Endometriosis Through The Ages: From Teens to Menopause: With Prof. Megan Wasson

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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

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Website endobattery.com

Episode Transcript

Speaker 1 (00:00):
Endometriosis doesn't care how old you are.
Maybe you're a teen withsymptoms and no one can explain.
Let's be honest many have heardyou're too young for
endometriosis.
Maybe you've spent your 20s or30s chasing answers.
Maybe you're in menopause,thinking, wait, why am I still
in pain?
In this episode, dr MeganWasson, chair of Medical and

(00:20):
Surgical Gynecology at the MayoClinic, walks us through what
endo can look like at everystage of life.
We talk about symptoms that aretoo often dismissed, approaches
to pain management when surgerymakes sense and what care
should look like, not just inyour reproductive years but
beyond.
Yes, we even go there Endoafter menopause.

(00:42):
If you've ever felt confused,dismissed, just plain tired of
the fight, this episode is foryou.
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,

(01:03):
because you are not alone inthis fight.
Welcome to EndoBattery, where Ishare my journey with
endometriosis and chronicillness, while learning and
growing along the way.
This podcast is not asubstitute for medical advice,
but a supportive space toprovide community and valuable
information so you never have toface this journey alone.

(01:23):
We embrace a range ofperspectives that may not always
align with our own, believingthat open dialogue helps us grow
and gain new tools, join me asI share stories of strength,
resilience and hope, frompersonal experiences to expert
insights.
I'm your host, alana, and thisis IndoBattery charging our
lives when endometriosis drainsus.

(01:44):
Welcome back to Indoobattery.
Charging our lives whenendometriosis drains us.
Welcome back to Endobattery.
Grab your cup of coffee or yourcup of tea and join me at the
table.
Today's guest is someone whobrings a deep expertise,
compassion and innovation to thefield of gynecology.
Dr Megan Wasson is the chair ofthe Department of Medical and
Surgical Gynecology at the MayoClinic in Arizona and a

(02:06):
professor of obstetrics andgynecology at the Mayo Clinic
College of Medicine and Science.
She's a leader in minimallyinvasive gynecologic surgery, a
respected educator namedOutstanding Emerging Educator in
2020, and an internationallyrecognized speaker with over 200
invited lectures and more than70 peer-reviewed publications.

(02:27):
Her clinical focus includesendometriosis, chronic pelvic
pain and advanced surgicaltechniques, and she holds a
fellowship with both theAmerican College of Obstetrics
and Gynecology and AmericanCollege of Surgeons.
Whether it's in the operatingroom, at the podium or shaping
global surgical standards, drWasson is helping redefine what
care can look like for patientsaround the world.

(02:50):
Please help me in welcoming DrMegan Wasson to the table.
Thank you, dr Wasson, so muchfor joining me today.
I'm so grateful to have you.
Thank you for taking the timeto sit down with me.
I know your schedule is socrazy.
You're a busy doctor, busy mom,so thank you so much.

Speaker 2 (03:05):
Oh my gosh, thank you for having me.
I will always make the time totalk about endometriosis, so
thank you for inviting me andsharing a little bit of your
time today.

Speaker 1 (03:15):
Absolutely.
This is what I love doing.
I love being able tocommunicate all the things that
we get to talk about today, andone of the things that we're
both passionate about isendometriosis.
But before we dive in, can youtell us a bit about what drew
you to this work and what keepsyou passionate about helping
people with endometriosis?

Speaker 2 (03:34):
Oh my gosh, it's definitely been a journey, for
sure.
So initially I started to evenunderstand endometriosis and
start to see it during myresidency.
So after medical school, doctorsgo to residency where they
learn more in-depth specialtytraining.
So for those of us whospecialize in endometriosis,
that's typically going to be anOBGYN residency.

(03:54):
So during OBGYN you spend timewith different surgeons and
infertility specialists andthat's really where I started to
learn about endometriosis butminimally invasive surgery as a
whole.
And that's when I chose to do afellowship and thankfully I
matched at Mayo Clinic inArizona, where there is a huge
focus on endometriosis, andthat's where I really started to
actually understand the diseaseand the individuals that this

(04:18):
disease affects and how much ofan impact there is on quality of
life.
And not only understanding thedisease, the amazing surgeries
that we're able to do to helpthese individuals, but then also
seeing the impact that I canhave just by being a listening
set of ears and seeing peopleand hearing people when they
haven't been seen or heard trulyfor at least half their

(04:39):
lifetime very commonly isincredibly rewarding.
And then seeing the outcomesafter we're able to treat
endometriosis I just I love it.

Speaker 1 (04:48):
It gives the fire in my belly and gives me a reason
to get up every day and come inand do what I love Is there one
specific story or patient thatreally sticks out to you, that
really helped frame your workand how that just completely
changed the way that you treatpatients, the way that you

(05:09):
investigate endometriosispatients.
Is there one story that juststicks out to you the most?

Speaker 2 (05:15):
Oh my gosh, there are so many stories.
To pick one is really, reallyhard because everyone is so
amazing in their own right.
But very commonly and there isa specific patient that comes to
mind but hearing that patientsstarted having issues back when
they first got their period theyremember being in high school
laying on the bathroom floorcurled up in the fetal position,

(05:37):
having to have mom come andpick them up from school and
take them home is a very commonstory.
That starts the endometriosisjourney and then patients are
put on birth control pills verycommonly, which is fine.
Birth control pills can be veryhelpful, but eventually a lot
of individuals want to start afamily and so for this one
particular patient, that'sexactly what she did.

(05:58):
She wanted to start a familywith her husband, stopped the
birth control pills, tried toget pregnant, was not able to
get pregnant, but all of thesesymptoms really just came to
light.
She started having cyclicalbleeding from her belly button.
She was having severe ascites,so fluid accumulating in her
abdominal cavity to the pointthat there was five, six, seven

(06:20):
liters that were getting drainedoff.
She had pleural effusions, hugeamount of fluid in her chest
cavity every time she had amenstrual cycle, and it all was
because of endometriosis, and sothe birth control pills were
doing amazing, masking hersymptoms, putting the bandaid on
the symptoms.
But then, when life changed andshe wanted to pursue pregnancy,

(06:42):
that's when the disease wastruly recognized.
Unfortunately, because thedisease was so advanced, she
ultimately was not able topursue pregnancy.
She ultimately had ahysterectomy before she was able
to have any children, which,yes, I saw.
That it's heartbreaking.
It's heartbreaking that thedisease takes so much away from
people.
But she also had to have abowel resection.

(07:04):
She had to have her bellybutton removed.
She had to have a VATSprocedure.
A large portion of her thoraciccavity and her diaphragm
removed, the sac around herheart, like really, really
extensive disease that sheprobably wouldn't have even
known she had if she had neverstopped the birth control pills.

Speaker 1 (07:22):
Wow, I mean, that's huge.
That's what, in advocacy, wetry so hard to convey is like
the sooner you get this takencare of, the better, which
brings me to our wholediscussion today.
We're going to walk through thedifferent stages of
endometriosis, and by stages Imean the different ages and
stages of endometriosis, sowe're talking from adolescence

(07:45):
to postmenopausal, because thisaffects people at a wide range,
but it might affect themslightly differently and you
have treated patients from everyrange, and so I want to go into
this with an open mind.
But also I really want toempower people with wherever
they're at, to learn somethingand to get that information so

(08:07):
that they can advocate betterfor their care.
And that's, you know, one ofthe sweet things that we get to
do is, in advocacy is we get tolearn with everyone.
So can you briefly just, we'regoing to go through the
adolescence and early teen years, ages roughly 10 to 19,.
What are some early warningsigns of endometriosis in

(08:30):
adolescents that often getdismissed as normal period pains
?

Speaker 2 (08:35):
Yeah, so exactly what you just said is number one,
that it's quote unquote normalperiod pain.
That unfortunately, there's alot of generational trauma that
can almost happen.
That because we know there is afamilial component to
endometriosis, that if mom hadendometriosis and really, really
struggled with painful cyclesand then her daughter is now

(08:56):
starting to have cycles andreally struggling, they don't
know any different, and so themom tells the daughter yeah,
this is your cycle, this is justwhat it is.
So there's that huge elementthat can happen, that the family
is normalizing it.
Now, if an individual goes andtalks to her doctor, most
commonly the pediatrician is whois going to be the first
sounding board for this and theysay, yeah, I'm having cramps.

(09:19):
And the pediatrician doesn'tdelve into it any further and
they say, well, yeah, everyonehas cramps with their period.
It gets dismissed and that'swhere the cycle starts happening
that that patient may neverbring it up again because, well,
I told my doctor and they saidit was normal.
So, yeah, I guess this is justwhat it means to be a woman and
what it means to have my cycle,and so that's where we need to

(09:41):
do better very early In terms ofspecific symptoms, to watch for
.
My best recommendation isalways to think about your
period just as an inconvenience.
If someone is having symptomswith their cycle, that is more
than an inconvenience If they'rehaving to change their
activities.
They're not able to do theirsports, they're not able to
dance, they're not able to go toschool, they're missing going

(10:04):
to the movies with their friendsbecause of their menstrual
cycle.
That is not normal.
That should absolutely perkears and raise red flags, that
maybe something should beinvestigated a little bit
further, specifically for theadolescent population.
We also know that it's verycommon to have pain outside of
the menstrual cycle.
So if individuals are havingpain, not just with bleeding,

(10:27):
but complaining about pelviccramping, discomfort even
outside of that timeframe, thatshould also heighten our
suspicion.
There could also be a lot ofthe weird vague symptoms that
can carry on truly throughoutlife, so nausea, diarrhea with
the menstrual cycle.
So anything along those linesshould at least elevate the
suspicion that endometriosis isa possibility what age range do

(10:49):
you typically see presentationsand symptoms in these patients?
yeah, so if you have thatheightened index of suspicion, a
lot of patients will actuallypresent even before they get
their first menstrual cycle.
So as the hormones are turningon, as the ovaries are starting
to circulate, that estrogen andprogesterone, that's happening

(11:10):
before you actually have awithdrawal bleed, so the actual
menstrual bleeding, and soindividuals can start to have
pelvic discomfort, pelviccramping, even before they start
bleeding and, as we know, theage of menarche so when the
first period comes is startingto go down.
It's not uncommon to startseeing symptoms even before the

(11:31):
age of 10.

Speaker 1 (11:32):
Yeah, and that's interesting because I think, as
someone who experienced a lot ofthese symptoms prior to my
first actual period, I'm verymindful in my children to look
for those things because theyare more likely to have
endometriosis, and so for me tobe aware of these signs and
symptoms prior to even theirmenstrual cycle really starting

(11:55):
or shedding of the blood, that'skey for a parent to recognize.
But how early can a pelvic exambe safely and ethically
performed, especially in theseyoung 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 toindividuals if that first pelvic
exam is not done verythoughtfully and very
deliberately, is not done verythoughtfully and very
deliberately, pelvic exams andphysical exams in general can be
incredibly beneficial becausenot all pain is endometriosis
and we need to make sure thatwe're not missing alternative

(12:34):
sources of pain.
But there's a subspecialtywithin OBGYN and it's called
pediatric and adolescentgynecology and they've really
perfected how we can do theseexams and not do trauma.
Speculum exams really don'thave much place at all in the
pediatric adolescent population,especially in someone who has

(12:55):
not been yet sexually active.
There's a lot of trauma that wecan do with that.
But we can inspect the vulva,we can inspect the introitus and
make sure there isn't somethinglike an imperforate hymen that
someone may truly be cycling butthe blood just can't get out
and that's where their pain iscoming from.
So we can do physical exams,especially in those with pelvic

(13:16):
pain, but that doesn'tnecessitate doing what most
individuals would think of as apelvic exam.
You don't need to do a speculumexam.
You don't need to do thatbimanual exam where we're
feeling the uterus, feeling theovaries.
A lot of just inspection isadequate 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 reallywant to do an exam like that?

Speaker 2 (13:48):
Yeah.
So that external inspection isincredibly helpful, specifically
to make sure there isn't thatoutlet obstruction.
So the imperforate hymen, okay,but that isn't the point that
we stop.
So we absolutely can benefitfrom doing a ultrasound, but
again, it doesn't have to be aninternal ultrasound, doing a
screening ultrasound with justthe probe on the abdomen,

(14:10):
looking at the structure of theuterus, looking at the structure
of the ovaries to make surethere's no mass, make sure
there's no big cyst on the ovary.
That's the source of thisdiscomfort.
If someone does have thatoutflow obstruction, that even
if the cervix is blocked andthey're not able to bleed
through the cervix, you'll seethe uterus being filled with
blood and you'll be able to seethat on the ultrasound.

(14:32):
So very commonly in youngerindividuals who are struggling
with pain, we do lean veryheavily on just that extra
inspection of the vulva and theopening of the vagina, but then
also ultrasound.
We really don't like to do CATscans, especially because that's
radiation exposure for youngindividuals.
And then MRI absolutely we canuse it in very select patients,

(14:55):
but we don't want to do that oneveryone either, because that's
a 45 to an hour long exam verycommonly that you're asking a
10-year-old to lay on a tableand hear this clanging, banging
like how much trauma does thatinduce?
So we just need to be verydeliberate and very thoughtful
about what we're putting theseyoung individuals through and

(15:15):
making sure that there is trulythe benefit on the other side of
it and we're not doing moreharm than good.

Speaker 1 (15:20):
Yeah, and that's something that I think many of
us need to consider when we arewalking through this with our
children is the trauma aspect ofit, not just the treatment of
and not just the disease, notjust addressing the disease, but
also the trauma because theirbrains are still developing in

(15:45):
that.
You know this, I think, when wecreate more of that fight or
flight mode, that sympatheticmode, with more trauma, it's
really hard to get into thatparasympathetic mode because
their brains are just notdeveloped enough 100%.

Speaker 2 (15:56):
I love that you're bringing that, because we need
to remember that we're treatingpeople.
We're treating kids and, yes,they may have endometriosis, but
this is still an individualthat'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 advocatefor answers, because that's also
something that can contributeto 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 isshifting in a good way with some
of this, that the discussion ofthe menstrual cycle is becoming
less and less taboo, that it issomething that is talked about
in common conversation, thatit's not something that we're
going to go into the corner andwe're going to hide a tampon in
our sleeve or the pad in oursleeve.
No one can know I'm bleeding,right.

(16:43):
So just having it be part ofsociety and, yes, this is part
of the normal physiology of awoman I think can be very
helpful because, in turn, ifsomeone isn't afraid to say, hey
, I'm bleeding today, they'realso going to have less fear
saying, hey, I'm bleeding todayand 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 workwith your children's school to
help get them on a program thatcan accommodate for things like
this when their menstrual cycledoes come around and they have
to miss school and they're notin a stage where they can maybe
even have surgery or maybe theydo have to have surgery but to

(17:26):
have that accessibleavailability to them for being
able to get accommodations forwhen things like this come about
.
Working with your school,working with your teachers to
help your student is key infurthering their education.

Speaker 2 (17:46):
Yeah, I almost feel like it instills those life
lessons of self-care and don'tput yourself on the back burner.
You need to make sure thatyou're showing up as your very
best self, and teaching ourteenagers to do that is going to
serve them well for very, verylong-term success in their lives
.
I love the idea of the schoolnurses as well.
Shannon Cohn is doing a lot ofgreat work to bring advocacy to

(18:10):
school nurses because they'revery commonly that first touch
point that kid doesn't want tobe in class because they're so
miserable and then they go tothe school nurse.
Well, similar to what I wasmentioning with the pediatrician
, that school nurse can eithervalidate those symptoms and say,
yes, what you're experiencing,what you're feeling, is real and
I am here to help you, or sayyou need to suck it up and deal

(18:32):
with it and this isn't that bad.
So making sure that we aregiving that platform so that
these young, pliable brains aregiven that validation, which is
going to serve them very welland 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 ofthings is working with their
health teachers, because whatI'm able to do is not
necessarily get face to facewith the students, but with the
teachers who are seeing thesestudents miss school.
And what's interesting aboutthis is that it comes full
circle for those teachers whoalso have endometriosis and
they're getting this educationwhen advocacy steps in and says

(19:13):
we're advocating for these youngpeople but also for you as
teachers.
So you know, that's like just acircle moment for me personally
is to see these teachers andthese 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 thatthey need.
Oh my gosh, that's amazing.
I love that you're able to seethat.

Speaker 1 (19:28):
Yeah, absolutely, it's been a really cool thing.
What would you tell a parentwho'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 alludingto, the brain is incredibly
pliable and the brain learnsthings and then responds
accordingly.
So if these kiddos are dealingwith pain day in and day out
because, like I mentioned, it'snot just when they're bleeding,
they're having pain outside oftheir menstrual cycle the brain

(19:56):
is going to learn that signalingand it will take very little to
then send that signaling 10years from now, 20 years from
now.
So we want to stop that paincycle early, to prevent that
pliability in the brain and thatlearning of chronic pain that,
in turn down the road, becomesvery challenging to undo.
Central sensitization issomething that we see very

(20:18):
commonly in individuals withchronic pain and endometriosis
because of those changes in thebrain.
So don't put bury your head inthe sand, don't pretend that
this isn't happening.
It truly is something that, ifyou see your child suffering,
don't expect that it will justget better.
Don't expect that it's just aphase you know.

(20:38):
Seek out, help, seek outanswers to ensure that we are
preventing those long-termissues from developing.

Speaker 1 (20:44):
On that.
When we're talking treatmentapproaches, Matt, when we're
talking treatment approaches, alot of times they do medical
management.
What is your approach withadolescents when it comes to
either surgery or medicalmanagement, Because this could
be a very challenging thing tothink about surgery for a young
child, but also we know that itcould be beneficial.

(21:05):
What is that breaking pointthere?

Speaker 2 (21:07):
Yeah.
So there is a lot of thatshared decision making to ensure
that we're not just makingunilateral decisions as
endometriosis specialists, butalso that individuals parents,
kids are not making decisionsunilaterally based on the
information that they know.
That may not be the completepicture, so there is absolutely

(21:28):
a place for hormonal managementin this.
I know that hormonal managementcan get a little bit of a bad
rap, but if we're saying that,okay, well, I can put you on a
birth control pill or aprogesterone only pill, I can
stabilize your hormones and notput you through a major surgery,
that could potentially be ahuge win for that individual.

(21:51):
Endometriosis surgery is majorsurgery and, as we talk about
trauma, it absolutely is atrauma to the body.
It's a trauma to that youngperson's brain to go through
surgery and, yes, we do it, butwe don't need to do it on every
single person.
So my general mainstay is usemedical management as first-line
therapy, and sometimes that canbe just doing ibuprofen and

(22:15):
Tylenol, not saying that that isgoing to always cure all of the
pain, but that can be firststep in preemptively using it.
If you know that, okay, yeah,the cycle is going to come
tomorrow.
I'm going to start theibuprofen today, that can be
very helpful, but also doingsomething along the lines of
that birth control pill, theprogesterone only pill that I
was, mentioning the role of GnRHagonists, antagonists, so

(22:39):
oralisa, elegolics, myfembri,depo-lupron that group of
medications really should not beutilized in the adolescent
population because the bones aregrowing so rapidly during that
time and we don't want tonegatively impact that.
But if those medical managementoptions are ineffective, if
someone's trying them andthey're not getting relief,

(23:00):
that's when we really shouldhave a very thoughtful
conversation as to is surgeryworth it and is this the time
that we should be going downthat road?
Or do we want to continue totry to utilize these Band-Aids
for what we presume to beendometriosis, knowing that
surgery may be coming in twoyears, three years, five years?
But right now we can avoid itwith the medications?

Speaker 1 (23:23):
Right, and I think that also goes to say that I
think you should be open withany new provider that you go to
as to why you started thesemedications, because I think
that there could be those cuesin there that maybe we should
evaluate it further as you getolder, and that's where that

(23:43):
birth control can suppress thosesymptoms for so long.
But knowing why you'resuppressing these symptoms,
being honest in your care, iskey for when you get into this
next stage of life, when I feellike you know we're seeing our
young adults 20s and 30 yearolds right, we're now looking
more into has the diseaseprogressed, has it?

(24:06):
You know I'm advancing in myyears.
I want to potentially getpregnant, there's all of these
things.
How does endo tend to evolvefrom adolescence into adulthood?

Speaker 2 (24:18):
Yeah, we know that endometriosis is a progressive
condition, so it's not uncommonfor not only the disease to grow
.
If we're doing like imaging,watching things on ultrasound
MRI, it's not uncommon for thereto be that progression and
disease burden.
But it's also not uncommon tosee progression and symptoms.
That initially, yeah, I hadpainful cycles.

(24:39):
I was starting on birth controlpills as a 13 year old which,
again, I don't necessarilydisagree with.
I think that's fine as a firststep and, yep, it worked.
I put a bandaid on it.
But now I'm 18, 19, 20, and nowI'm starting to have pain
outside of my cycle or the painis no longer controlled with the
birth control pills.
That we're starting to see moreand more symptoms.

(25:01):
That's a very classicpresentation of endometriosis.

Speaker 1 (25:05):
Yeah.
What are the commonmisdiagnoses during this time?

Speaker 2 (25:11):
Yeah, so irritable bowel syndrome is a very, very
common one.
That, yes, you can have somediarrhea, constipation and
that's just anxiety as well, isa very common misdiagnosis that
I very commonly hear as well,that people are having

(25:31):
difficulty with intercourse justbecause they're new in their
sexual journey and so it'll justtake a little bit of time.
Primary dysmenorrhea is anothervery common word thrown out and
diagnosis thrown out, that it'sbecause of the prostaglandins
that the uterus releases andthat's where the pain is coming
from.
Also labral tears, soorthopedic injuries can be the
source.
Like truly everyone wants tothink about things outside of

(25:55):
GYN when we're starting to thinkabout progressive symptoms as
well.

Speaker 1 (26:01):
Yeah, and I think a lot of us have experienced that
from that stage and personally Ihave as well and that is
harmful no-transcript surgicalconsultation versus going on the

(26:33):
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 remindmyself, as well as the
individuals that I'm caring for.
This is a quality of life issue.
So just because a treatmentoption is a good option for one
person doesn't mean it's bestfor another person and it really
needs to be individualized toyou, focused on your priorities,

(26:55):
your goals, your expectations.
So, in terms of when someoneshould consider surgery, lots of
different reasons.
Number one, if it's somethingthat's always been in the back
of your mind and constantly beenthis well, do I have it, do I
not have it?
And it keeps you up at nightand is causing a lot of anxiety,
a lot of stress For someindividuals.
Just having that definitive yesor no is this or is this not

(27:16):
endometriosis gives so muchpeace of mind and so much peace
in general that it's incrediblyhelpful.
So that's where I am neveropposed to just giving someone
that definitive answer.
But when we talk about the otherquality of life issues, so
those symptoms, if someone ishaving symptoms that are not
being controlled with thoseband-aids, the birth control

(27:37):
pills, iuds, progesterone-onlypills then that's where there
should be a very thoughtfulconversation about is it time to
do something different, andthat may include surgery versus
pelvic floor, physical therapy,acupuncture there's a lot of
adjuncts that we can use to helpsupport the body as it
processes and copes withendometriosis.

(27:58):
Additionally, if someone iswanting to pursue pregnancy and
cannot be on those bandaidmedications because, let's be
honest, being on birth controlpills when you're trying to get
pregnant, that is not conducive.
So if you can't be on yourBand-Aid and being off the
Band-Aid is not conducive eitheryeah, doing a surgery may

(28:20):
absolutely be justified at thatprecise moment in time, with the
secondary benefit of not onlycan we surgically help to
decrease those symptoms, but wecan also help optimize, whether
that's for natural pregnancy,which there is good evidence to
show that removing endometriosiscan help optimize for natural
fertility, being able to getpregnant without any

(28:40):
intervention, as well as helpingto optimize for artificial
reproductive technology.
So, individuals who do needthings like intrauterine
insemination, in vitrofertilization, excising
endometriosis, getting rid ofthat 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, isgoing to benefit your body.
It's going to help support theway that it should be
functioning, not the way that ithas been functioning.
It's going to optimize youroverall health.
So there is benefit to justremoving that, but that's not

(29:20):
always accessible to everyone,and that's something that we
always have to keep in mind,right?
That's, I'm sure, somethingthat for you, as a provider you
have in your mind as well islike this may not be accessible
to this patient, and thatbecomes 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 passionateabout education and having my
fellows learning aboutendometriosis, because I am only
one human 10% of reproductiveaged women are affected by
endometriosis, so that's noteven including the prepubescent
or postmenopausal women 10% Icannot take care of 10% of the

(30:01):
female population and we need toincrease access by increasing
the number of individuals whounderstand endometriosis, know
how to do these surgeries andcan provide excellent outcomes.
But we have so far to go interms of meeting the demand of
what is out there.

Speaker 1 (30:19):
Absolutely, absolutely, and that was just
something that is always on thetop of my mind is something to
be cognizant of, because this isa stage of life that we're
really seeing a lot of peoplestruggle with access to care and
access to even diagnosis, whichis why you know it's a little
frustrating, right, as peoplewho hear this day in and day out

(30:42):
.
But can you also speak to theimportance or limits of imaging
like MRI and ultrasound and allof those things at this stage,
because that will help somepeople with whether they're on
insurance or not, maybe evaluatewhether 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 atany diagnostic tool, even like
blood work, if you're gettingblood work done to check for
your hemoglobin, for anemia,there are very specific criteria
that we use to say well, howaccurate is that test?
So what is the sensitivity?

(31:24):
If you have anemia, what's thelikelihood that that blood test
is going to actually show youhave anemia?
What's the specificity?
What's the positive predictivevalue, negative predictive value
?
And that becomes very importantwhen we talk about imaging.
So not all ultrasounds arecreated equal, not all MRIs are
created equal and there arelimitations to the testing.

(31:45):
So even here at Mayo Clinic,where I have a phenomenal team
of radiologists around me whoare really focused and
specialized on endometriosis,like I am, I love my team,
they're amazing, but they stillcan't see everything.
And we have this delicatebalance of, well, don't over
call things, don't tell methings that you're like, well,
maybe I see a little hint ofsomething, because then I don't

(32:08):
really know if I can trust it.
But on the flip side of it, wedon't want to under call either,
because then we're missingsignificant disease and telling
individuals that no, your pelvisis normal, when really it isn't
.
But even here we're seeing that.
So it's very important torecognize the skill set of the
individuals who are obtainingthe images.

(32:30):
Recognize the skill set of theindividuals who are obtaining
the images.
So are they following anendometriosis protocol for the
ultrasounds as well as the MRIs?
Are they getting a narrow fieldof view, meaning doing a lot of
slices, a lot of pictures?
So that way we're gettingreally good at quality imaging.
And then what's the skill setof the radiologist?
Just like a endometriosissurgeon, you can talk to some

(32:51):
individuals who don't really doendometriosis surgery but
they're an OBGYN and they'reboarded, so technically they can
do this.
But what's that level ofexpertise?
So there are really goodstudies that have shown you need
to have high quality imagingfollowed by high quality
interpretation to be able toaccurately get that diagnosis.

Speaker 1 (33:11):
Yeah, you know that's something that's been key in my
care is understanding theimaging and having a
multidisciplinary team thatunderstands 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 isthe limitations that even in the
very best centers, superficialendometriosis is not able to be
accurately detected.
If we move to the outside ofthe pelvis, into the abdomen,
the diaphragm diaphragm is evenharder to see endometriosis

(33:45):
accurately and so I never take aquote, unquote negative exam to
be diagnostic of you do nothave endometriosis.
I take it to mean okay, we'renot worried about needing to do
a bowel resection, we're notworried about needing to
re-implant a ureter becausewe're still suspecting that
there's endometriosis but it'smore superficial disease that we

(34:06):
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 evenlooking at endometriosis, and
most of the time they'll tellyou it's not beneficial to even
do an MRI or an ultrasound oranything like that.
But then you know, they'll saywell, you don't have
endometriosis because your scansare clear.
Well, that's not a definitivetool because it doesn't

(34:30):
necessarily mean that you don'thave 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'swhere the big organizations,
acog, the European version ofACOG, the Canadian version of
ACOG, the American College ofObstetrics and Gynecology is
ACOG and gives guidelines as towhat we should be doing.
They even say that diagnosticlaparoscopy cannot be replaced

(34:57):
by imaging.
At this point, if you suspectendometriosis, you still need to
go in surgically.
That is where you're going toget that definitive yes or no.

Speaker 1 (35:05):
Right, absolutely Should.
People who don't want children.
You know we talked about thefertility aspect, but for people
who don't want children, shouldthey still be concerned about
fertility related symptoms orrisks?

Speaker 2 (35:18):
So yes and no.
So I am always going to befully supportive that.
You know your body, you knowyour life.
Not every single person on thisplanet needs to reproduce.
So if you are not concernedabout having pregnancy, fine,
not a problem.
However, we should not minimizequality of life and a lot of
these symptoms of endometriosisbe it painful intercourse,

(35:38):
painful cycles, painful bowelmovements it can be a sign of
more significant disease burden.
So even if we're not focused onwell, let's optimize for
fertility.
Let's optimize so that you canget pregnant.
I want to optimize so you canlive 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 ofpeople think, well, I don't want
to have kids, but I still wantmy uterus, or you know, there's
there is that caveat there aswell is that it's not always
endometriosis, it could beadenomyosis.

Speaker 2 (36:11):
Yeah, absolutely, and I am always again, I think you
know so far just the way I speakabout this is patients have the
right to decide what happenswith their bodies.
Yes, I can give guidance, I cangive opinions, but ultimately
it affects you much more than itwill ever affect me.
So you get to be in thedriver's seat, you get to decide
what we're going to do.
And so, yeah, we do see a lotof pelvic pain from adenomyosis

(36:35):
as well, which is where we needto think of pelvic pain more as
an onion, that you get multiplelayers of pain, that it can be
endometriosis, but you can alsohave adenomyosis.
You can also have pelvic venousinsufficiency, also called
pelvic congestion syndrome.
You can have myofascial pain,you can have nerve impingement
and all of these things addtogether to this constellation

(36:56):
that is pelvic pain, that youhave to treat every single one
of those layers to make anyheadway.
But, that being said, it's hardto say how much each of those
layers is contributing to thatperception of pain.
So for that individual that wehighly suspect adenomyosis but
does not want to lose her uterus, that's fine.
We can't treat the endo.

(37:17):
We can treat the pelvic floor.
We can treat the muscles, thenerves, the blood vessels and
optimize everything so that waythe symptoms that are coming
from the adenomyosis areminimized 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 Absolutelyas we go on, because that's a
big portion of that stage.
But as people progress in laterproductive years mid-30s, early
40s how do symptoms shift orworsen during this stage?

Speaker 2 (37:48):
Yeah, so for individuals who are on that
hormonal suppression we can seethat same progression in
symptoms that we can see in the20s, that the disease just
outgrows the Band-Aid.
So always keeping that in theback of our mind.
And the other thing that wehaven't touched on that I think
is really important is thequality of life issues.
And thinking about it from thatperspective is more for

(38:08):
superficial disease withoutsignificant disease burden, if
we are seeing significantdisease burden with like bowel
involvement, ureteralinvolvement, that needs to be
followed because that can shiftfrom a quality of life issue to
a quantity of life issue that Idon't want you to be in renal
failure because we've ignoredthis disease around your kidney.

(38:29):
So really watching andmonitoring for that progression
if we know there's significantdisease burden, even if the
patients are not wanting to godown the road of surgery, is
critically important.
But for individuals who havethat more superficial disease,
we're not worried aboutsignificant organ involvement
but we're monitoring forsymptoms If individuals are not

(38:50):
on that hormonal suppression andtheir bodies are just
functioning normally.
We do see the perimenopausaltransition very commonly
starting in the early fortiesand that's where you can get
huge surges in different hormonelevels and then drops in
hormone levels and so with thathuge surge and drop, you can
also see a huge surge and dropin endometriosis related
symptoms.

(39:11):
So we can't see more flares inthe 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 andwaning happening.

Speaker 1 (39:23):
Absolutely.
Does endometriosis get moreaggressive 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 mostcommonly see.
So it's not suddenly thatyou're getting rapid growth in
those cells.
If we are seeing rapid growththat we previously were
monitoring and everything wasreally stable, then all of a
sudden we're seeing rapidprogression.
That actually perks our earsthat there can be malignant

(39:50):
transformation, which happens inless than 2% of patients with
deep infiltrating endometriosis,but it can.
So it's always in the back ofour mind.
But what we can see is that asthe hormone levels drop and we
do make that transition intomenopause, that symptoms related
to endometriosis can verycommonly improve for a lot of

(40:10):
individuals not all, but a lotof individuals will see
improvement in symptoms as theytransition into menopause.

Speaker 1 (40:17):
Yeah, and we kind of touched on this a little bit.
But for someone who's hadhormonal suppression for years,
how do you weigh the benefit ofsurgical intervention now in
this state?

Speaker 2 (40:26):
Yeah, so it really does become very individualized
that if the Band-Aid is workingand you're feeling great and
you're not having the blockageof the urine, or that you're
developing hydronephrosis,backup of urine into the kidney,
that I'm worried about yourkidney function.
You're not having bloody stoolsbecause you're having a nodule
of endometriosis going all theway through your rectum, If it

(40:48):
truly is more suspectedsuperficial disease and the
Band-Aid whether that's a birthcontrol pill, an IUD,
progesterone-only pill if thatBand-Aid is adequately
suppressing your symptoms.
There are a lot of individualsthat 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 thisother aspect of this of like the
comorbid conditions.
How do you factor that intoyour 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 youhaving pain with intercourse,
but I also ask about what'shappening in the body as a whole
.
Are you having excessivefatigue that no one's been able
to pinpoint?
Are you having awful migraineheadaches that no one's been
able to pinpoint?
Are you having GI dysfunctionthat you're nauseated all the

(41:41):
time?
You've seen a million GIs.
They scope, everything looksnormal, so they say, yep, this
is your body.
So if there are these otherthings that might not be
obviously associated withendometriosis, that's where we
might start to say, okay, yeah,your pelvis is good, but you can
be having other symptoms andother related conditions that

(42:02):
might get better.
I can't promise, I can'tguarantee.
But if we get rid of thatinflammation that is
endometriosis, if we resetwhat'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 riskof surgery with that kind of big
question mark?
I can't promise if it's goingto get better or not.

Speaker 1 (42:24):
Right.
And that kind of leads me tothis next question of the
postmenopausal, perimenopausal,mid-40s and beyond the hormonal
myths of it all, let's talkabout the myth of menopause
cures endometriosis.
Why isn't?

Speaker 2 (42:38):
that always true cures endometriosis.
Why isn't that always true?
So, number one one of mybiggest pet peeves with
endometriosis in general is whenindividuals have their uterus
removed, their ovaries removed,and nothing is done for
endometriosis.
But I cured your endometriosis.
Nothing could be further fromthe truth.
So endometriosis, yes, itresponds to the hormones that

(43:01):
the ovaries release, but it'snot an issue with the ovaries,
it's an issue with how thattissue is responding.
So we need to focus on fixingthat tissue rather than just
castrating everyone and removingovaries.
So I very, very rarely amremoving ovaries for treatment
of pelvic pain, for treatment ofendometriosis, and the reason

(43:22):
for that is, if we reallyunderstand endometriosis, it
truly is endometrial-like tissue.
It is not the endometrium.
So endometriosis has a chemicalin it called aromatase, and
aromatase converts testosteroneinto estrogen.
So even if the ovaries are gone, the endometriosis is going to
continue to feed itself, and so,whether that's surgical

(43:46):
menopause, natural menopause,medical menopause, using those
various medications that Ipreviously mentioned, symptoms
can continue.
Symptoms can't progress, and weshouldn't just ignore them and
say, well, I guess you'remenopausal and there's nothing
else we can do, so now youreally 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 andyou want to do hormone
replacement therapy, and I thinkthat a lot of people are leery
of doing that because they haveendometriosis and they don't
want to make it worse.
Can you touch on that just alittle bit, because I think that
is a fear of a lot of thesepeople walking through this
stage of life.

Speaker 2 (44:27):
Yeah, and that's where you really need to
understand how these hormonesinterplay and what affects
endometriosis.
I recently just saw a patient.
She came in, was gettingtestosterone supplementation and
was completely asymptomatic.
Endometriosis had never evenentered the conversation until
she was getting testosteronesupplementation and was
completely asymptomatic.
Endometriosis had never evenentered the conversation until
she was getting thattestosterone and all of a sudden
she developed severe pelvicpain and no one could understand

(44:49):
why.
Well, endometriosis convertsthat testosterone into estrogen
and so it just caused thatvicious cycle to really ramp up.
So, that being said, hormonereplacement therapy is not the
enemy.
We just need to be very mindfuland very cognizant about what
we're doing with hormonereplacement therapy and
balancing those risks andbenefits.

(45:10):
So just another plug for whyremoving the ovaries doesn't
really make sense.
So if you have someone who isvery young and you remove the
ovaries, you induce menopause,the immediate next thing is
going to be well, now you're atrisk for osteoporosis, heart
disease.
I need to give you hormones nowto reduce that risk.
So we've taken the hormonesaway, but now I'm going to give

(45:30):
you hormones because you needthe hormones in your body.
It just doesn't logically lineup.
So that's another point for whywe just really shouldn't be
doing that.
But after menopause, in thatperimenopausal transition,
there's a lot of other symptomsthat can arise Hot flashes,
difficulty sleeping, that brainfog is very common and hormones

(45:53):
can help with that.
And so if you need hormones tohelp to support your body during
that transition, absolutely wecan do that.
If someone still has a largeamount of disease burden with
endometriosis, so that patientwho we've been following with
endometriomas hasn't wanted todo surgery, I do recommend
estrogen and progesteronetogether in that patient, even

(46:15):
if they've had a hysterectomy.
So for some individuals afterhysterectomy we say only
estrogen, you don't need anyprogesterone.
But if it's someone who's had avery thorough excision of
endometriosis, we're notsuspicious of significant
disease burden remaining.
That's where someone can useestrogen alone and that's
completely fine If they needestrogen to help with those
menopausal symptoms.

(46:36):
Absolutely Endometriosis is nota 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 hormonereplacement therapy has been key
to me, but I've also been verycognizant of making sure my
dosage is correct, and that'ssomething that working with the
hormone specialist is going tobe very important for when you
are considering these options.
Again, that's something whyit's important to have a

(47:05):
multidisciplinary team and ateam that can work together,
whether that's your excisionspecialist surgeon as well as a
hormone replacement therapyexpert.
Those are really key things tobe working together on with
those people.
In my personal opinion andthat's what I've experienced and
that's what's been helpful forme to do that yeah, I'm glad
that you have that teamsurrounding you, because

(47:27):
endometriosis is a whole bodydisease.

Speaker 2 (47:30):
You can't treat it just with one provider, one
individual.
And I'm glad you've also seenthe positive response to the
correct hormones and making surethat you are utilizing them to
your body's best ability Forsomeone who has had a
hysterectomy but has never hadexcision 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'sreally based on symptoms.
Whether that's naturalmenopause or surgical menopause
is really based on symptoms.
So if they are having asignificant pelvic pain,
significant issues surroundingendometriosis, like those other
symptoms that we mentionedpreviously, then yeah, we can

(48:12):
absolutely consider excisionsurgery.
For those individuals who mighthave significant disease burden
and the fear and the concern ofthat malignant transformation
is there, then again excisionsurgery may be worth it.
So just because someone'smenopausal doesn't mean that we
should suddenly forget aboutendometriosis and ignore the

(48:32):
impact that it can have.

Speaker 1 (48:34):
Yeah, absolutely, and I think some people don't even
think they have endometriosisbut are still having significant
pain, and that might besomething to explore when you
are having pain that it couldpotentially be endometriosis.

Speaker 2 (48:47):
Yeah, I mean, as we've alluded to, talking about
the teenagers and theadolescents, not everyone
understands what endometriosisis, and so, as society is
gaining awareness, yes, peopleare starting to think about this
more.
But for the menopausalpopulation, they are of that
generation that may have beentold this is normal their entire
lives and may have never eventhought that endometriosis is a

(49:09):
possibility.
So asking the questions,perking the ear, is absolutely
worth it, regardless of wheresomeone is in their lifespan.

Speaker 1 (49:16):
Are there increased risks associated with excision
later on in life as opposed todoing it earlier in life for
those that maybe haven't beendiagnosed?

Speaker 2 (49:26):
Yeah, so it's not necessarily that the surgery is
going to be more risky, higherrisk for complications.
In general, the surgery is thesame regardless of where someone
is in their lifespan.
However, we do know that as weage we do develop what's called
comorbidities.
So having diabetes,hypertension, cardiac disease,

(49:46):
that all is going to be moreprevalent as we age.
So surgery can be a little bitmore risky as we age, but not
because of endometriosis, ratherbecause our bodies are a little
bit older and not as wellperforming 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 continueto monitor endometriosis
symptoms or like postmenopausal?

Speaker 2 (50:16):
Should they continue monitoring that, yeah, so if we
are more worried aboutsuperficial disease and it truly
is symptomatology that we'rewatching.
Absolutely Having a good pulseon your body, I think, is always
critically important andalerting your providers if
there's any deviation from thatnormal.
So if you're having pain butyou can deal, it's not worth it

(50:40):
for surgery for you.
Absolutely, we can continue towatch that.
But if at any point you'rehaving changes, that you're
having more discomfort, morepain, something just doesn't
feel the same, you shouldabsolutely reach out to your
provider.
On the flip side of that, ifyou are someone with that deep
infiltrating disease, sosignificant endometriosis
involving the bowel, involvingthe bladder, those are patients

(51:03):
that I'm going to be monitoringwith imaging, regardless of what
their symptomatology is,because that is the population
of individuals thatunfortunately is at higher risk
for developing that malignanttransformation, that we can see
cancer cells developing withinthat deep infiltrating disease.

Speaker 1 (51:27):
Right, those are things that many of us wouldn't
even consider as we progress inlife is to really look at those
different variations andvariables when it comes to this
disease.
And that just goes to showagain it's not a reproductive
disease, it's a whole bodydisease 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

(51:47):
that you've gone through,picking up those subtle symptoms
and changes that we walkthrough throughout the years,
can be really helpful to yourhealthcare providers.
What do you wish all providersunderstood 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 cureendometriosis.
We need to stop castratingwomen.
That does not treat the diseaseand can cause a whole host of
other issues.
That's not to say there's notgood reason for removing reasons
some individuals, but as theprimary treatment for
endometriosis it really needs tobe removed from that algorithm

(52:24):
and don't assume that someone'ssymptoms are not from
endometriosis if they'remenopausal.
Just because the estrogenlevels have declined doesn't
mean the estrogen levels arezero and endometriosis does
continue to cause issues.
So listen to the patient ratherthan just looking at numbers
and statistics.

Speaker 1 (52:45):
Yeah, absolutely.
How can patients of all agesadvocate for themselves,
especially in healthcare systemsthat 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 convincesomeone that something is real
if they don't believe it's real.
And so, yes, I am always a fanof education.
That's why I spend a lot oftime teaching my fellows,
teaching at conferences.
But if someone truly does notbelieve that endometriosis can

(53:17):
be a source of symptoms, nomatter what you say, they're not
going to believe it.
So don't beat your head againsta wall.
Go find someone who understandsthe disease and is willing to
at least listen to you and helpnavigate the system Absolutely.

Speaker 1 (53:32):
But adversely.
What can family members,partners, teachers do to support
someone in any of these lifestages that they encounter?

Speaker 2 (53:42):
Yeah.
So that village aroundindividuals with endometriosis
is incredibly important to makesure that we are not normalizing
symptoms, making sure we're notcontributing to that trauma and
being another advocate in theroom with that person, Because a
lot of these visits can becomevery overwhelming.
There's a lot of telling thestory over and over and over and

(54:04):
that can become exhausting.
So to be that second voice tointerject and add the details
that someone may not beremembering to add can be
incredibly helpful.
And also being that secondvoice to say no, we do need some
help, rather than just lettingthings be dismissed and pushed
to the wayside.

Speaker 1 (54:24):
Absolutely.
My husband has been able topick up on cues and symptoms
before I could.
He's recognizing more because Iam so focused on the pain and
just trying to make it throughday to day that sometimes I
don't pick up on those littlecues.
And so the support people areso vital to proper advocated

(54:44):
care.

Speaker 2 (54:45):
Yeah Well, and like you have mentioned multiple
times, this is not areproductive disease, it's a
whole body disease, but it'salso a whole family disease.

Speaker 1 (54:54):
It's not just something that affects the
individual, it affects theirentire network around them
Absolutely and I saw that in mykids and how they remember
things and their early childhoodmemories of me being sick and
it does.
It really affects the wholefamily.
If you could leave listenerswith one piece of advice for
recognizing and honoring theirsymptoms at any age, what would

(55:17):
it be?

Speaker 2 (55:18):
Your period should be no more than an inconvenience.
Truly, that should be theguiding rule of thumb.
If your period is more than aninconvenience, something is
wrong, and it doesn'tnecessarily mean endo.
It can but make sure thatyou're talking to your
healthcare providers, make surethat you're being heard, so that
way you can get the help youneed and the help you deserve.

Speaker 1 (55:37):
Absolutely, absolutely.
Dr Wasson, thank you so muchfor taking your time and energy
and continue advocating for us.
You do that all the time in theway that you educate and the
way that you continue to pushyourself to learn more about
endometriosis, and I admire thatso much.
Having known you for a littlewhile now, I know how passionate

(55:58):
you are about this disease andI know that you continue pushing
yourself to understand it more.
So thank you for doing that.
Thank you for standing up forthose patients who wouldn't have
other doctors do that andstepping into a space of healing
, and I just appreciate youtaking the time to do that for
us today as well.

Speaker 2 (56:16):
Oh my gosh.
Thank you and I will echo itback to you Thank you for all
that you do in this space andthe advocacy.
We can't do it in silos.
We have to work together theproviders, the patients and
those who are struggling withendometriosis, those who are
supporting those withendometriosis.
So I'm really excited aboutwhat the future of endometriosis
looks like because of peoplelike you.

(56:37):
So thank you for doing the hardwork day in and day out.

Speaker 1 (56:45):
Thank you.
I really appreciate that.
It's always a pleasure to speakwith you.
It's always a pleasure to sitdown with you.
I learn every single time and Ijust enjoy that so much.
So you'll have to come backagain at some point and we'll do
some more fun stuff.
So, yes, yes, I look forward toit.
Yes, until next time.
Everyone continue advocatingfor you and for others.