertility issues I like to say. So that's what I'm gonna say clinically about it. What I'm gonna say personally about it, my journey started when I was young. I was having, again, those. Debilitating pains that I would talk about. I would literally be like laying in bed. It would be terrible.

I remember my friends will even tell you that there were always bouts where, you know, we would be out and I would be laying in bed. I, I mean, my best friend can tell you like, we were in Europe and I was like about to pass out on a train. I remember missing a trip to DC like a reunion back to college because I literally could not get up off the couch.

And I was not a woos. I was not a wimp. And the culmination, I remember in medical school where Nimrod Diane, one of my best friends, was um, at school. It was one of the only days I [00:08:00] missed a, like a class A rotation in medical school. And I was writhing back and forth in. I actually thought I had a kidney stone.

That's how bad it was. In retrospect, I believe that was the beginning of my end endometrioma, where I had it in my ovary and I think it must have been twisting. And I remember calling him and saying, I am not showing up for our rotation and PS I will never have children because whatever's going on in this body is horrible and I would like a hysterectomy.

This shows how little I knew at the time because I was not yet an ob g. Medical student. I had not gone through that rotation and I was like, I don't know what's happening. Is it my uterus? Is it, I don't know what it is. Is it a kidney stone? I just, everything here is bad. And as it turns out, within the next three months, I was in my OB G Y N rotation and a resident that I had become close friends with said, you're in so much pain, I need to do an exam.

And as she examined me, she literally, Shiva, you feel like you are four months pregnant Because I had a cyst in my [00:09:00] ovary that was 17 centimeters and me who was by the way, 40, 35 pounds less than I am now. did not know that. Didn't know it because what do we do as women? You know? I have been peeing a little bit more lately, you know?

I do feel like I've been having some more pressure lately. Like I did what we all do as women. I did not pay attention to my symptoms. Exactly. I was like, I have been feeling pain. I did have that day where I was laying in bed and I thought I wanted a hysterectomy. I do feel like I was a little bit more bloated, bloating, pain, and.

Ladies or people with uteruses and ovaries. If you have bloating, pain, or pressure and it lasts more than two weeks, you likely don't have anything onerous. But we don't know that. Do not do what most women do. Do not assume it was, you know, you're, you're a white wine that you had your trainees who you had, don't assume anything other than, I'm sure I'm not dying, I'm not gonna be crazy, but it could be something.

I'm gonna call my doctor and I'm going to say that I need a pelvic [00:10:00] ultrasound and I'm gonna con confirm that I. , even if she doesn't suggest it. And I'm unfortunately gonna know that my insurance might not cover it. And that is not my doctor's fault. I'm gonna call my insurance company and bitch to them about it and they still might not cover it.

That's a fact. That's a whole nother thing we could talk about. So fast forward, I called my mom and said, uh, turns out I have a big cyst and I'm gonna stay here in Tel Aviv to have it operated on. And of course my mother said, hell no. You're gonna come back to America where I know all the doctors. So I went home and an amazing doctor Effi Chang.

Remove that 17 centimeter endometriosis, preserved whatever she could of my ovary. I'm fairly certain that never, that ovary never worked again. And I say that purposefully, so y'all know that I went on to then get pregnant nine times, nine times six miscarriages that had nothing to do with endometriosis.

Um, flash forward my endometriosis was then very controlled with birth control pills. And then in between my birth control pills, I was pregnant. . I then [00:11:00] stopped taking birth control pills after my last pregnancy, my baby girl when I was 41, and I birthed her. I had no signs of endometriosis anywhere else in my pelvis during my C-section, and so I had a good five years where I really had nothing, and then it started to come back as again.

Pretty debilitating pain. And that will be the beginning of my discussion about my ovarian cancer journey. That will be for another day. I wanna use this as a discussion though. Women are so strong and that is amazing. But ladies, we cannot ignore our bodies and our pain. We have to be strong and uber sensitive in the best possible way about ourselves and our bodies.

Sensitivity does not have to mean weakness. Sensitivity means the most deep and emotional engagement, not only with the outside world, but with our. You need to be in touch with yourself. You need to be emotionally engaged and physically engaged with yourself. This notion that to be strong and powerful in this world [00:12:00] somehow means that we need to be like men disengaged.

Obnoxious, um, ab aggressive in a way where we power through things is wrong. We need to absolutely understand who we are and how we feel, again, emotionally and physically. The fact that I do at times ignore my own physical symptoms is not something I'm proud of. It is not something that I wanna teach the next generation.

Am I proud that I. That I have a great work, work ethic and that I feel strength and power in my physical, my physicality. I, I do feel str. I feel very proud of that. I really do because I do feel that despite everything I've put my body through, I am a physically and emotionally strong and powerful woman.

But I do think that I have not honored my body as much as I should have in my entire life for many different reasons. The food aspects, how I treat my body as far as exercise, certainly how I've honored my, my pelvis in my body. [00:13:00] I did not pay attention often to the signs and symptoms. I'm lucky. Then in the end I did, and that's how I caught my ovarian cancer, which again, we will talk about.

But when it comes to pelvic pain, we need to be much more mindful. If we want to catch the signs and symptoms of two incredibly important things, endometriosis and ovarian cancer, we need to do better as. And I will fight for that. And as women, and I will urge you for that. And I will say again, sorry, people with uteruses, if you have pain, pressure or bloating for more than two weeks, please call your doctor.

If you have periods that are mildly crampy and you get through it with like maybe a Tylenol or an Advil or nothing where you just have. That is perfectly fine. That is your uterus contracting from the effect of prostaglandin. But if you have pain that is putting you in bed, laying you flat, you need a heating pad, you need Motrin or Advil or you don't need it merely because you are [00:14:00] weathering through it and powering through it.

You need an evaluation. And if you're merely being told like, well, I don't see anything, that means you're. , that is not the answer. It doesn't mean you're fine. It means we haven't found anything concrete, but you have pain. So we need to address the reasons why they can occur that we cannot discover. Does that make sense?

Okay. There's so much more to discussion on this topic. It is an emotional discussion. It is a physical discussion. It is a political discussion because here's where I will say the patriarchy, the government, the insurance, c. They do not have a vested interest in making sure that people have time to take care of themselves, that people have the care when it comes to insurance companies and insurers to get the testing they need to get potentially the medication they need.

And this is absolutely a polarizing discussion when it comes to Western and integrative medicine. So much more to say. Have a good day.