July 28, 2025 • 22 mins
This conversation explores the need for new approaches to diagnose and treat endometriosis — a painful disease that impacts millions of women yet remains notoriously under-researched. We share one woman's story dealing with painful sex due to the disease followed by an interview with Dr. Idhaliz Flores, a six-time PhD, professor at Ponce Health Sciences University, and Chief Scientific Officer at Nura Health, who talks about her personal journey from patient to pioneering researcher for reshaping the options for care.
We can't stop talking about:
- Endometriosis affecting an estimated 10% of women globally — yet it’s still commonly misdiagnosed or misunderstood. Symptoms like severe cramps, fatigue, and pain during sex are often normalized or dismissed for years.
- The only definitive diagnosis for endometriosis being laparoscopic surgery. That means many women go undiagnosed for years — often until infertility or severe complications arise.
- Endometriosis tissue has been found not only in the pelvis — but in the lungs and even the brain. It’s not just a reproductive condition; it's a full-body disease with systemic symptoms like inflammation and chronic fatigue.
- There’s no cure for endometriosis — and most treatments are hormonal contraceptives. These aren’t viable for everyone, especially for women trying to conceive, leaving many stuck choosing between pain relief and fertility.
- Blood-based biomarker tests for endometriosis are finally emerging. Dr. Flores and her team at Nura Health are working to enable diagnosis through a simple sample — no surgery required.
Connect with Idhaliz:
LinkedIn: Dr. Idhaliz Flores
Visit: Nura Health
Visit: The EMMA Consortium
Have an idea or story to share? We’d love to hear from you! Visit: her-house.com/your-stories — 100% anonymous submissions welcome.
Contact: melissa@her-house.com
Visit: her-house.com
Instagram: @herhouse.forwomenshealth
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Melissa (00:02):
It's her house built for women's health, and we're
talking about innovations thatare shaping the future of
women's health care, answeringunder research topics, and at
the end of the day, fueling abetter quality of life for
women. I'm Melissa D'Elia, andafter years of frustration,
venting to my mom, and tradinghorror stories with friends, I'm
(00:22):
so excited to see awareness andinvestment actually transforming
how our bodies are understood,how we're diagnosed, and how
women are cared for. In eachepisode, we share stories from
real women like you, your mom,your sister, friends, and we
interview experts who aretackling women's health
challenges head on.
Anonymous (00:44):
I went to my gyno and told her I was having extreme
pain during sex. Like,literally, I felt like I was
being torn open. And I thought Iwas just little and he's too
big. And my gyno was like,you're probably just expecting
pain. So here's some lidocaine,rub that on, then have sex.
So I would use lidocaine, numbmyself, and shove a dilator
(01:08):
inside me for thirty minutes aday because that's what I looked
up online to do. That I have topush a little in and wait for
the pain to subside, push alittle more in and wait for the
pain to subside. I had gone backto the guy now and she was like,
how's the sex? And I was like,so great. Okay. I can almost get
him fully in. He can move everso slightly inside me and I
barely cry. And she goes, oh,no. No. That's that's not right.
(01:33):
How's the pill treating you?Well, before I had extremely bad
cramps and really heavy periodsso the pills really mellowed
that out. She's like, Okay,honey. You probably have
endometriosis. Unfortunately,you cannot diagnose that without
surgery. I'm going to give youto the best endometriosis
specialist I know. He isfantastic.
So I went and I met him. Firstthing he said was, I know why
(01:56):
you're here but I want to hearwhy you're here. Tell me. I got
my period when was 16 and like ayear later, I started having
extreme cramps like literally tothe day. And then my cramps just
kept escalating from there.Motrin stopped working. I was to
have to take Pamprin Maxstrength so I could like sit up
and drive to work. I used to beso light headed from the blood
loss.
I told him, I was like, I'm soworried that like I'm just a
(02:19):
whip. He was like, Yeah,everyone who comes in here
thinks they don't haveendometriosis, think they're
being overdramatic. He's like,So you women need to start
believing in yourselves becauseyou are in pain and
unfortunately there's no cure.He told me I'd have to be on
hormones, like you know, justhormonal birth control the rest
of my life essentially to slowdown the endometriosis because
(02:40):
it's going to grow back. I wasvery fortunate to be believed
immediately.
So yeah, and I'm doing muchbetter now. I have no pain
during sex. Crazy experience toenjoy myself and not sob. I'm
doing better. So hallelujah.
Melissa (03:00):
So that was a firsthand experience from somebody who
went through being diagnosedwith endometriosis and obviously
the brutal symptoms that shedealt with for many years before
the diagnosis. On this show, wetalk about women's health issues
and in a lot of cases they aretopics that have been left
behind. But there are people whoare going after these gaps in
(03:22):
information, the questions thathaven't yet been answered, and
I'm obsessed with finding them.I'm obsessed with finding the
people who are trying todiscover these answers. And
that's the really good stuff.
Digging in with theprofessionals who are actually
working to improve women'shealth. They're delivering
solutions and hopefully findingcures. And they're joining us to
(03:44):
share how we got here, what weknow today, and really what
they're trying to solve. In thisexpert interview, we're going to
a place where medicine has beenslow to catch up. Again, the
disease is called endometriosis.
If you haven't heard about it,and we're going to talk about
the pain that's been dismissed,even though it's estimated that
one in ten women haveendometriosis. And we're
(04:07):
exploring those symptoms, thesesymptoms that were waived off as
normal because it takes seven toten years on average to diagnose
this disease as a result. Ourexpert interview is with Doctor.
Italise Flores. She's a six timePhD professor at Ponca Health
Sciences University and chiefscientific officer at
(04:28):
NeuroHealth.
Her own personal diagnosis isactually what led her to a
career pivot before most peoplewere even paying attention to
the disease. Now she's bringingdecades of research to
developing new methods fordiagnosing and treating it.
Idhaliz, thank you so much forjoining us today.
Dr. Flores (04:47):
I'm so pleased to be here. Thanks for the invite.
Meliss (04:50):
It's so nice to see you. And, of course, as I mentioned
last time we talked, thebeautiful art in your
background, I think it's amazinghow that is connected to your
work.
Dr. Flores (05:00):
This piece of work here by doctor Pedro Santiago
depicts two women. One here, isobviously fertile. There's
another woman by her who isobviously going through,
infertility. This painting iscalled endometriosis, and that's
(05:20):
the disease that I study in mylaboratory. It's a condition
that can cause infertility asthis painting depicts.
Melissa (05:27):
I was actually at a conference recently and there
were people in the room. It wasa women's health conference that
didn't know what endometriosiswas. Where is it in your body
and what is the actual disease?
Dr. Flores (05:40):
So endometriosis is defined as endometrial like
tissue that is growing outsidethe uterus, affecting organs in
the pelvis primarily, includingthe uterus, fallopian tubes,
ovaries, but also the bladder,the GI tract. So this presence
(06:01):
of tissue where it's notsupposed to be is gonna be
causing inflammation,prostaglandins, and a whole lot
of pain, infertility, and theimpact on the quality of life as
you can imagine.
Meliss (06:17):
I'm picturing when you see mushrooms that are growing
outside of a tree.
Dr. Flores (06:21):
It's a good analogy actually. And then they can grow
as lesions are superficial, someare actually invasive and
actually cause another importantsymptom of endometriosis, which
is pain with sex calleddyspareunia and also ovarian
cysts that damage, the ovariescausing infertility.
Meliss (06:44):
Where did your career start and how did your
experience lead you to where youare today?
Dr. Flores (06:50):
So I was born in Puerto Rico. I went to the
University of Puerto Rico and Istarted my career as a
microbiologist. Then I went toThe US to pursue a PhD in
molecular genetics andmicrobiology. This is where I
learned I could apply so many ofthese molecular biology
techniques to studying differentdiseases and conditions, not
(07:13):
only infectious diseases. But itwasn't until my own diagnosis of
endometriosis when I discoveredthat I would be really, it would
be really important for me toapply all these techniques to
studying the disease that wasactually affecting me and some
people around me.
Melissa (07:32):
Gosh, it's crazy to think that it's 2025 and
endometriosis is still somethingthat we're wrapping our heads
around. What was that experiencelike for you thirty years ago?
Dr. Flores (07:44):
So imagine waking up in the emergency room in a
hospital with many doctorslooking at you and telling you,
we don't know what you have. Youcame here with excruciating
pain. You actually collapsed inyour apartment. But we ruled out
everything from, I don't know,any inflammatory disease,
(08:07):
infections, appendicitis, andthat it has happened twice. Then
at the third time, imagine beingtold, oh, you have a mass in
your ovary.
It might be cancer. We need todo emergency surgery. I mean,
this is how frightening this allwas. And then waking up after
emergency surgery, hearing forthe first time the word
(08:32):
endometriosis. I was only 28,but now I had to deal with this
disease or this diagnosis I knewnothing about.
So as a scientist, as oftenscientists do, I went to PubMed
to try to look into theliterature. There was very
little research done on thisdisease. The only way to
(08:54):
diagnose it was via surgery.There were no effective
treatments, only hormones thatmay help with symptomatology,
but still are not curative. So,I was drawn back.
I was like, what is this diseaseand what can I do about it as a
(09:14):
molecular biologist? And this ishow it all started.
Melissa (09:18):
And you were doing something that hadn't been done.
How did you address gettingsupport for the work?
Dr. Flores (09:23):
So I have to be honest and tell you, was hard.
Even colleagues, they would say,but why would you devote your
lab, your career to a diseasethat nobody knows about? So I
had to persevere and startlooking for other resources, not
only NIH, but also a foundation.Only $60,000,000 of funding from
(09:46):
NIH were allocated toendometriosis. That's only $2
per person. So that was veryfrustrating at the beginning,
the lack of research funding.
Melissa (09:57):
Were there gaps in the research that frustrated you the
most?
Dr. Flores (10:01):
Yeah, to me, and one hundred and seventy six million
women that are estimated to haveendometriosis. Yeah, I mean, the
biggest concerns, I mean, atleast for me, I mean, it took so
many years since my adolescencewhere I was experiencing like
severe cramps, severe menstrualpain, nobody had told me that
(10:24):
this was, you know, there wassomething wrong with me. So I
have devoted many of thesetwenty years in my laboratory
just to look at biomarkers inblood, in serum plasma, or
urine, or even menstrual fluid.We need some way to non
invasively diagnose thisdisease. And the other area
(10:47):
where it's really challengingand has been very frustrating is
treatment.
Usually the treatments forendometriosis are, oral
contraceptives or other types ofhormonal, treatments.
Unfortunately, hormones cannotbe taken by all women and we
desperately need some treatmentsthat are non hormonal. Let me
(11:09):
tell you something else. Thesetreatments are contraceptives.
And many women withendometriosis, actually thirty
to fifty percent, want, youknow, are infertile or have
problems getting pregnant andmight want to get pregnant.
So they have to be put in thisscenario where they have to
choose quality of life becauseof the pain I'm suffering or
(11:31):
actually trying to get pregnantand have my family. It's quite
frustrating.
Melissa (11:36):
I think that a lot of people today, whether it's
themselves or just other peoplethat they know can relate to
fertility struggles. But to pilethat on top of, you know, all
the unknowns related toendometriosis, it's even more
daunting. What types of evidenceare you seeing that could shift
how we understand endometriosisand treat it?
Dr. Flores (11:58):
So luckily, in the last couple of years, research
on endometriosis have beenimproving, and there's more and
more interesting understandingthis disease. And it has been
nurtured by research from otherfields, such as cancer,
etcetera. And now, of thesetools we're applying, and we're
understanding things like someof the mechanisms that cancer
(12:22):
use to survive and grow,endometriosis might also use
them. And now there's also anunderstanding that this is not
only a disease of the pelvicarea. We know that endometriosis
lesions can appear in otherorgans like the lungs, even the
brain in rare cases. So thiswould explain the systemic
(12:43):
inflammation and the systemicsymptoms that are quite
debilitating, including thingsthat you couldn't link to
endometriosis, such as fatigue,and also involvement of other
organs beyond the pelvis.
Melissa (13:00):
It's pretty astonishing to think that even now we're
just learning where the tissueis growing. You mentioned the
only way to effectively diagnoseit is through laparoscopic
surgery. Is that invasive andpotentially costly?
Dr. Flores (13:16):
We shouldn't do a surgery just to diagnose the
condition. Diagnosis could bedone with symptomatology. It
could be done with biomarkersand through just a blood sample.
And then that would allow us tohelp patients navigate this
process.
Meliss (13:33):
And so those biomarkers or tests, will they be done at
home?
Dr. Flores (13:38):
Even right now, there's some commercially
available tests forendometriosis that are direct to
consumers, meaning you can buythem at the pharmacy or order
them and you can test yourself.We rather have our test be a
complement to the doctor'svisit. Remember, endometriosis,
it is a complex disorder. Itwill require, the interpretation
(14:02):
of a physician in the context ofthe patient's symptomatology and
circumstances. Right?
So we would, prefer that ourtest, is done either in a
hospital setting, of course, or,preferably, in a gynecological
office setting.
Melissa (14:22):
I think that most people, I mean, I personally,
even if I'm digestinginformation directly, appreciate
having a medical professional asmy partner in diagnosing what's
going on with my body. Switchinggears a little bit, one of the
things that we like to do onthis show is highlight how
(14:44):
crucial it is to studybiological differences between
women and men. Can you talkabout the importance of the
diversity in your subjects?
Dr. Flores (14:53):
Yeah, absolutely. So yes, endometriosis does, impacts
women predominantly. There havebeen some very rare cases of
men. Mostly because they'reunder the influence of, estrogen
therapy. So there might be some,they call them like fetal tissue
remnants that may activate andbehave like endometrium. But
(15:16):
these are obviously very rarecases. So, yeah, I'm all for
diversity. I'm Hispanic Latina,of course. So I am pressing that
the inclusion of women of LatinAmerican heritage, of, you know,
African American heritage willbe also part of the research
(15:38):
that is being conducted. Forexample, there's been a lot of,
efforts on understanding thegenetics of endometriosis, and
there are just beautiful studiesbeing conducted, around the
world. But 98% of theparticipants are of, you know,
European heritage. It's soimportant that we ensure that
(16:01):
people from different races,ethnicities, geographical
locations, cultures even,participate in this type of
research? Otherwise, how can weeven make sure that whatever
findings and advancements we'refinding would apply to everyone?
And we want this research to beequitable.
Meliss (16:23):
Genetics are much more than just your family heritage
or a few generations back. Sosuper impressive, and thank you
for all your work that you'vedone on the research side. We
originally met through thesprint for women's health out of
the NIH, which funded a selectnumber of companies. You and
your team are the scientificglue between a consortium of
(16:45):
related companies. Can you talkabout how they collaborate and
what each of them brings to thetable?
Dr. Flores (16:51):
The master plan of involvement, not only
NeuroHealth, which, discoversnew ways to diagnose
endometriosis in blood, but alsocompanies that have innovated in
this space by creating solutionsand tools. If we are able to
match biomarker levels withspecific symptoms, some patient
(17:18):
subtypes, patient phenotypeswith lots of data points and
using the newest technologies ofartificial intelligence, that
will really move the needle. Iwas convinced that is the way to
go. But not only that, but thisplatform is so unique and so
(17:38):
innovative that it will not onlyhelp define these biomarker
levels, link them to particularphenotypes, but will also help
to identify which hormonaltreatments, and in the future,
other types of treatments arebest, are most efficacious and
with less side effects forparticular patients.
Melissa (18:02):
It's good to hear implementation of technology
across the projects. How are youtesting these new products on
humans?
Dr. Flores (18:10):
Yes, we are actually recruiting for this trial. So
basically we're asking womenwith endometriosis, but also
women without endometriosis willbe also very helpful because we
want to be able to compare thesetwo groups of women. We ask
individuals who might want toparticipate to answer a very
(18:31):
short eligibility survey. Ifthey do, we will follow-up to
answer more in-depth questions.There we're we need information
about their symptoms and andalso important to follow-up
throughout a couple of months,ideally six months. And we're
gonna do that through an amobile app that very easily will
(18:52):
track all this, symptomatologyand circumstances in the women's
life that we can then track andcorrelate, in real time with
what's happening with thebiomarkers. And these will help
us in their path, in theirjourney to get the precise
treatment that will function forthem.
Melissa (19:12):
Thank you so much for your work. It really is
incredible that you took thatleap when other people weren't
paying attention to it. Andwhile I'm sorry that you had to
deal with that pain years ago,you really are making a
difference for the future ofother women that hopefully won't
have to, deal with such a scarysituation. To close our
(19:33):
conversation, we'd love for youto give a shout out to another
innovator in the women's healthspace.
Dr. Flores (19:38):
Only one? I have a few. Now very quickly.
Meliss (19:43):
We hear that often. Special shout out to Drs.
Annelyn Torres and CarolineAppleyard. They're my colleagues
and cofounders of Sur180Therapeutics. It's a company
that is researching new nonhormonal treatments for
endometriosis here from Ponce,Puerto Rico.
(20:05):
If people want to follow yourwork and follow the consortium,
what's the best way to do so?
Dr. Flores (20:11):
So the consortium has presence in LinkedIn, The
EMMA Consortium. They can followme also in LinkedIn, Idhaliz
Flores. And I will welcomeanybody's questions or comments.
This is my passion, has been myfocus for twenty years, and I
hope to continue for many moreyears to come.
Meliss (20:33):
Thank you, Idhaliz , and thank you for your entire team's
work.
Dr. Flores (20:36):
Thank you.
Melissa (20:40):
Thanks for listening. And I hope you're able to share
this podcast and what youlearned with others who care
about women's health. Whenever Iget frustrated about health
concern or struggle, I alwaysremind myself that I have more
information than my mother didand way more than my
grandmother's. These innovationsare so important and we can't
stop talking about them becausethose conversations result in
(21:03):
progress for generations tocome. I'd also really love to
hear your stories. The storiesthat end in hallelujah and the
bummers.
If you're comfortable, you canleave a voice message by going
to her-house.com and clickingyour stories. Again, that's her,
the dash symbol, house.com, andyour stories. Everything is a
(21:25):
100% anonymous and always willbe. I wanna hear about your
period, your doctor's visits,your PCOS, pregnancy, giving
birth, what happens after birth,being postpartum, raising your
daughters, caring for yourmothers.
I wanna hear about sexualhealth, mental health, weird
symptoms, your immune system,and seriously, any differences
(21:46):
that you recognize between womenand men, because we are
different down to thechromosomes that encode the
entire maps of our bodies.People are researching these
topics and we're going to findthem.
It's her house built for women's health, and we're
talking about innovations thatare shaping the future of
women's health care, answeringunder research topics, and at
the end of the day, fueling abetter quality of life for
women. I'm Melissa D'Elia, andafter years of frustration,
venting to my mom, and tradinghorror stories with friends, I'm
(00:22):
so excited to see awareness andinvestment actually transforming
how our bodies are understood,how we're diagnosed, and how
women are cared for. In eachepisode, we share stories from
real women like you, your mom,your sister, friends, and we
interview experts who aretackling women's health
challenges head on.
Anonymous (00:44):
I went to my gyno and told her I was having extreme
pain during sex. Like,literally, I felt like I was
being torn open. And I thought Iwas just little and he's too
big. And my gyno was like,you're probably just expecting
pain. So here's some lidocaine,rub that on, then have sex.
So I would use lidocaine, numbmyself, and shove a dilator
(01:08):
inside me for thirty minutes aday because that's what I looked
up online to do. That I have topush a little in and wait for
the pain to subside, push alittle more in and wait for the
pain to subside. I had gone backto the guy now and she was like,
how's the sex? And I was like,so great. Okay. I can almost get
him fully in. He can move everso slightly inside me and I
barely cry. And she goes, oh,no. No. That's that's not right.
(01:33):
How's the pill treating you?Well, before I had extremely bad
cramps and really heavy periodsso the pills really mellowed
that out. She's like, Okay,honey. You probably have
endometriosis. Unfortunately,you cannot diagnose that without
surgery. I'm going to give youto the best endometriosis
specialist I know. He isfantastic.
So I went and I met him. Firstthing he said was, I know why
(01:56):
you're here but I want to hearwhy you're here. Tell me. I got
my period when was 16 and like ayear later, I started having
extreme cramps like literally tothe day. And then my cramps just
kept escalating from there.Motrin stopped working. I was to
have to take Pamprin Maxstrength so I could like sit up
and drive to work. I used to beso light headed from the blood
loss.
I told him, I was like, I'm soworried that like I'm just a
(02:19):
whip. He was like, Yeah,everyone who comes in here
thinks they don't haveendometriosis, think they're
being overdramatic. He's like,So you women need to start
believing in yourselves becauseyou are in pain and
unfortunately there's no cure.He told me I'd have to be on
hormones, like you know, justhormonal birth control the rest
of my life essentially to slowdown the endometriosis because
(02:40):
it's going to grow back. I wasvery fortunate to be believed
immediately.
So yeah, and I'm doing muchbetter now. I have no pain
during sex. Crazy experience toenjoy myself and not sob. I'm
doing better. So hallelujah.
Melissa (03:00):
So that was a firsthand experience from somebody who
went through being diagnosedwith endometriosis and obviously
the brutal symptoms that shedealt with for many years before
the diagnosis. On this show, wetalk about women's health issues
and in a lot of cases they aretopics that have been left
behind. But there are people whoare going after these gaps in
(03:22):
information, the questions thathaven't yet been answered, and
I'm obsessed with finding them.I'm obsessed with finding the
people who are trying todiscover these answers. And
that's the really good stuff.
Digging in with theprofessionals who are actually
working to improve women'shealth. They're delivering
solutions and hopefully findingcures. And they're joining us to
(03:44):
share how we got here, what weknow today, and really what
they're trying to solve. In thisexpert interview, we're going to
a place where medicine has beenslow to catch up. Again, the
disease is called endometriosis.
If you haven't heard about it,and we're going to talk about
the pain that's been dismissed,even though it's estimated that
one in ten women haveendometriosis. And we're
(04:07):
exploring those symptoms, thesesymptoms that were waived off as
normal because it takes seven toten years on average to diagnose
this disease as a result. Ourexpert interview is with Doctor.
Italise Flores. She's a six timePhD professor at Ponca Health
Sciences University and chiefscientific officer at
(04:28):
NeuroHealth.
Her own personal diagnosis isactually what led her to a
career pivot before most peoplewere even paying attention to
the disease. Now she's bringingdecades of research to
developing new methods fordiagnosing and treating it.
Idhaliz, thank you so much forjoining us today.
Dr. Flores (04:47):
I'm so pleased to be here. Thanks for the invite.
Meliss (04:50):
It's so nice to see you. And, of course, as I mentioned
last time we talked, thebeautiful art in your
background, I think it's amazinghow that is connected to your
work.
Dr. Flores (05:00):
This piece of work here by doctor Pedro Santiago
depicts two women. One here, isobviously fertile. There's
another woman by her who isobviously going through,
infertility. This painting iscalled endometriosis, and that's
(05:20):
the disease that I study in mylaboratory. It's a condition
that can cause infertility asthis painting depicts.
Melissa (05:27):
I was actually at a conference recently and there
were people in the room. It wasa women's health conference that
didn't know what endometriosiswas. Where is it in your body
and what is the actual disease?
Dr. Flores (05:40):
So endometriosis is defined as endometrial like
tissue that is growing outsidethe uterus, affecting organs in
the pelvis primarily, includingthe uterus, fallopian tubes,
ovaries, but also the bladder,the GI tract. So this presence
(06:01):
of tissue where it's notsupposed to be is gonna be
causing inflammation,prostaglandins, and a whole lot
of pain, infertility, and theimpact on the quality of life as
you can imagine.
Meliss (06:17):
I'm picturing when you see mushrooms that are growing
outside of a tree.
Dr. Flores (06:21):
It's a good analogy actually. And then they can grow
as lesions are superficial, someare actually invasive and
actually cause another importantsymptom of endometriosis, which
is pain with sex calleddyspareunia and also ovarian
cysts that damage, the ovariescausing infertility.
Meliss (06:44):
Where did your career start and how did your
experience lead you to where youare today?
Dr. Flores (06:50):
So I was born in Puerto Rico. I went to the
University of Puerto Rico and Istarted my career as a
microbiologist. Then I went toThe US to pursue a PhD in
molecular genetics andmicrobiology. This is where I
learned I could apply so many ofthese molecular biology
techniques to studying differentdiseases and conditions, not
(07:13):
only infectious diseases. But itwasn't until my own diagnosis of
endometriosis when I discoveredthat I would be really, it would
be really important for me toapply all these techniques to
studying the disease that wasactually affecting me and some
people around me.
Melissa (07:32):
Gosh, it's crazy to think that it's 2025 and
endometriosis is still somethingthat we're wrapping our heads
around. What was that experiencelike for you thirty years ago?
Dr. Flores (07:44):
So imagine waking up in the emergency room in a
hospital with many doctorslooking at you and telling you,
we don't know what you have. Youcame here with excruciating
pain. You actually collapsed inyour apartment. But we ruled out
everything from, I don't know,any inflammatory disease,
(08:07):
infections, appendicitis, andthat it has happened twice. Then
at the third time, imagine beingtold, oh, you have a mass in
your ovary.
It might be cancer. We need todo emergency surgery. I mean,
this is how frightening this allwas. And then waking up after
emergency surgery, hearing forthe first time the word
(08:32):
endometriosis. I was only 28,but now I had to deal with this
disease or this diagnosis I knewnothing about.
So as a scientist, as oftenscientists do, I went to PubMed
to try to look into theliterature. There was very
little research done on thisdisease. The only way to
(08:54):
diagnose it was via surgery.There were no effective
treatments, only hormones thatmay help with symptomatology,
but still are not curative. So,I was drawn back.
I was like, what is this diseaseand what can I do about it as a
(09:14):
molecular biologist? And this ishow it all started.
Melissa (09:18):
And you were doing something that hadn't been done.
How did you address gettingsupport for the work?
Dr. Flores (09:23):
So I have to be honest and tell you, was hard.
Even colleagues, they would say,but why would you devote your
lab, your career to a diseasethat nobody knows about? So I
had to persevere and startlooking for other resources, not
only NIH, but also a foundation.Only $60,000,000 of funding from
(09:46):
NIH were allocated toendometriosis. That's only $2
per person. So that was veryfrustrating at the beginning,
the lack of research funding.
Melissa (09:57):
Were there gaps in the research that frustrated you the
most?
Dr. Flores (10:01):
Yeah, to me, and one hundred and seventy six million
women that are estimated to haveendometriosis. Yeah, I mean, the
biggest concerns, I mean, atleast for me, I mean, it took so
many years since my adolescencewhere I was experiencing like
severe cramps, severe menstrualpain, nobody had told me that
(10:24):
this was, you know, there wassomething wrong with me. So I
have devoted many of thesetwenty years in my laboratory
just to look at biomarkers inblood, in serum plasma, or
urine, or even menstrual fluid.We need some way to non
invasively diagnose thisdisease. And the other area
(10:47):
where it's really challengingand has been very frustrating is
treatment.
Usually the treatments forendometriosis are, oral
contraceptives or other types ofhormonal, treatments.
Unfortunately, hormones cannotbe taken by all women and we
desperately need some treatmentsthat are non hormonal. Let me
(11:09):
tell you something else. Thesetreatments are contraceptives.
And many women withendometriosis, actually thirty
to fifty percent, want, youknow, are infertile or have
problems getting pregnant andmight want to get pregnant.
So they have to be put in thisscenario where they have to
choose quality of life becauseof the pain I'm suffering or
(11:31):
actually trying to get pregnantand have my family. It's quite
frustrating.
Melissa (11:36):
I think that a lot of people today, whether it's
themselves or just other peoplethat they know can relate to
fertility struggles. But to pilethat on top of, you know, all
the unknowns related toendometriosis, it's even more
daunting. What types of evidenceare you seeing that could shift
how we understand endometriosisand treat it?
Dr. Flores (11:58):
So luckily, in the last couple of years, research
on endometriosis have beenimproving, and there's more and
more interesting understandingthis disease. And it has been
nurtured by research from otherfields, such as cancer,
etcetera. And now, of thesetools we're applying, and we're
understanding things like someof the mechanisms that cancer
(12:22):
use to survive and grow,endometriosis might also use
them. And now there's also anunderstanding that this is not
only a disease of the pelvicarea. We know that endometriosis
lesions can appear in otherorgans like the lungs, even the
brain in rare cases. So thiswould explain the systemic
(12:43):
inflammation and the systemicsymptoms that are quite
debilitating, including thingsthat you couldn't link to
endometriosis, such as fatigue,and also involvement of other
organs beyond the pelvis.
Melissa (13:00):
It's pretty astonishing to think that even now we're
just learning where the tissueis growing. You mentioned the
only way to effectively diagnoseit is through laparoscopic
surgery. Is that invasive andpotentially costly?
Dr. Flores (13:16):
We shouldn't do a surgery just to diagnose the
condition. Diagnosis could bedone with symptomatology. It
could be done with biomarkersand through just a blood sample.
And then that would allow us tohelp patients navigate this
process.
Meliss (13:33):
And so those biomarkers or tests, will they be done at
home?
Dr. Flores (13:38):
Even right now, there's some commercially
available tests forendometriosis that are direct to
consumers, meaning you can buythem at the pharmacy or order
them and you can test yourself.We rather have our test be a
complement to the doctor'svisit. Remember, endometriosis,
it is a complex disorder. Itwill require, the interpretation
(14:02):
of a physician in the context ofthe patient's symptomatology and
circumstances. Right?
So we would, prefer that ourtest, is done either in a
hospital setting, of course, or,preferably, in a gynecological
office setting.
Melissa (14:22):
I think that most people, I mean, I personally,
even if I'm digestinginformation directly, appreciate
having a medical professional asmy partner in diagnosing what's
going on with my body. Switchinggears a little bit, one of the
things that we like to do onthis show is highlight how
(14:44):
crucial it is to studybiological differences between
women and men. Can you talkabout the importance of the
diversity in your subjects?
Dr. Flores (14:53):
Yeah, absolutely. So yes, endometriosis does, impacts
women predominantly. There havebeen some very rare cases of
men. Mostly because they'reunder the influence of, estrogen
therapy. So there might be some,they call them like fetal tissue
remnants that may activate andbehave like endometrium. But
(15:16):
these are obviously very rarecases. So, yeah, I'm all for
diversity. I'm Hispanic Latina,of course. So I am pressing that
the inclusion of women of LatinAmerican heritage, of, you know,
African American heritage willbe also part of the research
(15:38):
that is being conducted. Forexample, there's been a lot of,
efforts on understanding thegenetics of endometriosis, and
there are just beautiful studiesbeing conducted, around the
world. But 98% of theparticipants are of, you know,
European heritage. It's soimportant that we ensure that
(16:01):
people from different races,ethnicities, geographical
locations, cultures even,participate in this type of
research? Otherwise, how can weeven make sure that whatever
findings and advancements we'refinding would apply to everyone?
And we want this research to beequitable.
Meliss (16:23):
Genetics are much more than just your family heritage
or a few generations back. Sosuper impressive, and thank you
for all your work that you'vedone on the research side. We
originally met through thesprint for women's health out of
the NIH, which funded a selectnumber of companies. You and
your team are the scientificglue between a consortium of
(16:45):
related companies. Can you talkabout how they collaborate and
what each of them brings to thetable?
Dr. Flores (16:51):
The master plan of involvement, not only
NeuroHealth, which, discoversnew ways to diagnose
endometriosis in blood, but alsocompanies that have innovated in
this space by creating solutionsand tools. If we are able to
match biomarker levels withspecific symptoms, some patient
(17:18):
subtypes, patient phenotypeswith lots of data points and
using the newest technologies ofartificial intelligence, that
will really move the needle. Iwas convinced that is the way to
go. But not only that, but thisplatform is so unique and so
(17:38):
innovative that it will not onlyhelp define these biomarker
levels, link them to particularphenotypes, but will also help
to identify which hormonaltreatments, and in the future,
other types of treatments arebest, are most efficacious and
with less side effects forparticular patients.
Melissa (18:02):
It's good to hear implementation of technology
across the projects. How are youtesting these new products on
humans?
Dr. Flores (18:10):
Yes, we are actually recruiting for this trial. So
basically we're asking womenwith endometriosis, but also
women without endometriosis willbe also very helpful because we
want to be able to compare thesetwo groups of women. We ask
individuals who might want toparticipate to answer a very
(18:31):
short eligibility survey. Ifthey do, we will follow-up to
answer more in-depth questions.There we're we need information
about their symptoms and andalso important to follow-up
throughout a couple of months,ideally six months. And we're
gonna do that through an amobile app that very easily will
(18:52):
track all this, symptomatologyand circumstances in the women's
life that we can then track andcorrelate, in real time with
what's happening with thebiomarkers. And these will help
us in their path, in theirjourney to get the precise
treatment that will function forthem.
Melissa (19:12):
Thank you so much for your work. It really is
incredible that you took thatleap when other people weren't
paying attention to it. Andwhile I'm sorry that you had to
deal with that pain years ago,you really are making a
difference for the future ofother women that hopefully won't
have to, deal with such a scarysituation. To close our
(19:33):
conversation, we'd love for youto give a shout out to another
innovator in the women's healthspace.
Dr. Flores (19:38):
Only one? I have a few. Now very quickly.
Meliss (19:43):
We hear that often. Special shout out to Drs.
Annelyn Torres and CarolineAppleyard. They're my colleagues
and cofounders of Sur180Therapeutics. It's a company
that is researching new nonhormonal treatments for
endometriosis here from Ponce,Puerto Rico.
(20:05):
If people want to follow yourwork and follow the consortium,
what's the best way to do so?
Dr. Flores (20:11):
So the consortium has presence in LinkedIn, The
EMMA Consortium. They can followme also in LinkedIn, Idhaliz
Flores. And I will welcomeanybody's questions or comments.
This is my passion, has been myfocus for twenty years, and I
hope to continue for many moreyears to come.
Meliss (20:33):
Thank you, Idhaliz , and thank you for your entire team's
work.
Dr. Flores (20:36):
Thank you.
Melissa (20:40):
Thanks for listening. And I hope you're able to share
this podcast and what youlearned with others who care
about women's health. Whenever Iget frustrated about health
concern or struggle, I alwaysremind myself that I have more
information than my mother didand way more than my
grandmother's. These innovationsare so important and we can't
stop talking about them becausethose conversations result in
(21:03):
progress for generations tocome. I'd also really love to
hear your stories. The storiesthat end in hallelujah and the
bummers.
If you're comfortable, you canleave a voice message by going
to her-house.com and clickingyour stories. Again, that's her,
the dash symbol, house.com, andyour stories. Everything is a
(21:25):
100% anonymous and always willbe. I wanna hear about your
period, your doctor's visits,your PCOS, pregnancy, giving
birth, what happens after birth,being postpartum, raising your
daughters, caring for yourmothers.
I wanna hear about sexualhealth, mental health, weird
symptoms, your immune system,and seriously, any differences
(21:46):
that you recognize between womenand men, because we are
different down to thechromosomes that encode the
entire maps of our bodies.People are researching these
topics and we're going to findthem.
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