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Endometriosis

[00:00:00] Yep. The bulb is here today I wanna talk about endometriosis because I heard the term endo warrior twice this week, and I have to tell you that while I really dislike kind of aggressive inflammatory terms, the word warrior here could not ring more true. I hesitate to even use the word warrior when it comes to my cancer treatment for various reasons. 

But when it comes to endometriosis, if you've had it, you know that monthly when your period comes, or for some people in between their periods, that feeling like you're going into battle is actually there. You have to brace yourself because it is terrible in a way that cannot be explained to anyone who has not gone through it. 

So I say that as a doctor and a former endo warrior, now that I have no more endometriosis as my uterus and ovaries in. Feminine parts outside of my bald and vagina and breasts are gone, and I'm okay with that. I'm not defined by my parts. Here's what I really [00:01:00] want us to discuss with endometriosis. Just to give everyone a little background, endometriosis is basically when the lining of the uterus, which is called the endometrium or the endometrial cells, endo is inside. 

Endometrium is uterus, so the cells on the inside of the uterus as opposed to the myometrium, which is the muscles. These cells are very specific to the uterine lining. Every month they're supposed to thicken and then shed, and that's your period. We don't know how, there are multiple different theories, but some people with uteruses will have these endometrial cells or what will be called implants, growing in other parts of their body, most notably in other parts of their pelvis, outside of the uterus. 

Not where they should be. So you could imagine every month when the uterine lining is supposed to thicken and shed these other implants of endometrial cells can thicken and essentially they have no place to go. They have no egress, they have nowhere they can flow out of, like coming out of the uterine lining, like coming out of the cervix. 

And so they can cause [00:02:00] pain, pressure, bloating. They can cause scarring in your pelvis, meaning the outside surface of your uterus can have implants as well as on your bowel, on your. It's even been described in really remote parts of your body. People have had it in their brain and in their nose, which are rare. 

So most commonly it will be in other parts of your pelvis, and again, because it can sit on your bladder, you can have bladder pain and discomfort and bladder symptoms because it sits on your bowels. You can often have that gassy bloating. Is it gonna be constipation? Is it gonna be diarrhea labeled as ibs? 

You know right before your period, for example, for some. It is in our ovary, and then it's called an endometrioma. OMA means growth in the vernacular of medicine, and so an endometrioma means a growth of endometriosis. Why is that important? Well, for two reasons. One, endometriosis is very often underdiagnosed because we don't have a great test for it. 

You can have a normal ultrasound and you still very, very likely can have endometriosis if your symptoms seem [00:03:00] to make. Very painful periods. Lying in bed, by the way, with a heating pad every month when you have your period is not the norm. Don't let people make you think that's the norm. It's not, and it should be evaluated and treated. 

So we don't have great tests because ultrasounds can't rule it out. There's no other way other than directly looking in your pelvis with surgery to be able to diagnose endometriosis. And as you can imagine, we don't wanna put every single person through surgery to diagnose. Because the treatment will end up potentially being the same, which we talk about in a sec. 

So that's the first reason endometriosis are important because an endometrioma can be seen on an ultrasound. So one of the few times we can definitively say someone has endometriosis outside of just their symptoms is, oh, look, I see what looks like an endometrioma on your ultrasound or pelvic mri. The second reason is rarely, rarely, rarely, endometrioma. 

Can transform into ovarian cancer, which is what happened in my case. So if you are one of those few people who definitively knows that you have an endometrioma, please make sure that you are being followed and evaluated. regularly. There's no guideline to say how often, [00:04:00] but I would argue, talk to your doctor and set out a plan with her as to how often you need ultrasounds or MRIs to make sure that there has been no malignant transformation. 

Again, it's rare, so I don't wanna be inflammatory. Now, my feelings in general about endometriosis are it is all at once underdiagnosed, as I said, but it's almost all at. , um, overdiagnosed, and I say that in quotes because it's not exactly true. It's that many women, when they have very painful periods, they then read about endometriosis. 

They're completely accurate in saying, wait, this is what I think I have. How come no doctor has mentioned it to me before? There's a long history. It's why, right? Paternalism, lack of time, all the things that happened in the medical community. And then what ends up happening is the people who then read this on the interwebs get filled with fear and anxiety. 

because what they read is endometriosis will lead to scarring and infertility. And what I really wanna offer out there is I think we need to do a much better job about describing to people with uteruses that when you bleed, you shouldn't be doubled over in bed. You shouldn't [00:05:00] be downing a bottle of ibuprofen every month. 

You shouldn't need a heating pad every month. If you have those symptoms, please talk to us because it's possibly you have endometriosis. We should educate you on the fact that an ultrasound does not rule it out, but it's still very important to do, to make sure you don't have other reasons for these painful periods like fibroids or other cysts. 

We should also very much educate you on the fact that yes, in theory it can cause. Scarring or other release of maybe things that we don't even know about, inflammatory markers that can lead to infertility, but that there are millions, if not billions of women who have endometriosis, either diagnosed like me, who still have babies and didn't have fertility issues because of their endometriosis, or who never got diagnosed with it, had painful periods, went on the pill. 

The pill controlled it. They went off the pill, they got pregnant and they were fine. That's why I say it's. Overdiagnosed, meaning the anxiety attached to it can be, um, over amplified for some people. For other people it's under amplified. So it's a huge conundrum. So I wanna be very clear in what I feel about it. 

We have not done a great job in the medical community about. Describing [00:06:00] it to you, explaining what it is, explaining how we can rule it in or ruling it out. And in talking to you about the various different forms of treatment, which can range from very purely Western medical, like birth control pills, all the way through things like acupuncture, meditation, things like that. 

We don't describe enough that yes, there can be perils with endometriosis outside of just the pain and discomfort, which can be horrible, but also fertil. Problems with your bowel and your bladder, but we also at the same time need to not make it so fear-based that any one of you ever hears the word endometriosis then thinks they will not be able to get pregnant because that is also not true. 

So that was a lot to digest. I'm back to trying to do longer videos because I think I can just do better than 90 seconds. So I hope that makes sense. Please ask me questions. There's so much more to talk about than endometriosis. We can do better.