19: Understanding Endometriosis: Symptoms, Diagnosis, and Treatment with Dr. Sadikah Behbehani

Endometriosis is a chronic condition affecting millions of women worldwide, yet it remains widely misunderstood and often misdiagnosed. In this episode, I sit down with Dr. Sadikah Behbehani, a double board-certified OBGYN specializing in reproductive endocrinology, infertility, and minimally invasive gynecological surgery. We explore the complexities of endometriosis, from symptoms and diagnosis to treatment options that can restore quality of life.

Dr. Behbehani is an expert in fertility-sparing excision surgery and one of the few specialists dedicated to advanced endometriosis treatment. She has trained with pioneers in the field, published extensively on the topic, and educates physicians globally on the intricacies of the disease.

If you or someone you know experiences severe menstrual pain, infertility, or unexplained chronic pelvic discomfort, this episode is essential listening. Endometriosis is treatable, and no one should have to suffer in silence.

Key Themes & Takeaways:

• What is Endometriosis? Dr. Sadikah Behbehani explains that endometriosis is a chronic condition where tissue similar to the uterine lining grows outside the uterus, leading to inflammation, scarring, and severe pain. This misplaced tissue responds to hormonal cycles but has no way to exit the body, causing internal damage over time.
• Common Symptoms & Misdiagnosis: Endometriosis often presents as painful periods, chronic pelvic pain, painful intercourse, bloating, bowel and bladder issues, and infertility. However, due to widespread misconceptions, many women go undiagnosed for years, with their symptoms dismissed as "normal period pain" or treated with hormonal birth control without further investigation.
• Why Surgery is the Gold Standard for Diagnosis & Treatment: The only way to definitively diagnose endometriosis is through excision surgery, where tissue is removed and analyzed. Unlike ablation techniques that burn the surface of lesions, excision surgery removes endometriotic tissue entirely, reducing the risk of recurrence and improving long-term outcomes.
• The Link Between Endometriosis & Infertility: While 70% of women with endometriosis can conceive naturally, 30% experience infertility due to scarring, inflammation, and hormonal imbalances. Surgical removal of endometriosis can improve natural conception rates and enhance IVF success for those undergoing fertility treatments.
• The Role of Lifestyle & Gut Health in Endometriosis Management: Although diet cannot cure endometriosis, an anti-inflammatory diet—reducing sugar, processed foods, and inflammatory triggers—may help manage symptoms. Many women with endometriosis also experience SIBO (small intestinal bacterial overgrowth), highlighting the gut-health connection and the importance of addressing digestive imbalances.
• Endometriosis Beyond the Pelvis: How It Can Impact the Entire Body Endometriosis has been found in the lungs, brain, and other organs, spreading through blood and lymphatic channels. Some women experience cyclical migraines, lung collapses, or even brain bleeds linked to endometriotic lesions in distant parts of the body.

We talk about:

• 00:00 Introduction to Endometriosis
• 02:03 Understanding Endometriosis
• 04:11 Symptoms and Misdiagnosis
• 06:52 Diagnosis and Treatment
• 16:49 Theories and Causes
• 22:03 Endometriosis in Distant Organs
• 29:21 Recognizing Pelvic Pain and Its Misconceptions
• 30:08 The Importance of Proper Diagnosis and Treatment