Endo Battery

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Dr. Jeff Arrington joins us to discuss accessible endometriosis management options and surgical considerations for patients at different stages of their journey. We explore alternatives to excision surgery, the relationship between round ligament pain and endometriosis, and the real risks of deep excision procedures compared to standard gynecological surgeries.

• Various hormonal options including birth controls, progesterone-only medicines, and IUDs
• Low-risk alternatives like magnesium, omega-3s, turmeric, anti-inflammatory diets
• Physical therapy, acupuncture, and specialized pelvic pain clinics
• No clear connection between round ligament pain and endometriosis
• Deep excision risks include bleeding and organ injury but specialist complication rates are lower than for routine gynecological procedures
• Proper knowledge of pelvic nerves critical for preserving bladder and bowel function

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Surgical removal of reproductive organs creates an abrupt hormonal shift that requires thoughtful planning and preventive care. Dr. Christine Vaccaro discusses the importance of pre-surgical hormone replacement therapy planning and the significant risks of delaying treatment after ovary removal.

• Prevention is key—proactive planning can help avoid the "six weeks of awful" many women experience after surgery
• Transdermal estrogen products do not cause blood clots, contrary to some medical misconceptions
• Bone health suffers dramatically with hormonal depletion—even perimenopause can cause 10% bone density loss
• Sleep disruption without hormones can lead to cascading health problems including depression and chronic illness
• Starting hormone therapy immediately after surgery prevents suffering and protects long-term health
• Some patients with already low testosterone may benefit from starting replacement before surgery
• Withholding hormone replacement makes as little sense as withholding insulin from a diabetic

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Dr. Zachary Spiritos demystifies SIBO treatment for patients with complex conditions like endometriosis and mast cell activation syndrome. He cuts through the noise with a straightforward approach to this commonly misunderstood digestive condition, explaining why it's often simpler to treat than many functional medicine practitioners suggest.

• SIBO treatment basics: antibiotics like rifaximin that shift your microbiome rather than traditional systemic antibiotics
• Preventing recurrence by identifying root causes: antibiotic use, PPI use, chronic narcotic use, or other factors slowing bowel motility
• Pro-motility agents can help the small intestine function properly to prevent bacteria from accumulating where they don't belong
• Low FODMAP diets may help but are used sparingly due to their restrictive nature
• Elemental diets are a last resort for persistent cases
• SIBO is often overdiagnosed when the real issue is constipation or pelvic floor dysfunction
• Virtually all endometriosis patients have some degree of pelvic floor dysfunction
• Pelvic floor dysfunction prevents proper evacuation of both stool and gas, causing significant bloating

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

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Kate Downey shares her 22-year journey through debilitating period pain and her quest for answers that ultimately led to creating her podcast "Cramped." Through extensive research and interviews with experts, Kate uncovers why period pain remains so misunderstood despite affecting hundreds of millions of people worldwide.

• 30% of menstruating people (approximately 522 million worldwide) experience debilitating period pain
• The widely accepted explanation for period cramps is being questioned by researchers at the GYRL lab
• Female bodies are systematically excluded from medical research, leading to gaps in treatment effectiveness
• Even medications like antidepressants work differently depending on where you are in your menstrual cycle
• The stigma around periods keeps us isolated in our pain, which neurologically can make the pain worse
• Women's health research is making progress, but requires more advocacy and awareness
• Creating community through "women's circles" or "clam bakes" helps share crucial information about treatments
• Resources like cureperiodpain.org offer opportunities to participate in studies that advance menstrual research

You can find Kate Helen Downey's podcast "Cramped" wherever you listen to podcasts, and follow her on Instagram @KateHelenDowney or TikTok @KateIsCramped.

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Registered dietitian Sarah Rae shares evidence-based nutrition strategies for those managing both endometriosis and PCOS simultaneously. She explains why balanced blood sugar is crucial for both conditions and how protein intake, fiber, and healthy fats support hormone regulation.

• Similar nutrition approaches work for both endometriosis and PCOS despite perceived conflicts
• Focus on balancing blood sugars which impacts sleep, hormones, and hunger levels
• Aim for 20-30 grams of protein at each meal with fiber and healthy fats
• Those with PCOS and insulin resistance may need slightly more careful carbohydrate management
• Intermittent fasting generally not recommended as it can lead to disordered eating patterns
• Regular breakfast helps prevent binge eating, control sugar cravings, and manage bloating
• Anti-inflammatory food choices benefit both conditions

Have more questions? Send them to [email protected] or visit endobattery.com/contact to get expert answers on future episodes.

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Certified sex therapist Mallory Oxendine provides practical strategies for communicating with partners about pain during intimacy while maintaining connection and avoiding shame. She addresses the fear of rejection that often prevents these crucial conversations and introduces a framework that transforms vague concerns into specific requests partners can fulfill.

• Fear of rejection often prevents difficult conversations about sexual pain and limitations
• Avoidance of these discussions only deepens disconnection and misunderstanding
• John Townsend's "People Fuel" framework offers language for requesting specific relational nutrients
• Being clear about needing acceptance, comfort, or encouragement helps partners know how to respond
• Most partners want to be supportive but need guidance on what response would be most helpful
• Clear communication preserves emotional intimacy even when physical intimacy needs adaptation

Check out episodes 120 and 121 with Mallory for more insights on intimacy, endometriosis, and chronic illness.

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Endometriosis impacts every aspect of life—physical health, relationships, mental wellbeing, career, and finances—not just the reproductive system. Research validates what patients experience: this disease is systemic, serious, and requires comprehensive care approaches beyond dismissive "solutions" like yoga or positive thinking.

• Medical gaslighting occurs when clinicians discount or dismiss patient concerns, eroding trust and worsening health outcomes
• Women and people from marginalized communities experience heightened levels of medical dismissal
• "Kissing ovaries" visible on imaging can signal deep infiltrating endometriosis requiring surgical intervention
• Chronic pain from endometriosis physically rewires neurological systems affecting emotion regulation and cognitive processing
• Research shows endometriosis significantly impacts employment with higher rates of missed work and job loss
• Adolescents with endometriosis experience lower quality of life across physical, emotional, and academic domains
• Early intervention and patient-centered care dramatically improve long-term outcomes
• Validation of symptoms as legitimate biological experiences rather than emotional overreactions is essential

LINKS

Gaslighting of Inpatients-A threat to nursing care and a violation of relational autonomy. Nurs Ethics 2025 Mar 29:9697330251331194. 

Endometriosis, a Common but Enigmatic Disease with Many Faces: Current Concept of Pathophysiology & Diagnostic Strategy. Jpn J Radiol. 2024 Aug;42(8):801-819.

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective. J Clinical Medicine. 2023; 12(12):4056.

Does endometriosis affect professional life? A matched case-control study in Switzerland, Germany & Austria. BMJ Open 2019;9:e019570.

Impact of Endometriosis on Quality of Life in Adolescents. J Adolesc Health. 2018;63(6):766-772.

van Stein K, et al. 

Continue advocating for yourself and others. Your experiences are real, measurable, and deserve comprehensive care.

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Expert endometriosis surgeon Dr. Abhishek Mangeshikar debunks common myths and provides clear answers to pressing questions about endometriosis management. Drawing from his extensive experience at the Indian Center for Endometriosis, he offers evidence-based insights on treatments, surgical approaches, and unusual symptoms.

• No conclusive data supports the claim that birth control or Lupron causes regression of endometriosis lesions
• Shrinking endometriomas may actually indicate worsening disease as contents leak into the pelvis causing adhesions
• The timing of surgery relative to menstrual cycle generally doesn't matter for experienced excision specialists
• Operating during a patient's period may require additional cleaning of the surgical field but doesn't affect excision outcomes
• Cyclical nosebleeds might be connected to thoracic endometriosis, but medical data remains limited
• Hysteroscopy procedures are the main exception where avoiding menstruation is beneficial for visualization

Got a question? Send it in by using the link in the top of the description of this podcast episode, emailing [email protected], or visiting the endobattery.com contact page.

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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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