Endometriosis: symptoms, diagnosis, and treatment   Hello, I am Dr. Isabel Viña Bas, a physician and Scientific Director of IVB Wellness Lab. Do you have periods that leave you unable to get out of bed? Do you need to take ibuprofen every few hours to lead a normal life? Do you experience pain during intercourse, digestive issues, or difficulty getting pregnant? Pain that stops your life is not normal. Endometriosis affects approximately one in ten women of childbearing age, and yet, its diagnosis can take years. Many women go through various consultations before finding an explanation for symptoms that have long been normalized. In this episode of Your Friends the Hormones we talk about what endometriosis really is, why it can cause so much pain, which symptoms should make us suspicious, how it is currently diagnosed, and what we can do to improve its management. Because understanding what is happening is also a way to start taking care of ourselves. What exactly is endometriosis? The endometrium is the tissue that lines the inside of the uterus. During each menstrual cycle, it grows, and if pregnancy does not occur, it sheds, resulting in menstruation. In endometriosis, tissue similar to the endometrium appears outside its usual location. It can be found in the ovaries, on the peritoneum, and in different areas of the abdominal cavity. It can also affect the intestine, the bladder, and, less frequently, more distant locations such as the lung or the diaphragm. That tissue responds to hormonal changes and can generate inflammation and pain. That is why endometriosis is not simply a period that hurts a lot. It is a hormonal and inflammatory disease that can affect different parts of the body. Why can endometriosis hurt so much? Endometriosis implants have characteristics that allow them to survive outside the uterus. Among them is increased aromatase activity, an enzyme that participates in estrogen production. In addition, these tissues exhibit resistance to the action of progesterone. To this is added inflammation. The implants produce inflammatory substances, such as prostaglandins, which contribute to pain and maintain that inflammatory environment. This creates a cycle in which estrogens, inflammation, and progesterone resistance favor the activity of the disease. This also explains why an anti-inflammatory can help relieve pain, but does not treat endometriosis on its own. What symptoms might suggest endometriosis? The best-known symptom is intense menstrual pain, but endometriosis can manifest in many other ways. It can cause chronic pelvic pain, pain during sexual intercourse, pain when urinating or defecating, especially during menstruation. Constipation, diarrhea, abdominal distension, or a very marked feeling of bloating may also appear. In some women, it can also be related to difficulties in achieving pregnancy. And there are lesser-known symptoms. When implants affect the diaphragm, for example, they can cause referred pain in the right shoulder during menstruation. In lung locations, respiratory symptoms that coincide with the period may appear. That is why it is not always easy to recognize. Endometriosis can disguise itself as many different problems. When should menstrual pain worry us? A period can be bothersome. But if every month you have to miss work or class, get into bed, take painkillers to function, or stop doing activities that are part of your life, it is worth consulting a doctor. Also if the pain has been increasing over the years or appears even outside of menstruation. Almost nine out of ten women with endometriosis have chronic pelvic pain, but the intensity and the way it manifests can vary greatly. Therefore, you should not measure severity solely by how much the period hurts. You have to observe which symptoms appear and how much they interfere with your daily life. And this is especially important in adolescents. Symptoms can begin at this stage, so a debilitating period should not be normalized simply because "it's just your period." Why can endometriosis pain persist even outside of the period? In endometriosis, different pain mechanisms can be combined. On one hand, there is the pain produced by the lesion itself and the inflammation. On the other, the irritation of the nerves found around it. And, when the nervous system has been receiving pain signals for a long time, its sensitivity can increase. It is like an alarm that has been ringing for so long that it ends up reacting to increasingly smaller stimuli. That is why nociceptive, neuropathic, and nociplastic pain. can coexist. Understanding this helps to understand why some women continue to have significant pain even outside the time of menstruation. What is the relationship between endometriosis and fertility? Endometriosis can also affect fertility. Implants can appear in the ovaries or around the fallopian tubes and create an inflammatory environment that hinders fertilization and implantation. In some women, in fact, the difficulty in getting pregnant can be one of the reasons why the disease is finally discovered. This does not mean that having endometriosis necessarily implies infertility. But when there are fertility problems along with painful periods, pelvic pain, or other compatible symptoms, endometriosis should be one of the possibilities to consider. Why does endometriosis appear? There is no single cause. Genetics seems to play an important role. Having a mother or sister with endometriosis can increase the risk, but it does not mean that the disease will necessarily appear. There is also a relationship with the functioning of the immune system. One hypothesis is that part of the menstrual tissue can move retrogradely toward the abdominal cavity and that, in certain women, the body does not manage to eliminate it correctly. To this can be added other factors related to inflammation and the hormonal environment. That is why it is important not to fall into the idea that endometriosis appears because a woman does not take enough care of herself. There are factors that we cannot control and that are part of our individual predisposition. What is the relationship between endometriosis and microbiota? The microbiota is another area being studied in relation to endometriosis. Differences have been observed in the intestinal, vaginal, and uterine microbiota of women with this disease, and some research has found a greater presence of certain bacteria. But these results must be interpreted with caution. We cannot claim that an alteration of the microbiota is the cause of endometriosis. The relationship seems to be more complex: the disease itself and its inflammation can modify the microbiota and, at the same time, certain changes in the intestinal environment could contribute to maintaining that inflammatory state. That is why taking care of intestinal health can be part of the approach, but we should not reduce such a complex disease to "everything comes from the microbiota." How is endometriosis currently diagnosed? For years, it was considered necessary to undergo surgery to diagnose endometriosis. Today that is no longer the case. The first tool remains something as simple as listening to the patient. The medical history, symptoms, and physical examination allow for establishing a suspicion and guiding subsequent tests. From there, the most common imaging test is the transvaginal ultrasound, especially when performed by a professional with experience in endometriosis. If the ultrasound does not show lesions but the symptoms remain compatible, a magnetic resonance imaging with a specific protocol for endometriosis. can be performed. It is not a conventional MRI: it must be prepared to look for lesions that can go unnoticed. Is there a blood test to detect endometriosis? CA-125 is a marker that can appear elevated in some women with endometriosis, but it does not allow confirming or ruling out the disease on its own. In recent years, new diagnostic tools have also appeared. One of them is Endotest, a saliva test that analyzes small fragments of RNA related to the disease. The results collected in the episode are promising and point to a high capacity to detect endometriosis. However, it remains a complementary tool and does not replace medical assessment. The goal of these new techniques is to achieve something fundamental: reduce the years that many women spend waiting for a diagnosis. What treatments exist for endometriosis? Currently, endometriosis has no definitive cure, but there are treatments that allow for controlling symptoms and improving quality of life. Painkillers and anti-inflammatories can help control pain, although they act mainly on inflammation. Hormonal treatments can also be used, such as combined contraceptives or progestogen-based treatments, in addition to hormonal devices. Their goal is to reduce the hormonal activity that favors the symptoms. When these treatments do not work or are not tolerated, there are other pharmacological options that act on the hormonal signal between the brain and the ovaries. And in certain cases, it may be necessary to resort to surgery, especially when there is extensive disease or when medical treatment fails to adequately control the symptoms. There is no single treatment for all women. What can you do through diet? Diet does not replace medical treatment, but it can be part of daily care. The goal can be summarized in two ideas: less inflammation and better intestinal health. To do this, it is advisable to prioritize foods rich in fiber, such as vegetables, whole fruits, legumes, whole grains, seeds, and nuts. Fiber also helps feed the beneficial bacteria of the microbiota and participates in estrogen metabolism. Omega-3 fatty acids can also be part of this strategy. Among their sources are small oily fish, such as sardines, mackerel, or anchovies. It is also recommended to limit alcohol and tobacco, as well as to reduce the regular consumption of ultra-processed foods, sugars, and refined flours. Can exercise help? Yes, always adapted to each woman's situation. When the muscle works, it produces myokines, molecules that participate in different processes of the body and that have anti-inflammatory effects. In addition, exercise promotes the release of endorphins, which can contribute to pain control. But if a woman is going through an episode of intense pain, simply telling her to exercise is not enough. First, you have to get her to be able to move. Once the pain is controlled, exercise can become part of that positive circle: more movement, better physical condition, and more tools to take care of health. Physical therapy specialized in the pelvic floor can also be useful when there is tension or contracture of the musculature in this area. What role can supplementation have? Supplementation can be a complementary tool within the approach, but it does not replace medical treatment or habits. Among the compounds mentioned in the episode are omega-3, N-acetylcysteine, turmeric, vitamin C, vitex agnus-castus, and palmitoylethanolamide (PEA). PEA is especially interesting for its possible role in the different mechanisms involved in pain. The use of fiber can also be considered when it is difficult to meet needs through diet or when seeking to improve digestive tolerance. But it is not about taking many supplements. It is about identifying what each woman needs and using the tools that really make sense in her case. Endometriosis is not a period that hurts a lot Endometriosis can affect different organs, produce very different symptoms, and have a significant impact on quality of life. Therefore, the first step is to stop normalizing what should not be normalized. A period can be bothersome. But pain that prevents you from living your life is not normal. Today we know that it is not always necessary to go through surgery to start studying and treating the disease. We have the medical history, the examination, imaging tests, and new diagnostic tools that can help reduce the delay in diagnosis. And we also have different tools to address it: medical treatment, diet, exercise, physical therapy, and, when it makes sense, supplementation. There is no single solution for endometriosis. There is a toolbox, and you have to know which one to use for each woman. If you have been in pain for years, you are not exaggerating. You deserve to be heard, to have what is happening to you studied, and to find with them the strategy that best adapts to your needs. Know more to fear less and choose better. I hope you like it :)For more information, you already know you can find me on my Instagram @isabelvina where I share daily contentMy TikTok @isabelvinabasOn my YouTube channel And the supplements formulated by me https://ivbwellness.com  

In this episode, we speak with Sandra Gómez, a physiotherapist specializing in pelvic floor and sexology, about the importance of caring for a part of the body that is rarely discussed. We talk about urine leakage, pain during intimacy, physical exercise, hormonal contraceptives, menstrual pain, and other symptoms that are often normalized when they shouldn't be. Additionally, we debunk common myths and explain why the pelvic floor is also important for men's health. A practical episode to understand that living with discomfort is not normal and that there are solutions.

In today's episode, we talk with Dr. Rocío Belda, a gynecologist and obstetrician specializing in women's hormonal health, menopause, polycystic ovary syndrome (PCOS), and endometriosis. We discuss everything that often goes unspoken: How to recognize the first symptoms of perimenopause. Why menopause is not just about hot flashes but also includes symptoms such as brain fog, lack of hydration of mucous membranes, and even recurrent urinary tract infections , and how to address it. Why the stages of perimenopause and menopause are key times to take care of our cardiovascular health more than ever. The reasons why PCOS and endometriosis are so variable among women. The real role that nutrition, exercise, and supplementation play at each stage. A conversation filled with science, humanity, and clinical experience, designed to help you understand your body and better support you through each phase. If you're going through any of these stages, or want to better support a woman who is, this episode is for you. Instagram Dr. Isabel Viña: @isabelvina TikTok @isabelvinabas Information from Dr. Rocío Belda: Web: https://www.doctorabelda.com/ Email for inquiries: beldaginecologia@gmail.com Instagram Dr. Rocío Belda