March 26, 2025 • 38 mins
This episode focuses on the critical aspects of endometriosis, a complex condition affecting millions of women, emphasizing awareness and understanding its symptoms, diagnosis, and treatment options. Host Dr. Holly Thacker discusses the challenges with fertility linked to endometriosis, the importance of early diagnosis, and holistic approaches for symptom management.
• Discussing endometriosis and its prevalence among women
• Common symptoms including pelvic pain and fertility issues
• Challenges in diagnosing endometriosis
• Overview of risk factors and genetic components
• Exploration of treatment options from hormonal therapies to surgery
• The importance of nutritional support and lifestyle changes
• Encouraging open conversations about female reproductive health
• Calls for greater awareness and support for women experiencing endometriosis
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
Listen on: Apple Podcasts Spotify
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new podcast, and on thispodcast episode, I am going to
(00:26):
be talking about endometriosis,as March is Endometriosis
Awareness Month, so maybe youknow what endometriosis is,
maybe you don't, and you thinkmaybe, if I don't think I have
it, why should I know about it?
You think, maybe, if I don'tthink I have it, why should I
know about it?
Well, it's a very perplexingcondition in women and it can
(00:49):
cause a lot of havoc.
And if you're suffering from it, or you think you're suffering
from it, maybe it hasn't beendiagnosed.
So I think it is very importantto bring awareness to this
female condition.
And endometriosis is when thelining of the uterus, the
so-called endometrium, growsoutside the uterus, and
(01:14):
currently, in 2025, when we'retaping this, it cannot be cured
or prevented completely, butthankfully, the pain and the
fertility problems it causes canbe relieved.
And of the more than five and ahalf million United States
(01:36):
American women withendometriosis, 30 to 40% of them
have difficulty conceiving.
Now, personally, I haveexperienced endometriosis and
had terrible pains and had alittle bit of trouble conceiving
, but thankfully that's allbehind me and, as a lot of
(01:59):
long-term listeners know, I havethree sons and I am just about
to get my fourth grandchild inMarch, so that's very exciting.
So there is certainly hope andfertility is a big issue.
Women are putting off childbearing.
(02:20):
They feel young, they want toestablish their adult life and
their careers, but there'sreally just a very finite period
of time that women especiallyhave maximal fertility, and I
don't think women hear thisenough, and I have taken care of
thousands of women over theyears and when I've seen younger
(02:44):
women, I always ask them andinquire about their childbearing
plans and a lot of times theyhaven't even really thought
about it.
And since half of allpregnancies can be unplanned and
simple things like getting goodnutrition and adequate folic
acid prior to conception reducesso many neurologic problems, it
really is an importantdiscussion to have, even if you
(03:06):
don't think that you're going tohave children or you're not
trying to conceive.
So, getting back toendometriosis, when you have
small islands of tissue that arehistologically very similar to
the inner lining of the uterus,the endometrium, when they
implant themselves on otherorgans like the abdominal organs
(03:29):
, the colon, even potentiallythe lung.
During the cycle ofmenstruation this ectopic tissue
can bleed and cause a lot ofpainful inflammation.
Lot of painful inflammation,severe menstrual cramps can
(03:50):
occur, heavy periods, tenesmus,which is painful bowel movements
.
In fact, the differentialdiagnosis for tenesmus is
endometriosis endometriosis,endometriosis in females.
There are other causes, ofcourse.
Endometriosis in females.
There are other causes, ofcourse, but that really is the
primary one.
(04:14):
Some of the most common places awoman can develop endometriosis
includes the space right behindthe uterus.
It can occur in the muscle ofthe uterus, adenomyosis, and
that's more common in womenwho've had C-sections, who've
had the muscle cut to get thebaby out for delivery.
There can be deposits on theovaries which look like
chocolate cysts.
The dark brown is the darkblood.
(04:35):
It can occur in the peritoneum,the lining of the abdomen, the
fallopian tubes which if they'rescarred or blocked can cause
ectopic pregnancy or justdefinite infertility.
Less common places include therectum, the bladder, the
intestines, the diaphragm,that's the muscle that separates
(04:59):
the lungs from the abdomen.
Actually, there can be ectopicdeposits in the vagina.
I have seen colon polyps biopsythat are actually endometrial
tissue, so it's actually gotteninside the colon and in the
lungs.
It can be really a problembecause during menses if there's
(05:21):
bleeding into the lungs, thatcould actually cause severe
pulmonary symptoms and evenpotentially pneumothorax, where
the lung collapses, which can bevery dramatic and even
potentially life-threatening.
So it's a relatively commoncondition.
One in 10 women experience this.
(05:43):
Most of the time, healthcareclinicians diagnose it in women
in their 20s and 30s andthankfully a lot of the symptoms
are manageable with treatment.
Now the most common symptom ispelvic pain, which can be
intense or mild.
Symptoms are usually worse justright before and during the
(06:05):
period due to the inflammationbrought on by the hormonal
changes and the bleeding thatcan occur in the abdomen.
Blood is very inflammatory andif blood is present where it
shouldn't be, it really sets offa lot of alarms in the body.
So very painful menstrualcramps I remember having such
(06:26):
pain.
I remember telling my family Ijust wanted a hysterectomy as a
teenager, which thankfully Ididn't have done Abdominal pain
or back pain during the period,heavy bleeding or spotting and
of course there's lots ofdifferent things that can cause
heavy bleeding and abnormalspotting and that always should
(06:48):
be evaluated by your women'shealth care clinician.
And if you didn't hear lastseason's interview with nurse
practitioner Kelsey Kennedy onabnormal uterine bleeding.
That's a great one to go backto listen to bleeding.
That's a great one to go backto listen to.
Pain during sexual activity.
(07:10):
The medical term for that isdyspareunia, which can be deep.
There's also superficialdyspareunia.
There's vulvar skin conditionsthat can cause pain with sexual
activity, pain that occursduring defecation or urination.
Stomach issues, gi issues likediarrhea or constipation or
(07:33):
bloating can be more common.
Some women with endometriosisfeel fatigued and they may have
some increased risk for anxietyand depression, which are
relatively common conditions inwomen, and a lot of it is
lifestyle and nutritional.
I have found in my practice,since doing more intense
(07:58):
nutritional assessments checkingvitamin D levels, b12 and zinc
and omega-3, that a lot of minormood disturbances can really be
improved with exercise, goodsleep and excellent nutrition.
We did a podcast I believe itwas season one on food as
(08:23):
medicine, and so it's importantto be holistic.
Some conditions need more thanjust lifestyle support, but a
lot of things can be mitigatedor even treated with focusing on
a healthy lifestyle.
Now, some women really don'thave a lot of symptoms.
(08:45):
It just gets diagnosed whenthey're undergoing an
infertility evaluation.
Now you might wonder well, whatcauses this condition.
We're not really sure, but weknow that there's probably a
genetic component, like withmost conditions.
So it's always good to knowyour biological family history
(09:06):
conditions.
So it's always good to knowyour biological family history,
your mother's history offertility, which obviously if
she had you, she had some degreeof fertility.
And when I get family historiesI mean it's really lovely
because people identify theperson who helped raise them as
their parent or theirgrandparent.
But that's always notbiologically the case.
So when your physician or nursepractitioner or physician
(09:28):
assistant ask you about yourmother's health or your father's
health or your grandmother'shealth, they don't mean
necessarily the one that youpsychologically associate with
all that nurturing.
Also your, your sister, yoursister if you have a full
(09:48):
sibling, that's the same sex youshare the most DNA with.
Now it usually starts betweenages 20 and 40, but teenagers
like myself can experience itThankfully after menopause.
That is one of the things thatdoes improve, because the
(10:09):
uterine tissue, the endometrialtissue, gets thinner and you
don't have the repetitivecycling of up and down hormone
levels.
So other risk factors includethe family history.
For women who have shortermenstrual cycles, and a
menstrual cycle can be normal 21days to up to 42 days.
(10:29):
So if your cycle is fewer than27 days.
That's another risk.
Never having children?
It seems like having childrennot only matures the breast,
especially the younger age youhave children, which is we think
it matures the breast,especially the younger age you
have children, which is, wethink it matures the breast and
makes it more resistant tobreast cancer.
It also seems to mature thereproductive tract and women who
(10:53):
previously had fertilityproblems with their first baby
many of them are surprised toquickly have their second baby.
In fact, my second son came 18months after the first one and I
never had a period in betweenall that time, because the first
ovulation was conception.
(11:14):
And having very heavy periodsas well may also be another risk
factor.
But there's other things thatcause heavy bleeding, including
some bleeding disorders andanatomical uterine problems as
well.
So we can't just assume thatit's endometriosis.
(11:36):
Now diagnosing endometriosis istricky.
The only definitive waycurrently is through surgery via
laparoscopy, where a smalllittle incision is made into the
belly button and a lightedscope is inserted to look all
around the whole abdomen andpelvis.
(11:57):
But this would not be doneright off the bat.
Certainly a full, completephysical exam and pelvic exam,
gynecologic obstetrical historyis needed pelvic ultrasound,
possibly pelvic MRI, can helpmake informed decisions.
So, getting on to the treatmentplan while there's no way to
(12:22):
cure it completely, there areways to treat it.
Treatment options that can bevery helpful can include
hormonal contraceptives beingput on.
Hormonal contraceptives toquiet the ovaries, to stop the
fluctuating hormones, to stopthe ovulation and stop the
menstrual bleeding can be agodsend to many women.
(12:43):
The menstrual bleeding can be agodsend to many women.
Other hormonal options elegolix, and sometimes surgery.
And sometimes surgery is neededto kind of debulk a lot of
endometriosis and sometimes it'sused to try to improve
(13:07):
fertility.
Now it does appear that theremay be some autoimmune
associations with endometriosis.
Women with endometriosis are alot more likely to have
Hashimoto's, autoimmune thyroidconditions, and Hashimoto's is
relatively common in women onein eight women.
If you didn't hear theinformation season two interview
(13:29):
with Dr Ula Abed, our centerendocrinologist, on thyroid
disorders, that's a great one tolisten to and I've been
evaluating those conditions andchecking the autoimmune status,
and anytime I ever diagnose awoman with any autoimmune
conditions, I'm also on thelookout for other autoimmune
(13:50):
conditions.
So with the use of hormonalcontraceptives, either oral
pills, hormonal patches or thevaginal rings, we have a Nuva
ring which lasts for three weeks, and then an Anovera ring which
can last for the whole entireyear.
If you have fewer periodsyou're going to have less
(14:14):
endometriosis bleeding andobviously less pain, and you may
even be able to shrink some ofthat excess endometrial tissue,
reduce cramps and help preventthe condition from worsening.
And in any woman who hasendometriosis and who does want
fertility, trying to conceivesooner rather than later is
(14:38):
generally the recommendation.
And even though there's never aperfect time to have a child,
people never seem to have enoughtime, enough money, enough job
security, enough extra help toraise the children.
Sometimes you just have to justjump right in, so to speak.
(15:02):
So hormonal agents that reducemenstruation are very popular
choices.
The pills contain some sort ofa progestin as well as an
estrogen substance, occasionallyjust a progesterone only
substance, particularly if thewoman cannot take estrogen, if
there is blood clots orthrombophilia.
(15:25):
The pills are taken daily, orthe patch or the ring is
generally taken continuouslywith no placebo break.
And if a woman does havebreakthrough bleeding, usually
the hormone therapies only stopfor four days, not longer than
that.
If a woman, especially a youngwoman with healthy, robust eggs,
(15:46):
goes more than five dayswithout hormonal suppression,
ovulation can ensue, so that canlead to pregnancy.
That's why when you hear aboutwomen who say I faithfully took
the pill but got pregnant,generally speaking it's because
they had too long a period ofoff the pill, which could be
(16:07):
five days Initially.
Some of the longer acting pillsthat were first fda approved
would have a period once aseason.
But there's nothing magicalabout bleeding.
The tissue doesn't build up.
You don't have to bleed.
And one of my favorite piecesof advice to women if you want
(16:27):
to get rid of your blood, pleasemake an appointment to donate
blood at the red cross.
It doesn't need to be donevaginally.
Okay, save on menstrual padsand tampons and pain.
So other tips that we recommendto help with endometriosis is
(16:49):
have your 25 hydroxy vitamin dlevel checked, because to help
with endometriosis is have your25-hydroxyvitamin D level
checked, because if your levelsare low, like they are in lots
of women in northern climatesand lots of people over age 40,
when the skin doesn't convert itas well from natural sunlight,
your immune system is going tobe off.
And season one podcast three ofthe regular podcast season.
(17:10):
I mean I did podcast my book,the Cleveland Clinic Guide to
Menopause.
I did do some continuingmedical education credits for
physicians and advanced practiceproviders as well, for free CME
, but in terms of my regularSpeaking of Women's Health
podcast, number three was allabout vitamin D and I can't
(17:30):
emphasize that enough Regularexercise, taking a B-complex
vitamin particularly if you'reon hormonal contraceptives where
you may metabolize thosevitamins faster and eating
omega-3 foods at least twice aweek.
And the more that I checkpeople's levels, the lower the
levels I get, even in people whodo tell me they eat fish twice
(17:52):
a week, and I think some of thatis from having too much
inflammatory seed oils.
And I did do a podcast onomega-3, and I'm going to do an
updated one because I have somany women asking me about this.
And you have been listening tothe Speaking of Women's Health
podcast.
I am your host, dr HollyThacker, the executive producer
(18:15):
of Speaking of Women's Health.
I also run our SpecializedWomen's Health Fellowship and
we've had some of our fellowsthat are currently in training
and some of our esteemedgraduates on the podcast, and I
also direct our Center forSpecialized Women's Health,
which is an interdisciplinarycenter that treats women who
(18:39):
have complex problems sometimesthat cross different disciplines
, that really want a holisticand a focused female evaluation
evaluation.
So moving on to other therapies,intrauterine devices or
intrauterine systems out ofsight, out of mind.
So another option for treatingendometriosis is an intrauterine
(19:04):
system, an IUS, and thisT-shaped device can remain in
the uterus for five or moreyears, releasing low levels of a
synthetic form of progesterone,levonorgestrel.
Now, that's different than thecopper IUD, which I would not
recommend if you have heavyperiods or painful periods or if
(19:25):
you have any copper metabolismimbalance which is pretty rare
Wilson's disease but does happen.
But the hormonal levonorgestrelintrauterine systems which our
center nurse practitioner, danaLeslie, has a great column on
IUDs not your grandmother's oldIUD, the Dalkon Shield, which
(19:49):
was infamous, the Dalkon Shield,which was infamous.
That's been off the market fora long, long time.
So IUDs or IUSs are popularforms of contraception, but we
medically use them many times totreat abnormal bleeding and
prior to hysterectomy foradenomyosis, when the lining of
the uterus grows into the muscleof the uterus.
(20:10):
It's used as a stopgap optionor possible treatment prior to
embarking on hysterectomy.
And an intrauterine system doesprevent the growth of
endometrial tissue and reducesmenstrual blood flow, sometimes
up to 90% or more.
Now for contraception, mirenaIUSs are approved for up to
(20:34):
eight years.
I've seen decidual tissue atthat level.
I think that's a little bit toolong.
I personally, if I had one forcontraception, would have it
removed by six or seven years.
But if you're using it toprotect the lining of the uterus
, to treat endometriosis, totreat pain or heavy bleeding, or
to use it in perimenopause whenyour physician's adding
(20:59):
estrogen to treat your hotflashes, then it's only good for
five years.
Another option is to considerbirth control, so-called
injections shots administered byyour physician or nurse
practitioner's office oryourself every three months,
containing a potent form ofmedroxyprogesterone acetate,
(21:24):
which can cause later andshorter periods.
Now there's new warnings onDepo-Provera for an increased
risk of a benign brain tumorcalled meningioma.
The baseline rate appears to beabout 1 in 10,000 women, but
with use of Depo-Provera eitherto give contraception or to
(21:48):
treat menstrual disorders orpain disorders like
endometriosis, it is 5 in 10,000women.
So it's still pretty low risk,but it does seem to increase
that risk.
And when I see women who havemeningiomas who maybe have not
ever been on Depo-Frovira, a lotof times the tumor is assessed
(22:09):
for progestin receptors becausethat may affect how we treat the
woman in terms ofpremenopausally and
postmenopausally if we're usingany hormonal options.
Now another therapy, if thestandard hormonal contraceptives
or injections don't work, is.
(22:30):
The next level would beinjectable monthly luprolide
injections, which is a strongersynthetic hormone that
suppresses the pituitary fromstimulating the ovaries to make
eggs.
It's like putting someone intoa medical menopause.
Now the medical treatments canrelieve pain but doesn't
(22:54):
necessarily improve fertility.
So again, women who hope tohave their own biological
children should let their healthcare team know sooner rather
than later.
Another option to talk about isoralisa.
Another option to talk about isoralisa.
The FDA has approved ElagolixE-L-A-G-O-L-I-X, also known as
(23:23):
oralisa, for oral treatment ofmoderate to severe pain
associated with endometriosis.
So Elagolix is agonadotropin-releasing hormone,
a GnRH antagonist, and it's thefirst and the only one that's
developed specifically formanaging this type of pain.
Other treatments Danazol, whichis an androgen, can treat
(23:45):
endometriosis.
It's synthetic androgen.
It's an effective treatment,but it can cause male-like side
effects like increased body hair, acne and weight gain.
I've occasionally used Danazolsuccessfully in women with
excruciating breast pain that'shormonal and cyclical.
It's pretty rare, but it's niceto have this option and it can
(24:08):
be used in varying doses andalso has some bone benefits.
So laparoscopy scoping out theproblem A outpatient procedure
it's done by a surgeon trainedin obstetrics and gynecology and
minimally invasive skillsinserts a very slim viewing tube
(24:30):
, called a laparoscope, througha very tiny belly button
incision and the outside of theuterus, the ovaries, the
fallopian tubes and the pelvicorgans.
Even the liver and abdomen canbe examined with small tissue
samples obtained for biopsy tolook under the microscope.
(24:53):
Now, if the biopsy show that itis endometriosis, surgery might
be necessary to relieve thesymptoms and improve fertility,
and at this time instruments canbe inserted through another
small incision to remove ordestroy the endometrial implants
(25:14):
.
Now, anytime you insertanything into the abdomen there
is a risk of bowel perforationand I have sadly seen a case of
a young woman undergoinglaparoscopy who had a bowel
perforation and died from sepsis.
So you know it's not somethingto be taken lightly and it's
(25:36):
very important to have a veryexperienced operator.
And anytime you have any typeof invasive procedure done, if
there's extreme pain or fever orthings don't feel right, you
must obtain emergency evaluationand for widespread
endometriosis, traditionalabdominal pelvic surgery may be
(25:57):
needed.
Surgery is often successful inrelieving pain, especially if
hormonal contraceptives are usedafterwards, but up to 20% of
women need additional painmanagement afterwards, and some
(26:21):
women need urologic interventionwith stents if the
endometriosis is affecting theirureter.
That is the tube that takes theurine from the kidney down into
the bladder.
Women who've totally completedtheir families may wish to have
a hysterectomy, with or withoutremoval of the ovaries.
Now, generally speaking, ifyou're having a hysterectomy for
any reason, we usually alwaysrecommend recommend that the
(26:41):
tubes come out, because mostovarian cancer starts in the
tubes and in fact, in the lastfew years, women undergoing
tubal ligations are actuallygetting complete removal of the
tubes, salpingectomies, not onlyto prevent pregnancy but to
prevent ovarian cancer.
And women who are at increasedrisk for ovarian and breast
(27:03):
cancer who are not yet ready tohave their ovaries removed,
sometimes will undergosalpingectomy first while still
keeping the hormonal milieu andbenefits of the ovaries until
they need to have the ovariesremoved, and some of it depends
on whether it's BRCA1 or BRCA2or other mutations, what their
(27:25):
family history is and theirpersonal preferences.
Now, when I do see high-riskwomen who are too young to get
rid of their ovaries, because ifyou have oophorectomy at a
young age, even with hormonetherapy, it can increase the
risk of neurodegenerativediseases.
So we ideally like to keep theovaries into age 40.
(27:48):
Occasionally, with BRCA1 orsome family histories, they may
need to come out a little bitearlier, but if you can make it
to 40, that's ideal.
Some women with endometriosiscannot and some can.
Now, if you're trying to reduceovarian cancer risk, you need a
hormonal contraceptive thatsuppresses ovulation, which
(28:09):
generally would contain someestrogenic substance, whether
it's by pill or by patch or byvaginal ring, or a lot of women,
especially younger women,really like the Mirena or Lylata
or Kylena or IUD for hormonalpurposes, and that reduces pain
and bleeding and gives excellentcontraception but doesn't
(28:30):
suppress ovulation.
So if you want to suppressovulation, which in general
breastfeeding, pregnancy andthat type of hormonal
contraception does, you doreduce ovarian cancer risk, even
if you're not a gene carrier.
You do reduce ovarian cancerrisk even if you're not a gene
carrier, and since we don't havegood therapies to screen for
(28:53):
ovarian cancer and ovariancancer can be deadly, I think
it's an important thought forall women and when I'm seeing my
patients that are BRCA carriersand they have female children
and they're too young to betested, and we do have a podcast
specifically on the GINA law,which anyone who's got a family
(29:17):
history of a genetic mutationshould definitely listen to,
listen to, and the law cancertainly change and be updated,
but we do have a lot ofprotections for individuals with
genetic mutations, but it'sstill important to be cognizant
of this.
Anyway, getting back to me,talking to my midlife patients
(29:41):
who have young daughters, I tellthem it doesn't matter whether
your daughter has the mutationor not.
Both sets of women can benefitfrom ovarian suppression.
So once ovulation has been setfor a year or two and the bones
fuse and there's no more heightgrowth for that female, I think
(30:03):
it's good to suppress ovulation,particularly if there's pain,
abnormal bleeding or any concernabout family history of ovarian
cancer.
Because if you're not trying toget pregnant, even if you're
not sexually active, you couldbe a woman who's joining the
nunnery and going to servereligiously.
That is wonderful and fine.
(30:24):
So it's not just aboutcontraception.
There are so many medical,hormonal and cancer-preventing
aspects to controlling thehypothalamic, pituitary, ovarian
, uterine axis.
So we consider generallyhysterectomy, removal of the
(30:47):
ovaries, kind of as a lastresort.
And when you do that and youremove the ovaries, you have
castration, surgical menopause,regardless of the woman's age.
It's not something you gothrough.
You are thrown into it, okay,and there's consequences of
losing estrogen naturally withnatural menopause, but even more
(31:09):
strikingly surgically, becauseyou also lose your testosterone
and androstenedione stromapromoting hormones and, for
those of you interested in kindof the whole biology and
physiology of ovarian hormones.
I do cover this in theCleveland Clinic Guide to
(31:32):
Menopause, which I podcasted anupdated version of back in
season one.
And even if you remove allvisible implants to the naked
eye of endometriosis, if yougive back estrogen afterwards
then there could be growth ofthose endometrial implants.
(31:54):
So surgery is not reallycompletely curative either.
Surgery to remove endometrialimplants may not even be the
solution for all women withfertility issues, because
endometriosis can still recur in20 to 40 percent of all
(32:14):
patients within five years andit's one reason why this area is
so hotly investigated Now.
You still can get pregnant ifyou have endometriosis.
It just might be more of astruggle, and if you don't want
to become pregnant, you cannotrely on the fact you have
endometriosis either to preventpregnancy.
(32:35):
So it is a common cause ofinfertility, although age
because women are just simplywaiting too long is really the
big one, and becauseendometriosis can cause tissue
to grow in places where itdoesn't belong, that tissue can
interfere with how a sperm andan egg move in terms of the
(32:58):
dance that they need to join toform a new human being.
That occurs during conception.
Now in vitro fertilization hasbeen going on now for a few
decades and it's certainly anoption for patients with
endometriosis.
It's a highly successfulalternative.
I'm personally glad that Ididn't have to undergo that, but
(33:22):
I remember thinking about itand looking into it.
Ivf generally begins withhormonal treatments which
stimulate the ovaries to producemultiple mature eggs.
When ready, the mature eggs arecollected through an outpatient
guided needle biopsy done undersome sedation.
Then the eggs are exposed tosperm in a culture dish, in the
(33:46):
laboratory or through ICSI.
A single sperm may be injectedinto a mature egg, particularly
if there are sperm issues.
Once the eggs are fertilized,embryo development is closely
monitored.
Selected embryos that developare placed into the woman's
uterus and then the additionalones, if there's any leftover,
(34:09):
can be frozen.
And today's IVF does result invery high pregnancy rates, with
the transfer of far few embryosthat have been done in the past.
According to our reproductiveendocrinology infertility REI
specialist, these are OBGYNs whothen go on and do several extra
(34:30):
years of training ininfertility, so this makes
pregnancy generally much saferOther options for future
pregnancy.
It can allow for eggs just tobe frozen on their own and then
the eggs defrosted and retrievedfor future use.
(34:51):
This is not nearly as successful, though, as freezing embryo.
So I think women have to thinklong and hard about making
personal decisions, and that'ssomething that generally
physicians and nursepractitioners are not doing
personal counseling in terms ofyour choices of what type of
(35:14):
life you want to have.
They're a little bit morefocused biologically, and I just
have so many women who tell meand are regretful that they did
not have their own family andthat they just thought that
technology or looking at themedia and seeing these older
(35:36):
stars having children in their40s and 50s, I can tell you that
a lot of times that's becauseof egg donation, and so that's
obviously a gift to donate eggs,you know, just like men can
donate semen, which is generallya lot easier process, of course
, than donating eggs, which is amuch more invasive procedure.
(35:57):
So these are all things tothink about, and busy young
women that aren't even marriedor are still in college or
starting their career aren'tnecessarily thinking about, but
they should be, and so if you dosuspect that you have
endometriosis, make anappointment with a women's
(36:18):
health specialist, especiallyone that has extra training in
fertility.
Doesn't necessarily have to bean REI Usually they want you to
have tried for at least sixmonths to a year trying to get
pregnant, but it probably shouldbe an OBGYN physician and there
are many options for treatmentand the sooner you're diagnosed,
(36:40):
the sooner you can starttreatment if necessary, or you
can start treatment if necessary.
So thank you so much forlistening to our Speaking of
Women's Health podcast.
Don't miss future episodes.
Hit, follow or subscribe, andyou can subscribe on Apple
Podcasts, spotify TuneInwherever you listen to podcasts,
(37:02):
and, if you like to see thepodcast, we have a Speaking of
Women's Health channel onYouTube and one on Rumble.
Please share these podcastswith others and leave us a
five-star rating, and you can goon speakingofwomenshealthcom
and hit donate to donate to ournonprofit.
Thanks again and I'll see younext time in the Sunflower House
(37:26):
.
Remember, be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new podcast, and on thispodcast episode, I am going to
(00:26):
be talking about endometriosis,as March is Endometriosis
Awareness Month, so maybe youknow what endometriosis is,
maybe you don't, and you thinkmaybe, if I don't think I have
it, why should I know about it?
You think, maybe, if I don'tthink I have it, why should I
know about it?
Well, it's a very perplexingcondition in women and it can
(00:49):
cause a lot of havoc.
And if you're suffering from it, or you think you're suffering
from it, maybe it hasn't beendiagnosed.
So I think it is very importantto bring awareness to this
female condition.
And endometriosis is when thelining of the uterus, the
so-called endometrium, growsoutside the uterus, and
(01:14):
currently, in 2025, when we'retaping this, it cannot be cured
or prevented completely, butthankfully, the pain and the
fertility problems it causes canbe relieved.
And of the more than five and ahalf million United States
(01:36):
American women withendometriosis, 30 to 40% of them
have difficulty conceiving.
Now, personally, I haveexperienced endometriosis and
had terrible pains and had alittle bit of trouble conceiving
, but thankfully that's allbehind me and, as a lot of
(01:59):
long-term listeners know, I havethree sons and I am just about
to get my fourth grandchild inMarch, so that's very exciting.
So there is certainly hope andfertility is a big issue.
Women are putting off childbearing.
(02:20):
They feel young, they want toestablish their adult life and
their careers, but there'sreally just a very finite period
of time that women especiallyhave maximal fertility, and I
don't think women hear thisenough, and I have taken care of
thousands of women over theyears and when I've seen younger
(02:44):
women, I always ask them andinquire about their childbearing
plans and a lot of times theyhaven't even really thought
about it.
And since half of allpregnancies can be unplanned and
simple things like getting goodnutrition and adequate folic
acid prior to conception reducesso many neurologic problems, it
really is an importantdiscussion to have, even if you
(03:06):
don't think that you're going tohave children or you're not
trying to conceive.
So, getting back toendometriosis, when you have
small islands of tissue that arehistologically very similar to
the inner lining of the uterus,the endometrium, when they
implant themselves on otherorgans like the abdominal organs
(03:29):
, the colon, even potentiallythe lung.
During the cycle ofmenstruation this ectopic tissue
can bleed and cause a lot ofpainful inflammation.
Lot of painful inflammation,severe menstrual cramps can
(03:50):
occur, heavy periods, tenesmus,which is painful bowel movements
.
In fact, the differentialdiagnosis for tenesmus is
endometriosis endometriosis,endometriosis in females.
There are other causes, ofcourse.
Endometriosis in females.
There are other causes, ofcourse, but that really is the
primary one.
(04:14):
Some of the most common places awoman can develop endometriosis
includes the space right behindthe uterus.
It can occur in the muscle ofthe uterus, adenomyosis, and
that's more common in womenwho've had C-sections, who've
had the muscle cut to get thebaby out for delivery.
There can be deposits on theovaries which look like
chocolate cysts.
The dark brown is the darkblood.
(04:35):
It can occur in the peritoneum,the lining of the abdomen, the
fallopian tubes which if they'rescarred or blocked can cause
ectopic pregnancy or justdefinite infertility.
Less common places include therectum, the bladder, the
intestines, the diaphragm,that's the muscle that separates
(04:59):
the lungs from the abdomen.
Actually, there can be ectopicdeposits in the vagina.
I have seen colon polyps biopsythat are actually endometrial
tissue, so it's actually gotteninside the colon and in the
lungs.
It can be really a problembecause during menses if there's
(05:21):
bleeding into the lungs, thatcould actually cause severe
pulmonary symptoms and evenpotentially pneumothorax, where
the lung collapses, which can bevery dramatic and even
potentially life-threatening.
So it's a relatively commoncondition.
One in 10 women experience this.
(05:43):
Most of the time, healthcareclinicians diagnose it in women
in their 20s and 30s andthankfully a lot of the symptoms
are manageable with treatment.
Now the most common symptom ispelvic pain, which can be
intense or mild.
Symptoms are usually worse justright before and during the
(06:05):
period due to the inflammationbrought on by the hormonal
changes and the bleeding thatcan occur in the abdomen.
Blood is very inflammatory andif blood is present where it
shouldn't be, it really sets offa lot of alarms in the body.
So very painful menstrualcramps I remember having such
(06:26):
pain.
I remember telling my family Ijust wanted a hysterectomy as a
teenager, which thankfully Ididn't have done Abdominal pain
or back pain during the period,heavy bleeding or spotting and
of course there's lots ofdifferent things that can cause
heavy bleeding and abnormalspotting and that always should
(06:48):
be evaluated by your women'shealth care clinician.
And if you didn't hear lastseason's interview with nurse
practitioner Kelsey Kennedy onabnormal uterine bleeding.
That's a great one to go backto listen to bleeding.
That's a great one to go backto listen to.
Pain during sexual activity.
(07:10):
The medical term for that isdyspareunia, which can be deep.
There's also superficialdyspareunia.
There's vulvar skin conditionsthat can cause pain with sexual
activity, pain that occursduring defecation or urination.
Stomach issues, gi issues likediarrhea or constipation or
(07:33):
bloating can be more common.
Some women with endometriosisfeel fatigued and they may have
some increased risk for anxietyand depression, which are
relatively common conditions inwomen, and a lot of it is
lifestyle and nutritional.
I have found in my practice,since doing more intense
(07:58):
nutritional assessments checkingvitamin D levels, b12 and zinc
and omega-3, that a lot of minormood disturbances can really be
improved with exercise, goodsleep and excellent nutrition.
We did a podcast I believe itwas season one on food as
(08:23):
medicine, and so it's importantto be holistic.
Some conditions need more thanjust lifestyle support, but a
lot of things can be mitigatedor even treated with focusing on
a healthy lifestyle.
Now, some women really don'thave a lot of symptoms.
(08:45):
It just gets diagnosed whenthey're undergoing an
infertility evaluation.
Now you might wonder well, whatcauses this condition.
We're not really sure, but weknow that there's probably a
genetic component, like withmost conditions.
So it's always good to knowyour biological family history
(09:06):
conditions.
So it's always good to knowyour biological family history,
your mother's history offertility, which obviously if
she had you, she had some degreeof fertility.
And when I get family historiesI mean it's really lovely
because people identify theperson who helped raise them as
their parent or theirgrandparent.
But that's always notbiologically the case.
So when your physician or nursepractitioner or physician
(09:28):
assistant ask you about yourmother's health or your father's
health or your grandmother'shealth, they don't mean
necessarily the one that youpsychologically associate with
all that nurturing.
Also your, your sister, yoursister if you have a full
(09:48):
sibling, that's the same sex youshare the most DNA with.
Now it usually starts betweenages 20 and 40, but teenagers
like myself can experience itThankfully after menopause.
That is one of the things thatdoes improve, because the
(10:09):
uterine tissue, the endometrialtissue, gets thinner and you
don't have the repetitivecycling of up and down hormone
levels.
So other risk factors includethe family history.
For women who have shortermenstrual cycles, and a
menstrual cycle can be normal 21days to up to 42 days.
(10:29):
So if your cycle is fewer than27 days.
That's another risk.
Never having children?
It seems like having childrennot only matures the breast,
especially the younger age youhave children, which is we think
it matures the breast,especially the younger age you
have children, which is, wethink it matures the breast and
makes it more resistant tobreast cancer.
It also seems to mature thereproductive tract and women who
(10:53):
previously had fertilityproblems with their first baby
many of them are surprised toquickly have their second baby.
In fact, my second son came 18months after the first one and I
never had a period in betweenall that time, because the first
ovulation was conception.
(11:14):
And having very heavy periodsas well may also be another risk
factor.
But there's other things thatcause heavy bleeding, including
some bleeding disorders andanatomical uterine problems as
well.
So we can't just assume thatit's endometriosis.
(11:36):
Now diagnosing endometriosis istricky.
The only definitive waycurrently is through surgery via
laparoscopy, where a smalllittle incision is made into the
belly button and a lightedscope is inserted to look all
around the whole abdomen andpelvis.
(11:57):
But this would not be doneright off the bat.
Certainly a full, completephysical exam and pelvic exam,
gynecologic obstetrical historyis needed pelvic ultrasound,
possibly pelvic MRI, can helpmake informed decisions.
So, getting on to the treatmentplan while there's no way to
(12:22):
cure it completely, there areways to treat it.
Treatment options that can bevery helpful can include
hormonal contraceptives beingput on.
Hormonal contraceptives toquiet the ovaries, to stop the
fluctuating hormones, to stopthe ovulation and stop the
menstrual bleeding can be agodsend to many women.
(12:43):
The menstrual bleeding can be agodsend to many women.
Other hormonal options elegolix, and sometimes surgery.
And sometimes surgery is neededto kind of debulk a lot of
endometriosis and sometimes it'sused to try to improve
(13:07):
fertility.
Now it does appear that theremay be some autoimmune
associations with endometriosis.
Women with endometriosis are alot more likely to have
Hashimoto's, autoimmune thyroidconditions, and Hashimoto's is
relatively common in women onein eight women.
If you didn't hear theinformation season two interview
(13:29):
with Dr Ula Abed, our centerendocrinologist, on thyroid
disorders, that's a great one tolisten to and I've been
evaluating those conditions andchecking the autoimmune status,
and anytime I ever diagnose awoman with any autoimmune
conditions, I'm also on thelookout for other autoimmune
(13:50):
conditions.
So with the use of hormonalcontraceptives, either oral
pills, hormonal patches or thevaginal rings, we have a Nuva
ring which lasts for three weeks, and then an Anovera ring which
can last for the whole entireyear.
If you have fewer periodsyou're going to have less
(14:14):
endometriosis bleeding andobviously less pain, and you may
even be able to shrink some ofthat excess endometrial tissue,
reduce cramps and help preventthe condition from worsening.
And in any woman who hasendometriosis and who does want
fertility, trying to conceivesooner rather than later is
(14:38):
generally the recommendation.
And even though there's never aperfect time to have a child,
people never seem to have enoughtime, enough money, enough job
security, enough extra help toraise the children.
Sometimes you just have to justjump right in, so to speak.
(15:02):
So hormonal agents that reducemenstruation are very popular
choices.
The pills contain some sort ofa progestin as well as an
estrogen substance, occasionallyjust a progesterone only
substance, particularly if thewoman cannot take estrogen, if
there is blood clots orthrombophilia.
(15:25):
The pills are taken daily, orthe patch or the ring is
generally taken continuouslywith no placebo break.
And if a woman does havebreakthrough bleeding, usually
the hormone therapies only stopfor four days, not longer than
that.
If a woman, especially a youngwoman with healthy, robust eggs,
(15:46):
goes more than five dayswithout hormonal suppression,
ovulation can ensue, so that canlead to pregnancy.
That's why when you hear aboutwomen who say I faithfully took
the pill but got pregnant,generally speaking it's because
they had too long a period ofoff the pill, which could be
(16:07):
five days Initially.
Some of the longer acting pillsthat were first fda approved
would have a period once aseason.
But there's nothing magicalabout bleeding.
The tissue doesn't build up.
You don't have to bleed.
And one of my favorite piecesof advice to women if you want
(16:27):
to get rid of your blood, pleasemake an appointment to donate
blood at the red cross.
It doesn't need to be donevaginally.
Okay, save on menstrual padsand tampons and pain.
So other tips that we recommendto help with endometriosis is
(16:49):
have your 25 hydroxy vitamin dlevel checked, because to help
with endometriosis is have your25-hydroxyvitamin D level
checked, because if your levelsare low, like they are in lots
of women in northern climatesand lots of people over age 40,
when the skin doesn't convert itas well from natural sunlight,
your immune system is going tobe off.
And season one podcast three ofthe regular podcast season.
(17:10):
I mean I did podcast my book,the Cleveland Clinic Guide to
Menopause.
I did do some continuingmedical education credits for
physicians and advanced practiceproviders as well, for free CME
, but in terms of my regularSpeaking of Women's Health
podcast, number three was allabout vitamin D and I can't
(17:30):
emphasize that enough Regularexercise, taking a B-complex
vitamin particularly if you'reon hormonal contraceptives where
you may metabolize thosevitamins faster and eating
omega-3 foods at least twice aweek.
And the more that I checkpeople's levels, the lower the
levels I get, even in people whodo tell me they eat fish twice
(17:52):
a week, and I think some of thatis from having too much
inflammatory seed oils.
And I did do a podcast onomega-3, and I'm going to do an
updated one because I have somany women asking me about this.
And you have been listening tothe Speaking of Women's Health
podcast.
I am your host, dr HollyThacker, the executive producer
(18:15):
of Speaking of Women's Health.
I also run our SpecializedWomen's Health Fellowship and
we've had some of our fellowsthat are currently in training
and some of our esteemedgraduates on the podcast, and I
also direct our Center forSpecialized Women's Health,
which is an interdisciplinarycenter that treats women who
(18:39):
have complex problems sometimesthat cross different disciplines
, that really want a holisticand a focused female evaluation
evaluation.
So moving on to other therapies,intrauterine devices or
intrauterine systems out ofsight, out of mind.
So another option for treatingendometriosis is an intrauterine
(19:04):
system, an IUS, and thisT-shaped device can remain in
the uterus for five or moreyears, releasing low levels of a
synthetic form of progesterone,levonorgestrel.
Now, that's different than thecopper IUD, which I would not
recommend if you have heavyperiods or painful periods or if
(19:25):
you have any copper metabolismimbalance which is pretty rare
Wilson's disease but does happen.
But the hormonal levonorgestrelintrauterine systems which our
center nurse practitioner, danaLeslie, has a great column on
IUDs not your grandmother's oldIUD, the Dalkon Shield, which
(19:49):
was infamous, the Dalkon Shield,which was infamous.
That's been off the market fora long, long time.
So IUDs or IUSs are popularforms of contraception, but we
medically use them many times totreat abnormal bleeding and
prior to hysterectomy foradenomyosis, when the lining of
the uterus grows into the muscleof the uterus.
(20:10):
It's used as a stopgap optionor possible treatment prior to
embarking on hysterectomy.
And an intrauterine system doesprevent the growth of
endometrial tissue and reducesmenstrual blood flow, sometimes
up to 90% or more.
Now for contraception, mirenaIUSs are approved for up to
(20:34):
eight years.
I've seen decidual tissue atthat level.
I think that's a little bit toolong.
I personally, if I had one forcontraception, would have it
removed by six or seven years.
But if you're using it toprotect the lining of the uterus
, to treat endometriosis, totreat pain or heavy bleeding, or
to use it in perimenopause whenyour physician's adding
(20:59):
estrogen to treat your hotflashes, then it's only good for
five years.
Another option is to considerbirth control, so-called
injections shots administered byyour physician or nurse
practitioner's office oryourself every three months,
containing a potent form ofmedroxyprogesterone acetate,
(21:24):
which can cause later andshorter periods.
Now there's new warnings onDepo-Provera for an increased
risk of a benign brain tumorcalled meningioma.
The baseline rate appears to beabout 1 in 10,000 women, but
with use of Depo-Provera eitherto give contraception or to
(21:48):
treat menstrual disorders orpain disorders like
endometriosis, it is 5 in 10,000women.
So it's still pretty low risk,but it does seem to increase
that risk.
And when I see women who havemeningiomas who maybe have not
ever been on Depo-Frovira, a lotof times the tumor is assessed
(22:09):
for progestin receptors becausethat may affect how we treat the
woman in terms ofpremenopausally and
postmenopausally if we're usingany hormonal options.
Now another therapy, if thestandard hormonal contraceptives
or injections don't work, is.
(22:30):
The next level would beinjectable monthly luprolide
injections, which is a strongersynthetic hormone that
suppresses the pituitary fromstimulating the ovaries to make
eggs.
It's like putting someone intoa medical menopause.
Now the medical treatments canrelieve pain but doesn't
(22:54):
necessarily improve fertility.
So again, women who hope tohave their own biological
children should let their healthcare team know sooner rather
than later.
Another option to talk about isoralisa.
Another option to talk about isoralisa.
The FDA has approved ElagolixE-L-A-G-O-L-I-X, also known as
(23:23):
oralisa, for oral treatment ofmoderate to severe pain
associated with endometriosis.
So Elagolix is agonadotropin-releasing hormone,
a GnRH antagonist, and it's thefirst and the only one that's
developed specifically formanaging this type of pain.
Other treatments Danazol, whichis an androgen, can treat
(23:45):
endometriosis.
It's synthetic androgen.
It's an effective treatment,but it can cause male-like side
effects like increased body hair, acne and weight gain.
I've occasionally used Danazolsuccessfully in women with
excruciating breast pain that'shormonal and cyclical.
It's pretty rare, but it's niceto have this option and it can
(24:08):
be used in varying doses andalso has some bone benefits.
So laparoscopy scoping out theproblem A outpatient procedure
it's done by a surgeon trainedin obstetrics and gynecology and
minimally invasive skillsinserts a very slim viewing tube
(24:30):
, called a laparoscope, througha very tiny belly button
incision and the outside of theuterus, the ovaries, the
fallopian tubes and the pelvicorgans.
Even the liver and abdomen canbe examined with small tissue
samples obtained for biopsy tolook under the microscope.
(24:53):
Now, if the biopsy show that itis endometriosis, surgery might
be necessary to relieve thesymptoms and improve fertility,
and at this time instruments canbe inserted through another
small incision to remove ordestroy the endometrial implants
(25:14):
.
Now, anytime you insertanything into the abdomen there
is a risk of bowel perforationand I have sadly seen a case of
a young woman undergoinglaparoscopy who had a bowel
perforation and died from sepsis.
So you know it's not somethingto be taken lightly and it's
(25:36):
very important to have a veryexperienced operator.
And anytime you have any typeof invasive procedure done, if
there's extreme pain or fever orthings don't feel right, you
must obtain emergency evaluationand for widespread
endometriosis, traditionalabdominal pelvic surgery may be
(25:57):
needed.
Surgery is often successful inrelieving pain, especially if
hormonal contraceptives are usedafterwards, but up to 20% of
women need additional painmanagement afterwards, and some
(26:21):
women need urologic interventionwith stents if the
endometriosis is affecting theirureter.
That is the tube that takes theurine from the kidney down into
the bladder.
Women who've totally completedtheir families may wish to have
a hysterectomy, with or withoutremoval of the ovaries.
Now, generally speaking, ifyou're having a hysterectomy for
any reason, we usually alwaysrecommend recommend that the
(26:41):
tubes come out, because mostovarian cancer starts in the
tubes and in fact, in the lastfew years, women undergoing
tubal ligations are actuallygetting complete removal of the
tubes, salpingectomies, not onlyto prevent pregnancy but to
prevent ovarian cancer.
And women who are at increasedrisk for ovarian and breast
(27:03):
cancer who are not yet ready tohave their ovaries removed,
sometimes will undergosalpingectomy first while still
keeping the hormonal milieu andbenefits of the ovaries until
they need to have the ovariesremoved, and some of it depends
on whether it's BRCA1 or BRCA2or other mutations, what their
(27:25):
family history is and theirpersonal preferences.
Now, when I do see high-riskwomen who are too young to get
rid of their ovaries, because ifyou have oophorectomy at a
young age, even with hormonetherapy, it can increase the
risk of neurodegenerativediseases.
So we ideally like to keep theovaries into age 40.
(27:48):
Occasionally, with BRCA1 orsome family histories, they may
need to come out a little bitearlier, but if you can make it
to 40, that's ideal.
Some women with endometriosiscannot and some can.
Now, if you're trying to reduceovarian cancer risk, you need a
hormonal contraceptive thatsuppresses ovulation, which
(28:09):
generally would contain someestrogenic substance, whether
it's by pill or by patch or byvaginal ring, or a lot of women,
especially younger women,really like the Mirena or Lylata
or Kylena or IUD for hormonalpurposes, and that reduces pain
and bleeding and gives excellentcontraception but doesn't
(28:30):
suppress ovulation.
So if you want to suppressovulation, which in general
breastfeeding, pregnancy andthat type of hormonal
contraception does, you doreduce ovarian cancer risk, even
if you're not a gene carrier.
You do reduce ovarian cancerrisk even if you're not a gene
carrier, and since we don't havegood therapies to screen for
(28:53):
ovarian cancer and ovariancancer can be deadly, I think
it's an important thought forall women and when I'm seeing my
patients that are BRCA carriersand they have female children
and they're too young to betested, and we do have a podcast
specifically on the GINA law,which anyone who's got a family
(29:17):
history of a genetic mutationshould definitely listen to,
listen to, and the law cancertainly change and be updated,
but we do have a lot ofprotections for individuals with
genetic mutations, but it'sstill important to be cognizant
of this.
Anyway, getting back to me,talking to my midlife patients
(29:41):
who have young daughters, I tellthem it doesn't matter whether
your daughter has the mutationor not.
Both sets of women can benefitfrom ovarian suppression.
So once ovulation has been setfor a year or two and the bones
fuse and there's no more heightgrowth for that female, I think
(30:03):
it's good to suppress ovulation,particularly if there's pain,
abnormal bleeding or any concernabout family history of ovarian
cancer.
Because if you're not trying toget pregnant, even if you're
not sexually active, you couldbe a woman who's joining the
nunnery and going to servereligiously.
That is wonderful and fine.
(30:24):
So it's not just aboutcontraception.
There are so many medical,hormonal and cancer-preventing
aspects to controlling thehypothalamic, pituitary, ovarian
, uterine axis.
So we consider generallyhysterectomy, removal of the
(30:47):
ovaries, kind of as a lastresort.
And when you do that and youremove the ovaries, you have
castration, surgical menopause,regardless of the woman's age.
It's not something you gothrough.
You are thrown into it, okay,and there's consequences of
losing estrogen naturally withnatural menopause, but even more
(31:09):
strikingly surgically, becauseyou also lose your testosterone
and androstenedione stromapromoting hormones and, for
those of you interested in kindof the whole biology and
physiology of ovarian hormones.
I do cover this in theCleveland Clinic Guide to
(31:32):
Menopause, which I podcasted anupdated version of back in
season one.
And even if you remove allvisible implants to the naked
eye of endometriosis, if yougive back estrogen afterwards
then there could be growth ofthose endometrial implants.
(31:54):
So surgery is not reallycompletely curative either.
Surgery to remove endometrialimplants may not even be the
solution for all women withfertility issues, because
endometriosis can still recur in20 to 40 percent of all
(32:14):
patients within five years andit's one reason why this area is
so hotly investigated Now.
You still can get pregnant ifyou have endometriosis.
It just might be more of astruggle, and if you don't want
to become pregnant, you cannotrely on the fact you have
endometriosis either to preventpregnancy.
(32:35):
So it is a common cause ofinfertility, although age
because women are just simplywaiting too long is really the
big one, and becauseendometriosis can cause tissue
to grow in places where itdoesn't belong, that tissue can
interfere with how a sperm andan egg move in terms of the
(32:58):
dance that they need to join toform a new human being.
That occurs during conception.
Now in vitro fertilization hasbeen going on now for a few
decades and it's certainly anoption for patients with
endometriosis.
It's a highly successfulalternative.
I'm personally glad that Ididn't have to undergo that, but
(33:22):
I remember thinking about itand looking into it.
Ivf generally begins withhormonal treatments which
stimulate the ovaries to producemultiple mature eggs.
When ready, the mature eggs arecollected through an outpatient
guided needle biopsy done undersome sedation.
Then the eggs are exposed tosperm in a culture dish, in the
(33:46):
laboratory or through ICSI.
A single sperm may be injectedinto a mature egg, particularly
if there are sperm issues.
Once the eggs are fertilized,embryo development is closely
monitored.
Selected embryos that developare placed into the woman's
uterus and then the additionalones, if there's any leftover,
(34:09):
can be frozen.
And today's IVF does result invery high pregnancy rates, with
the transfer of far few embryosthat have been done in the past.
According to our reproductiveendocrinology infertility REI
specialist, these are OBGYNs whothen go on and do several extra
(34:30):
years of training ininfertility, so this makes
pregnancy generally much saferOther options for future
pregnancy.
It can allow for eggs just tobe frozen on their own and then
the eggs defrosted and retrievedfor future use.
(34:51):
This is not nearly as successful, though, as freezing embryo.
So I think women have to thinklong and hard about making
personal decisions, and that'ssomething that generally
physicians and nursepractitioners are not doing
personal counseling in terms ofyour choices of what type of
(35:14):
life you want to have.
They're a little bit morefocused biologically, and I just
have so many women who tell meand are regretful that they did
not have their own family andthat they just thought that
technology or looking at themedia and seeing these older
(35:36):
stars having children in their40s and 50s, I can tell you that
a lot of times that's becauseof egg donation, and so that's
obviously a gift to donate eggs,you know, just like men can
donate semen, which is generallya lot easier process, of course
, than donating eggs, which is amuch more invasive procedure.
(35:57):
So these are all things tothink about, and busy young
women that aren't even marriedor are still in college or
starting their career aren'tnecessarily thinking about, but
they should be, and so if you dosuspect that you have
endometriosis, make anappointment with a women's
(36:18):
health specialist, especiallyone that has extra training in
fertility.
Doesn't necessarily have to bean REI Usually they want you to
have tried for at least sixmonths to a year trying to get
pregnant, but it probably shouldbe an OBGYN physician and there
are many options for treatmentand the sooner you're diagnosed,
(36:40):
the sooner you can starttreatment if necessary, or you
can start treatment if necessary.
So thank you so much forlistening to our Speaking of
Women's Health podcast.
Don't miss future episodes.
Hit, follow or subscribe, andyou can subscribe on Apple
Podcasts, spotify TuneInwherever you listen to podcasts,
(37:02):
and, if you like to see thepodcast, we have a Speaking of
Women's Health channel onYouTube and one on Rumble.
Please share these podcastswith others and leave us a
five-star rating, and you can goon speakingofwomenshealthcom
and hit donate to donate to ournonprofit.
Thanks again and I'll see younext time in the Sunflower House
(37:26):
.
Remember, be strong, be healthyand be in charge.
Popular Podcasts
40s and Free Agents: NFL Draft Season
Daniel Jeremiah of Move the Sticks and Gregg Rosenthal of NFL Daily join forces to break down every team's needs this offseason.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.