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Registered dietitian Sarah Rae shares practical strategies for managing endometriosis symptoms while traveling and eating at restaurants. She provides evidence-based nutrition advice specifically addressing how to reduce bloating and discomfort when eating outside your controlled home environment.

• Avoid skipping meals when traveling - aim to eat every 4-5 hours to prevent increased bloating
• Pack portable snacks like protein bars or hard-boiled eggs to maintain regular eating patterns
• Don't hesitate to ask restaurants about food preparation or request modifications to avoid trigger ingredients
• Consider carrying digestive enzymes like FODZYME to help break down trigger foods when unavoidable
• Stay well-hydrated and consider limiting caffeine and alcohol when traveling if these trigger symptoms
• Remember that supplements like FODZYME should be discussed with healthcare providers

Send your questions about endometriosis management by using the link in the episode description, emailing [email protected], or visiting the EndobBattery.com contact page.

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Dr. Naomi Whittaker explains the two types of adenomyosis and their differing impacts on fertility, revealing that the condition is often over-diagnosed on ultrasound. She emphasizes that surgeon selection is crucial for women with reproductive concerns, sharing concerning examples of unauthorized fallopian tube removals during surgeries.

• Diffuse adenomyosis is common in women who have had children and typically does not cause infertility
• Adenomyosis is often "over-called" on ultrasound as technology becomes more advanced
• Focal adenomyosis (adenomyomas) can cause infertility but are usually resectable with proper surgical techniques
• Choosing a fertility-friendly surgeon who respects reproductive goals is critical
• Proper surgical technique and tissue handling significantly impact fertility outcomes
• Patient autonomy and informed consent should always be respected during reproductive surgeries

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Vanessa Weiland, a certified menopause practitioner, explains when hormone replacement therapy (HRT) is warranted after hysterectomy while still having ovaries. She breaks down the progression of perimenopause symptoms and emphasizes that treatment is appropriate whenever these symptoms impact quality of life.

• Without periods as markers, focus on recognizing other menopausal symptoms
• Early perimenopause often presents with anxiety and sleep issues due to declining progesterone
• Middle perimenopause brings classic symptoms like hot flashes, night sweats, and vaginal dryness
• Less recognized symptoms include heart palpitations, itchy skin, joint pain, and brain fog
• Symptoms usually peak around what would have been the final period, then gradually improve
• HRT is reasonable to pursue whenever symptoms affect quality of life
• Treatment is generally safe and can serve as both therapy and diagnostic tool

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Thoracic endometriosis is likely more common than we think, and we're only seeing "the tip of the iceberg" according to thoracic surgeon Dr. Francesco Di Chiara, who specializes in minimally invasive chest surgery at Oxford's John Radcliffe Hospital.

• Most patients wait 7-8 years for endometriosis diagnosis, then additional years before seeing a thoracic specialist
• Current patients typically arrive in their 30s with pre-existing endometriosis diagnosis from gynecologists
• Dr. Di Chiara envisions a future where adolescents with chest symptoms would see thoracic specialists first
• Surgery for thoracic endometriosis in younger patients may actually be safer than in older adults
• The main surgical risks relate to age-related heart and lung diseases, not present in teens and young adults
• Healthcare coverage for thoracic endometriosis remains "patchy" across countries including the UK's NHS
• Work is ongoing with NHS England to create a unified network for complex endometriosis care

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

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Sarah Rae, a registered dietitian specializing in endometriosis and fertility nutrition, shares evidence-based strategies to help manage endometriosis symptoms through diet. She debunks nutrition myths and offers practical approaches to meal planning that focus on nourishment rather than restriction.

• Start with small steps when transitioning to an endometriosis-friendly diet 
• Most women need around 2000 calories daily, especially if active
• Include protein at every meal and snack for muscle function, blood sugar regulation, and hormone support
• Add colorful produce to your meals, using frozen or cooked options if fresh isn't accessible
• Create meal planning systems with protein rotations and consistent frameworks to reduce decision fatigue
• Consider meal delivery kits during busy life seasons for nutritionally balanced options
• Working with a dietitian can provide personalized meal planning assistance

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We dive into endometriosis research, breaking down recent studies to understand what they actually mean for patients and where science may be misleading us.

• Critical review reveals nearly half of endometriosis research isn't even studying the right tissue
• Bilateral oophorectomy before age 45 leads to significant quality of life challenges, with HRT providing insufficient relief
• Large study confirms endometriosis shares genetic links with multiple immune conditions
• Research on childhood adversity and endometriosis confuses correlation with causation
• Scientists need to study actual endometriosis lesions rather than using endometrium as a stand-in
• Understanding research limitations empowers patients to advocate for better care

Continue advocating for yourself and others, and keep pushing for more accurate research that will lead to better treatments and understanding of endometriosis.

Links

Endometriosis is not the endometrium: Reviewing the over-representation of eutopic endometrium in endometriosis research

Quality of life of patients with bilateral oophorectomy before the age of 45 for the treatment of endometriosis

The phenotypic and genetic association between endometriosis and immunological diseases

Adverse childhood experiences and the risk of endometriosis—a nationwide cohort study

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Dr. Francesco Di Chiara, a leading consultant thoracic surgeon, shares critical insights about thoracic endometriosis and its impact on lung function. The episode explores the differences between thoracic endometriosis and lung disease, the implications of lung collapse during menstruation, and the most commonly misdiagnosed symptoms.

• Lung endometriosis is one presentation of thoracic endometriosis
• Lung collapse during menstruation (pneumothorax) is a sign that shouldn't be overlooked rather than immediately dangerous
• Shoulder and neck pain are the most commonly missed symptoms, often leading to incorrect orthopedic treatments
• Adhesions in the lungs can prevent full expansion, reducing capacity and exercise tolerance
• After surgical treatment, thoracic endometriosis may recur but typically in a less invasive form
• Research on thoracic endometriosis recurrence rates is still developing

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Dr. Francesco Di Chiara, a leading consultant thoracic surgeon at John Radcliffe Hospital in Oxford, shares his expertise on thoracic endometriosis - when endometriosis affects the chest cavity, diaphragm and lungs. He illuminates the challenges patients face with this often-overlooked manifestation of endometriosis that can cause collapsed lungs, shoulder pain, and breathing difficulties.

• Thoracic endometriosis causes symptoms including pneumothorax (collapsed lung), shoulder pain, hemoptysis (coughing blood), effusions and hemothorax
• 90% of patients with thoracic endometriosis first see orthopedic surgeons for shoulder pain before correct diagnosis
• Symptoms are often "self-limiting" which leads to medical dismissal since they temporarily resolve after each cycle
• Imaging challenges include MRI movement artifacts and that lesions are often thinner than MRI resolution capabilities
• Surgical excision involves a thoracoscopic or robotic approach with most complex procedures involving the diaphragm
• Diaphragmatic surgery requires special consideration for patients planning pregnancy due to added strain on surgically repaired tissues
• Multi-disciplinary care is crucial with thoracic surgeons involved early rather than being called in only after discovery during gynecological surgery
• Dr. Di Chiara classifies thoracic endometriosis lesions in a color spectrum from pink (superficial) to white (scarred) with purple and brown in between
• Thoracic surgeons with endometriosis expertise are rare - patients should seek high-volume centers with established multidisciplinary teams

If you suspect thoracic endometriosis, seek out high-volume endometriosis centers that work directly with thoracic surgeons, and insist on meeting your entire surgical team before committing to treatment.

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Professor Mark Possover shares groundbreaking insights on neuropelviology, the revolutionary field addressing chronic pelvic pain that bridges gynecology, neurology, and minimally invasive surgery. His work offers hope to patients who've been told to simply "live with" their pain, targeting the pelvic nerves directly when the source of pain is elusive or deemed untreatable.

• The vagus nerve does not extend into the pelvic cavity, ending at the level of the colon and stomach
• Damage to nerves in the pelvis involves the pelvic splanchnic nerve system, not the vagus nerve
• Patients with autoimmune diseases often develop pathology of the pelvic vessels that can compress pelvic nerves
• Conditions like Ehlers-Danlos, Raynaud's, Marfanoid syndrome and Hashimoto's show connections to pelvic nerve issues
• Endometriosis demonstrates strong links to other autoimmune diseases and conditions like diabetes

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Professor Marc Possover, world-renowned pioneer in neuropelviology, discusses when and why to be concerned about sciatic endometriosis. He explains the critical distinction between regular endometriosis near the sciatic nerve versus endometriosis growing within the nerve itself, which requires specialized neurosurgical intervention.

• Cyclical sciatic pain during menstruation may suggest endometriosis involvement
• Sensory disorders, numbness, and weakness are serious warning signs requiring immediate attention
• Vascular entrapment is the most common cause of sciatic pain in the pelvis
• Endometriosis of the sciatic nerve requires specifically trained neuropelviological surgeons, not just gynecologists
• Improper surgery on the sciatic nerve can cause permanent disability like foot drop
• A comprehensive neuropelviological workup is essential before any surgical intervention
• True sciatic nerve endometriosis surgery is among the most difficult and dangerous pelvic procedures

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