Send us a text with a question or thought on this episode ( We cannot replay from this link)
Is endometriosis really just a reproductive disease? Dr. Megan Wasson, Chair of Medical and Surgical Gynecology at the Mayo Clinic, joins us to break down how endometriosis impacts people at every age — from teens with “normal” cramps to postmenopausal individuals still battling symptoms.
We unpack the red flags, the myths, and what true care should look like at each stage of life.
In this episode, you’ll learn:
• Why period pain that affects school, work, or life is never normal
• How early symptoms in teens are often mislabeled as anxiety
• What trauma-informed pelvic exams should look like for adolescents
• Why “birth control is a bandaid” and not a cure for endo
• When excision surgery can support fertility — and when it may not
• What to know about perimenopause and endo symptom flares
• Why menopause doesn’t always “cure” endometriosis
• How hormone replacement therapy (HRT) can still be safe and helpful
• Why surgery can still help after menopause
• The critical role of support people in navigating care
👉 If your period is more than an inconvenience, something is wrong. It’s time to speak up, be heard, and get the care you deserve.
🎧 Tune in now on your favorite podcast app or watch the full conversation on YouTube.
#Endometriosis #ChronicPain #MayoClinic #TeenPeriodPain #PelvicPain #Menopause #HRT #ExcisionSurgery #InvisibleIllness #EndoEducation #WomensHealth
Website endobattery.com
Endometriosis at every age
Speaker 1
0:00
Endometriosis
doesn't
care
how
old
you
are
.
Maybe
you're
a
teen
with
symptoms
and
no
one
can
explain
.
Let's
be
honest
many
have
heard
you're
too
young
for
endometriosis
.
Maybe
you've
spent
your
20s
or
30s
chasing
answers
.
Maybe
you're
in
menopause
,
thinking
,
wait
,
why
am
I
still
in
pain
?
In
this
episode
,
dr
Megan
Wasson
,
chair
of
Medical
and
Surgical
Gynecology
at
the
Mayo
Clinic
,
walks
us
through
what
endo
can
look
like
at
every
stage
of
life
.
We
talk
about
symptoms
that
are
too
often
dismissed
,
approaches
to
pain
management
when
surgery
makes
sense
and
what
care
should
look
like
,
not
just
in
your
reproductive
years
but
beyond
.
Yes
,
we
even
go
there
Endo
after
menopause
.
If
you've
ever
felt
confused
,
dismissed
,
just
plain
tired
of
the
fight
,
this
episode
is
for
you
.
Dr
Waston
brings
clarity
,
compassion
and
real
insight
into
the
care
we
all
deserve
,
whether
you're
14
,
45
,
or
74
.
So
grab
your
favorite
drink
,
take
a
deep
breath
and
join
us
,
because
you
are
not
alone
in
this
fight
.
Speaker 1
1:09
Welcome
to
EndoBattery
,
where
I
share
my
journey
with
endometriosis
and
chronic
illness
,
while
learning
and
growing
along
the
way
.
This
podcast
is
not
a
substitute
for
medical
advice
,
but
a
supportive
space
to
provide
community
and
valuable
information
so
you
never
have
to
face
this
journey
alone
.
We
embrace
a
range
of
perspectives
that
may
not
always
align
with
our
own
,
believing
that
open
dialogue
helps
us
grow
and
gain
new
tools
,
join
me
as
I
share
stories
of
strength
,
resilience
and
hope
,
from
personal
experiences
to
expert
insights
.
I'm
your
host
,
alana
,
and
this
is
IndoBattery
charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
Indoobattery
.
Charging
our
lives
when
endometriosis
drains
us
.
Welcome
back
to
Endobattery
.
Grab
your
cup
of
coffee
or
your
cup
of
tea
and
join
me
at
the
table
.
Speaker 1
1:53
Today's
guest
is
someone
who
brings
a
deep
expertise
,
compassion
and
innovation
to
the
field
of
gynecology
.
Dr
Megan
Wasson
is
the
chair
of
the
Department
of
Medical
and
Surgical
Gynecology
at
the
Mayo
Clinic
in
Arizona
and
a
professor
of
obstetrics
and
gynecology
at
the
Mayo
Clinic
College
of
Medicine
and
Science
.
She's
a
leader
in
minimally
invasive
gynecologic
surgery
,
a
respected
educator
named
Outstanding
Emerging
Educator
in
2020
,
and
an
internationally
recognized
speaker
with
over
200
invited
lectures
and
more
than
70
peer-reviewed
publications
.
Her
clinical
focus
includes
endometriosis
,
chronic
pelvic
pain
and
advanced
surgical
techniques
,
and
she
holds
a
fellowship
with
both
the
American
College
of
Obstetrics
and
Gynecology
and
American
College
of
Surgeons
.
Whether
it's
in
the
operating
room
,
at
the
podium
or
shaping
global
surgical
standards
,
dr
Wasson
is
helping
redefine
what
care
can
look
like
for
patients
around
the
world
.
Speaker 1
2:50
Please
help
me
in
welcoming
Dr
Megan
Wasson
to
the
table
.
Thank
you
,
dr
Wasson
,
so
much
for
joining
me
today
.
I'm
so
grateful
to
have
you
.
Thank
you
for
taking
the
time
to
sit
down
with
me
.
I
know
your
schedule
is
so
crazy
.
You're
a
busy
doctor
,
busy
mom
,
so
thank
you
so
much
.
Speaker 2
3:05
Oh
my
gosh
,
thank
you
for
having
me
.
I
will
always
make
the
time
to
talk
about
endometriosis
,
so
thank
you
for
inviting
me
and
sharing
a
little
bit
of
your
time
today
.
Speaker 1
3:15
Absolutely
.
This
is
what
I
love
doing
.
I
love
being
able
to
communicate
all
the
things
that
we
get
to
talk
about
today
,
and
one
of
the
things
that
we're
both
passionate
about
is
endometriosis
.
But
before
we
dive
in
,
can
you
tell
us
a
bit
about
what
drew
you
to
this
work
and
what
keeps
you
passionate
about
helping
people
with
endometriosis
?
Speaker 2
3:34
Oh
my
gosh
,
it's
definitely
been
a
journey
,
for
sure
.
Speaker 2
3:37
So
initially
I
started
to
even
understand
endometriosis
and
start
to
see
it
during
my
residency
.
Speaker 2
3:43
So
after
medical
school
,
doctors
go
to
residency
where
they
learn
more
in-depth
specialty
training
.
So
for
those
of
us
who
specialize
in
endometriosis
,
that's
typically
going
to
be
an
OBGYN
residency
.
So
during
OBGYN
you
spend
time
with
different
surgeons
and
infertility
specialists
and
that's
really
where
I
started
to
learn
about
endometriosis
but
minimally
invasive
surgery
as
a
whole
.
And
that's
when
I
chose
to
do
a
fellowship
and
thankfully
I
matched
at
Mayo
Clinic
in
Arizona
,
where
there
is
a
huge
focus
on
endometriosis
,
and
that's
where
I
really
started
to
actually
understand
the
disease
and
the
individuals
that
this
disease
affects
and
how
much
of
an
impact
there
is
on
quality
of
life
.
And
not
only
understanding
the
disease
,
the
amazing
surgeries
that
we're
able
to
do
to
help
these
Dr. Wasson's journey with endometriosis care
Speaker 2
4:28
individuals
,
but
then
also
seeing
the
impact
that
I
can
have
just
by
being
a
listening
set
of
ears
and
seeing
people
and
hearing
people
when
they
haven't
been
seen
or
heard
truly
for
at
least
half
their
lifetime
very
commonly
is
incredibly
rewarding
.
And
then
seeing
the
outcomes
after
we're
able
to
treat
endometriosis
I
just
I
love
it
.
Speaker 1
4:48
It
gives
the
fire
in
my
belly
and
gives
me
a
reason
to
get
up
every
day
and
come
in
and
do
what
I
love
Is
there
one
specific
story
or
patient
that
really
sticks
out
to
you
,
that
really
helped
frame
your
work
and
how
that
just
completely
changed
the
way
that
you
treat
patients
,
the
way
that
you
investigate
endometriosis
patients
.
Is
there
one
story
that
just
sticks
out
to
you
the
most
?
Speaker 2
5:15
Oh
my
gosh
,
there
are
so
many
stories
.
To
pick
one
is
really
,
really
hard
because
everyone
is
so
amazing
in
their
own
right
.
But
very
commonly
and
there
is
a
specific
patient
that
comes
to
mind
but
hearing
that
patients
started
having
issues
back
when
they
first
got
their
period
they
remember
being
in
high
school
laying
on
the
bathroom
floor
curled
up
in
the
fetal
position
,
having
to
have
mom
come
and
pick
them
up
from
school
and
take
them
home
is
a
very
common
story
.
That
starts
the
endometriosis
journey
and
then
patients
are
put
on
birth
control
pills
very
commonly
,
which
is
fine
.
Birth
control
pills
can
be
very
helpful
,
but
eventually
a
lot
of
individuals
want
to
start
a
family
and
so
for
this
one
particular
patient
,
that's
exactly
what
she
did
.
Speaker 2
5:58
She
wanted
to
start
a
family
with
her
husband
,
stopped
the
birth
control
pills
,
tried
to
get
pregnant
,
was
not
able
to
get
pregnant
,
but
all
of
these
symptoms
really
just
came
to
light
.
She
started
having
cyclical
bleeding
from
her
belly
button
.
She
was
having
severe
ascites
,
so
fluid
accumulating
in
her
abdominal
cavity
to
the
point
that
there
was
five
,
six
,
seven
liters
that
were
getting
drained
off
.
She
had
pleural
effusions
,
huge
amount
of
fluid
in
her
chest
cavity
every
time
she
had
a
menstrual
cycle
,
and
it
all
was
because
of
endometriosis
,
and
so
the
birth
control
pills
were
doing
amazing
,
masking
her
symptoms
,
putting
the
bandaid
on
the
symptoms
.
But
then
,
when
life
changed
and
she
wanted
to
pursue
pregnancy
,
that's
when
the
disease
was
truly
recognized
.
Speaker 2
6:46
Unfortunately
,
because
the
disease
was
so
advanced
,
she
ultimately
was
not
able
to
pursue
pregnancy
.
She
ultimately
had
a
hysterectomy
before
she
was
able
to
have
any
children
,
which
,
yes
,
I
saw
.
That
it's
heartbreaking
.
It's
heartbreaking
that
the
disease
takes
so
much
away
from
people
.
But
she
also
had
to
have
a
bowel
resection
.
She
had
to
have
her
belly
button
removed
.
She
had
to
have
a
VATS
procedure
.
A
large
portion
of
her
thoracic
cavity
and
her
diaphragm
removed
,
the
sac
around
her
heart
,
like
really
,
really
extensive
disease
that
she
probably
wouldn't
have
even
known
she
had
if
she
had
never
stopped
the
birth
control
pills
.
Speaker 1
7:22
Wow
,
I
mean
,
that's
huge
.
That's
what
,
in
advocacy
,
we
try
so
hard
to
convey
is
like
the
sooner
you
get
this
taken
care
of
,
the
better
,
which
brings
me
to
our
whole
discussion
today
.
We're
going
to
walk
through
the
different
stages
of
endometriosis
,
and
by
stages
I
mean
the
different
ages
and
stages
of
endometriosis
,
so
we're
talking
from
adolescence
to
postmenopausal
,
because
this
affects
people
at
a
wide
range
,
but
it
might
affect
them
slightly
differently
and
you
have
treated
patients
from
every
range
,
and
so
I
want
to
go
into
this
with
an
open
mind
.
But
also
I
really
want
to
empower
people
with
wherever
they're
at
,
to
learn
something
and
to
get
that
information
so
that
they
can
advocate
better
for
their
care
.
And
that's
,
you
know
,
one
of
the
sweet
things
that
we
get
to
do
is
,
in
advocacy
is
we
get
to
learn
with
everyone
.
So
can
you
briefly
just
,
we're
going
to
go
through
the
adolescence
and
early
teen
years
,
ages
roughly
10
to
19,
.
What
are
some
early
warning
signs
of
endometriosis
in
adolescents
that
often
get
dismissed
as
normal
period
pains
?
Early warning signs in adolescents
Speaker 2
8:35
Yeah
,
so
exactly
what
you
just
said
is
number
one
,
that
it's
quote
unquote
normal
period
pain
.
That
unfortunately
,
there's
a
lot
of
generational
trauma
that
can
almost
happen
.
That
because
we
know
there
is
a
familial
component
to
endometriosis
,
that
if
mom
had
endometriosis
and
really
,
really
struggled
with
painful
cycles
and
then
her
daughter
is
now
starting
to
have
cycles
and
really
struggling
,
they
don't
know
any
different
,
and
so
the
mom
tells
the
daughter
yeah
,
this
is
your
cycle
,
this
is
just
what
it
is
.
So
there's
that
huge
element
that
can
happen
,
that
the
family
is
normalizing
it
.
Speaker 2
9:09
Now
,
if
an
individual
goes
and
talks
to
her
doctor
,
most
commonly
the
pediatrician
is
who
is
going
to
be
the
first
sounding
board
for
this
and
they
say
,
yeah
,
I'm
having
cramps
.
And
the
pediatrician
doesn't
delve
into
it
any
further
and
they
say
,
well
,
yeah
,
everyone
has
cramps
with
their
period
.
It
gets
dismissed
and
that's
where
the
cycle
starts
happening
that
that
patient
may
never
bring
it
up
again
because
,
well
,
I
told
my
doctor
and
they
said
it
was
normal
.
So
,
yeah
,
I
guess
this
is
just
what
it
means
to
be
a
woman
and
what
it
means
to
have
my
cycle
,
and
so
that's
where
we
need
to
do
better
very
early
In
terms
of
specific
symptoms
,
to
watch
for
.
My
best
recommendation
is
always
to
think
about
your
period
just
as
an
inconvenience
.
Speaker 2
9:52
If
someone
is
having
symptoms
with
their
cycle
,
that
is
more
than
an
inconvenience
If
they're
having
to
change
their
activities
.
They're
not
able
to
do
their
sports
,
they're
not
able
to
dance
,
they're
not
able
to
go
to
school
,
they're
missing
going
to
the
movies
with
their
friends
because
of
their
menstrual
cycle
.
That
is
not
normal
.
That
should
absolutely
perk
ears
and
raise
red
flags
,
that
maybe
something
should
be
investigated
a
little
bit
further
,
specifically
for
the
adolescent
population
.
We
also
know
that
it's
very
common
to
have
pain
outside
of
the
menstrual
cycle
.
So
if
individuals
are
having
pain
,
not
just
with
bleeding
,
but
complaining
about
pelvic
cramping
,
discomfort
even
outside
of
that
timeframe
,
that
should
also
heighten
our
suspicion
.
There
could
also
be
a
lot
of
the
weird
vague
symptoms
that
can
carry
on
truly
throughout
life
,
so
nausea
,
diarrhea
with
the
menstrual
cycle
.
So
anything
along
those
lines
should
at
least
elevate
the
suspicion
that
endometriosis
is
a
possibility
what
age
range
do
you
typically
see
presentations
and
symptoms
in
these
patients
?
Speaker 2
10:54
yeah
,
so
if
you
have
that
heightened
index
of
suspicion
,
a
lot
of
patients
will
actually
present
even
before
they
get
their
first
menstrual
cycle
.
So
as
the
hormones
are
turning
on
,
as
the
ovaries
are
starting
to
circulate
,
that
estrogen
and
progesterone
,
that's
happening
before
you
actually
have
a
withdrawal
bleed
,
so
the
actual
menstrual
bleeding
,
and
so
individuals
can
start
to
have
pelvic
discomfort
,
pelvic
cramping
,
even
before
they
start
bleeding
and
,
as
we
know
,
the
age
of
menarche
so
when
the
first
period
comes
is
starting
to
go
down
.
It's
not
uncommon
to
start
seeing
symptoms
even
before
the
age
of
10
.
Speaker 1
11:32
Yeah
,
and
that's
interesting
because
I
think
,
as
someone
who
experienced
a
lot
of
these
symptoms
prior
to
my
first
actual
period
,
I'm
very
mindful
in
my
children
to
look
for
those
things
because
they
are
more
likely
to
have
endometriosis
,
and
so
for
me
to
be
aware
of
these
signs
and
symptoms
prior
to
even
their
menstrual
cycle
really
starting
or
shedding
of
the
blood
,
that's
key
for
a
parent
to
recognize
.
But
how
early
can
a
pelvic
exam
be
safely
and
ethically
performed
,
especially
in
these
young
patients
and
in
those
experiencing
chronic
symptoms
?
Speaker 2
12:12
Oh
my
gosh
,
I
love
this
question
so
much
because
we
can
do
a
lot
of
trauma
to
individuals
if
that
first
pelvic
exam
is
not
done
very
thoughtfully
and
very
deliberately
,
is
not
done
very
thoughtfully
and
very
deliberately
,
pelvic
exams
and
physical
exams
in
general
can
be
incredibly
beneficial
because
not
all
pain
is
endometriosis
and
we
need
to
make
sure
that
we're
not
missing
alternative
sources
of
pain
.
Speaker 2
12:35
But
there's
a
subspecialty
within
OBGYN
and
it's
called
pediatric
and
adolescent
gynecology
and
they've
really
perfected
how
we
can
do
these
exams
and
not
do
trauma
.
Speculum
exams
really
don't
have
much
place
at
all
in
the
pediatric
adolescent
population
,
especially
in
someone
who
has
not
been
yet
sexually
active
.
There's
a
lot
of
trauma
that
we
can
do
with
that
.
But
we
can
inspect
the
vulva
,
we
can
inspect
the
introitus
and
make
sure
there
isn't
something
like
an
imperforate
hymen
that
someone
may
truly
be
cycling
but
the
blood
just
can't
get
out
and
that's
where
their
pain
is
coming
from
.
So
we
can
do
physical
exams
,
especially
in
those
with
pelvic
pain
,
but
that
doesn't
necessitate
doing
what
most
individuals
would
think
of
as
a
pelvic
exam
.
You
don't
need
to
do
a
speculum
exam
.
You
don't
need
to
do
that
bimanual
exam
where
we're
feeling
the
uterus
,
feeling
the
ovaries
.
A
lot
of
just
inspection
is
adequate
to
get
the
answers
we
need
.
Speaker 1
13:32
Is
it
necessary
to
do
that
to
be
able
to
potentially
diagnose
or
know
next
steps
?
Or
is
imaging
an
ultrasound
for
,
like
MRI
,
beneficial
in
those
cases
where
you
don't
really
want
to
do
an
exam
like
that
?
Speaker 2
13:48
Yeah
.
So
that
external
inspection
is
incredibly
helpful
,
specifically
to
make
sure
there
isn't
that
outlet
obstruction
.
So
the
imperforate
hymen
,
okay
,
but
that
isn't
the
point
that
we
stop
.
So
we
absolutely
can
benefit
from
doing
a
ultrasound
,
but
again
,
it
doesn't
have
to
be
an
internal
ultrasound
,
doing
a
screening
ultrasound
with
just
the
probe
on
the
abdomen
,
looking
at
the
structure
of
the
uterus
,
looking
at
the
structure
of
the
ovaries
to
make
sure
there's
no
mass
,
make
sure
there's
no
big
cyst
on
the
ovary
.
That's
the
source
of
this
discomfort
.
If
someone
does
have
that
outflow
obstruction
,
that
even
if
the
cervix
is
blocked
and
they're
not
able
to
bleed
through
the
cervix
,
you'll
see
the
uterus
being
filled
with
blood
and
you'll
be
able
to
see
that
on
the
ultrasound
.
Speaker 2
14:32
So
very
commonly
in
younger
individuals
who
are
struggling
with
pain
,
we
do
lean
very
heavily
on
just
that
extra
inspection
of
the
vulva
and
the
opening
of
the
vagina
,
but
then
also
ultrasound
.
We
really
don't
like
to
do
CAT
scans
,
especially
because
that's
radiation
exposure
for
young
individuals
.
And
then
MRI
absolutely
we
can
use
it
in
very
select
patients
,
but
we
don't
want
to
do
that
on
everyone
either
,
because
that's
a
45
to
an
hour
long
exam
very
commonly
that
you're
asking
a
10-year-old
to
lay
on
a
table
and
hear
this
clanging
,
banging
like
how
much
trauma
does
that
induce
?
So
we
just
need
to
be
very
deliberate
and
very
thoughtful
about
what
we're
putting
these
young
individuals
through
and
making
sure
that
there
is
truly
the
benefit
on
the
other
side
of
it
and
we're
not
doing
more
harm
than
good
.
Speaker 1
15:20
Yeah
,
and
that's
something
that
I
think
many
of
us
need
to
consider
when
we
are
walking
through
this
with
our
children
is
the
trauma
aspect
of
it
,
not
just
the
treatment
of
and
not
just
the
disease
,
not
just
addressing
the
disease
,
but
also
the
trauma
because
their
brains
are
still
developing
in
that
.
You
know
this
,
I
think
,
when
we
create
more
of
that
fight
or
flight
mode
,
that
sympathetic
mode
,
with
more
trauma
,
it's
really
hard
to
get
into
that
parasympathetic
mode
because
their
brains
are
just
not
developed
enough
100%
.
Speaker 2
15:56
I
love
that
you're
bringing
that
,
because
we
need
to
remember
that
we're
treating
people
.
We're
treating
kids
and
,
yes
,
they
may
have
endometriosis
,
Examining and treating young patients
Speaker 2
16:04
but
this
is
still
an
individual
that's
affected
every
single
day
by
that
potential
diagnosis
.
Speaker 1
16:09
Right
,
right
.
How
can
we
validate
teens'
experiences
while
also
helping
them
and
their
family
advocate
for
answers
,
because
that's
also
something
that
can
contribute
to
some
of
that
trauma
.
Speaker 2
16:22
Yeah
,
so
I
do
think
society
is
shifting
contribute
to
some
of
that
trauma
.
Yeah
,
so
I
do
think
society
is
shifting
in
a
good
way
with
some
of
this
,
that
the
discussion
of
the
menstrual
cycle
is
becoming
less
and
less
taboo
,
that
it
is
something
that
is
talked
about
in
common
conversation
,
that
it's
not
something
that
we're
going
to
go
into
the
corner
and
we're
going
to
hide
a
tampon
in
our
sleeve
or
the
pad
in
our
sleeve
.
No
one
can
know
I'm
bleeding
,
right
.
So
just
having
it
be
part
of
society
and
,
yes
,
this
is
part
of
the
normal
physiology
of
a
woman
I
think
can
be
very
helpful
because
,
in
turn
,
if
someone
isn't
afraid
to
say
,
hey
,
I'm
bleeding
today
,
they're
also
going
to
have
less
fear
saying
,
hey
,
I'm
bleeding
today
and
I'm
having
a
lot
of
pain
,
and
this
is
really
,
really
awful
.
Speaker 1
17:03
Right
,
and
this
is
something
that
I
want
to
tell
people
too
it
is
okay
to
work
with
your
children's
school
to
help
get
them
on
a
program
that
can
accommodate
for
things
like
this
when
their
menstrual
cycle
does
come
around
and
they
have
to
miss
school
and
they're
not
in
a
stage
where
they
can
maybe
even
have
surgery
or
maybe
they
do
have
to
have
surgery
but
to
have
that
accessible
availability
to
them
for
being
able
to
get
accommodations
for
when
things
like
this
come
about
.
Working
with
your
school
,
working
with
your
teachers
to
help
your
student
is
key
in
furthering
their
education
.
Speaker 2
17:46
Yeah
,
I
almost
feel
like
it
instills
those
life
lessons
of
self-care
and
don't
put
yourself
on
the
back
burner
.
You
need
to
make
sure
that
you're
showing
up
as
your
very
best
self
,
and
teaching
our
teenagers
to
do
that
is
going
to
serve
them
well
for
very
,
very
long-term
success
in
their
lives
.
I
love
the
idea
of
the
school
nurses
as
well
.
Shannon
Cohn
is
doing
a
lot
of
great
work
to
bring
advocacy
to
school
nurses
because
they're
very
commonly
that
first
touch
point
that
kid
doesn't
want
to
be
in
class
because
they're
so
miserable
and
then
they
go
to
the
school
nurse
.
Well
,
similar
to
what
I
was
mentioning
with
the
pediatrician
,
that
school
nurse
can
either
validate
those
symptoms
and
say
,
yes
,
what
you're
experiencing
,
what
you're
feeling
,
is
real
and
I
am
here
to
help
you
,
or
say
you
need
to
suck
it
up
and
deal
with
it
and
this
isn't
that
bad
.
So
making
sure
that
we
are
giving
that
platform
so
that
these
young
,
pliable
brains
are
given
that
validation
,
which
is
going
to
serve
them
very
well
and
decrease
that
trauma
moving
forward
,
Absolutely
.
Speaker 1
18:50
And
you
know
,
one
of
the
things
that
I
have
started
doing
with
the
nonprofit
side
of
things
is
working
with
their
health
teachers
,
because
what
I'm
able
to
do
is
not
necessarily
get
face
to
face
with
the
students
,
but
with
the
teachers
who
are
seeing
these
students
miss
school
.
And
what's
interesting
about
this
is
that
it
comes
full
circle
for
those
teachers
who
also
have
endometriosis
and
they're
getting
this
education
when
advocacy
steps
in
and
says
we're
advocating
for
these
young
people
but
also
for
you
as
teachers
.
So
you
know
,
that's
like
just
a
circle
moment
for
me
personally
is
to
see
these
teachers
and
these
students
get
the
help
that
they
need
.
Oh
my
gosh
,
that's
amazing
.
Speaker 2
19:24
I
love
that
you're
able
to
see
these
teachers
and
these
students
get
the
help
that
they
need
.
Oh
my
gosh
,
that's
amazing
.
I
love
that
you're
able
to
see
that
.
Speaker 1
19:28
Yeah
,
absolutely
,
it's
been
a
really
cool
thing
.
What
would
you
tell
a
parent
who's
unsure
whether
to
pursue
further
evaluation
?
Speaker 2
19:35
We
want
to
get
on
top
of
these
symptoms
sooner
rather
than
later
.
We
know
,
as
you
were
alluding
to
,
the
brain
is
incredibly
pliable
and
the
brain
learns
things
and
then
responds
accordingly
.
So
if
these
kiddos
are
dealing
with
pain
day
in
and
day
out
because
,
like
I
mentioned
,
it's
not
just
when
they're
bleeding
,
they're
having
pain
outside
of
their
menstrual
cycle
the
brain
is
going
to
learn
that
signaling
and
it
will
take
very
little
to
then
send
that
signaling
10
years
from
now
,
20
years
from
now
.
So
we
want
to
stop
that
pain
cycle
early
,
to
prevent
that
pliability
in
the
brain
and
that
learning
of
chronic
pain
that
,
in
turn
down
the
road
,
becomes
very
challenging
to
undo
.
Speaker 2
20:14
Central
sensitization
is
something
that
we
see
very
commonly
in
individuals
with
chronic
pain
and
endometriosis
because
of
those
changes
in
the
brain
.
So
don't
put
bury
your
head
in
the
sand
,
don't
pretend
that
this
isn't
happening
.
It
truly
is
something
that
,
if
you
see
your
child
suffering
,
don't
expect
that
it
will
just
get
better
.
Don't
expect
that
it's
just
a
phase
you
know
.
Seek
out
,
help
,
seek
out
answers
to
ensure
that
we
are
preventing
those
long-term
issues
from
developing
.
Speaker 1
20:44
On
that
.
When
we're
talking
treatment
approaches
,
Matt
,
when
we're
talking
treatment
approaches
,
a
lot
of
times
they
do
medical
management
.
What
is
your
approach
with
adolescents
when
it
comes
to
either
surgery
or
medical
management
,
Because
this
could
be
a
very
challenging
thing
to
think
about
surgery
for
a
young
child
,
but
also
we
know
that
it
could
be
beneficial
.
What
is
that
breaking
point
there
?
Speaker 2
21:07
Yeah
.
So
there
is
a
lot
of
that
shared
decision
making
to
ensure
that
we're
not
just
making
unilateral
decisions
as
endometriosis
specialists
,
but
also
that
individuals
parents
,
kids
are
not
making
decisions
unilaterally
based
on
the
information
that
they
know
.
That
may
not
be
the
complete
picture
,
so
there
is
absolutely
a
place
for
hormonal
management
in
this
.
I
know
that
hormonal
management
can
get
a
little
bit
of
a
bad
rap
,
but
if
we're
saying
that
,
okay
,
well
,
I
can
put
Surgery versus medical management
Speaker 2
21:39
you
on
a
birth
control
pill
or
a
progesterone
only
pill
,
I
can
stabilize
your
hormones
and
not
put
you
through
a
major
surgery
,
that
could
potentially
be
a
huge
win
for
that
individual
.
Speaker 2
21:51
Endometriosis
surgery
is
major
surgery
and
,
as
we
talk
about
trauma
,
it
absolutely
is
a
trauma
to
the
body
.
It's
a
trauma
to
that
young
person's
brain
to
go
through
surgery
and
,
yes
,
we
do
it
,
but
we
don't
need
to
do
it
on
every
single
person
.
So
my
general
mainstay
is
use
medical
management
as
first-line
therapy
,
and
sometimes
that
can
be
just
doing
ibuprofen
and
Tylenol
,
not
saying
that
that
is
going
to
always
cure
all
of
the
pain
,
but
that
can
be
first
step
in
preemptively
using
it
.
If
you
know
that
,
okay
,
yeah
,
the
cycle
is
going
to
come
tomorrow
.
I'm
going
to
start
the
ibuprofen
today
,
that
can
be
very
helpful
,
but
also
doing
something
along
the
lines
of
that
birth
control
pill
,
the
progesterone
only
pill
that
I
was
,
mentioning
the
role
of
GnRH
agonists
,
antagonists
,
so
oralisa
,
elegolics
,
myfembri
,
depo-lupron
that
group
of
medications
really
should
not
be
utilized
in
the
adolescent
population
because
the
bones
are
growing
so
rapidly
during
that
time
and
we
don't
want
to
negatively
impact
that
.
Speaker 2
22:53
But
if
those
medical
management
options
are
ineffective
,
if
someone's
trying
them
and
they're
not
getting
relief
,
that's
when
we
really
should
have
a
very
thoughtful
conversation
as
to
is
surgery
worth
it
and
is
this
the
time
that
we
should
be
going
down
that
road
?
Or
do
we
want
to
continue
to
try
to
utilize
these
Band-Aids
for
what
we
presume
to
be
endometriosis
,
knowing
that
surgery
may
be
coming
in
two
years
,
three
years
,
five
years
?
But
right
now
we
can
avoid
it
with
the
medications
?
Speaker 1
23:23
Right
,
and
I
think
that
also
goes
to
say
that
I
think
you
should
be
open
with
any
new
provider
that
you
go
to
as
to
why
you
started
these
medications
,
because
I
think
that
there
could
be
those
cues
in
there
that
maybe
we
should
evaluate
it
further
as
you
get
older
,
and
that's
where
that
birth
control
can
suppress
those
symptoms
for
so
long
.
But
knowing
why
you're
suppressing
these
symptoms
,
being
honest
in
your
care
,
is
key
for
when
you
get
into
this
next
stage
of
life
,
when
I
feel
like
you
know
we're
seeing
our
young
adults
20s
and
30
year
olds
right
,
we're
now
looking
more
into
has
the
disease
progressed
,
has
it
?
You
know
I'm
advancing
in
my
years
.
I
want
to
potentially
get
pregnant
,
there's
all
of
these
things
.
How
does
endo
tend
to
evolve
from
adolescence
into
adulthood
?
Speaker 2
24:18
Yeah
,
we
know
that
endometriosis
is
a
progressive
condition
,
so
it's
not
uncommon
for
not
only
the
disease
to
grow
.
If
we're
doing
like
imaging
,
watching
things
on
ultrasound
MRI
,
it's
not
uncommon
for
there
to
be
that
progression
and
disease
burden
.
But
it's
also
not
uncommon
to
see
progression
and
symptoms
.
That
initially
,
yeah
,
I
had
painful
cycles
.
I
was
starting
on
birth
control
pills
as
a
13
year
old
which
,
again
,
I
don't
necessarily
disagree
with
.
I
think
that's
fine
as
a
first
step
and
,
yep
,
it
worked
.
I
put
a
bandaid
on
it
.
But
now
I'm
18
,
19
,
20
,
and
now
I'm
starting
to
have
pain
outside
of
my
cycle
or
the
pain
is
no
longer
controlled
with
the
birth
control
pills
.
That
we're
starting
to
see
more
and
more
symptoms
.
That's
a
very
classic
presentation
of
endometriosis
.
Speaker 1
25:05
Yeah
.
What
are
the
common
misdiagnoses
during
this
time
?
Speaker 2
25:11
Yeah
,
so
irritable
bowel
syndrome
is
a
very
,
very
common
one
.
That
,
yes
,
you
can
have
some
diarrhea
,
constipation
and
that's
just
anxiety
as
well
,
is
a
very
common
misdiagnosis
that
I
very
commonly
hear
as
well
,
that
people
are
having
difficulty
with
intercourse
just
because
they're
new
in
their
sexual
journey
and
so
it'll
just
take
a
little
bit
of
time
.
Primary
dysmenorrhea
is
another
very
common
word
thrown
out
and
diagnosis
thrown
out
,
that
it's
because
of
the
prostaglandins
that
the
uterus
releases
and
that's
where
the
pain
is
coming
from
.
Also
labral
tears
,
so
orthopedic
injuries
can
be
the
source
.
Like
truly
everyone
wants
to
think
about
things
outside
of
GYN
when
we're
starting
to
think
about
progressive
symptoms
as
well
.
Speaker 1
26:01
Yeah
,
and
I
think
a
lot
of
us
have
experienced
that
from
that
stage
and
personally
I
have
as
well
and
that
is
harmful
no-transcript
surgical
consultation
versus
going
on
the
conservative
management
route
.
Speaker 2
26:35
Yeah
,
that's
a
really
great
question
and
it's
not
a
one
size
fits
all
.
I
always
step
back
and
remind
myself
,
as
well
as
the
individuals
that
I'm
caring
for
.
This
is
a
quality
of
life
issue
.
So
just
because
a
treatment
option
is
a
good
option
for
one
person
doesn't
mean
it's
best
for
another
person
and
it
really
needs
to
be
individualized
to
you
,
focused
on
your
priorities
,
your
goals
,
your
expectations
.
Speaker 2
26:58
So
,
in
terms
of
when
someone
should
consider
surgery
,
lots
of
different
reasons
.
Number
one
,
if
it's
something
that's
always
been
in
the
back
of
your
mind
and
constantly
been
this
well
,
do
I
have
it
,
do
I
not
have
it
?
And
it
keeps
you
up
at
night
and
is
causing
a
lot
of
anxiety
,
a
lot
of
stress
For
some
individuals
.
Just
having
that
definitive
yes
or
no
is
this
or
is
this
not
endometriosis
gives
so
much
peace
of
mind
and
so
much
peace
in
general
that
it's
incredibly
helpful
.
So
that's
where
I
am
never
opposed
to
just
giving
someone
that
definitive
answer
.
Speaker 2
27:27
But
when
we
talk
about
the
other
quality
of
life
issues
,
so
those
symptoms
,
if
someone
is
having
symptoms
that
are
not
being
controlled
with
those
band-aids
,
the
birth
control
pills
,
iuds
,
progesterone-only
pills
then
that's
where
there
should
be
a
very
thoughtful
conversation
about
is
it
time
to
do
something
different
,
and
that
may
include
surgery
versus
pelvic
floor
,
physical
therapy
,
acupuncture
there's
a
lot
of
adjuncts
that
we
can
use
to
help
support
the
body
as
it
processes
and
copes
with
endometriosis
.
Speaker 2
27:58
Additionally
,
if
someone
is
wanting
to
pursue
pregnancy
and
cannot
be
on
those
bandaid
medications
because
,
let's
be
honest
,
being
on
birth
control
pills
when
you're
trying
to
get
pregnant
,
that
is
not
conducive
.
So
if
you
can't
be
on
your
Band-Aid
and
being
off
the
Band-Aid
is
not
conducive
either
yeah
,
doing
a
surgery
may
absolutely
be
justified
at
that
precise
moment
in
time
,
with
the
secondary
benefit
of
not
only
can
we
surgically
help
to
decrease
those
symptoms
,
but
we
can
also
help
optimize
,
whether
that's
for
natural
pregnancy
,
which
there
is
good
evidence
to
show
that
removing
endometriosis
can
help
optimize
for
natural
fertility
,
being
able
to
get
pregnant
without
any
intervention
,
as
well
as
helping
to
optimize
for
artificial
reproductive
technology
.
So
,
individuals
who
do
need
things
like
intrauterine
insemination
,
in
vitro
fertilization
,
excising
endometriosis
,
getting
rid
of
that
inflammation
,
can
help
to
optimize
for
that
as
well
.
Speaker 1
28:57
Well
,
when
you
think
about
it
,
and
getting
the
endometriosis
out
of
your
body
,
whether
it's
on
your
reproductive
organs
or
not
,
is
going
to
benefit
your
body
.
It's
going
to
help
support
the
way
that
it
should
be
functioning
,
not
the
way
that
it
has
been
functioning
.
It's
going
to
optimize
your
overall
health
.
So
there
is
benefit
to
just
removing
that
,
but
that's
not
always
accessible
to
everyone
,
and
that's
something
that
we
always
have
to
keep
in
mind
,
right
?
That's
,
I'm
sure
,
something
that
for
you
,
as
a
provider
you
have
in
your
mind
as
well
is
like
this
may
not
be
accessible
to
this
patient
,
and
that
becomes
a
little
bit
of
a
challenge
as
well
.
Speaker 2
29:36
Yeah
,
so
not
to
go
off
too
much
on
a
tangent
,
but
that's
why
I'm
so
passionate
about
education
and
having
my
fellows
learning
about
endometriosis
,
because
I
am
only
one
human
10%
of
reproductive
aged
women
are
affected
by
endometriosis
,
so
that's
not
even
including
the
prepubescent
or
postmenopausal
women
10%
I
cannot
take
care
of
10%
of
the
female
population
and
we
need
to
increase
access
by
increasing
the
number
of
individuals
who
understand
endometriosis
,
know
how
to
do
these
surgeries
and
can
provide
excellent
outcomes
.
But
we
have
so
far
to
go
in
terms
of
meeting
the
demand
of
what
is
out
there
.
Speaker 1
30:19
Absolutely
,
absolutely
,
and
that
was
just
something
that
is
always
on
the
top
of
my
mind
is
something
to
be
cognizant
of
,
because
this
is
a
stage
of
life
that
we're
really
seeing
a
lot
of
people
struggle
with
access
to
care
and
access
to
even
diagnosis
,
which
is
why
you
know
it's
a
little
frustrating
,
right
,
as
people
who
hear
this
day
in
and
day
out
.
But
can
you
also
speak
to
the
importance
or
limits
of
imaging
like
MRI
and
ultrasound
and
all
of
those
things
at
this
stage
,
because
that
will
help
some
people
with
whether
they're
on
insurance
or
not
,
maybe
evaluate
whether
they
have
endometriosis
or
if
it's
progressed
?
Speaker 2
31:03
Yeah
,
no
,
imaging
can
be
very
,
very
helpful
with
very
specific
caveats
.
So
whenever
we're
looking
at
any
diagnostic
tool
,
even
like
blood
work
,
if
you're
getting
blood
work
done
to
check
for
your
hemoglobin
,
for
anemia
,
there
are
very
specific
criteria
that
we
use
to
say
well
,
how
accurate
is
that
test
?
So
what
is
the
sensitivity
?
If
you
have
anemia
,
what's
the
likelihood
that
that
blood
test
is
going
to
actually
show
you
have
anemia
?
What's
the
specificity
?
What's
the
positive
predictive
value
,
negative
predictive
value
?
And
that
becomes
very
important
when
we
talk
about
imaging
.
Speaker 2
31:37
So
not
all
ultrasounds
are
created
equal
,
not
all
MRIs
are
created
equal
and
there
are
limitations
to
the
testing
.
So
even
here
at
Mayo
Clinic
,
where
I
have
a
phenomenal
team
of
radiologists
around
me
who
are
really
focused
and
specialized
on
endometriosis
,
like
I
am
,
I
love
my
team
,
they're
amazing
,
but
they
still
can't
see
everything
.
And
we
have
this
delicate
balance
of
,
well
,
don't
over
call
things
,
don't
tell
me
things
that
you're
like
,
well
,
maybe
I
see
a
little
hint
of
something
,
because
then
Reproductive years and fertility concerns
Speaker 2
32:08
I
don't
really
know
if
I
can
trust
it
.
But
on
the
flip
side
of
it
,
we
don't
want
to
under
call
either
,
because
then
we're
missing
significant
disease
and
telling
individuals
that
no
,
your
pelvis
is
normal
,
when
really
it
isn't
.
But
even
here
we're
seeing
that
.
So
it's
very
important
to
recognize
the
skill
set
of
the
individuals
who
are
obtaining
the
images
.
Speaker 2
32:30
Recognize
the
skill
set
of
the
individuals
who
are
obtaining
the
images
.
So
are
they
following
an
endometriosis
protocol
for
the
ultrasounds
as
well
as
the
MRIs
?
Are
they
getting
a
narrow
field
of
view
,
meaning
doing
a
lot
of
slices
,
a
lot
of
pictures
?
So
that
way
we're
getting
really
good
at
quality
imaging
.
And
then
what's
the
skill
set
of
the
radiologist
?
Just
like
a
endometriosis
surgeon
,
you
can
talk
to
some
individuals
who
don't
really
do
endometriosis
surgery
but
they're
an
OBGYN
and
they're
boarded
,
so
technically
they
can
do
this
.
But
what's
that
level
of
expertise
?
So
there
are
really
good
studies
that
have
shown
you
need
to
have
high
quality
imaging
followed
by
high
quality
interpretation
to
be
able
to
accurately
get
that
diagnosis
.
Speaker 1
33:11
Yeah
,
you
know
that's
something
that's
been
key
in
my
care
is
understanding
the
imaging
and
having
a
multidisciplinary
team
that
understands
it
,
and
it's
such
a
powerful
tool
for
many
people
.
Speaker 2
33:25
So
the
other
thing
that
I
think
is
really
critical
to
understand
about
imaging
is
the
limitations
that
even
in
the
very
best
centers
,
superficial
endometriosis
is
not
able
to
be
accurately
detected
.
If
we
move
to
the
outside
of
the
pelvis
,
into
the
abdomen
,
the
diaphragm
diaphragm
is
even
harder
to
see
endometriosis
accurately
and
so
I
never
take
a
quote
,
unquote
negative
exam
to
be
diagnostic
of
you
do
not
have
endometriosis
.
I
take
it
to
mean
okay
,
we're
not
worried
about
needing
to
do
a
bowel
resection
,
we're
not
worried
about
needing
to
re-implant
a
ureter
because
we're
still
suspecting
that
there's
endometriosis
but
it's
more
superficial
disease
that
we
just
can't
see
on
imaging
.
Speaker 1
34:09
Yes
,
and
we
will
hear
that
a
lot
of
times
from
people
who
aren't
familiar
with
even
looking
at
endometriosis
,
and
most
of
the
time
they'll
tell
you
it's
not
beneficial
to
even
do
an
MRI
or
an
ultrasound
or
anything
like
that
.
But
then
you
know
,
they'll
say
well
,
you
don't
have
endometriosis
because
your
scans
are
clear
.
Well
,
that's
not
a
definitive
tool
because
it
doesn't
necessarily
mean
that
you
don't
have
it
in
areas
that
they're
not
even
looking
or
can't
see
.
Speaker 2
34:35
You
know
,
and
that's
something
that
I
ran
into
in
my
journey
as
well
,
and
that's
where
the
big
organizations
,
acog
,
the
European
version
of
ACOG
,
the
Canadian
version
of
ACOG
,
the
American
College
of
Obstetrics
and
Gynecology
is
ACOG
and
gives
guidelines
as
to
what
we
should
be
doing
.
They
even
say
that
diagnostic
laparoscopy
cannot
be
replaced
by
imaging
.
At
this
point
,
if
you
suspect
endometriosis
,
you
still
need
to
go
in
surgically
.
That
is
where
you're
going
to
get
that
definitive
yes
or
no
.
Speaker 1
35:05
Right
,
absolutely
Should
.
People
who
don't
want
children
.
You
know
we
talked
about
the
fertility
aspect
,
but
for
people
who
don't
want
children
,
should
they
still
be
concerned
about
fertility
related
symptoms
or
risks
?
Speaker 2
35:18
So
yes
and
no
.
So
I
am
always
going
to
be
fully
supportive
that
.
You
know
your
body
,
you
know
your
life
.
Not
every
single
person
on
this
planet
needs
to
reproduce
.
So
if
you
are
not
concerned
about
having
pregnancy
,
fine
,
not
a
problem
.
However
,
we
should
not
minimize
quality
of
life
and
a
lot
of
these
symptoms
of
endometriosis
be
it
painful
intercourse
,
painful
cycles
,
painful
bowel
movements
it
can
be
a
sign
of
more
significant
disease
burden
.
So
even
if
we're
not
focused
on
well
,
let's
optimize
for
fertility
.
Let's
optimize
so
that
you
can
get
pregnant
.
I
want
to
optimize
so
you
can
live
the
life
that
you
want
to
live
.
Right
,
right
.
Speaker 1
35:54
Well
,
and
this
also
speaks
to
adenomyosis
,
because
I
think
a
lot
of
times
,
a
lot
of
people
think
,
well
,
I
don't
want
to
have
kids
,
but
I
still
want
my
uterus
,
or
you
know
,
there's
there
is
that
caveat
there
as
well
is
that
it's
not
always
endometriosis
,
it
could
be
adenomyosis
.
Speaker 2
36:11
Yeah
,
absolutely
,
and
I
am
always
again
,
I
think
you
know
so
far
just
the
way
I
speak
about
this
is
patients
have
the
right
to
decide
what
happens
with
their
bodies
.
Yes
,
I
can
give
guidance
,
I
can
give
opinions
,
but
ultimately
it
affects
you
much
more
than
it
will
ever
affect
me
.
So
you
get
to
be
in
the
driver's
seat
,
you
get
to
decide
what
we're
going
to
do
.
And
so
,
yeah
,
we
do
see
a
lot
of
pelvic
pain
from
adenomyosis
as
well
,
which
is
where
we
need
to
think
of
pelvic
pain
more
as
an
onion
,
that
you
get
multiple
layers
of
pain
,
that
it
can
be
endometriosis
,
but
you
can
also
have
adenomyosis
.
Speaker 2
36:46
You
can
also
have
pelvic
venous
insufficiency
,
also
called
pelvic
congestion
syndrome
.
You
can
have
myofascial
pain
,
you
can
have
nerve
impingement
and
all
of
these
things
add
together
to
this
constellation
that
is
pelvic
pain
,
that
you
have
to
treat
every
single
one
of
those
layers
to
make
any
headway
.
But
,
that
being
said
,
it's
hard
to
say
how
much
each
of
those
layers
is
contributing
to
that
perception
of
pain
.
So
for
that
individual
that
we
highly
suspect
adenomyosis
but
does
not
want
to
lose
her
uterus
,
that's
fine
.
We
can't
treat
the
endo
.
We
can
treat
the
pelvic
floor
.
We
can
treat
the
muscles
,
the
nerves
,
the
blood
vessels
and
optimize
everything
so
that
way
the
symptoms
that
are
coming
from
the
adenomyosis
are
minimized
as
much
as
we
possibly
can
.
Speaker 1
37:28
Oh
,
that's
a
really
good
point
is
to
address
the
things
that
you
can
Absolutely
as
we
go
on
,
because
that's
a
big
portion
of
that
stage
.
But
as
people
progress
in
later
productive
Perimenopausal changes and flare patterns
Speaker 1
37:41
years
mid-30s
,
early
40s
how
do
symptoms
shift
or
worsen
during
this
stage
?
Speaker 2
37:48
Yeah
,
so
for
individuals
who
are
on
that
hormonal
suppression
we
can
see
that
same
progression
in
symptoms
that
we
can
see
in
the
20s
,
that
the
disease
just
outgrows
the
Band-Aid
.
So
always
keeping
that
in
the
back
of
our
mind
.
And
the
other
thing
that
we
haven't
touched
on
that
I
think
is
really
important
is
the
quality
of
life
issues
.
And
thinking
about
it
from
that
perspective
is
more
for
superficial
disease
without
significant
disease
burden
,
if
we
are
seeing
significant
disease
burden
with
like
bowel
involvement
,
ureteral
involvement
,
that
needs
to
be
followed
because
that
can
shift
from
a
quality
of
life
issue
to
a
quantity
of
life
issue
that
I
don't
want
you
to
be
in
renal
failure
because
we've
ignored
this
disease
around
your
kidney
.
So
really
watching
and
monitoring
for
that
progression
if
we
know
there's
significant
disease
burden
,
even
if
the
patients
are
not
wanting
to
go
down
the
road
of
surgery
,
is
critically
important
.
But
for
individuals
who
have
that
more
superficial
disease
,
we're
not
worried
about
significant
organ
involvement
but
we're
monitoring
for
symptoms
If
individuals
are
not
on
that
hormonal
suppression
and
their
bodies
are
just
functioning
normally
.
Speaker 2
38:54
We
do
see
the
perimenopausal
transition
very
commonly
starting
in
the
early
forties
and
that's
where
you
can
get
huge
surges
in
different
hormone
levels
and
then
drops
in
hormone
levels
and
so
with
that
huge
surge
and
drop
,
you
can
also
see
a
huge
surge
and
drop
in
endometriosis
related
symptoms
.
So
we
can't
see
more
flares
in
the
pain
,
we
can
see
more
flares
in
the
symptoms
in
general
,
followed
by
periods
of
time
where
I
feel
amazing
.
This
is
great
.
So
you
can
have
that
waxing
and
waning
happening
.
Speaker 1
39:23
Absolutely
.
Does
endometriosis
get
more
aggressive
with
age
,
or
can
it
settle
?
Speaker 2
39:29
So
it
doesn't
tend
to
get
more
aggressive
with
age
,
it
just
tends
to
outgrow
.
The
band-aids
is
what
most
commonly
see
.
So
it's
not
suddenly
that
you're
getting
rapid
growth
in
those
cells
.
If
we
are
seeing
rapid
growth
that
we
previously
were
monitoring
and
everything
was
really
stable
,
then
all
of
a
sudden
we're
seeing
rapid
progression
.
That
actually
perks
our
ears
that
there
can
be
malignant
transformation
,
which
happens
in
less
than
2%
of
patients
with
deep
infiltrating
endometriosis
,
but
it
can
.
So
it's
always
in
the
back
of
our
mind
.
But
what
we
can
see
is
that
as
the
hormone
levels
drop
and
we
do
make
that
transition
into
menopause
,
that
symptoms
related
to
endometriosis
can
very
commonly
improve
for
a
lot
of
individuals
not
all
,
but
a
lot
of
individuals
will
see
improvement
in
symptoms
as
they
transition
into
menopause
.
Speaker 1
40:17
Yeah
,
and
we
kind
of
touched
on
this
a
little
bit
.
But
for
someone
who's
had
hormonal
suppression
for
years
,
how
do
you
weigh
the
benefit
of
surgical
intervention
now
in
this
state
?
Speaker 2
40:26
Yeah
,
so
it
really
does
become
very
individualized
that
if
the
Band-Aid
is
working
and
you're
feeling
great
and
you're
not
having
the
blockage
of
the
urine
,
or
that
you're
developing
hydronephrosis
,
backup
of
urine
into
the
kidney
,
that
I'm
worried
about
your
kidney
function
.
You're
not
having
bloody
stools
because
you're
having
a
nodule
of
endometriosis
going
all
the
way
through
your
rectum
,
If
it
truly
is
more
suspected
superficial
disease
and
the
Band-Aid
whether
that's
a
birth
control
pill
,
an
IUD
,
progesterone-only
pill
if
that
Band-Aid
is
adequately
suppressing
your
symptoms
.
There
are
a
lot
of
individuals
that
I
suspect
endo
in
that
we
never
end
up
doing
a
surgery
.
Speaker 1
41:09
Interesting
and
what
would
be
that
deciding
factor
?
Because
I
think
there
is
this
other
aspect
of
this
of
like
the
comorbid
conditions
.
How
do
you
factor
that
into
your
treatment
and
potential
surgery
or
no
surgery
factor
?
Speaker 2
41:19
Yeah
,
and
so
that's
where
I
focus
,
not
just
on
what's
happening
in
the
pelvis
,
so
not
just
focusing
on
are
you
having
painful
cycles
,
are
you
having
pain
with
intercourse
,
but
I
also
ask
about
what's
happening
in
the
body
as
a
whole
.
Are
you
having
excessive
fatigue
that
no
one's
been
able
to
pinpoint
?
Are
you
having
awful
migraine
headaches
that
no
one's
been
able
to
pinpoint
?
Are
you
having
GI
dysfunction
that
you're
nauseated
all
the
time
?
You've
seen
a
million
GIs
.
They
scope
,
everything
looks
normal
,
so
they
say
,
yep
,
this
is
your
body
.
Speaker 2
41:47
So
if
there
are
these
other
things
that
might
not
be
obviously
associated
with
endometriosis
,
that's
where
we
might
start
to
say
,
okay
,
yeah
,
your
pelvis
is
good
,
but
you
can
be
having
other
symptoms
and
other
related
conditions
that
might
get
better
.
I
can't
promise
,
I
can't
guarantee
.
But
if
we
get
rid
of
that
inflammation
that
is
endometriosis
,
if
we
reset
what's
happening
in
your
body
,
those
conditions
may
improve
.
And
so
for
each
individual
,
that's
a
delicate
balance
as
to
for
them
.
Do
they
want
to
take
that
risk
of
surgery
with
that
kind
of
big
question
mark
?
I
can't
promise
if
it's
going
to
get
better
or
not
.
Speaker 1
42:24
Right
.
And
that
kind
of
leads
me
to
this
next
question
of
the
postmenopausal
,
perimenopausal
,
mid-40s
and
beyond
the
hormonal
myths
of
it
all
,
let's
talk
about
the
myth
of
menopause
cures
endometriosis
.
Why
isn't
?
Speaker 2
42:38
that
The menopause myth debunked
Speaker 2
42:39
always
true
cures
endometriosis
.
Why
isn't
that
always
true
?
So
,
number
one
one
of
my
biggest
pet
peeves
with
endometriosis
in
general
is
when
individuals
have
their
uterus
removed
,
their
ovaries
removed
,
and
nothing
is
done
for
endometriosis
.
But
I
cured
your
endometriosis
.
Nothing
could
be
further
from
the
truth
.
Speaker 2
42:57
So
endometriosis
,
yes
,
it
responds
to
the
hormones
that
the
ovaries
release
,
but
it's
not
an
issue
with
the
ovaries
,
it's
an
issue
with
how
that
tissue
is
responding
.
So
we
need
to
focus
on
fixing
that
tissue
rather
than
just
castrating
everyone
and
removing
ovaries
.
So
I
very
,
very
rarely
am
removing
ovaries
for
treatment
of
pelvic
pain
,
for
treatment
of
endometriosis
,
and
the
reason
for
that
is
,
if
we
really
understand
endometriosis
,
it
truly
is
endometrial-like
tissue
.
It
is
not
the
endometrium
.
So
endometriosis
has
a
chemical
in
it
called
aromatase
,
and
aromatase
converts
testosterone
into
estrogen
.
So
even
if
the
ovaries
are
gone
,
the
endometriosis
is
going
to
continue
to
feed
itself
,
and
so
,
whether
that's
surgical
menopause
,
natural
menopause
,
medical
menopause
,
using
those
various
medications
that
I
previously
mentioned
,
symptoms
can
continue
.
Symptoms
can't
progress
,
and
we
shouldn't
just
ignore
them
and
say
,
well
,
I
guess
you're
menopausal
and
there's
nothing
else
we
can
do
,
so
now
you
really
have
to
just
suck
it
up
and
deal
with
it
.
Speaker 1
44:06
Right
,
I
think
there's
a
lot
of
fear
as
well
when
you
get
into
this
stage
and
you
want
to
do
hormone
replacement
therapy
,
and
I
think
that
a
lot
of
people
are
leery
of
doing
that
because
they
have
endometriosis
and
they
don't
want
to
make
it
worse
.
Can
you
touch
on
that
just
a
little
bit
,
because
I
think
that
is
a
fear
of
a
lot
of
these
people
walking
through
this
stage
of
life
.
Speaker 2
44:27
Yeah
,
and
that's
where
you
really
need
to
understand
how
these
hormones
interplay
and
what
affects
endometriosis
.
I
recently
just
saw
a
patient
.
She
came
in
,
was
getting
testosterone
supplementation
and
was
completely
asymptomatic
.
Endometriosis
had
never
even
entered
the
conversation
until
she
was
getting
testosterone
supplementation
and
was
completely
asymptomatic
.
Endometriosis
had
never
even
entered
the
conversation
until
she
was
getting
that
testosterone
and
all
of
a
sudden
she
developed
severe
pelvic
pain
and
no
one
could
understand
why
.
Well
,
endometriosis
converts
that
testosterone
into
estrogen
and
so
it
just
caused
that
vicious
cycle
to
really
ramp
up
.
Speaker 2
44:58
So
,
that
being
said
,
hormone
replacement
therapy
is
not
the
enemy
.
We
just
need
to
be
very
mindful
and
very
cognizant
about
what
we're
doing
with
hormone
replacement
therapy
and
balancing
those
risks
and
benefits
.
So
just
another
plug
for
why
removing
the
ovaries
doesn't
really
make
sense
.
So
if
you
have
someone
who
is
very
young
and
you
remove
the
ovaries
,
you
induce
menopause
,
the
immediate
next
thing
is
going
to
be
well
,
now
you're
at
risk
for
osteoporosis
,
heart
disease
.
I
need
to
give
you
hormones
now
to
reduce
that
risk
.
So
we've
taken
the
hormones
away
,
but
now
I'm
going
to
give
you
hormones
because
you
need
the
hormones
in
your
body
.
It
just
doesn't
logically
line
up
.
So
that's
another
point
for
why
we
just
really
shouldn't
be
doing
that
.
Speaker 2
45:41
But
after
menopause
,
in
that
perimenopausal
transition
,
there's
a
lot
of
other
symptoms
that
can
arise
Hot
flashes
,
difficulty
sleeping
,
that
brain
fog
is
very
common
and
hormones
can
help
with
that
.
And
so
if
you
need
hormones
to
help
to
support
your
body
during
that
transition
,
absolutely
we
can
do
that
.
If
someone
still
has
a
large
amount
of
disease
burden
with
endometriosis
,
so
that
patient
who
we've
been
following
with
endometriomas
hasn't
wanted
to
do
surgery
,
I
do
recommend
estrogen
and
progesterone
together
in
that
patient
,
even
if
they've
had
a
hysterectomy
.
So
for
some
individuals
after
hysterectomy
we
say
only
estrogen
,
you
don't
need
any
progesterone
.
But
if
it's
someone
who's
had
a
very
thorough
excision
of
endometriosis
,
we're
not
suspicious
of
significant
disease
burden
remaining
.
That's
where
someone
can
use
estrogen
alone
and
that's
completely
fine
If
they
need
estrogen
to
help
with
those
menopausal
symptoms
.
Absolutely
Endometriosis
is
not
a
contraindication
to
hormone
replacement
therapy
.
Speaker 1
46:41
And
that's
something
I've
experienced
as
someone
who
has
had
a
nephrectomy
.
The
importance
of
that
hormone
replacement
therapy
has
been
key
to
me
,
but
I've
also
been
very
cognizant
of
making
sure
my
dosage
is
correct
,
and
that's
something
that
working
with
the
hormone
specialist
is
going
to
be
very
important
for
when
you
are
considering
these
options
.
Again
,
that's
something
why
it's
important
to
have
a
multidisciplinary
team
and
a
team
that
can
work
together
,
whether
that's
your
excision
specialist
surgeon
as
well
as
a
hormone
replacement
therapy
expert
.
Those
are
really
key
things
to
be
working
together
on
with
those
people
.
In
my
personal
opinion
and
that's
what
I've
experienced
and
that's
what's
been
helpful
for
me
to
do
that
yeah
,
I'm
glad
that
you
have
that
team
surrounding
you
,
because
endometriosis
is
a
whole
body
disease
.
Speaker 2
47:30
You
can't
treat
it
just
with
one
provider
,
one
individual
.
And
I'm
glad
you've
also
seen
the
positive
response
Hormone therapy and post-menopausal care
Speaker 2
47:36
to
the
correct
hormones
and
making
sure
that
you
are
utilizing
them
to
your
body's
best
ability
For
someone
who
has
had
a
hysterectomy
but
has
never
had
excision
and
is
now
post-menopausal
.
Speaker 1
47:49
what
are
your
thoughts
on
the
viability
of
excision
?
Speaker 2
47:52
Yes
,
I
do
a
good
amount
of
excision
surgery
on
individuals
who
are
menopausal
,
whether
that's
natural
menopause
or
surgical
menopause
,
it's
really
based
on
symptoms
.
Whether
that's
natural
menopause
or
surgical
menopause
is
really
based
on
symptoms
.
So
if
they
are
having
a
significant
pelvic
pain
,
significant
issues
surrounding
endometriosis
,
like
those
other
symptoms
that
we
mentioned
previously
,
then
yeah
,
we
can
absolutely
consider
excision
surgery
.
For
those
individuals
who
might
have
significant
disease
burden
and
the
fear
and
the
concern
of
that
malignant
transformation
is
there
,
then
again
excision
surgery
may
be
worth
it
.
So
just
because
someone's
menopausal
doesn't
mean
that
we
should
suddenly
forget
about
endometriosis
and
ignore
the
impact
that
it
can
have
.
Speaker 1
48:34
Yeah
,
absolutely
,
and
I
think
some
people
don't
even
think
they
have
endometriosis
but
are
still
having
significant
pain
,
and
that
might
be
something
to
explore
when
you
are
having
pain
that
it
could
potentially
be
endometriosis
.
Speaker 2
48:47
Yeah
,
I
mean
,
as
we've
alluded
to
,
talking
about
the
teenagers
and
the
adolescents
,
not
everyone
understands
what
endometriosis
is
,
and
so
,
as
society
is
gaining
awareness
,
yes
,
people
are
starting
to
think
about
this
more
.
But
for
the
menopausal
population
,
they
are
of
that
generation
that
may
have
been
told
this
is
normal
their
entire
lives
and
may
have
never
even
thought
that
endometriosis
is
a
possibility
.
So
asking
the
questions
,
perking
the
ear
,
is
absolutely
worth
it
,
regardless
of
where
someone
is
in
their
lifespan
.
Speaker 1
49:16
Are
there
increased
risks
associated
with
excision
later
on
in
life
as
opposed
to
doing
it
earlier
in
life
for
those
that
maybe
haven't
been
diagnosed
?
Speaker 2
49:26
Yeah
,
so
it's
not
necessarily
that
the
surgery
is
going
to
be
more
risky
,
higher
risk
for
complications
.
In
general
,
the
surgery
is
the
same
regardless
of
where
someone
is
in
their
lifespan
.
However
,
we
do
know
that
as
we
age
we
do
develop
what's
called
comorbidities
.
So
having
diabetes
,
hypertension
,
cardiac
disease
,
that
all
is
going
to
be
more
prevalent
as
we
age
.
So
surgery
can
be
a
little
bit
more
risky
as
we
age
,
but
not
because
of
endometriosis
,
rather
because
our
bodies
are
a
little
bit
older
and
not
as
well
performing
as
they
did
when
we
were
20
.
Speaker 1
50:02
And
because
,
you
know
,
even
going
up
the
stairs
can
be
challenging
at
times
.
So
there's
that
,
exactly
,
exactly
,
yeah
.
Should
older
patients
continue
to
monitor
endometriosis
symptoms
or
like
postmenopausal
?
Speaker 2
50:16
Should
they
continue
monitoring
that
,
yeah
,
so
if
we
are
more
worried
about
superficial
disease
and
it
truly
is
symptomatology
that
we're
watching
.
Absolutely
Having
a
good
pulse
on
your
body
,
I
think
,
is
always
critically
important
and
alerting
your
providers
if
there's
any
deviation
from
that
normal
.
So
if
you're
having
pain
but
you
can
deal
,
it's
not
worth
it
for
surgery
for
you
.
Absolutely
,
we
can
continue
to
watch
that
.
But
if
at
any
point
you're
having
changes
,
that
you're
having
more
discomfort
,
more
pain
,
something
just
doesn't
feel
the
same
,
you
should
absolutely
reach
out
to
your
provider
.
On
the
flip
side
of
that
,
if
you
are
someone
with
that
deep
infiltrating
disease
,
so
significant
endometriosis
involving
the
bowel
,
involving
the
bladder
,
those
are
patients
that
I'm
going
to
be
monitoring
with
imaging
,
regardless
of
what
their
symptomatology
is
,
because
that
is
the
population
of
individuals
that
unfortunately
is
at
higher
risk
for
developing
that
malignant
transformation
,
that
we
can
see
cancer
cells
developing
within
that
deep
infiltrating
disease
.
Speaker 1
51:27
Right
,
those
are
things
that
many
of
us
wouldn't
even
consider
as
we
progress
in
life
is
to
really
look
at
those
different
variations
and
variables
when
it
comes
to
this
disease
.
And
that
just
goes
to
show
again
it's
not
a
reproductive
disease
,
it's
a
whole
body
disease
and
that
we
really
have
to
pay
attention
to
that
Exactly
,
exactly
,
and
it's
a
challenge
.
But
it's
knowing
your
body
,
too
,
and
knowing
all
the
things
that
you've
gone
through
,
picking
up
those
subtle
symptoms
and
changes
that
we
walk
through
throughout
the
years
,
can
be
really
helpful
to
your
healthcare
providers
.
What
do
you
wish
all
providers
understood
about
the
trajectory
of
endometriosis
over
a
lifetime
?
Speaker 2
52:03
Oh
my
gosh
that
it
is
a
progressive
disease
,
that
menopause
does
not
cure
endometriosis
.
We
need
to
stop
castrating
women
.
That
does
not
treat
the
disease
and
can
cause
a
whole
host
of
Patient advocacy and family support
Speaker 2
52:15
other
issues
.
That's
not
to
say
there's
not
good
reason
for
removing
reasons
some
individuals
,
but
as
the
primary
treatment
for
endometriosis
it
really
needs
to
be
removed
from
that
algorithm
and
don't
assume
that
someone's
symptoms
are
not
from
endometriosis
if
they're
menopausal
.
Just
because
the
estrogen
levels
have
declined
doesn't
mean
the
estrogen
levels
are
zero
and
endometriosis
does
continue
to
cause
issues
.
So
listen
to
the
patient
rather
than
just
looking
at
numbers
and
statistics
.
Speaker 1
52:45
Yeah
,
absolutely
.
How
can
patients
of
all
ages
advocate
for
themselves
,
especially
in
healthcare
systems
that
often
dismiss
their
pain
?
Speaker 2
52:55
Yeah
.
So
if
you
are
being
dismissed
,
I
would
go
find
a
different
provider
.
You're
never
going
to
convince
someone
that
something
is
real
if
they
don't
believe
it's
real
.
And
so
,
yes
,
I
am
always
a
fan
of
education
.
That's
why
I
spend
a
lot
of
time
teaching
my
fellows
,
teaching
at
conferences
.
But
if
someone
truly
does
not
believe
that
endometriosis
can
be
a
source
of
symptoms
,
no
matter
what
you
say
,
they're
not
going
to
believe
it
.
So
don't
beat
your
head
against
a
wall
.
Go
find
someone
who
understands
the
disease
and
is
willing
to
at
least
listen
to
you
and
help
navigate
the
system
Absolutely
.
Speaker 1
53:32
But
adversely
.
What
can
family
members
,
partners
,
teachers
do
to
support
someone
in
any
of
these
life
stages
that
they
encounter
?
Speaker 2
53:42
Yeah
.
So
that
village
around
individuals
with
endometriosis
is
incredibly
important
to
make
sure
that
we
are
not
normalizing
symptoms
,
making
sure
we're
not
contributing
to
that
trauma
and
being
another
advocate
in
the
room
with
that
person
,
Because
a
lot
of
these
visits
can
become
very
overwhelming
.
There's
a
lot
of
telling
the
story
over
and
over
and
over
and
that
can
become
exhausting
.
So
to
be
that
second
voice
to
interject
and
add
the
details
that
someone
may
not
be
remembering
to
add
can
be
incredibly
helpful
.
And
also
being
that
second
voice
to
say
no
,
we
do
need
some
help
,
rather
than
just
letting
things
be
dismissed
and
pushed
to
the
wayside
.
Speaker 1
54:24
Absolutely
.
My
husband
has
been
able
to
pick
up
on
cues
and
symptoms
before
I
could
.
He's
recognizing
more
because
I
am
so
focused
on
the
pain
and
just
trying
to
make
it
through
day
to
day
that
sometimes
I
don't
pick
up
on
those
little
cues
.
And
so
the
support
people
are
so
vital
to
proper
advocated
care
.
Speaker 2
54:45
Yeah
Well
,
and
like
you
have
mentioned
multiple
times
,
this
is
not
a
reproductive
disease
,
it's
a
whole
body
disease
,
but
it's
also
a
whole
family
disease
.
Speaker 1
54:54
It's
not
just
something
that
affects
the
individual
,
it
affects
their
entire
network
around
them
Absolutely
and
I
saw
that
in
my
kids
and
how
they
remember
things
and
their
early
childhood
memories
of
me
being
sick
and
it
does
.
It
really
affects
the
whole
family
.
If
you
could
leave
listeners
with
one
piece
of
advice
for
recognizing
and
honoring
their
symptoms
at
any
age
,
what
would
it
be
?
Speaker 2
55:18
Your
period
should
be
no
more
than
an
inconvenience
.
Truly
,
that
should
be
the
guiding
rule
of
thumb
.
If
your
period
is
more
than
an
inconvenience
,
something
is
wrong
,
and
it
doesn't
necessarily
mean
endo
.
It
can
but
make
sure
that
you're
talking
to
your
healthcare
providers
,
make
sure
that
you're
being
heard
,
so
that
way
you
can
get
the
help
you
need
and
the
help
you
deserve
.
Speaker 1
55:37
Absolutely
,
absolutely
.
Dr
Wasson
,
thank
you
so
much
for
taking
your
time
and
energy
and
continue
advocating
for
us
.
You
do
that
all
the
time
in
the
way
that
you
educate
and
the
way
that
you
continue
to
push
yourself
to
learn
more
about
endometriosis
,
and
I
admire
that
so
much
.
Having
known
you
for
a
little
while
now
,
I
know
how
passionate
you
are
about
this
disease
and
I
know
that
you
continue
pushing
yourself
to
understand
it
more
.
So
thank
you
for
doing
that
.
Thank
you
for
standing
up
for
those
patients
who
wouldn't
have
other
doctors
do
that
and
stepping
into
a
space
of
healing
,
and
I
just
appreciate
you
taking
the
time
to
do
that
for
us
today
as
well
.
Speaker 2
56:16
Oh
my
gosh
.
Thank
you
and
I
will
echo
it
back
to
you
Thank
you
for
all
that
you
do
in
this
space
and
the
advocacy
.
We
can't
do
it
in
silos
.
We
have
to
work
together
the
providers
,
the
patients
and
those
who
are
struggling
with
endometriosis
,
those
who
are
supporting
those
with
endometriosis
.
So
I'm
really
excited
about
what
the
future
of
endometriosis
looks
like
because
of
people
like
you
.
So
thank
you
for
doing
the
hard
work
day
in
and
day
out
.
Speaker 1
56:45
Thank
you
.
I
really
appreciate
that
.
It's
always
a
pleasure
to
speak
with
you
.
It's
always
a
pleasure
to
sit
down
with
you
.
I
learn
every
single
time
and
I
just
enjoy
that
so
much
.
So
you'll
have
to
come
back
again
at
some
point
and
we'll
do
some
more
fun
stuff
.
So
,
yes
,
yes
,
I
look
forward
to
it
.
Yes
,
until
next
time
.
Everyone
continue
advocating
for
you
and
for
others
.