The Food Medic - S10 Ep 9 Endometriosis and Adenomyosis with Mr Martin Hirsch

Episode Date: November 27, 2023

In this episode Dr Hazel is joined by Mr Martin Hirsch, a consultant gynaecologist and endometriosis specialist practicing both in the NHS and privately.He can be found on instagram as @endometriosis.surgeon.ukThis episode covers: What is endometriosis? The symptoms of endometriosis Who gets endometriosis? What causes delays in diagnosis? New, faster diagnostic tests How nutrition and lifestyle can support symptom management Andenomyosis and how it differs from endometriosis Endometriosis and diet webinar: https://the-food-medic.mykajabi.com/store Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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exclusions and terms apply. Instacart, groceries that over-deliver. Hello, everyone, and welcome back to the Food Medic podcast. I'm your host, Dr. Hazel Wallace. I'm a medical doctor, nutritionist, PT, author and founder of The Food Medic. In the UK alone around 1.5 million women and those assigned female at birth are currently living with endometriosis and yet it takes eight years from onset of symptoms to get a diagnosis which is why conversations like this one are so important. Today I'm joined by Mr Martin Hirsch who is a consultant gynaecologist and endometriosis specialist practicing both in the NHS and privately. He works as a gynaecological surgeon specializing in the excision of endometriosis within the British Society of Gynaecological

Endoscopy Accredited Centre. In a research setting Martin works with many groups and has published over 40 papers on endometriosis. This episode covers everything to do with the medical and surgical management of endometriosis, but if you'd like more information on nutrition for endometriosis, do check out our webinar available on thefoodmedic.co.uk. Martin, welcome to the podcast. Thank you. Thank you for fitting us in today I would love to just start by learning a bit more about you and your background and how you got to doing what you're doing today yeah well I trained in

obstetrics and gynecology and I graduated from medical school back in 2007 so anyone that's kind of good at maths can figure out just how old I am but I was inspired by some amazing people on the south coast because I trained in Southampton um to go into Ups and Guiney loved the specialty from a medical student and um then just followed my gut topical but followed what I enjoy doing um and it's always kind of served me well and I've kind of just navigated my way through different training programs I spent a year in New Zealand before doing my specialist training in obstetrics and gynecology that ended up taking me about 10 years in central London finishing at one

of the prestigious hospitals very centrally and before then getting a consultant post out in Oxford where I now practice as a full-time NHS consultant. And you have specialised in endometriosis which is what we're going to talk about today but not all OBS and gynae doctors will actually specialise in that particular area. What drew you to endometriosis? That's a really really good question and I think there are two major factors one is you know that I was motivated by another extremely prominent person in my my early career as a junior doctor and his name is Colin Davis and he was at St Bartholomew's and is now works on Harley Street but he was so passionate about endometriosis that he would collaborate with another researcher to help fund research posts and so he was giving people of my level which was still quite junior

at that time so a junior registrar so it might have been third or fourth year of my junior training to help look into different diagnostic tests that might be available for endometriosis supported me through my researching and clinical progress to get to the point where I went from kind of knowing a bit about endometriosis and realizing that there was a lot more that needed to be known to actually feeling like I knew a lot. And he gave me that opportunity. And I think, you know, everyone in life needs people to give them that opportunity. And, you know, I'm so grateful to him. And another factor that I touched upon was that I don't think people with endometriosis get a fair ride like it's a disease that no one ever asked to get nothing that they've done in their lives would have ever led them to

have endometriosis um and it's so debilitating that it just drew me to want to help do more and provide more care for people with endometriosis. Yeah, it's so important. And I find your story so interesting because I trained in Cardiff Medical School. And during my OBS and gynae rotation, I was put on a clinic that was for patients with endometriosis. And the consultant was so passionate about the condition. And he really took his time to go through all the patients with me so I could really experience firsthand how debilitating it was for these women and how long it took for them to be diagnosed. And it really, like, struck a chord with me.

Even to this day, I remember, a chord with me even to this day I remember like really looking up to this man because he was so dedicated to improving their lives and they were coming in with like a multitude of different symptoms very different spectrums so let's start there like what are the common symptoms and maybe the less common symptoms of endometriosis yeah yeah really good and it's it's so hard to say who has endometriosis based on their symptoms because of the diversity of symptoms that it causes um it's a weird and wonderful condition and you know i'm sure some people listening to this will know but you know endometriosis has been found in people's arms it's been found in people's brains it's been found in

people's noses but it commonly affects people's pelvis and that's inside the tummy so it's also referred to as an invisible disease because you just you can't see it it's not like if someone has acne they know they have acne and they can go and see their doctor to get care but if someone has endometriosis they don't know they have endometriosis because of anything they can see and it tends to present and not all the time but with pain symptoms around someone's menstrual cycle so um with menstruation historically being a bit of a taboo topic it's not commonly discussed people don't necessarily sit down with their parents with their friends and say what's your period like at the moment you know how heavy is your period how painful is your period likewise there aren't that many good measures that we've got

around us to say like oh my period's this this painful or that painful like it's a very subjective measure pain that makes it again really challenging to compare what you're going through to someone else um but those people with endometriosis are thought to have more painful periods, has more debilitating impact on their life. So they often really struggle to study, really struggle to work, really struggle to socialize at the time when they're getting pain. And that impacts their development, particularly if, say, if they're developing it during adolescence and unfortunately we know that for those people that are diagnosed with endometriosis and their symptoms have come on during their adolescent years it takes them a lot longer to get a diagnosis and that really upsets me because to me i think well that's probably us as health care professionals not listening to their voices not respecting them as the leaders of the future with the symptoms

they're coming to us with and so again it inspires me to want to do more but it also upsets me that there are people that i see on a daily basis that haven't had the best experience with our health service with a health service that i love and our service that i love to work within um and so i'm passionate to try and change it so going back to your original question about what the symptoms are they're very varied but common symptoms that i see on a really regular basis are pain with someone's period and that pain if people are wondering like how do i know if that pain's normal or not it's commonly a pain that would impact their quality of life more than someone else so stop some studying stop some working stop some socializing stop some having intimate relationships um then uh other symptoms sometimes difficulties falling pregnant it's a really hard stat to say

but 50 of those people that have difficulties falling pregnant will have endometriosis um but it's also important to say that the majority of people with endometriosis will still fall pregnant naturally but there is a higher association with endometriosis and difficulties falling pregnant then there are some other generic symptoms like bloating or what people refer to as endo belly where you get a tummy swells out around the time of your period and other times as well um as well as there's a strong association with low mood and and um psychiatrical or mental health conditions um that i think we still don't know enough about but need to explore more yeah and i think you've just like illustrated there

that it can present in in various different ways and I think from my understanding the amount of endometriosis you have doesn't necessarily correlate to how severe symptoms are. Exactly yeah very true so there is and this isn't a classification that is used as much nowadays but there's a classification that that's referred to as stages one to four of endometriosis one being small amounts and four being really large amounts of endometriosis and in those first three stages of endometriosis there isn't a really strong association between increasing amounts of disease and the severity of pain that people feel unfortunately when you get to stage four or the most severe form of the disease where people's like anatomy or insides is often really distorted um there is a

strong association between that and pain and infertility um but yeah challenging yeah and do we know why some some women get it and some women don't because you mentioned in the beginning that one of the reasons that drove you to go into endometriosis research and kind of specializing in this field is because it can affect really anyone and there doesn't seem much to be much rhyme or reason yeah it's um what it's not known at the moment why some people get it and others don't um i think we can draw some like assumptions given that um if you have endometriosis, your first-degree relatives are seven times more likely to have it. If you have an identical twin,

there's a 75% association between those two twins having endometriosis. So there's likely to be some genetic feature, but we're just not quite sure what part of your genetic makeup influences or makes people get endometriosis. And we'll get on to tests in the future but there is an emerging test that's available to people with endometriosis that may we then may be able to work backwards using that test so if you've got an accurate test you can then find out and identify all those people that have the disease and then look at

specific traits or characteristics of those people to understand whether they're more likely to get it and that test looks at markers that influence your genes ability to produce proteins after they've replicated so not about how the genes replicate or how the genes are formed but the post trans i'm trying to get this right i can't remember my times in the laboratory but the post transcription expression of your genes and the production of proteins i'm sure there are some scientists out there like what's martin talking about but they're called micro rnas and there's a amazing test that is available that is reported to have 95% accuracy for detecting endometriosis. Oh, wow. Both if it's positive, it's 95% accurate.

And if it's negative, it's over 95% accurate as well. So it's really able to include people if it's positive and exclude people from the disease and enable them to move on to try and look at other diagnosis and other treatments if it's negative um that's not yet available on the nhs but we're hoping it will be soon yeah absolutely i guess it's you know naturally we should chat about the main way of diagnosing endometriosis which is one of the reasons it takes so long yeah to be diagnosed um do you want to chat a little bit about that? Yeah, definitely. Diagnosis is so tricky

and it's a major topic of conversation with everyone I speak to because by the time they see me in clinic, they have often had symptoms for seven to nine years before they've come to see me and be like, you know, I think I've got endometriosis and we talk through different options. But the availability of non-invasive tests so tests that don't include surgery

is really poor until recently um if we look at ultrasound scans the majority of ultrasound scans that are offered do not detect the two of the three types of endometriosis so i tend to try and break endometriosis down into three common types within the pelvis. The big clumps and lumps that are often associated with that stage four really severe disease, the cysts on the ovaries that cause the ovary to expand and can cause pain and difficulties falling pregnant, and then the small areas of endometriosis that line inside of the pelvis or superficial peritoneal endometriosis and that if you think about the historic classification that'd be more like the stage one and two disease common ultrasounds that people might get referred to to investigate it would only

ever detect the endometriosis of the ovaries because they're quite easy to spot they're an ovary that's expanded by um often blood contents that's quite characteristic on ultrasound whereas the other two just we don't have the skills to detect that um there are a few small numbers of centers in the uk that are able to detect deep endometriosis nodules and superficial disease but they're really small in number and if you I always try and make a comparison between the skills needed to detect endometriosis and COVID because it's so topical. And we used to talk about this R number where, you know, it would spread exponentially and so quickly with increasing numbers of people having it. Well, it's kind of the opposite with ultrasound and diagnosis of endometriosis because it takes someone so long to learn those skills so for one person to pass the skills on to another person to diagnose endometriosis with intensive

training is thought to be about six to twelve weeks of intensive training that's all you're doing all day every day for six to twelve weeks so highly skilled yeah you need to be highly skilled you need to have had dedicated time to to learn how to do it because it is such a nuanced skill that actually um it's hard to pick up yeah but it's also not many people have it so it's not spreading that quickly no no that's true um not it's not that not many people have endometriosis not many people have the skills to share for sure and and i guess that's probably one of the main drivers of this delay in diagnosing women from onset of symptoms but what are the other things that you think are causing this delay i assume based on what you've said like this normalization of like

menstrual pain is just kind of part and parcel of being a woman and we see that in all the pain research when it comes to women versus patriarchy unfortunately um the nhs and the health system was historically designed by men for men um that um didn't necessarily prioritize women's health conditions or people assigned female at birth and so that is changing and i'm pleased that is changing and i think a major step forward is acknowledging that the women's health report last year led by dame leslie regan has that in their executive summary um and of the women surveyed for that report 84 said they had felt that they hadn't been listened to by healthcare professionals. So there is a degree of normalising the symptoms, perhaps because it's part of a process that is a normal process for many people, even though that is a normal process that can go wrong with conditions like endometriosis and adenomyosis.

But also a normalisation perhaps because the system wasn't necessarily designed for women's health and women's health conditions so we definitely need to change that and i think we are changing that change never happens overnight with whatever whatever you do but i think there is um more and more people wanting and driving that change to ensure our health system supports people with this condition can diagnose it sooner can treat it quicker and can treat it more effectively um and as long as i'm practicing and i hope it will be many many more years i'll be saying and wanting to do exactly that yeah i completely agree with you there and it is great to see that there's a lot more done at a government level,

but it just needs to kind of be implemented now, doesn't it? It does, yeah. But things always start small. And I think the women's health strategy and the women's focus groups that are being put together to ensure that health hubs and health systems are designed to treat the needs of the people in the regions, as well as the people based on their different demographics is really important. So I think we've taken that initial step of acknowledging that what we've done wasn't great.

We've taken steps to say, you know, we need to involve people in this and we're starting to make slow steps forward let's move on to treatment options when i posted on instagram to say that we're going to have this conversation there was many questions coming in largely around treatment and the question of do I need surgery? Is surgery a definitive way to remove my endometriosis? So I think this is something that we should tackle because there's a lot of women who are maybe not at that stage yet and are unsure about what options they should go for. It's a really good question. And I say that there isn't a fixed answer for everyone there are very few absolute indications for surgery with endometriosis and one of those

might be your kidneys getting blocked off by the endometriosis and that tends to occur with the more severe end of the disease um if you then try to exclude that small proportion of patients and i think that's around one percent of the people that i see have absolute indications for endometriosis surgery the rest is about helping people manage their quality of life so it is a disease that negatively impacts people's quality of life and i'm here as a clinician to offer people choice, not my choice, but their choice of what treatments can help them improve their quality of life. Get back to swimming if they like swimming, get back to studying if they're not able to study. And for that, we have lots of different treatment options with varying benefit for each individual. And the challenge for me is that I don't have a crystal ball to know whether one treatment option would be better for the person in front of me than another and we don't have enough of that

granular detail to know which specific treatment is going to benefit someone else but they can be broadly broken down into kind of three categories one is like non-hormonal treatment options that tends to include your painkillers as well as more holistic approaches, such as dietary modification, heat therapy, exercise, acupuncture, meditation. And then there's hormonal treatment options that I then tend to subgroup into those where you're giving people hormones and then other hormones where you're taking them away, putting people into a temporary but reversible medical menopause. Nothing about this is is nice unfortunately it's treatment options that nobody really would want to choose to have but i guess when i'm sat there having a chat with people it's about balancing

whether the treatment option is likely to cause more side effects but reduce their pain yeah um or the other way around so um there are hard decisions to make when thinking about hormonal treatment options because lots of people do have side effects with with hormonal treatment options and so it's um it's not unfortunately that kind of it will cure everything that can be negative effects when you are getting the positives of pain reduction and then if we've i think moving on from hormone treatment options there are surgical options and surgical options provide two approaches one is you can get more definitive diagnosis if your imaging was uncertain and two you can also treat it at the same time and so that's

commonly done by keyhole surgery where you pass a camera through the belly button two or three other instruments into the tummy and you identify the endometriosis in my practice I always excise it or cut the disease out because an alternative treatment option is burning endometriosis but that in itself carries with it some risks because you don't always know what's underneath the endometriosis um but that in itself carries with it some risks because you don't always know what's underneath the endometriosis and so there's potentially a risk of damaging what's underneath or incompletely um ablating or burning the disease and leaving some endometriosis behind which is not something i'd want um so surgery has those two approaches cutting it out

or burning it but i think cutting it out is widely acknowledged amongst the endometriosis community both patients and surgeons as the gold standard approach um but accessing surgery takes a long time you know it's another reason why diagnosis take take seven to nine years for most people because from the onset of symptoms, sat at home, perhaps really struggling with your periods, you've got to go through so many hoops to get to the stage where you're actually being considered for surgery. And that's normally when you're seeing a specialist. And it can be a real challenge for people to get there. hormonal kind of options i think what i'm witnessing on not just in kind of with women who have endometriosis but across the spectrum there's a bit of a pushback with any hormonal

treatment and i think because a lot more women are questioning whether they should be putting synthetic hormones into their body and obviously these hormones have a place and there's a very important kind of way that they work in endometriosis and i think maybe explaining that like rationale might be really helpful for women no i completely agree um and so i guess i'll go back to my my point i made earlier in that I like to discuss hormonal treatments as an option for people because it may help them. But at no point would I ever force or say that someone has to try hormonal treatments before they have surgery. So I think it's important that we are promoting choice and that we are promoting the options for people to try different treatments. But I'm seeing it more and more frequently that hormonal treatments are impacting people's well-being in their own right so someone might

come to me with pain they might opt to have a hormonal treatment but then their mental health may deteriorate as a result of the hormonal treatments that they've started and so the hormonal treatments that you commonly offer for people first time presenting with endometriosis are contraceptives so that may be a benefit to some people that are wanting contraceptives to prevent pregnancy and that the rationale behind them working is is the thought that they stop you from ovulating so ovulation is um commonly occurs during a person's menstrual cycle, normally around day 14 of a 28-day cycle, and leads to the production or results from the production of hormones, but also produces hormones in itself.

And so it's thought that that cyclical production of hormones from the ovaries is what stimulates the cells that are similar to the lining of the womb and that's hence the name endometriosis not endometrium and it's endometrium that is in the lining of the womb and endometriosis which is where the cells similar to the endometrium are found outside the womb but they respond in a similar fashion to cells inside the womb and get a thought to be stimulated in line with the hormones that are produced by the ovaries. So the hormonal treatment options that we recommend are contraceptives that tend to stop people from ovulating. And we think that may have a role in

treating symptoms, perhaps for people that have endometriosis, but potentially also preventing endometriosis. Because there are theories from an amazing set of colleagues that I work with at UCLH that endometriosis is caused by a hemorrhagic ovulation. So ovulation, ovary producing an egg. In some circumstances, that small follicle that's developed the egg and released the egg can bleed and cause hemorrhage into the pelvis. That blood, like with gravity, goes to the lowest possible place in your pelvis,

which is often right behind your womb in a strangely named pouch of Douglas. And it's thought that that then causes a reaction to the surrounding pelvic lining that we call the peritoneum. So it engulfs that area of hemorrhage, shrinks it down. And over time, that area of hemorrhage changes into something that's a bit more fibrotic, hard and nodular. That goes on to be the endometriotic nodules that we see in people's bowels. And often in the same place place which is right behind the womb so it's a theory that I think there's still more research needed to look into it but it is a theory that could open the window of opportunity to prevent endometriosis

with hormonal options that prevent ovulation. Yeah, super interesting. What I'd love to discuss with you next is the kind of lifestyle modifications that potentially patients could make with endometriosis because I think we see this a lot with all women's health conditions. A lot of women find that they aren't getting the answers that they need from perhaps their health care system. And then they turn to kind of, you know, self-professed gurus online who will give them like a specific diet.

And as a nutritionist, I will, you know, a lot of women will come to me who've been on very restrictive diets because they're afraid it's, you know, worsening their endometriosis. So I'd love to chat a bit about kind of the evidence for um kind of dietary modification and kind of maybe some do's and don'ts there it's really hard because i still think we're in the infancy of knowing but i have no doubt that there is an association between your gut health and endometriosis there was a recent study that i think made quite high profile mainstream media about how altering the gut microbiome in i think it's either rats or mice directly affected whether

they went on to develop endometriosis or not so it appears in the these animal models that there is a role to play with your gut health and your gut microbiome and the development of endometriosis what that precise relationship is i'm not clear on um and i don't think we're that close to be able to provide tailored diets or tailored changes to people's gut microbiome to help either treat endometriosis or prevent it but i think that will be something for the next five to ten years that will be a huge emerging market in terms of being able to know what how we can alter our diet and modify things um to benefit people with endometriosis and and the and other health conditions um but um going back to your

question about dietary modifications um there is an association between your diet and endometriosis symptoms, but it's not the same for everyone. So I guess it brings me back to that kind of alteration of all the millions or billions of bugs that are in your bowel that are directly affected by what you eat. And so I do say to people to perhaps try altering their diet and seeing if that works. But if their

alterations don't work i tell them to bring that food group back in immediately um you know i always recommend people eat as healthy a diet as possible um and if you know i think we're all guilty of having some things that aren't that healthy and if you were to cut things out initially it would be those unhealthy aspects of your diet but i don't think there's there's an there's a clear association yet as to what areas of people's diet will be able to help them so with my limited knowledge and limited knowledge of the the the kind of scientific research is available i say just try and eat as healthy as possible um and if you were to make any changes make sure you're trying to make them to become more healthy and if you were to try to look at perhaps removing some food groups don't remove too many food groups

remove one food group um at a time and certainly bring that food group back in if it is um if it's not helped your pain yeah there doesn't seem to be any specific diet and i guess what makes the most sense to me would be opting for more of an anti-inflammatory very colorful diet given the amount of inflammation that's going on in the body but i think it's quite trendy to go dairy free and gluten free in that that community. And there is a subset of people who are going gluten-free actually can be quite helpful, but not everyone. And there's also a link with celiac disease there as well. So it's quite complex.

But I agree with you. I think it can be quite risky also when you go down the route of cutting out things because you can make yourself deficient in a particular nutrient, which could potentially worsen your symptoms or cause other symptoms. So I think it's kind of a discussion you should have with your own doctor, plus or minus dietitian, to kind of figure that out. You know, I work closely with a dietitian and, you know, I think as health care professionals, we all need to acknowledge our limitations. And I say, you know, if you do have any bowel symptoms, I would want you to see my colleague who's a dietician. Or if they're more severe or they're more red flag symptoms, I might refer them on to my colorectal or gastroenterology colleagues.

But I think for people with endometriosis or other conditions where they might have bowel symptoms and say menstrual health symptoms it is about working with multiple health specialists to get that improvement that you need the more specialists unfortunately you see the more of a challenge it can often be to get you to the right place but um there are conditions in the pelvis where if you have one organ that's inflamed it can irritate the other organs in the pelvis or known as visceral hypersensitivity so you can get an over or you know an overstimulated bladder as a result of pain symptoms perhaps in your bowel or or your womb so um a condition of one organ can also then manifest symptoms in another organ yeah That is a challenge, I think, just due to the geographical nature of the pelvis

being the lowest possible point and where lots of the organs kind of settle when people rest. Yeah, absolutely. You also mentioned physical activity and exercise. Do we kind of understand the relationship between how exercise could support endometriosis so i'm not aware that exercise can affect the progression or change or development of the disease but what i do see and read is that exercise can help people's pain symptoms um so you know whether that's through the endorphins that are released through exercise or other aspects of of enhancing your well-being through exercise, it's certainly thought to help, which is why a few years ago, the NICE guidelines on the management of pain included exercise. And for a lot of people, it feels counterintuitive.

You know, if you're in pain, perhaps the last thing you're going to want to do is go out and exercise or you might not even be able to exercise because you're in so much pain but i think it's about doing what you can you know for someone that might be just you know having a walk around their house for other people that may be taking the next step and and running or running further and further and further so um it's about perhaps trying where where you can to increase what exercise you do yeah yeah it's super individual but i do think it does feel kind of counterintuitive it's the same with pre-sit round menstruation and exercise where it seems to be like almost like opioid inducing because it can act like as an analgesic which is amazing but it can feel like the last thing you want to do

is just figuring out a form of movement that is not going to cause any discomfort, but is getting the blood flowing and getting you moving. For anyone who's listening at home who might think that they have endometriosis, maybe struggling to get a diagnosis, what advice do you have for them? Really good question and i think you

know try to access any like you know reliable sources of information you know selfless plug you know i offer an instagram channel that i try to promote high quality reliable accurate information so see whether what your symptoms you're having relate to the condition based on an accurate source of information but then track and map your symptoms i always say to people you know take a pain diary um you know buy a small like flip chart diary and and write down the pain score for that day and also maybe color code it for days when you're on your period just before your period so you can map whether your pain symptoms do change with your menstrual cycle um also write important things in that diary as to whether or not you've you know couldn't go out that day you

know needed a hot water bottle and really struggled at work had to leave work early things like that that can then enable you to go back and reflect upon it when you're going to see your healthcare professional because um you know we want everyone to have that meaningful dialogue with their healthcare professional but sometimes it can be a challenge and i certainly speak to lots of people that find conversations with healthcare professionals really really challenging because it's almost like you're speaking a different language to them you're going in there they're saying i've got really bad pain but the doctor that sat in front of you's got eight minutes until they know their next patient needs to be seen and they want to try and figure out what you've got what's going to help you

and then prescribe it to you all in the space of six to eight minutes so it can be really challenging when you're going to your gp but if you go to your gp with a concise pain diary and an ability to say i've tracked my my periods for the past three months my pain scores go from a zero on days when i'm not menstruating to a 10 on days when i am it stops me from going out it stops me from exercising stops me from being intimate um and i need these painkillers i think this relates to a condition called endometriosis or maybe adenomyosis um you know could we look at different tests that are available or could i be referred on to a specialist um so taking the symptoms you've got summarizing them saying how it impacts your quality of life, giving your healthcare professional a bit of an idea as to the fact that you think you know

what might be causing your symptoms. And let's face it, that makes their life a bit easier. And then a suggestion about what you might think is the next step in terms of getting a scan or getting referred on to a specialist. And, you know, I think I just ran through that in about 30 to 45 seconds. So it's making your healthcare professionals time more efficient and your time in that consultation more effective for you to get to that end goal, which is finding an effective treatment.

I'm a big fan of a symptom diary. Yeah. I always think you never really can remember like how you felt 10 days ago. So it's always really helpful to map it out and also see patterns with like where you're having the pain. You know, how often across a month. But you did mention adenomyosis, which is related to endometriosis, but slightly different. And I often get asked about this. I think for, you know, for women who do have this diagnosis less information available to them compared to endometriosis and so it would be great to just

kind of briefly discuss that what it is and how it differs and how the symptoms might differ. Sure sure so they're both conditions where cells that are meant to be inside the womb or similar to them are found outside their normal place so go back to endometrium being cells that are meant to be inside the womb or similar to them are found outside their normal place so go back to endometrium being cells that are inside the womb endometriosis is where cells similar to the lining of the womb are found outside the womb and adenomyosis is where cells very similar to those that meant to be found inside the lining of the womb are found in the muscle of the womb so when they and they're thought to migrate rather than you know travel and then implant they're thought to migrate from the lining of the womb into the muscle of the womb and at that stage they're trapped you know they're they've got nowhere to go they still

get stimulated by the natural hormones that are produced by the ovaries to swell and perhaps produce blood each month but they've got nowhere for that blood to go because it can't come out as a period because those cells are trapped in the muscle of the womb it causes localized inflammation and response so one of the hallmark features on a scan for adenomyosis might be that one side of the womb is actually bigger than the other side of the womb it causes you know pockets of fluid within the muscle of the womb which is why another hallmark feature on scan is these um small cysts below the endometrium that are visible on the scan um and it is characterized more by painful and heavy periods whereas with endometriosis i see it also including those symptoms but including pain symptoms and more broader symptoms outside of someone's period um adenomyosis can cause your womb to grow to

become really quite large um whereas endometriosis tends not to cause that so it is again a horrible a horrible condition to have a condition that you know is not um brought on by anything that we're aware of from an environment environmental perspective um what you eat or what you do or what you don't do um but it is thought to get more common with age it's also thought to be a progressive condition that where the symptoms are related to the severity of the disease so with increasing numbers of features of adenomyosis you tend to get a deterioration in your symptoms so whether that's heavier periods or more painful periods and it can be a real challenge to manage because the treatments are the common treatments are broken down again into

either hormonal strategies that for a lot of people struggle to tolerate or might not be effective or surgical strategies but with surgical strategies for adenomyosis there aren't as many conservative surgeries available by conservative i mean like womb preserving so enable people to go on and have children in the future the gold standard used to be removal of the womb but for people that are young with adenomyosis that's just just not an option if they want to go on and have a family um and there's a very limited evidence to support surgical treatments that preserve the womb so it is a again a horrible condition that i think needs needs more um attention more research and more funding um and more advocacy which i hope you know we're doing today yeah yeah absolutely i think that's raising awareness and having these discussions are are really important but as you said also research and more funding into women's reproductive

conditions is so important before you go i'd love to give you three questions that we ask all our guests the first is if you had an extra hour in the day how would you spend it i'd spend it with my kids i get i get a lot of um guilt about not spending as much time with them as I'd want to. So that extra hour would be with my daughter, Eva, and my son, Ira. Oh, lovely. And if you're going to a desert island, what three things are you bringing with you? They can't be people.

They can't be people, okay. Well, I might borrow some inspiration from other people and take, say, Raymier's survival guide for obvious reasons to help me survive. I bring an eye mask because I love an eye mask. Guilty pleasure. It feels like my eyes are being cuddled. It really helps me sleep. And from having watched all these kind of like survival programs where they're on a desert island, like sleep is one of the things I think makes people really angry or not get on with other people. And then bug spray.

Because if you're covered in bites, you're itching, and you haven't slept, and you don't know how to survive, then I think it would be a pretty horrible place. But I think with those three things, I think it might be just a little bit more bearable. I think your answer has actually probably been the most practical that we've had. Classic doctor. We've had the most practical. I really have. Classic doctor. We've had like the most random things. Marie, who went first, I think she just said snacks as one category. Just like, just snacks.

All the snacks. All the snacks. What's one thing that you're grateful for today? I think my health. So, you know, I traveled in from Oxford and I got on the tube that I don't do very often now, now that I'm not in London and there was someone that needed help with their mobility and I kind of gave way and

helped them onto the tube and I just thought you know what, it's something that I just don't have to worry about at the moment and I'm really really grateful for that and I wouldn't take any of that hour away from my kids but i also want to make sure that i'm prioritizing my health as well make sure i stay as fit and healthy as i can be

it's a good reminder and finally before you go remind everyone of kind of your handle on instagram so they know where to find more information brilliant thank you um i run instagram channel called endometriosis.surgeon.uk and my goals are to try and deliver reliable, accurate and professional information about endometriosis and some other, to a lesser extent, gynaecological diseases. I hope it's a forum that can bring people together to chat openly about what they're going through, seek advice. Again, I can't provide individual, personalised advice, but I can help try and signpost people to good sources of information

and bring together a community that I think has historically not been treated as well as they should have. And so I want to do my bit to make sure people with endometriosis and adenomyosis and other gynaecological conditions are represented and are able to access the information they need to in that huge gulf between seeing a gp who's not a specialist and that six to nine month wait to see your specialist in the clinic appointment there's very little in the middle of that i find um and so i'm pleased to be able to offer you know free to access instagram account that i think

hopefully gives people information. It's a really good mission. Thank you. Thank you for coming on the podcast. That's all from me but before you go, I've got a little favour to ask you and that is to please leave us a review and rating and to share this episode with someone you know will love it too.

See you next time.