In this episode, I am speaking with Jessica Drummond, MPT, CCN, CHC – the founder and CEO of the Integrative Women’s Health Institute and author of Outsmart Endometriosis. Dr. Drummond has 20 years of experience in working with women in overcoming pelvic pain and endometriosis. We will discuss the most common causes and symptoms of endometriosis and the best strategies to treat it.
Table of Contents
In this podcast, Dr. Drummond and I discuss:
- The most common symptoms of endometriosis
- Who can get endometriosis – and how prevalent is it
- How endometriosis shows up in your body
- The difficulty with diagnosing endometriosis
- The problems with the current treatments for pelvic pain
- The best strategies for endometriosis treatment and management
Listen or download on iTunes
Listen outside iTunes
Ari: Hey, everyone, welcome back to The Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me my friend, Dr. Jessica Drummond, who is the CEO of the Integrative Women’s Health Institute and author of Outsmart Endometriosis. She holds licenses in physical therapy and clinical nutrition and is a board certified health coach. She has 20 years of experience working with women with chronic pelvic pain, facilitates educational programs for women’s health professionals in more than 60 countries globally, and leads virtual wellness programs for people with endometriosis. Dr. Drummond lives and works with her husband and daughters between Houston, Texas and Fairfield, Connecticut.
Welcome to the show. This has been a long time in the making and a lot of canceled appointments on both your end and my end, but I’m glad we’re finally able to connect and make this happen.
Dr. Drummond: Yes. Thanks so much for having me.
What is Endometriosis?
Ari: My pleasure. You have a new book, Outsmart Endometriosis. I’m curious, can you just for people who maybe don’t know, talk about what endometriosis is, first of all?
Dr. Drummond: Absolutely. Endometriosis is a disease process that probably has three underlying factors. There’s a lot of debate still in the literature about exactly what endometriosis is, but it does have a genetic component. There were studies done on female fetuses, have roughly the same percentage, about 9% in female fetuses, 10% in adult women, or people with uteruses that are presenting with endometrial cells, endometriosis lesion cells. There’s also an inflammatory factor and there’s an autoimmune factor. From my perspective, I think of it as cancer or Alzheimer’s, where you have the physical lesions, the plaques, the tangles, the cancer cells and then they can be worsened or progressed, proliferated by inflammation and there’s an underlying autoimmune component. Also, there’s a lot of comorbidity with other autoimmune diseases.
Ari: Very interesting. It’s cells that are where and are doing what?
Dr. Drummond: They are cells that are very similar to, but not exactly the same as the lining of the uterus, which is called the endometrium. These are cells that are very similar, that are by definition, growing outside of the uterus. They’re generally growing on the outside of the ovaries, the outside of the uterus, on the bowel, on the small intestine, anywhere in the abdominal pelvic cavity. You also see more extra pelvic endometriosis in some cases, which is more rare, but still available. You’ll see it in places like C-section scars, on the lung. It’s even been found in the knee and inside the nose, so it’s like little cancerous lesions, but it’s not a cancer. It’s actually benign from that definition.
Ari: Okay, so when you say it’s cancerous lesions, what exactly do you mean by that if it’s not a cancer?
Dr. Drummond: It’s not cancer, it doesn’t act like cancer, it’s not fatal, but there are cellular lesions of several different types of these cells, [unintelligible] like the lining inside the uterus.
Ideally, the treatment includes having those lesions cut out, but that’s not the full picture. Just like in cancer, we want to lower inflammation, optimize immune health, and that sort of thing. It’s different. It’s not deadly in the sense that cancer is, but it’s very quality of life altering, and it does increase the risk for certain cancers such as ovarian cancer, but even melanoma. People with endometriosis have increased risk of melanoma, so there is some overlap, but it’s not exactly the same.
Ari: Interesting. Okay, so it impacts quality of life. It’s not really that deadly, but it impacts quality of life. I guess there’s two layers to this. One is, subjectively, how does someone get impacted in terms of their quality of life? I guess answer that part first, and then I want to go into the mechanisms of what it’s doing.
Dr. Drummond: Okay, yes. Usually, it presents in a timeline, which is hard to see usually until you’re looking backwards, but pre puberty. It’s definitely heightened or expressed at puberty, but pre puberty, you often find between eight and 12 years old, a girl presenting with things like stomach aches, digestive issues, and then bad periods, but when they’re teenagers and preteens the period pain is not generally cyclical. It can be anytime. You’ll have this family history of moms, grandmas, aunts, sisters having bad periods, terrible periods, run in our family. Infertility is very common. A lot of pelvic pain, sexual pain, digestive issues. Also, an overlay of fatigue and anxiety, which I find is generally related to the digestive issues, where it’s a challenge with absorption, because don’t forget, a lot of times these lesions are growing on the small intestine and bowel. There’s endo belly, which often really is SIBO, because you’ve got adhesions and lesions growing on the small intestine, which create these perfect little pockets for bacteria and other microbes to thrive. Motility can slow down, and so you have bloating, digestive issues, constipation, and then period pain that doesn’t start off perfectly cyclical, but eventually can be cyclical or can be all the time. It’s actually the number one reason that girls miss middle or high school, because they have this kind of intense pain with or even without their periods.
Ari: Meaning days of school missed or entirely pulling out of school?
Dr. Drummond: No, days of school missed, so staying home, sick or in pain.
Ari: Interesting. It’s fascinating to me that the range of how this can be expressed in terms of symptoms, from pelvic pain to infertility, to gut symptoms, to bad period related symptoms. I think there was a few others that you mentioned in there. How does this actually work in terms of the mechanisms that are causing these effects? Is it almost like senescent cells that are producing inflammatory cytokines in the area? What are these cells doing to create these symptoms?
Dr. Drummond: There is the structural physical problems where you’ve got lesions growing on the bowel, so it’s structurally impairing motility or getting in the way of the functioning of the fallopian tube, things like that. There’s the structural piece of it.
Ari: How big can they be in that regard?
Dr. Drummond: They can be quite big. The endometriomas can be very big, like grapefruit size.
Ari: Okay, so they can create what would maybe manifest almost in terms of the phenotype, in terms of the looks like a cancerous tumor.
Dr. Drummond: Correct, but they could also be microscopic. They can also be a little black or red tinier things that are visible, but they’re not giant. There’s several different expressions. There is a structural component, but, yes, we also find increased inflammatory cytokines and increased autoantibodies sometimes that are similar to things like lupus antibodies or rheumatoid arthritis antibodies. In fact, when the lesions are removed by having scaled surgery, the antibodies decrease at least for a transient period of time of at least six to 12 months.
Ari: Very interesting. You mentioned fatigue as one of the symptoms of how this can manifest, which is obviously of great interest to people listening to this podcast. What would be the mechanism of how it would cause fatigue? Is it the inflammatory cytokine component?
Dr. Drummond: That’s part of it. Mitochondrial overwhelm is one piece. I think another piece is lack of absorption of amino acids or even nutrients in general, so nutrient deficiencies, both macro and micronutrient deficiencies because you have so much digestive issues and a lot of pain with eating. I think it’s also really the clinical journey of trying to be treated, because it takes an average of 6 to 12 years for this to be diagnosed, so you have a lot of people telling you, “It’s all in your head. Just try birth control.” In general, it’s not well-managed by Western medicine, so the path of getting a true diagnosis– The other big challenge is, the only way to get a true diagnosis is through scaled laparoscopic surgery. You can’t just do imaging or a blood test. You can sometimes see some of these things on imaging, but if you don’t, it doesn’t rule it out.
The problems with endometriosis diagnosis
Ari: With the path for diagnosis being so invasive, they’re probably not rushing– Both patients and practitioners are not rushing to check, I would imagine, so that’s probably a big barrier. You have this problem, as you said, of so many people who maybe are suffering from these kinds of symptoms, pelvic pain, or infertility, or fatigue, period-related symptoms, that are dealing with this for years, and years, and years before they ever get to this stage of, “Okay, we’ve exhausted all other options. Let’s perform this surgery to check for endometriosis.” Is that accurate?
Dr. Drummond: Yes. The other thing that could happen is, because there is a genetic component, it can be normalized within even the family for a period of time, and there’s such a wide range of presentation. For some people, it’s super debilitating pain a lot of the time. For other people, it’s actually silent and they don’t even know they have it unless they’re struggling with infertility or something like that. I think that’s part of the problem too. You have a wide variety of presentations and with everyone in the family has period pain, well, that’s normal, so there’s not even a strong [unintelligible] and then the training–
I was talking to Betsy Greenleaf, who was the first female urogynecologist board-certified in the US and she said she didn’t even really learn any of this in school. It’s not well-trained. Most gynecologists, and even urogynecologists haven’t been well-trained in the deep dive management of this.
Ari: You’re saying even for gynecologists, they’re not well-trained in this?
Dr. Drummond: Yes.
Ari: Okay. Having said that, there are these symptoms you mentioned. There are these wide variety of how this may present or manifest. It might be normalized in certain families. You have this very invasive way of how you would diagnose this. If there are people listening to this, if there are women listening to this who are saying, “Some of these symptoms seem to resonate with me. Maybe I should get checked for endometriosis. Maybe that’s the cause of my fatigue, and pelvic pain, and some of these other things,” what would you say are the– How would somebody present to you clinically, in terms of their symptoms and what they’re describing? Are there issues that would make you say, “I would bet a lot of money that this is 99% going to be endometriosis. You should get checked for endometriosis.” What would that look like?
Dr. Drummond: I think the history really tells us that timeline of digestive issues, family histories of infertility, family history of pelvic or period pain. [inaudible 00:16:01] people going on birth control just to quiet their period symptoms, maybe even this person herself. The other thing that you hear, and we were talking about this at one of the endo conferences recently, going in the bathroom in middle school or high school and sitting on the floor in a cold sweat from the pain, just resting your chin on the toilet because it’s cooler. There are certain things that we hear over and over in the history that really point to this and then because there’s that family history component, and then a lot of times, the only treatment that’s been given would be something like pain management or hormonal birth control, which sometimes helps, sometimes doesn’t. Having that path is where really I can say, “This very commonly sounds like endometriosis.”
Two other things that are also very common are bladder pain symptoms, because the endometriomas or the various lesions can grow on the bladder, so chronic UTIs, chronic bladder issues, bladder pain syndrome without a true cause, maybe not urinary tract issues that weren’t ever shown to be bacterial and then pain with defecation, again because of how often the bowel is involved. It’s that overlay of more than just painful periods, but intensely painful periods. A lot of times, when you talk about this– It’s 10% of women or people with uteruses, so if you’re in a group of twenty 17-year-old girls, they know who the two are that have it.
Ari: Interesting. This is a topic that I’ve never really looked into in-depth, so it’s very interesting for me to hear this. My wife has definitely told me on numerous occasions that when she was in high school, that she had incredibly painful period symptoms, and that her sister did, her mom did, her grandma did. Migraines also. I’m curious if that’s related to this constellation of symptoms, if migraines are also associated with endometriosis, but incredibly painful periods that were debilitating.
She told me she fainted one time in school from the pain. My wife is actually very physically tough, not anywhere near the hypochondriac end of the spectrum. If she says she was in a lot of pain, I definitely believe her. They were, both her and her sister, put on birth control to mitigate these symptoms back in high school. I’m just curious, are migraines associated with it? What I just described there, does that fit with the narrative or do you think it could be something else?
Dr. Drummond: That definitely does fit with the narrative. We’d have to dig a little bit more. Were there other bowel or bladder issues? Were there any infertility challenges in her family or for herself? Did the birth control help? Up until early 2018, the prevailing thought was that the lesions were mostly fed by estrogen in the same way that breast cancer lesions are fed by estrogen.
Now they did some histological studies in Belgium in 2018 and similar results have come out of other labs, that when you look at the lesions, some of them have upregulated estrogen receptors, some have more progesterone receptors, some have both, some have neither, and all of these different kinds of lesions can present in the same person. For those that do have the estrogen-driven lesions, there are a lot of estrogen suppressing medications, including, of course, hormonal birth control that do help, but there’s a lot of people who don’t respond to that, so we’re like, “Why not? If we’re suppressing the estrogen, how come they’re still having so many symptoms?” Now we know it’s not that simple. Of course, there’s the inflammatory component and the work that I do is everything obviously except the surgery. The more we can optimize immune health with lowered inflammation and improvements in the barriers between the digestive system and the immune system, so lowering the autoimmune presentation or challenges there and then just normalizing the hormones but not really trying– Making sure estrogen is being metabolized well, make sure there’s not so much xenoestrogens from plastics. As an example, I had a client in the Middle East, super hot. She was having all these estrogenic symptoms that she realized she was wearing plastic flip flops all the time and it was absorbing through her skin. Lowering the toxic load, supporting liver and gut metabolism of estrogen, but not fully suppressing everything is really a better approach.
Sometimes, that’s really helpful to be on birth control, at least for the short term while they’re having a diagnosis. The problem is that, a lot of times, say your wife and her sister were put on birth control at 15 and 17, then [unintelligible] If it quiets the symptoms, then the only perspective is like, “Hey, let’s just leave the person on it until she wants to get pregnant.” but you’ve left this disease process manifesting for a decade or more before someone is trying to actively get pregnant and you’re not trying to optimize the health of the system. Does that make sense?
How many women get endometriosis?
Ari: Yes, absolutely. I’m curious in terms of causation. Is this like, obesity, like type two diabetes, like cardiovascular disease, neurological diseases, cancer? Is this a disease of civilization? Is this something that has skyrocketed in the last 70 years with the rise of the standard American diet, the modern Western lifestyle or is this something that just a portion, 10% of women have had going back millennia?
Dr. Drummond: As far as I can tell, it’s 10% of women. That number has remained fairly constant. What I would say potentially, although it’s really hard to say because the treatment of this hasn’t been very good, like up until even– There are some really good excision surgeons in the US and even globally now, who take a very holistic approach. They see the excision surgery as being the valuable part of the puzzle, but not the whole thing. Even that is very new. I started treating this 20 plus years in my practice.
At that time, we used to see a lot of ablation surgery which is basically go in and just try to burn off these bad cells. I would very commonly see someone having 12, 15 ablation surgeries and just keep going in and trying to burn it all, not really ever dealing with the whole organism. Whereas excision, the goal is to do one, maybe two surgeries in a lifetime, and ideally, support all of these other factors, immune health, hormonal health, and so forth. Because endometriosis until very recently, we’re talking in the last five, 10 years, hasn’t been well managed at all, it’s very hard to say if it’s worsening.
I see the picture of how people are recovering if they have a good treatment. It is a lot better than I used to see 20 years ago. We used to go down these spiraling paths of pain management and the best you could do. We’d do manual physical therapy [unintelligible] people would have stimulators inserted into their spine to try to manage the pain, a lot of opioid use. In that sense, it’s improving. I can’t say that the numbers are increasing because of an inflammatory lifestyle, but I definitely think that managing inflammation could really make the therapeutic outcome a heck of a lot better.
The main causes of pelvic pain
Ari: It seems to me that if that is the case– Let’s imagine a scenario where there just isn’t good data for people with type two diabetes and we have no history of testing up until the last let’s say 10 or 15 years and we don’t really know how common it was going back 70 years ago and so on. We don’t know what’s causing it necessarily, but we figured out that if you change people’s diet from a standard American diet to a whole foods diet, rich in plant foods, and you get them to lose 10% or 15% of their body weight and excess adipose tissue, that you reverse the insulin resistance and can in many cases or in most cases, cure the type two diabetes, it seems just logical to conclude that if those nutritional lifestyle and lifestyle factors are good therapy, that poor nutrition and lifestyle are probably part of the cause of the problem in the first place.
Dr. Drummond: Sure. That very well could be. I think the challenge is, as you just said, we don’t really know. We don’t have the same kind of data before 70, 50 years back. Before really, it was just in– Even 20 years ago, when I started treating this, it was burn it off and take estrogen-blocking drugs. Basically, they would put people into a chemical menopause, which had horrible side effects. That’s still a common treatment. When you’re 17, to be put in chemical menopause, it’s terrible for your bones, terrible for your brain and terrible for your heart.
Hysterectomy used to be a treatment, but of course, we know that doesn’t do anything because the lesions are by definition outside of the uterus. In some cases–
Ari: When in doubt, just take out the uterus and burn it off. That’s my approach to pretty much all medical problems. Just burn it off.
Dr. Drummond: Honestly, that’s really the true gynecologic wizardry that we had. [laughs]
Ari: There was a client who came to me recently and he’s like, “I have erectile dysfunction.” I’m like, “Burn it off. Get rid of it.”
Dr. Drummond: Right. That’s really how women’s health has been, literally up to about 20 years ago and even overlapping the last little bit, even now.
There’s this sister condition called adenomyosis, which is these lesions that are inside the uterine musculature. In that case, doing a hysterectomy is the only treatment. Again, you can’t know until you’ve done the hysterectomy. Now, obviously, people who are really skilled at this, the same way you just asked me, can tell from– They’ve tried treating everything, they’ve tried treating endo, they’re doing all the other stuff, still having a lot of pain. The next thing to do is take out the uterus and hope that it was adenomyosis.
Ari: Interesting. In the last five, 10 years, it sounds like the state of the science and the state of standard of care treatment has advanced a lot.
Can you tell me what a conventional medical treatment as of 2020 would look like for somebody who is diagnosed with endometriosis? I want to talk about what your vision of the ideal treatment should look like.
Dr. Drummond: Still, most general gynecologists are going to prescribe birth control or pain management or something like that. Sometimes, they’ll do a look around laparoscopic surgery, where they’ll look around and see if they find anything, but the people who are very well trained in what’s called minimally invasive excision surgery, so they go in and they do this all day every day. They’re not also delivering babies. They’re going in and taking out endometriosis or similar kinds of lesions. That is a very different kind of surgery that takes a lot longer.
Obviously, it’s more complex. Often, they have a general surgeon there or a GI surgeon because [unintelligible 00:29:21] so often involved or a urologist or a urologic surgeon. There’s a whole team that’s really prepared. The challenge is that for the physicians, the reimbursement is the same. If you go in and look around or you have a 10-person team full day surgery, your reimbursement is the same.
Most of those surgeons that are really good at this, practice in a cash-based system. They’re still having a lot of trouble getting true buy-in from ECOG, the general organization that oversees the gynecologists. Depending on if you see one of those specialists who– There are, I don’t know, a hundred in the US or something like that or less, or you see your regular family gynecologist, your conventional treatment will be very different. One would be a very skilled surgery situation and in some cases, some pre-op and post-op management, not always that sort of varies, depending on their perspective and everything.
Other times, it’s the same thing as it was 20 years ago. Look around, maybe burn it off, maybe excise it, birth control, pain management, estrogen suppression, things like that.
The best lifestyle approaches to treating endometriosis
Ari: Okay, got it. What does your approach look like?
Dr. Drummond: My approach is, ideally now, not in every case do my patients have surgery. There’s a lot of reasons why you would choose not to have surgery, but assuming they’re going to have surgery and even if they aren’t, we want to spend about three months preoperatively or just in general, really optimizing the digestive, immune and nervous system from a nutrition and lifestyle standpoint, so sleep, generally, it’s a backbone of an autoimmune paleo food plan that’s very plant heavy.
There is a lot of bladder issues, so sometimes there are oxalate and histamine sensitivities that we have to manage. Digestive function is huge and increased intestinal permeability, low stomach acid is really common, dysbiosis, SIBO, so managing all of the digestive function issues. Lowering inflammation and then that expands to lifestyle. Do they have mindfulness practices? What’s their exercise look like? Sleep, stress management, all of that. Then be much better prepared for surgery so that neurologically– Of course, surgery is an inflammatory [unintelligible] just by definition, but going in with a quieter nervous system, not so much– Sympathetic upregulation really quieting all that, then following up outpatient about or the other side of surgery about six weeks for anywhere from six to 24 months depending on the recovery and how extensive the disease was and how complicated the surgery and all of that. Other people can have complete symptom relief without surgery by doing the holistic approach of nutrition and digestive support, immune support, liver support, nervous system support, and pelvic physical therapy which addresses the myofascial pain involved in the pelvic region, low back, hips, that sort of stuff.
That can happen. We can actually have complete symptom relief in some– I don’t know what the percentage of cases is, but certainly in some cases, the reason that I still encourage clients to at least consult with an excision surgeon is that we can have symptom relief but we will not be able to necessarily change fertility. We want to at least give them the opportunity to consider what their fertility plans are, because having the surgery could really preserve fertility.
Ari: Interesting. Of all those things you just mentioned, what do you think are the biggest needle movers?
Dr. Drummond: I think the gut microbiome digestive function in general. Stomach acid is a huge issue because there’s so much dysbiosis. Of course, to me, it’s like, “How would you get all those bad bacteria in your small intestine?” There’s only two ways, right? Eating it or it comes in back from the ileocecal valve.
A lot of times, with maybe even other surgeries before someone’s come to see me, the [unintelligible] has been changed such that the ileocecal valve is not functioning anymore, so we’re always battling some level of SIBO, some slow motility.
I would say an anti-inflammatory diet in general, in the context of optimizing digestive function.
Ari: Got it. Very, very, very interesting. Are there any other aspects of this that you feel are worth delving into in more detail? I’ve learned a lot about endometriosis. This is, as I said, a topic I’ve done very little research on and have very little expertise in or no expertise in, I should say. This has been enlightening for me and I feel like this is just a really wonderful tour of this whole landscape of what it is and how it works and the mechanisms behind it and what conventional treatment can do, what someone like you can do. Are there any other aspects here that you feel are worth digging into in more detail?
Dr. Drummond: I think the one other thing is that we know a lot more about pain neuroscience than when I first started in practice 20 plus years ago. I think that information is really reassuring too.
From a nutrition standpoint, when you’re optimizing digestive function, you’re much better at absorbing the building blocks we need to optimize brain function, so quieting any mitochondrial, oxidative stress, so lots of antioxidants, amino acids, so getting protein absorption is key for balancing neurotransmitters, making sure someone’s not anemic because there’s a lot of heavy bleeding that can go along with this, the menstrual bleeding.
When biochemically, the brain health is optimized, it’s a lot easier to use our pain neuroscience strategies to reduce pain from a musculoskeletal standpoint and from a behavioral standpoint, so that we don’t have to use such intense neuromodulators and pain medications that often have a lot of side effects and may or may not be very effective.
Ari: Very, very interesting. I do have one more question for you. Are there any specific supplements or herbs that have any kind of known efficacy for endometriosis?
Dr. Drummond: Yes, there are several. Probably the ones I would highlight the most are certain antioxidants. Tumeric has about 12 different mechanisms that we can use. Curcumin for lesion improvement, lower inflammatory cytokines, things like that. Even got microbiome improvements.
French pine bark or Pycnogenol has been shown even in human studies to decrease the size of endometriosis lesions. Those are two really good ones. Another one for period and pelvic pain is fish oil. Those are three that most of my patients– I’m doing a constellation of antioxidants. I’m lucky because I was originally trained as a physical therapist, not as a physician and then my doctorate is in Clinical Nutrition. I don’t think in that model of, “What supplement do we need for this?” [laughs] When you have this foundation of antioxidant-rich and mineral-rich, and amino acid-rich food plan, then those other antioxidants at therapeutic levels can be really effective.
Ari: Very, very fascinating stuff, Dr. Drummond. Thank you so much for coming on the show. I really appreciate you sharing your wisdom with my audience on this topic which is something that we’ve never addressed on the podcast before. I think it’s an incredibly important topic. I’m sure there’s lots of women listening to this who are thinking “Maybe this is the missing key for me.”
If somebody wants to follow your work, if somebody wants to get in touch with you and work with you, I’m assuming you do some telemedicine or are you just in the physical clinic for people in your local area in Connecticut or–
Dr. Drummond: No. We have a telehealth practice globally in nutrition and we also have some coaching programs for people to do group coaching. We work with patients all over the world.
Ari: Excellent. If somebody is listening and they want to work with you, where can they reach out to you?
Dr. Drummond: Our main website is integrativewomenshealthinstitute.com. If anyone wants a free downloadable copy of the book, I’m happy to give it to them at outsmartendo.com.
Ari: That’s a nice one.
Dr. Drummond: We’re on Instagram and Facebook and all of that. Instagram is probably the fastest way to find me @integrativewormenshealth.
Ari: Beautiful. Just out of curiosity, would somebody be able to work with you specifically or would they be working with other people in your clinic?
Dr. Drummond: I do our deep dive strategy session and then looking at all the details, if they’ve had any labs or things that are more complex, I do those personally.
We also have a team of coaches, who most of them are also probably physical therapists and we do a lot of telehealth coaching with the team. We do both of those things but I’m pretty hands on in my clinic.
Ari: Excellent. This has been fascinating stuff. Thank you again for sharing your knowledge. I really appreciate you coming on the show and I’m glad we were finally able to make this happen. For everybody listening, hope you enjoyed this and I hope that this maybe is the missing key for many people listening to this. Many women specifically. I don’t want to speak in the politically correct terms where we’re being inclusive of everybody if this is a women’s specific issue. It is women’s specific, right? It’s entirely women, right?
Dr. Drummond: It’s generally women-specific, although there are transgender men who also deal with this, so anyone who has a uterus from birth.
Ari: Okay, got it. Fascinating stuff. Thank you so much again, Dr. Drummond. I really appreciate it.
Dr. Drummond: Thank you.
What is Endometriosis? (3:50)
The problems with endometriosis diagnosis (12:48)
How many women get endometriosis? (22:00)
The main causes of pelvic pain (24:35)
The best lifestyle approaches to treating endometriosis (30:36)