WEBVTT - From the Vault - Endometriosis: Menstrual Backwash (Ep 88) 0:00:00.400 --> 0:00:03.840 Hi, There, Erin and Aaron here. We recorded this episode 0:00:03.840 --> 0:00:08.240 on endometriosis back in January of twenty twenty two, and 0:00:08.480 --> 0:00:10.639 it was really the first time that we had covered 0:00:10.640 --> 0:00:11.440 a topic like this. 0:00:11.760 --> 0:00:14.760 Yeah, this episode has stayed with us and it's usually 0:00:14.800 --> 0:00:17.320 our first answer when someone asks us what our favorite 0:00:17.360 --> 0:00:19.040 episode is it is. 0:00:19.880 --> 0:00:23.160 We are especially grateful to Susie, who provided the first 0:00:23.200 --> 0:00:26.680 hand account which resonated with us and with so many 0:00:26.720 --> 0:00:26.960 of you. 0:00:27.720 --> 0:00:30.520 Earlier this year, Susie's husband reached out to us to 0:00:30.600 --> 0:00:33.440 let us know that Susie had passed away in September 0:00:33.479 --> 0:00:36.280 of twenty twenty four due to complications from cancer. 0:00:37.120 --> 0:00:40.120 We are heartbroken for her family and her loved ones, 0:00:40.880 --> 0:00:45.160 and we remain eternally grateful for her vulnerability and willingness 0:00:45.200 --> 0:00:48.479 to share her story. 0:00:48.680 --> 0:00:52.479 Hi. My name is Susie sol Aviv. From a pretty 0:00:52.520 --> 0:00:55.520 young age, I taught myself not to pay a lot 0:00:55.560 --> 0:00:59.240 of attention to my body. When I was younger, I 0:00:59.240 --> 0:01:02.640 didn't really have any issues, but after puberty, I started 0:01:02.640 --> 0:01:05.760 to have pretty bad cramps. I had to go to 0:01:05.840 --> 0:01:09.560 the bathroom fairly often, and I also found out that 0:01:09.600 --> 0:01:12.200 I was anemic, and I would occasionally if I was 0:01:12.240 --> 0:01:16.800 exercising too hard, start to black out. Nobody really had 0:01:16.840 --> 0:01:19.760 a good explanation for this, and nobody really directed me 0:01:20.000 --> 0:01:24.399 to a doctor or anything. So I just ignored it 0:01:24.520 --> 0:01:27.600 and moved forward. Lots of other people in my high 0:01:27.600 --> 0:01:31.440 school had period cramps, Plenty of people were going on 0:01:31.480 --> 0:01:34.760 birth control to try to control the cramps, and you know, 0:01:34.840 --> 0:01:36.800 it was easy enough for me to get past it 0:01:36.800 --> 0:01:40.120 was a little bit of ybuprofen. I was also raised 0:01:40.440 --> 0:01:44.920 very religious, and I'm still quite religious, and unfortunately, some 0:01:45.280 --> 0:01:50.480 American purity culture crept into my upbringing, and so I 0:01:50.480 --> 0:01:53.720 didn't spend a lot of time thinking about, for lack 0:01:53.760 --> 0:01:56.760 of a better word, my reproductive parts. Spent a lot 0:01:56.760 --> 0:02:00.560 of time ignoring them, spent a lot of time nothing 0:02:00.640 --> 0:02:03.720 was really going on, and generally being embarrassed about it. 0:02:03.800 --> 0:02:07.040 So I got good at disassociating from those parts of 0:02:07.080 --> 0:02:10.960 my body. After I got married, I ended up having 0:02:11.160 --> 0:02:16.480 extremely painful sex, and I assumed that it was related 0:02:16.480 --> 0:02:19.360 to purity culture, and I assumed it was psychological. I 0:02:19.400 --> 0:02:22.919 talked to my PCP about it. I think I got 0:02:22.919 --> 0:02:26.160 a referral to pelvic floor therapy at one point, but 0:02:26.240 --> 0:02:29.800 nobody was really concerned and again, I just decided that 0:02:29.840 --> 0:02:32.400 it wasn't a very big deal. It was just something 0:02:32.440 --> 0:02:34.200 that was in my head, and I was able to 0:02:34.240 --> 0:02:37.200 move past it. In our first year of marriage, I 0:02:37.240 --> 0:02:42.480 got pregnant unexpectedly and had no problems with the pregnancy 0:02:43.000 --> 0:02:46.760 except that it was I was very nauseous through the 0:02:46.919 --> 0:02:50.320 entire thing. I was in a lot of pain, and 0:02:50.360 --> 0:02:53.200 then when I had to have cervical checks, I was 0:02:53.200 --> 0:02:56.640 a tremendous amount of pain. Again, I told them that 0:02:56.760 --> 0:02:58.400 I thought this was due to growing up with a 0:02:58.400 --> 0:03:01.919 certain amount of purity culture and that it was psychological, 0:03:02.720 --> 0:03:06.639 and nobody questioned it. So after I had my daughter, 0:03:07.160 --> 0:03:10.520 eventually my period returned and I started having worse and 0:03:10.600 --> 0:03:15.120 worse cramps. But everybody tells you that after you have 0:03:15.160 --> 0:03:18.519 a baby, your periods get worse. That's just what people 0:03:18.560 --> 0:03:21.520 tell you, and so once again I chose to disassociate 0:03:21.600 --> 0:03:24.080 from it and ignore it. Some of the painful sex 0:03:24.120 --> 0:03:28.760 symptoms subsided, others remained. Mostly I was just proceeding with 0:03:28.840 --> 0:03:33.960 business as usual. Last year, I started having cramps so 0:03:34.160 --> 0:03:37.080 bad that I would have bladder spasms, which means that 0:03:37.120 --> 0:03:41.680 I would literally be my pants with no control. It 0:03:41.720 --> 0:03:44.920 only happened a few times, thank goodness, but I also 0:03:45.080 --> 0:03:49.120 ended up starting to have to lie down when I 0:03:49.200 --> 0:03:53.480 had my cramps, and I was surprised that it wasn't great, 0:03:53.480 --> 0:03:55.560 but I could generally manage it with like three to 0:03:55.600 --> 0:04:00.800 four ibuprofen and heat pack. But by the fall things 0:04:00.800 --> 0:04:03.760 had escalated and the ibuprofen wasn't cutting it and the 0:04:03.800 --> 0:04:06.720 heat pack wasn't cutting it, but the killer was when 0:04:06.720 --> 0:04:09.400 I noticed that there was blood in my stool. I 0:04:09.440 --> 0:04:12.160 didn't really want to do anything about it, but by January, 0:04:12.200 --> 0:04:14.360 my sister told me that I had to do something 0:04:14.400 --> 0:04:18.240 about it, so I went into urgent care. They took 0:04:18.279 --> 0:04:20.880 some samples and told me that I needed a colonoscopy 0:04:20.920 --> 0:04:23.880 and that I should not have any ibuprofen until after 0:04:23.880 --> 0:04:27.960 I had the colonoscopy. Then, on my thirty fifth birthday, 0:04:28.000 --> 0:04:30.880 I spent the entire day in agony and the worst 0:04:30.960 --> 0:04:33.880 pain I've ever had because I was experiencing my cramps 0:04:34.880 --> 0:04:39.359 without any sort of pain blocker. I went in for 0:04:39.400 --> 0:04:43.279 a colonoscopy at the beginning of March, and I didn't 0:04:43.320 --> 0:04:46.839 expect them to find much of anything, because again I 0:04:46.880 --> 0:04:50.160 didn't really believe that I had any problems and I 0:04:50.200 --> 0:04:52.160 thought to myself, the only problem that I could really 0:04:52.200 --> 0:04:55.919 have is cancer, because cancer runs rampant in my family. 0:04:56.480 --> 0:04:59.520 Both my father and my brother died of fairly rare cancers, 0:04:59.520 --> 0:05:04.560 my father viuvial melanoma and my brother of colangiocarsonoma. So 0:05:04.640 --> 0:05:07.640 I was a little anxious about the colonoscopy, but not overly. 0:05:07.720 --> 0:05:11.200 So when I woke up from the colonoscopy, the doctor 0:05:11.400 --> 0:05:13.240 went to get my husband and took me to his 0:05:13.320 --> 0:05:16.440 office and sat me down and told me that he 0:05:16.480 --> 0:05:18.880 had found something and it was very likely to be cancer. 0:05:19.680 --> 0:05:22.320 So this was incredibly traumatic for me because I was 0:05:22.320 --> 0:05:27.040 immediately convinced I was going to die. I also delivered 0:05:27.080 --> 0:05:31.080 the news to my family and told basically everyone I know, 0:05:31.160 --> 0:05:33.400 because I decided that if I did indeed have cancer, 0:05:33.440 --> 0:05:35.920 I wanted everybody to start praying as quickly as possible, 0:05:36.440 --> 0:05:39.279 and I maintained that it worked because a week later, 0:05:39.839 --> 0:05:42.359 the same doctor called me back and told me that 0:05:42.400 --> 0:05:44.880 the cell samples, to his great shock, had come back 0:05:44.920 --> 0:05:48.919 not as cancer but as endometriosis. I literally fell to 0:05:49.000 --> 0:05:53.839 my knees on the ground. I changed doctors, so I 0:05:53.839 --> 0:05:57.000 went in for a second opinion. I had another not 0:05:57.080 --> 0:06:02.640 another colonoscopy, but a flexible sigmoidoscopy, and the doctor told 0:06:02.680 --> 0:06:06.880 me he thought that I had endometriosis and maybe cancer, 0:06:07.440 --> 0:06:12.280 and I was referred to the gynecological oncology department. I 0:06:12.320 --> 0:06:14.600 went in and met with one of the directors of 0:06:14.640 --> 0:06:19.040 the guyinanc department, who told me that she thought, yes, 0:06:19.040 --> 0:06:23.039 there's a possibility of cancer, but mostly it was horrible endometriosis. 0:06:23.640 --> 0:06:27.120 So she showed me the images that they had taken 0:06:27.160 --> 0:06:29.920 of my body in the MRI and everything, and you 0:06:29.960 --> 0:06:32.880 could see that there was something growing out of my 0:06:33.000 --> 0:06:37.400 left ovary into my colon, and we knew that it 0:06:37.440 --> 0:06:40.440 was probably in other places, but there is no way 0:06:40.480 --> 0:06:46.200 to confirm endometriosis except by surgery, so they could not confirm, 0:06:46.640 --> 0:06:48.640 and they thought there was a possibility that there was 0:06:48.680 --> 0:06:53.039 still cancer. So the other thing that the guynanc told 0:06:53.080 --> 0:06:54.440 me was that she thought I was going to have 0:06:54.480 --> 0:06:58.240 to have a complete hysterectopy and eupherectomy. I had been 0:06:58.279 --> 0:07:01.600 trying for a second child point for almost a year 0:07:02.240 --> 0:07:06.000 and this was devastating, but because there was a chance 0:07:06.000 --> 0:07:08.159 of cancer, I was like, just take it all. I 0:07:08.160 --> 0:07:12.080 don't want it, get rid of it. So I had 0:07:12.120 --> 0:07:14.800 a period farewell party with my friends over Zoom. We 0:07:14.880 --> 0:07:17.400 drank cranberry juice, we toasted. I wrote a letter to 0:07:17.400 --> 0:07:20.640 aunt Flow, sending her out into the worlds, and my 0:07:20.800 --> 0:07:25.160 surgery was scheduled for May fourth. My last period was 0:07:25.200 --> 0:07:28.200 one of the worst pains I've ever had in my life. 0:07:28.320 --> 0:07:31.000 The ibuprofen didn't ease it, the heat didn't ease it. 0:07:31.040 --> 0:07:33.640 I was just lying in bed for two days and 0:07:35.000 --> 0:07:36.560 was more or less silent screaming. 0:07:36.600 --> 0:07:37.760 It was horrific. 0:07:38.640 --> 0:07:44.040 I had surgery. They confirmed stage four endometriosis. I discussed 0:07:44.080 --> 0:07:47.000 with my surgeon that I wanted to try to keep 0:07:47.000 --> 0:07:50.200 my rite ovary if possible, because I didn't want to 0:07:50.200 --> 0:07:52.840 go into surgical menopause at thirty five. There are a 0:07:52.880 --> 0:07:56.800 lot of issues associated with going into menopause early, and 0:07:56.880 --> 0:08:00.040 I wanted to avoid them if I could. Also, I 0:08:00.120 --> 0:08:03.560 have I struggle with my mental health. I have depression anxiety, 0:08:04.240 --> 0:08:08.720 and I knew that the severe hormonal shift would be 0:08:08.840 --> 0:08:12.680 very difficult. Although there was less than a five percent 0:08:12.800 --> 0:08:16.560 chance that they could save my ovary, the surgeon was 0:08:16.640 --> 0:08:20.360 able to do it. There is still an insignificant amount 0:08:20.360 --> 0:08:24.040 of endometriosis on my right ovary. It's less than one centimeter, 0:08:25.280 --> 0:08:28.960 but they were able to remove fourteen point five centimeters 0:08:28.960 --> 0:08:32.040 of colon, which is about the size of sharp b 0:08:32.800 --> 0:08:37.720 a six centimeter rectovaginal septum tumor, which which is about 0:08:37.720 --> 0:08:41.440 the size of an egg, and a seven centimeter left 0:08:41.480 --> 0:08:44.240 ovarian tumor, which is about the size of peach. And 0:08:44.280 --> 0:08:47.240 the left ovary. I woke up to the very happy 0:08:47.280 --> 0:08:49.439 news that I still had an ovary, which I did 0:08:49.480 --> 0:08:53.080 not expect, and about a week later I got the 0:08:53.160 --> 0:08:58.360 even happier news that there wasn't cancer, it was just endometriosis. 0:08:59.000 --> 0:09:01.320 So after the surgery, it took me about three months 0:09:01.320 --> 0:09:07.880 to feel normal again. The biggest shift since the surgery 0:09:07.960 --> 0:09:11.240 is that I've had to relearn my body. I have 0:09:11.360 --> 0:09:13.960 to relearn what feels good and bad, what's painful and 0:09:14.000 --> 0:09:18.000 what's not, because I just disassociated from it so much 0:09:18.640 --> 0:09:21.640 that I had no idea that I was in pain. 0:09:22.960 --> 0:09:26.880 The emotionally challenging part of this, aside from thinking that 0:09:26.960 --> 0:09:29.680 I was going to die of cancer for a fairly 0:09:29.800 --> 0:09:33.839 significant amount of time, was that there's almost no chance 0:09:33.880 --> 0:09:36.960 of me ever having another biological child, and so I've 0:09:37.000 --> 0:09:39.640 had to give up on that particular dream because the 0:09:39.679 --> 0:09:43.600 hope was just too much. But we got a puppy, 0:09:43.920 --> 0:09:49.040 and so that's my replacement baby. I have also learned 0:09:49.080 --> 0:09:52.200 to be a lot kinder to myself and to trust 0:09:52.200 --> 0:09:54.920 my body more. I accept now that I am living 0:09:54.920 --> 0:09:57.400 with a chronic illness. I try to take naps a lot, 0:09:57.520 --> 0:10:01.120 I try to listen to what feels good and what 0:10:01.240 --> 0:10:03.960 feels bad. But when I stopped to really think about it, 0:10:04.000 --> 0:10:07.559 the thing that really makes me angry is that I 0:10:07.640 --> 0:10:10.840 had no idea I had endometriosis before any of this started. 0:10:12.559 --> 0:10:17.000 It is absurd that no one thought of endometriosis, That 0:10:17.240 --> 0:10:21.439 I was never presented with any education about endometriosis, that 0:10:21.840 --> 0:10:25.520 no one in my friend's circle ever talked about endometriosis, 0:10:25.559 --> 0:10:27.600 even though I found out more and more people have it, 0:10:28.120 --> 0:10:31.040 and I just feel like I know so little. In 0:10:31.080 --> 0:10:33.079 a post I wrote on Reddit, I wrote, I've been 0:10:33.160 --> 0:10:35.839 a feminist for my entire life without understanding that I've 0:10:35.840 --> 0:10:41.320 been trapped in a patriarchal pain trap. So thank you 0:10:41.360 --> 0:11:27.319 for listening to my story. 0:11:27.960 --> 0:11:31.280 Thank you so much Susie for taking the time and 0:11:31.360 --> 0:11:35.959 being willing to share your story. It was Oh my gosh, 0:11:36.040 --> 0:11:36.559 I mean. 0:11:36.640 --> 0:11:39.200 Yeah, I can't wow, thank you. 0:11:39.760 --> 0:11:40.920 Yeah. 0:11:41.080 --> 0:11:45.040 Hi, I'm Erin Welsh and I'm Erin allman updyke. 0:11:44.840 --> 0:11:47.000 And this is this podcast will kill you. 0:11:48.000 --> 0:11:51.520 It's uh, it's gonna be a big episode. Erin. 0:11:52.280 --> 0:12:01.240 This is certainly my longest notes like by I think 0:12:01.600 --> 0:12:06.360 like kind of a bit so just yeah, I really 0:12:06.440 --> 0:12:09.000 kind of it got away from me. But I'm excited 0:12:09.040 --> 0:12:09.440 about it. 0:12:10.600 --> 0:12:13.000 I am too. I have like a lot of feelings 0:12:13.080 --> 0:12:17.640 about it. So it's going to be a good one. 0:12:17.960 --> 0:12:21.000 Yeah, And what exactly is going to be a good one? 0:12:21.320 --> 0:12:21.440 Oh? 0:12:21.520 --> 0:12:24.880 Yeah, that's right. Today we're covering endometriosis. 0:12:25.440 --> 0:12:32.840 That's right. What even is endometriosis? At the end of 0:12:32.840 --> 0:12:36.079 this episode, will we have a satisfactory answer to that question? 0:12:36.559 --> 0:12:39.800 I think we'll have, like at least most of a 0:12:39.840 --> 0:12:42.679 satisfactory answer, will have a clinical definition. 0:12:43.440 --> 0:12:48.120 That's true, that's true. Where does that leave us? I 0:12:48.120 --> 0:12:50.920 guess we'll find out before we get into the nitty 0:12:50.920 --> 0:12:55.520 gritty of all of that. Though. Should we do quarantining? 0:12:56.280 --> 0:12:57.640 We really should? 0:12:58.679 --> 0:12:59.959 What are we drinking this week? 0:13:00.360 --> 0:13:06.000 We're drinking the chocolate cyst of course. Oh boy, honestly, 0:13:06.160 --> 0:13:09.080 that's I think that's a grosser name than our diabetes 0:13:09.160 --> 0:13:12.320 one sweet Pea. Yeah, I think this is grosser. 0:13:12.840 --> 0:13:15.840 Is it grosser than our MRSA one? 0:13:15.960 --> 0:13:22.240 Mm? No, mah, maybe, I don't know. You tell us listeners, 0:13:22.360 --> 0:13:23.480 You tell us listeners. 0:13:23.840 --> 0:13:27.480 Yeah, what's the grossest one yet? So why are we 0:13:27.559 --> 0:13:29.680 calling it the chocolate cist though? Yeah? 0:13:29.720 --> 0:13:34.920 Okay, so a chocolate cyst is like one of the 0:13:35.080 --> 0:13:41.400 descriptors for an endometrioma, which is when you get endometriosis 0:13:41.400 --> 0:13:43.960 on your ovary. We're gonna get into all of it, 0:13:44.080 --> 0:13:46.920 but basically, sometimes you get these things that look like 0:13:46.960 --> 0:13:49.319 a little chocolate truffle. 0:13:49.800 --> 0:13:55.120 Liquid or Okay, well, definitely garnish this with a chocolate 0:13:55.200 --> 0:13:56.319 truffle if you can. 0:13:57.840 --> 0:13:59.520 So what's in the chocolate cyst? 0:14:00.240 --> 0:14:07.400 Chocolate liqueur, banana liqueur, coffee liqueur, and cream and then 0:14:07.480 --> 0:14:09.920 of course s garnish like I said, with a chocolate truffle. 0:14:10.280 --> 0:14:13.600 And also the placy Burita is just probably going to 0:14:13.600 --> 0:14:17.720 be the most decadent, delicious chocolate milkshake you've ever had, 0:14:18.000 --> 0:14:24.400 chocolate banana milkshake. Yeah. And you can find our recipe 0:14:24.440 --> 0:14:28.600 for our quarantini as well as our non alcoholic Placyburta 0:14:28.600 --> 0:14:31.680 on our website. This podcast willkill You dot Com and 0:14:31.760 --> 0:14:34.640 we'll also post it to all of our social media channels. 0:14:35.280 --> 0:14:37.680 On our website, this podcast will kill You dot com. 0:14:37.920 --> 0:14:40.680 You will find everything that you could want to find. 0:14:40.680 --> 0:14:44.400 We have merch we have links to Bloodmobile, who provides 0:14:44.440 --> 0:14:48.080 the music for this podcast. We have transcripts of all 0:14:48.160 --> 0:14:52.040 of our episodes now, which is thrilling. We've got a 0:14:52.080 --> 0:14:54.920 bookshop dot org affiliate account. We've got a good Reads list, 0:14:54.920 --> 0:14:57.000 we have a link to our patreon. We have it's 0:14:57.000 --> 0:14:57.680 all there. 0:14:57.640 --> 0:14:59.880 It's all there, it's all there, and more. 0:15:00.400 --> 0:15:04.160 With that, Aaron, should we just get into the endomeet 0:15:04.720 --> 0:15:07.960 trium of this episode? 0:15:08.040 --> 0:15:17.080 Erin, yes, yes, please please. Let's take a quick break first. 0:15:49.560 --> 0:15:54.120 I can kind of sum up this whole episode with 0:15:54.200 --> 0:15:56.920 one of the more recent papers that I found. It's 0:15:56.920 --> 0:16:00.760 the title of a paper from twenty twenty one, and 0:16:00.800 --> 0:16:06.920 the title is simply, the epidemiology of endometriosis is poorly 0:16:07.040 --> 0:16:10.920 known as the pathophysiology and diagnosis are unclear. 0:16:12.240 --> 0:16:14.160 And how that's the title. 0:16:14.680 --> 0:16:19.600 I know that's the title. Man, Yeah, it's uh yeah, 0:16:19.640 --> 0:16:20.960 We're off to a really good start. 0:16:21.040 --> 0:16:25.600 Strong yep spoilers. I feel like, yes, we're in that title. 0:16:26.800 --> 0:16:31.840 Okay, So endometriosis. I know there's probably a good subset 0:16:31.920 --> 0:16:34.560 of our listenership who has never heard of this. And 0:16:34.600 --> 0:16:37.640 I am going to get to the official definition really soon, 0:16:37.680 --> 0:16:44.160 I promise, but some little lead in. Okay, Endometriosis is 0:16:44.320 --> 0:16:49.120 almost always described as a disease of women of child 0:16:49.160 --> 0:16:55.600 bearing age. That is how it is described. It's a 0:16:55.640 --> 0:17:01.520 problem straight off the bat because this description ignores number one, 0:17:02.040 --> 0:17:05.320 anyone who is trans or non binary that has a 0:17:05.440 --> 0:17:10.040 uterus or has endometriosis. Number two, it ignores the fact 0:17:10.119 --> 0:17:16.080 that endometriosis pain and endometriosis itself can persist or even 0:17:16.200 --> 0:17:23.120 sometimes arise after menopause aka after quote child bearing. Number three, 0:17:23.240 --> 0:17:27.240 It also ignores the fact that cases of endometriosis, though 0:17:27.720 --> 0:17:32.680 very rare, have occurred in people assigned male at birth, 0:17:33.119 --> 0:17:38.000 which means that a uterus isn't necessarily a prerequisite for 0:17:38.080 --> 0:17:43.800 the disease. And finally, and I think most importantly, I 0:17:43.800 --> 0:17:47.320 don't know they're all important, but by designating this disease 0:17:47.359 --> 0:17:50.720 to this particular group quote women of child bearing age 0:17:51.240 --> 0:17:52.680 and Aaron, I know you're going to talk a lot 0:17:52.680 --> 0:17:53.159 more about this. 0:17:54.119 --> 0:17:56.720 Oh yeah, yeah, so I thought, is it's also been 0:17:56.760 --> 0:17:58.000 found in infants. 0:17:58.320 --> 0:18:01.720 Oh that's a good point. Yeah, yeah, it can definitely 0:18:01.760 --> 0:18:04.360 be in before child bearing age as well. 0:18:04.960 --> 0:18:07.200 Everyone can get very trios. 0:18:07.840 --> 0:18:12.080 But by designating it as the disease of women of 0:18:12.200 --> 0:18:15.680 childbearing age, it makes it really really easy in our 0:18:15.840 --> 0:18:20.960 society to dismiss it as a condition for oh, young 0:18:21.000 --> 0:18:24.359 women just have poor pain tolerance, or oh this is 0:18:24.440 --> 0:18:30.440 a women's problem, or even worse, as a normal part 0:18:30.960 --> 0:18:35.639 of young womanhood. Spoiler alert, it is none of those things. 0:18:35.960 --> 0:18:39.720 I'm going to be talking so much about this aspect 0:18:39.760 --> 0:18:40.200 of it. 0:18:40.480 --> 0:18:44.320 I can't wait. I'm gonna I'm going to try and 0:18:44.440 --> 0:18:47.239 just hit us all with the little that we do 0:18:47.359 --> 0:18:51.280 know about the biology. So let's actually define the topic 0:18:51.320 --> 0:18:52.560 of today's episode, shall we? 0:18:53.000 --> 0:18:53.400 Mm hmm? 0:18:53.680 --> 0:18:58.800 Okay, So the technical definition of endometriosis is simply the 0:18:58.880 --> 0:19:04.600 finding of endometrial glands and stroma, which just means endometrial 0:19:04.760 --> 0:19:11.600 like tissue outside of the uterus. So what does that mean? Yeah, 0:19:11.640 --> 0:19:14.200 to talk about that, I want to first talk about 0:19:14.240 --> 0:19:19.080 my personal favorite organ, the uterus. That's my favorite one. 0:19:19.600 --> 0:19:20.600 Do you have a favorite organ? 0:19:21.200 --> 0:19:23.400 I've never thought about it. 0:19:23.400 --> 0:19:24.200 It's a uterus. 0:19:24.720 --> 0:19:26.520 No, I don't. I don't think I would need I 0:19:26.520 --> 0:19:27.320 would need more time. 0:19:27.560 --> 0:19:30.879 Okay, that's fine. Okay. So we talked I think a 0:19:30.920 --> 0:19:33.960 fair bit about the uterus in our birth control episode 0:19:33.960 --> 0:19:36.920 because we talked about the whole menstrual cycle. So I'm 0:19:36.960 --> 0:19:41.320 just gonna briefly recap. The uterus is an organ that's 0:19:41.359 --> 0:19:45.000 made up of a muscular wall, the myometrium, and an 0:19:45.040 --> 0:19:49.199 inner layer, the endometrium, that's composed of glandular cells. So 0:19:49.240 --> 0:19:52.080 there are these cells that basically form into little glands 0:19:52.720 --> 0:19:56.640 as well as stroma or like support cells is how 0:19:56.640 --> 0:19:59.879 you can think of them. That surround these glandular cells 0:20:00.880 --> 0:20:04.960 and this endometrium. This inner lining of the uterus is 0:20:05.080 --> 0:20:10.679 constantly in flux. This lining is what responds to and 0:20:10.800 --> 0:20:15.280 changes with the influence of cyclic variation in our hormone levels, 0:20:15.840 --> 0:20:20.800 most specifically estrogen and progesterone. This is the menstrual cycle 0:20:20.800 --> 0:20:23.280 that we went over in our birth control episode, which 0:20:23.359 --> 0:20:26.439 was now a couple of years ago. To recap it, 0:20:26.880 --> 0:20:32.080 Under the influence of an increase in estrogen, oocytes in 0:20:32.119 --> 0:20:35.679 the ovaries begin to mature, and the uterus lining the 0:20:35.800 --> 0:20:42.200 endometrium proliferates, it grows in number. These stromo cells and 0:20:42.359 --> 0:20:46.119 these glandular cells, and this is known as the follicular 0:20:46.200 --> 0:20:51.480 phase or the proliferative phase, where this lining is growing 0:20:53.200 --> 0:20:56.560 and the endometril lining is becoming thicker in preparation for 0:20:56.640 --> 0:21:01.159 the potential implantation of a blastocyst. Then that peak of 0:21:01.320 --> 0:21:05.000 estrogen prompts a surge of another hormone that causes the 0:21:05.040 --> 0:21:08.920 release of an egg aka ovulation. And then as that 0:21:09.160 --> 0:21:13.600 surge of estrogen declines, progesterone, another hormone, begins to increase, 0:21:14.400 --> 0:21:18.320 and the uterus, the endometrium enters what's known as the 0:21:18.359 --> 0:21:23.600 secretary phase, where these glands thicken and the arteries within 0:21:23.720 --> 0:21:29.040 their widen and proliferate in number, and the endometrium undergoes 0:21:29.080 --> 0:21:34.679 this process, further preparing it for receiving a blasticist. And 0:21:34.720 --> 0:21:39.400 then without anything that implants, fourteen days go by and 0:21:39.800 --> 0:21:44.760 progesterone levels sharply decline, and this withdrawal leads to the 0:21:44.800 --> 0:21:47.840 separation of all these cells from their basal layer and 0:21:47.880 --> 0:21:52.720 they slough off aka menstruation. All of that endometrial tissue 0:21:52.720 --> 0:21:56.719 then exits through the cervix, which is the opening of 0:21:56.760 --> 0:22:03.960 the uterus through the vagina, and that is menstruation, right, yep, right, Okay, 0:22:04.000 --> 0:22:06.800 So if that all is the menstrual cycle, and that's 0:22:06.800 --> 0:22:10.679 what's happening inside of a uterus during that menstrual cycle, 0:22:11.560 --> 0:22:16.639 then what is endometriosis If it's the finding of these 0:22:16.760 --> 0:22:20.520 same type of cells that are found inside of a uterus, 0:22:20.560 --> 0:22:26.240 these endometrial, glandular and stromal cells, but now they are 0:22:26.440 --> 0:22:32.439 implanted in tissue outside of the uterus. So instead of 0:22:32.480 --> 0:22:37.440 being inside the lining of this muscular organ, it's outside 0:22:37.440 --> 0:22:40.919 on the wall of the organ, or on the wall 0:22:41.080 --> 0:22:44.040 of your belly, which is called the peritoneum, the inside 0:22:44.080 --> 0:22:47.520 wall of your abdomen. It could even be on your 0:22:47.520 --> 0:22:52.400 bladder or in your Philippian tubes, or on your ovary, 0:22:53.119 --> 0:22:56.719 or on your rectum. It could be anywhere literally in 0:22:56.760 --> 0:22:57.240 your body. 0:22:57.840 --> 0:22:59.080 Yeah. 0:22:59.280 --> 0:23:02.280 So then the question is how does this become a 0:23:02.320 --> 0:23:04.680 disease or a problem, Like why is it a problem 0:23:04.720 --> 0:23:09.680 to have this tissue outside of the uterus. Well, this 0:23:09.920 --> 0:23:15.720 tissue is still active. It's hormonally sensitive endometrial cells that 0:23:15.800 --> 0:23:22.400 are undergoing the same proliferative and secretory and then degeneration 0:23:22.880 --> 0:23:26.760 that happens within the uterus and would end in mensies 0:23:27.280 --> 0:23:30.960 leaving the body through the vagina, but it's happening in 0:23:31.000 --> 0:23:36.520 an abnormal location and therefore leading to not only abnormal 0:23:36.560 --> 0:23:42.080 responses in our body and massive amounts of inflammation, but 0:23:42.160 --> 0:23:44.879 it's also then not able to leave the body, so 0:23:44.920 --> 0:23:49.679 this inflammation stays contained within the body. That leads to 0:23:49.760 --> 0:23:54.000 tissue damage, which can then lead to scarring and fibrosis, 0:23:54.640 --> 0:23:59.760 which leads to the symptoms of endometriosis, which are chiefly pain, 0:24:00.440 --> 0:24:06.440 which doesn't begin to describe adequately like the true symptoms, 0:24:07.720 --> 0:24:12.800 and also infertility or difficulty conceiving or sustaining a pregnancy. 0:24:14.359 --> 0:24:16.720 So that was a lot, like all in a very 0:24:16.720 --> 0:24:18.920 short amount of time. And that's all we know about 0:24:18.960 --> 0:24:23.800 enemy dresses. Just kidding, We know like a tiny bit 0:24:23.840 --> 0:24:28.600 more than that. Yeah, So that explanation left a lot 0:24:28.640 --> 0:24:31.760 of open ended questions, and I think the first one 0:24:31.880 --> 0:24:34.080 that I would like to be able to answer is 0:24:34.840 --> 0:24:39.840 how how does this endometrial tissue end up in a 0:24:39.880 --> 0:24:45.840 place where endometrium shouldn't be. Tissue types in our body, 0:24:46.119 --> 0:24:49.520 like different cell types are actually pretty tightly regulated, So 0:24:49.640 --> 0:24:52.479 like the tissue that makes up our lining of our 0:24:52.560 --> 0:24:55.040 abdomen is different than the tissue that makes up the 0:24:55.080 --> 0:24:57.320 lining of your uterus, which is different than the tissue 0:24:57.600 --> 0:25:00.439 that makes up your heart or your blood, ves, souls, 0:25:00.520 --> 0:25:00.960 et cetera. 0:25:01.240 --> 0:25:05.280 Right, Right, And so then because it's so tightly regulated, 0:25:06.359 --> 0:25:10.160 shouldn't your body recognize that, like, hey, this isn't necessarily 0:25:11.040 --> 0:25:13.440 in the right spot it. 0:25:13.720 --> 0:25:16.480 Yeah, And in the case of anenometrius, that's part of 0:25:16.520 --> 0:25:19.639 the problem is that your body does recognize it as 0:25:19.680 --> 0:25:23.000 something that's not in the right spot and therefore causes 0:25:23.040 --> 0:25:27.240 a lot of inflammation within it, right, Yeah, And so 0:25:27.400 --> 0:25:29.439 then that leads to part of the problem, or at 0:25:29.520 --> 0:25:32.000 least we think that maybe that's how it's happening. And 0:25:32.280 --> 0:25:35.199 with a lot to do with endometriosis, it's hard to 0:25:35.320 --> 0:25:38.840 know who's the instigator, like which is the cause and 0:25:38.880 --> 0:25:44.760 which is the effect? Right, right, But yes, that can 0:25:44.800 --> 0:25:47.280 be part of the problem because our body does recognize 0:25:47.320 --> 0:25:51.080 when a tissue is not in the right place a 0:25:51.080 --> 0:25:53.879 lot of times. But again, this doesn't happen very often 0:25:53.920 --> 0:25:57.280 to have a tissue type in a location in the 0:25:57.280 --> 0:26:00.800 body where it doesn't belong. Because in general, as we 0:26:00.840 --> 0:26:03.600 develop from a single cell all the way into our 0:26:03.680 --> 0:26:09.240 multicellular human cells, our cells undergo this process of differentiation 0:26:09.640 --> 0:26:13.080 into all of our specific tissue types in a very 0:26:13.280 --> 0:26:19.080 characteristic pattern during the process of embryogenesis and development. So 0:26:19.240 --> 0:26:22.680