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Dr. Abhishek Mangeshikar shares critical insights on evaluating surgeon skill and the importance of comprehensive treatment for endometriosis. His expertise reveals that clean, meticulous surgical technique with respect for tissue significantly improves outcomes and reduces post-operative adhesions.

• Red flag if surgeon plans to "just remove the cyst" in a quick procedure
• Endometriosis cysts never exist as single entities—always accompanied by other disease
• Proper imaging should identify connections to surrounding structures
• Wait at least six months for post-operative imaging due to healing processes
• Original surgeon should review follow-up imaging to distinguish between fibrosis and disease
• Clean surgical technique with minimal bleeding significantly reduces adhesion formation
• "Tissue respect" approach leads to better outcomes than aggressive dissection
• Different bodies heal differently, affecting individual adhesion formation

Got a question? Send it in using the link in the episode description, email [email protected], or visit the endobattery.com contact page.

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Dr. Zac Spiritos, a neurogastroenterologist, shares his expertise on the complex connections between endometriosis and gastrointestinal symptoms. We explore the critical role of the nervous system in gut function and discuss practical approaches to managing painful bowel movements, bloating, and food sensitivities.

• Common GI issues with endometriosis include chronic constipation, diarrhea, bloating (endo-belly), and food sensitivities
• The nervous system plays a crucial role in gut function and pain perception
• Regular bowel movements are foundational for addressing other GI symptoms
• Slower gut motility is common in patients with Ehlers-Danlos Syndrome and endometriosis
• Antidepressants can be effective for gut pain by modulating pain signals, not treating depression
• The microbiome is promising but testing lacks standardization and actionable insights
• Painful periods are not normal and should be investigated, particularly if they disrupt quality of life
• Endometriosis is often misdiagnosed, with patients seeing an average of 12 providers before diagnosis
• GI symptoms can sometimes appear before traditional gynecological symptoms of endometriosis
• Finding providers who are open to dialogue and willing to investigate complex symptoms is crucial

If you're struggling with endometriosis and GI symptoms, start tracking your symptoms carefully, particularly around your cycle, and don't give up if your first provider doesn't have answers.

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Dr. Jeff Arrington, a renowned excision specialist and patient advocate, shares his expert perspective on when ablation might be appropriate in endometriosis treatment. He discusses the nuanced decision-making process that balances complete disease removal against fertility preservation, challenging the notion that excision is always the only acceptable approach.

• Small, superficial lesions could potentially be fully destroyed by ablation, though with more surrounding tissue damage
• When endometriosis grows around blood vessels to ovaries or the uterus, ablation may be used to preserve fertility
• Patient priorities, especially fertility concerns, should guide treatment approach decisions
• Ablation is ineffective for deeply invasive disease, especially on major organs
• Informed consent allows patients to understand risks and benefits of different approaches

Send your endometriosis questions for future Quick Connect episodes via the link in the episode description, by emailing [email protected], or through the contact page at endobattery.com.

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Dr. Zac Spiritos shares key insights about gastroenterology red flags and specialized dietary approaches for digestive disorders. We explore the concerning situation when doctors label symptoms as "just IBS" without proper explanation and the important distinctions between histamine intolerance and mast cell activation syndrome.

• Watch for doctors who label everything as IBS without explaining what it means or why their treatments would work for your specific case
• Histamine intolerance (lacking an enzyme that breaks down histamine) is different from mast cell activation syndrome
• Low histamine diets work well for histamine intolerance but need professional guidance to avoid becoming too restrictive.

Send your questions to [email protected] or through the link in the episode description for future Quick Connect episodes.

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A deep dive into the tangled web of GI symptoms and how they connect to endometriosis, EDS, POTS, and Mast Cell Activation Syndrome. Dr. Zac Spiritos, a neuro-gastroenterologist, shares insights on differentiating between these conditions and finding effective treatment approaches.

• IBS is a "software not hardware problem" involving miscommunication between gut and brain nerves
• Endometriosis can sensitize nerves in the pelvis, leading to IBS-like symptoms even after excision
• POTS affects the autonomic nervous system, causing standing tachycardia and various GI symptoms
• Mast Cell Activation Syndrome manifests through skin issues and unusual GI symptoms like early-onset heartburn
• EDS affects connective tissue throughout the body, potentially causing problems in every part of the GI tract
• Salt intake helps POTS patients by increasing blood volume, though this approach isn't sustainable for everyone
• Finding a doctor who remains curious about complex conditions is crucial for proper diagnosis and treatment
• Patient education is essential for informed decision-making and long-term management of chronic conditions

Follow Dr. Zac Spiritos on Instagram @drzacspiritos

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Sarah Rae, registered dietitian specializing in endometriosis and fertility nutrition, offers evidence-based strategies to help individuals navigate nutrition for endometriosis.

• SIBO treatment typically begins with antibiotics like rifaximin, often followed by or combined with a low FODMAP diet
• The low FODMAP diet should be temporary, not a long-term solution
• Highly processed carbohydrates and consuming too many carbs at once can worsen SIBO symptoms
• Focus on balancing protein, carbohydrates, and fiber for better SIBO management
• Omega-3 fatty acids are extremely beneficial for reducing endometriosis pain
• Supplementation (including vegan algae-based options) can help those unable to get enough from diet
• Omega-3s also benefit heart health, joint function, and brain health

Send your questions through the link in the episode description, by emailing [email protected], or by visiting the endobattery.com contact page.

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Neurogastroenterologist Dr. Zachary Spiritos explains the likely connection between leaky gut and rising rates of inflammatory conditions like endometriosis. He discusses how intestinal permeability may be influenced by stress and dietary factors, potentially contributing to various chronic conditions.

• Leaky gut (increased intestinal permeability) may be bidirectionally linked with endometriosis and other inflammatory conditions
• Reliable testing for leaky gut doesn't exist yet, but research suggests connections with autoimmune conditions
• Modern lifestyle factors including processed foods and stress may contribute to intestinal permeability issues
• GLP-1 agonists like semaglutide can benefit many GI conditions but may worsen gastroparesis or constipation
• Personalized risk assessment is crucial when considering weight management medications with pre-existing GI issues

Send in your questions by using the link in the description, emailing [email protected], or visiting the endobattery.com contact page.

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In this episode of Endo Battery Fast Charged, we dive into the ongoing delays in endometriosis diagnosis, emerging imaging tools like transvaginal ultrasound for superficial endometriosis, and how advocacy is shifting the standard of care.

Learn why most patients see up to 7 doctors and face years of dismissal before a diagnosis—and how that delay worsens pain and outcomes. We explore the latest research on imaging, the importance of recognizing all types of endometriosis, and why collaborative, patient-centered care is essential.

Featuring expert insights and patient advocates like Heather Guidone and Jenneh Rishe, this episode is a must-listen for anyone navigating endo or supporting someone who is.

Links to articles:

Collaboration is key in managing endometriosis

Understanding diagnostic delay for endometriosis: A scoping review using the social-ecological framework. Health Care for Women International, 46(3), 335–351(2024).

Diagnosis of superficial endometriosis on transvaginal ultrasound by visualization of peritoneum of pouch of Douglas. Ultrasound Obstet Gynecol. 2024;63(1):105-112.

“Road to Diagnosis: Stomach Pain and Other Symptoms My Endometriosis Was Causing”

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Dr. Abhishek Mangeshikar, leading endometriosis specialist from the Indian Center for Endometriosis, shares expert insights on post-excision medical management and endometrioma concerns. His straightforward explanations debunk common myths while providing practical guidance for patients navigating surgical recovery and ongoing treatment options.

• Medical management after excision may be appropriate for patients with adenomyosis who wish to keep their uterus
• Progesterone-containing IUDs like Mirena can help suppress adenomyosis symptoms
• Temporary hormonal suppression (3-4 months) may protect healing ovaries after large cyst removal
• Endometrioma rupture during surgery does not cause disease spread or "upstaging" as with cancer
• Virtually all endometrioma excisions involve some rupture as part of the surgical process
• Successful surgery requires complete ovary mobilization and removal of all underlying disease

Send your questions by using the link in the podcast description, emailing [email protected], or visiting the endobattery.com contact page.

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Dr. Jeff Arrington breaks down the differences between uterine ablation and hysterectomy while offering candid advice about advocating for yourself with dismissive doctors. His expert insights challenge conventional approaches to endometriosis and adenomyosis treatment, emphasizing the importance of evidence-based care and patient autonomy.

• Uterine ablation uses heat to destroy the uterine lining and primarily treats heavy bleeding, not painful periods
• Adenomyosis is one of the top reasons patients need hysterectomy after endometrial ablation
• For heavy bleeding with painful periods, a progesterone IUD may be better than ablation as it addresses both symptoms
• Post-ablation syndrome can occur when scarring traps active endometrial tissue, causing pain over time
• When doctors don't listen to your concerns, asking for supporting research studies may help
• If providers consistently dismiss you, finding a new doctor may be your only viable option
• Many physicians remain fixed in outdated residency training and fail to offer referrals to specialists

Have more questions? Send them in using the link in the episode description, email [email protected], or visit the endobattery.com contact page.

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