Why Endometriosis Keeps Coming Back (And How to Break the Cycle)

You started to mention some of those things that can get out of balance in somebody's body and influence why they may have endometriosis. And what we're learning is I think what is so interesting is it's not just a disease of the pelvis. It's a systemic disease where we want to think about it really comprehensively and systemically and ask that question why so we can treat our patients individually. Welcome to Office Hours. This is our dedicated one-on-one space to go deeper, get clearer and explore what truly moves the needle for your health. I'm Dr. Mark Heimman in each week. We're going to pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. This episode is brought to you by FunctionHealth, empowering you to live 100 healthy years with over 160 lab tests at just $365 a year. Sign up today at FunctionHealth.com/Mark and use code Mark2026 to get $50 towards your membership. Now, if you've ever been told that debilitating period pain is, well, just part of being a woman, I want you to hear this really clearly. It's not. One in 10 women lives with something called endometriosis. And yet it takes an average of seven to 10 years for women to get diagnosed if they have that problem. And during that whole time, lots of women have prescribed birth control, pills, pain medication, told surgeries, the only real auction. And sometimes surgeries necessary, but nobody really asks the deeper questions, why is this happening in the first place? That's what Functional Medicine is. It's the medicine of why. Not just what disease you have, but why do you have it? And endometriosis isn't just a gynecologic condition. It's just a uterine condition. It's an inflammatory condition. It's an immune condition. It's a hormonal disorder. And it's also connected to your gut health. It's also connected to how you metabolize estrogen. Even environmental toxins in your blood sugar and stress and your oral health and training of your whole body. So today for endometriosis awareness month, I'm joined by my friend and my colleague of decades, decades and decades. Dr. Elizabeth Boham from the Altruwilness Center. It's our practice in Linux, Massachusetts, where we take care of all sorts of patients, including those who have this condition and many other chronic illnesses. She's an expert in Functional Medicine. She's an expert in women's health. And together, we're going to go on a deep dive into the root cause of endometriosis. I'm just managing the symptoms, but addressing the inflammation, the hormone imbalances, the whole immune dysfunction that drives it. Because severe pain is not normal and it's not fun. And you deserve the answers beyond just trying to suppress the symptoms. So welcome Liz, great to see you. Thank you, Mark. It's really great to be with you. And I think this is such an important topic to speak about and really help people understand how we do it differently with Functional Medicine, not just suppressing symptoms, but asking that question, why? And looking upstream, and you started to mention some of those things that can get out of balance in somebody's body and influence why they may have endometriosis. And what we're learning is I think what is so interesting is it's not just a disease of the pelvis, right? It's like you were saying, it's a systemic disease where we want to think about it, maybe comprehensively and systemically, and ask that question why so we can treat our patients individually, come up with a personalized plan for why do they have this endometriosis going on? And what can we do to help them feel better? Exactly. Okay, so let's get into it. What is it? Like briefly, because it's a complicated, so briefly tell us what is endometriosis? Because it's a big medical word, most people understand it. So tell us what it is. So endometriosis occurs when the cells from the inside of your uterus, that endometrium, leave the uterus and they go into the pelvic cavity or the peritoneal cavity, which is the area outside of the uterus inside the abdominal area, so to say, and cells get stuck there. These endometrial cells get stuck there and they create inflammation and that can go on to create a lot of pain. And because of this tissue can grow outside of the uterus, it can be around areas of the phylopean tubes and the ovaries and so that can impact people's, women's infertility and so that's been associated with infertility. And it also causes a lot of symptoms. Symptoms from pain and it can cause a lot of digestive symptoms, which can make it somewhat difficult to sometimes diagnose, you know, bloating, constipation, diarrhea. And as I mentioned, infertility, yeah. So the basically the lining of the uterus, the endometrium gets like deposited around the abdominal cavity on your bladder, on your bowel, on your phylopean tubes, all over the place. And so when you have your period, it gets activated, right? And so that's kind of what's going on at this weird, weird thing that it's like, it's almost like your kidney tissue would get transplanted in other parts of your body, which is kind of a weird thing, but it's really unusual, but it's extremely symptomatic and painful. Yeah. And it's thought that even 10% of women may be dealing with this and it's tricky to, because it can be tricky to diagnose, but it goes often undiagnosed for many years. And what we know is that when that endometrium, the endometrial cells start to deposit outside of the uterine lining, they create this sort of feed forward inflammatory cycle. And then those endometrial cells can create, they can actually create their own estrogen through this process of aromate, so we can talk more about that, but that can then create even more growth. And so it becomes a often a vicious cycle as do a lot of things that happen. And I've only been thinking about it as a gynecologic problem. It's just a hormone problem. And it is hormone-ly infected, but there's some evidence that it's a number autoimmune disease, right? Can you talk about how the immune system plays a role in this? Absolutely. So we know that a lot of inflammation can occur locally and can create more growth of this tissue and then more inflammation. And so we've got to think about what can be triggering this inflammatory process in the body. And so as we were saying in functional medicine, we go upstream and we say, okay, is that because of issues with dysbiosis or imbalances in the gut microbiome, is that because of issues with estrogen metabolism and how we're getting rid of our estrogen? Is it because of issues of inflammation in the whole body or immune dysregulation? And so those are things we've got to ask so we can help that patient feel better. I find it really fascinating that this is immune condition because we think of the uterus and your period is mostly hormonally regulated. But it seems that this condition is regulated in a large part by the immune system and the gut plays a huge part in this. So can you talk about the whole role of gut health and inflammation and even as a root cause of autoimmune and immune dysregulation? You know, we always say in functional medicine, start with a gut, right? Because so much inflammation and autoimmune and immune dysregulation can stem from the digestive system. It can stem because of increased intestinal permeability, because of dysbiosis, or imbalances in the gut microbiome. And also because the gut microbiome is really involved in how we metabolize our estrogen. And we know that estrogen can cause endometriosis to become more problematic, right? So we think about the gut for all of those reasons. We know that there's, you know, women with endometriosis have a two to three times higher risk of having inflamed irritable bowel disease. So it's really connected with IBS or irritable bowel disease. And we know that women with endometriosis have a higher rate of having food allergies, food sensitivities, non-silioic gluten sensitivity, and even silioic disease. So there's a lot of connection. And what I thought was most fast is so fascinating is this connection with the gut microbiome, but not just the gut microbiome, but they're also looking at the connection between the vaginal and cervical and uterine microbiome, influencing risk of endometriosis. So we know that when women have dysbiosis in the vaginal cervical area, that that can be associated with more endometriosis, just like dysbiosis in the gut microbiome is associated with it as well. Yeah, fascinating. And you know, use a lot of big words like dysbiosis. That just means like bad bugs in the gut. Like, you should have a nice, like it's like, think about like weed, a weed in your garden. And you should do all kinds of nasty stuff. So you want good bugs, not the bad bugs. And you talk about permeability. That's what we call leaky gut where all these bad bugs and food proteins kind of leak in and then your immune system is right there and then it gets triggered and then it creates inflammation. And that means the immune system is constantly activated and that can actually influence you know, the endometriosis. So do we have any understanding about that mechanism? in which the autoimmune regulation, disregulation from the gut directly plays a role in endometriosis? - Well, there's research to show that when there's certain patterns in the gut microbiome that are associated with endometriosis and certain patterns in the gut microbiome that are associated with, or sorry, imbalances in the vaginal microbiome that's associated with it, which is fascinating. We know that there's certain imbalances in the microbiome that trigger more inflammation in the body, both locally and systemically. And so we need to, you know, we're always learning more in this area and I know there's more that we need to learn, but I think it's a fascinating area. And something we can test for, right? We can look at the microbiome, we can look at what balance of bugs somebody has and how pro-inflammatory they are and how likely are they to produce this substance called beta-glucuronidase and beta-glucuronidase is this enzyme that certain bugs in the gut can produce. And that will result in more estrogen being reabsorbed in the body. I think that's one reason why dysbiosis is associated, but probably not the only reason, that's for sure. - Yeah, I mean, that's an interesting point. So basically you've got these certain bugs that grow in there that produce a certain enzyme. And normally when your estrogen is used up in your body or your liver processes it, it packages it up in a little nice package and then it goes out into your bile and into your digestive tract and you poop it out. But when it hits this enzyme, it's almost like it unwraps the package and you reabsorbed the estrogen and you get higher amounts of estrogen. So you've already got this estrogen dependent tissue, this weird like lining of your uterus, it's everywhere in your abdominal cavity and then you're feeding it with this estrogen. So that's kind of an interesting framework where you can look at how the gut bacteria directly are affecting the hormone regulation and that gives more growth in these lesions and then the whole irritable bowel thing is all connected. Like you said, in the Delta Walnut Center we do test for these things. We test for food sensitivity, we test for the microbiome, we test for bacterial overgrowth and bad bugs in the gut through breath testing and all of these are incredibly important to figure out what's going on because if you don't look you won't find it. And then there's a real structured approach to actually healing the gut. So can you just touch briefly on the approach that we use in functional medicine to repair the gut 'cause that often can really even help things like endometriosis? - Absolutely, so that five-hour approach is kind of the framework for how we deal with problems with the gut and how the gut may be impacting the immune system and hormone balance. And so the first are is remove and that means you wanna remove foods that are causing a lot of inflammation. So an elimination diet or a great diet is Mark your 10-day detox diet because it's anti-inflammatory, it removes inflammatory foods and it also supports detoxification. And so that type of diet, that's part of the remove. If there is dysbiosis, we need to treat it. And so depending on what's going on, what we find, we can treat it with herbs or even prescription medication sometimes or even just things that build up the good bugs, a prebiotics, which are phytonutrients and fibers and probiotics sometimes. And so that can help with rebalancing. So remove and then replace, that's if somebody needs help with digestion, re-enoculate, those are probiotics, repair, those are things that help to heal the gut lining and rebalance those, that's really just recognizing the connection between the mind body connection, right? Really doing things to help with activating that parasympathetic nervous system and calming down the body, and which helps the body with healing. So that's that five-hour approach. - Yeah, and it's getting very granular. Like I remember learning what I've started doing functional medicine about, you know, food is medicine and certain fibers like flaxseeds, like real thing. And they really do affect this estrogen metabolism in the gut and then the isoflavone's in soy, that doesn't act like an estrogen. It's sort of, it's not fair to say that, but it does modulate estrogen activity. And it actually can help. So you can actually eat certain foods that actually rebuild the normal health of the microbiome, but also specifically target estrogen, function and estrogen metabolism, which is interesting. - Those are great examples, Mark, yeah. Because like you said, they're working from a couple of angles, right? They're feeding the good microbiome, but they're also, they have, they're called phytoestrogens, so they can impact the estrogen receptor and people think are used to worry that that meant they were causing more estrogen in the body, but actually the opposite is true, right? 'Cause it decreases your own estrogen binding to the estrogen receptor or even those Xenoestrogens from binding to that estrogen receptor. - Yeah, we're, you have big spring plants in your body, keep up. Congratulations, the job changes, big moves, new routines, it's exciting, but major transitions don't run on good vibes or willpower. They're fueled by energy, resilience, stable hormones to sleep. In the truth, many people are sprinting into their next chapter on an empty tank without even knowing it, like low iron or elevated chronic inflammation or hormone imbalances, all quietly draining your capacity while life speeds up. Spring is the perfect moment to do an all one check for your health. To see exact reason, function was built. Get 160 lab tests that treat exactly where you stand with your heart, your hormones, new nutrients, toxins, metabolism, and lots more. All this insight for $365 a year at functionhealth.com. Get your data before life shifts into high gear and make sure your body is ready to move with you. We're gonna get to that next. Before we jump to the toxins and the Xenoestrogens, I just wanna explain how in functional medicine we're so specific and how we think about things and how we treat people at the Delta Walnut Center, 'cause it's really different. If you are someone out there listening who's got menstrual issues, cramps, pain, abdominal pain, and any metrosis, whether you're diagnosed or not, you're gonna get just a standard care, which is here, take the birth control pill or here, just will match your hormones with this for that, or you'll put you into premature menopause. That's one of the treatments, which is terrible, I think, treatment. There's some granular things we can do. For example, you mentioned this weird enzyme that certain bad bugs make in the gut. Well, if you can take an antibiotic, sometimes to kill them, but you can also take a probiotic called saccharomyces or a probiotic, which is a very specific probiotic that you can take that helps lower the levels of this particular enzyme in the gut and these bacteria that are producing the enzyme. So it gets very specific and very granular, and I think it's a very different thing when you get if you go to a regular OB/GYN and try to say, "Hey, how do I deal with this endometriosis stuff I got?" And that's really the point here, is that there's a whole new way of thinking about treating health and disease, not just obviously endometriosis, but pretty much everything. And we're sort of agnostic to disease, at the ultra-1 of center because it really doesn't matter what you have. We understand the underlying causes of illness, and even if we've never seen a problem before, we can often help because we are used following basic laws of nature, that I call the laws of biology, that we can apply across any disease, and often they'll work in surprising ways that, I mean, I just treat some of the ALS, and I don't really see many ALS patients, but I'm like, "Okay, well, here's our underlying principles, and here's what we can do." And like, I just got a text from him, and he's doing amazing years later, which is, you know, most people would be in a wheelchair by then. So anyway, it's just, it's really exciting to kind of talk about this, because people don't really understand that there's a whole new paradigm happening in medicine and science, they're not getting when they go to the spiritual doctors, and that's why it's so proud of what we built at the ultra-1 of center. So before we go to kind of the next topic, I want to kind of get into the toxic thing. Now, you mentioned Zenoestrogens, and this is a big one. Zeno means foreign estrogen. So talk about this idea of estrogen metabolism, Zenoestrogens, this whole theory of estrogen dominance, estrogen dysregulation. That's just about high estrogen. This whole, there's a whole mishmash of things going on that creates all these hormonal dysregulations that we can actually do something about, but we have to understand what they are. So can you kind of unpack that first list, because I know you're really deep in on this stuff. - Yeah, absolutely. So Zenoestrogens are those toxins in the environment that can impact estrogen levels in the body. They can bind to the estrogen receptor. They influence how estrogen is broken down. They impact our estrogen levels in the body. And we've been learning a lot about this over the years, right? So BPA is kind of the first Zenoestrogens, we started to pay attention to that hard plastic. But we know that Zenoestrogens are in lots of chemicals, unfortunately, in our environment, from parabens to thalates, to dioxin, to pesticides, to herbicides, and the hard plastics like BPA. And so, and this is something you wanna try to decrease your exposure to as much as possible. But we also have to just work on supporting the body's detoxification system. We know, unfortunately, that sometimes these exposures to these Zenoestrogens happened when we were, when we were in our mom's belly. So when we were a fetus and we're early in life, and that influences our risk of diseases later in life. And sometimes that's frustrating because you feel like, "Well, what can I do now?" But what I always work with women on is, and all people actually is just whatever we can do to lower our exposure and then support our body's detoxification capacity. And so that really does tie in with estrogen metabolism too, right? So because the way that we break down our estrogen and metabolize it. influences how dangerous it is for our body, right? So there's certain types of metabolites of estrogen that are more potentially inflammatory in the body. And so we can influence that. That's why everybody talks about the glucose scina lates or sulfuraphane that are in your cruciferous vegetables because they help you, yeah, exactly, broccoli, broccoli sprouts, right? Palliflower, cabbage, Brussels sprouts. They help your body metabolize your estrogen in a healthier way. But we can measure that. And I think that can be really helpful to know why does somebody have this situation that feels like they have too much estrogen in their body. And what can we do to manage that? And so we'll look at things like the beta-glucuronase we were talking about before. We can measure toxin levels. We can look at how the body is metabolizing estrogen. Yeah, I think I want to double click on that because this is something very unusual. Maybe people heard about poop test. But one of the most enlightening things I ever learned about as I was studying hormone metabolism was this whole science, this body of literature that seems seemingly totally ignored by traditional gynecologists that has to do with how your estrogen are metabolized. And there's no such thing as estrogen, their estrogen's, and they're all different. And they all have different roles. And we can do a 24-year-in collection. And we can see all the different pathways that the estrogen is going down, kind of like a pinball machine, whether it's going down this pathway or that pathway. And there's estrogens that get produced that are very protective. And our protective against cancer, other ones that are more carcinogenic and problematic. And there's also a whole set of genetics we can test that are around hormone metabolism and genetics so we can say, oh, you have this little kind of weak pathway here. We're going to support it in this particular way. And this is where we really talk about personalized medicine, individualized care. It's not something that you get when you go to the regular doctor. So I want people to understand that there is hope and help, but it's hard to find. And that's why I think people need to understand that there is a world of functional medicine that there are clinics like ours at the Ultramanocena that do this kind of work. So let's kind of dive into the second piece. We talked about eliminating household cleaning products, you know, for your food, reducing toxic load, makeup. You know, there's a lot of ways. And the environmental work in group has a lot of great resources, the wg.org on how to actually reduce these exposures and numb on the board, but it's really a great resource. And the second is, what do you do to support your body's own detoxification pathways? You mentioned cruciferous vegetables, like broccoli, cabbage, color. What else can we do? Absolutely. So, you know, this is where we try to really increase the amount of fiber somebody has in their diet because fiber is really great for, of course, helping you have regular bowel movements, but those fibers really help bind to toxins and help your body get rid of them. We know even things like good exercise and sweating and sauna use all help your body with mobilizing toxins as well. You need to make sure you're getting enough nutrition, right? So sometimes if we're cutting back on protein or not eating enough, that can influence how well we're able to detoxify. So, you know, we're really thinking about it from a whole body perspective, you know, regular bowel movements, lots of sweating movement for lymphatic circulation and drinking sufficient water and good healthy water, right? All those things are really important. Yeah, so important. And I think also, you know, while we also understand that there are nutritional supplements that help regulate these pathways, like they help, you know, go down this pinball pathway or that pinball pathway so that it's actually beneficial. So can you talk about some of the nutritional supplements that can be helpful and how we guide people around that? My, you know, my favorite supplement is sulfurethane. It's a glucose scintillate with morassinase that then in the body gets converted to sulfurethane and-- That's a lot of big words, Liz. I don't know what-- I know. It's a lot of big words. That's a lot of big words. What are you talking about? You're looking for sulfurethane. The products will say sulfurethane on them. And-- It's broccoli in a pill. It's like broccoli sprouts in a pill, essentially. And it is great because it helps support both phase one and phase two detoxification. It helps the body produce more glutathione, which helps the body with detoxification again. And it's probably my go to, you know, I use it so much in my practice. We also think about methylation. You know, methylation is involved in metabolism. And so we will measure markers of methylation from homeostistine to methamelotic acid. And it would be-- What does all that mean? What does all that mean? Yeah, all that means is how many B vitamins do you need? And if you do need B vitamins, you need them in a specific form that's healthier for you because it's the methylfolate. So it's-- You don't want to just go to a regular drug store and pick up a B complex. You really want to go to-- this is where you want to-- well, there's a lot of places where you want to spend the money. But you really want a good quality, the one here, that it's going to make a difference. For some people, it's going to work way better. So that's important. And this whole thing of methylation is a key part of detox in many, many other functions. But it's like B6, B12 folate. And then you can measure these tests, which we do, almost cysteine, methamelotic acid you mentioned, which are better than the regular blood test for folate or B12 that you get maybe a regular doctor. And so we can start to really dive deep on what's going on in the personally. We'll also look at magnesium, which plays a role. And a lot of this can be very helpful. So these things are things we can measure. We can identify. And then we can treat even genetics around methylation. We know there's genetics that affect different people's individual needs for different amounts and different forms of different nutrients. So you can have true personalized care. So I think this is a real big one. So we talked about the immune dysregulation. We talked about the gut. We talked about now we talked about the toxins. And I think there's a few other tips here on like filtering your water and don't cook in plastic. And June, she's clean beauty products and don't eat ultra processed food. I mean, the common sense stuff. But the idea is you want to reduce the estrogen load that's coming from this estrogenic environment. And that's why these little kids are eight years old. The girls are getting their period. Because we're living in a sea of estrogen-like compounds that are not actually estrogen, but that are mimicking estrogen that are quite concerning. So let's talk about kind of other things. Because this is, there's other things we can measure. Toxins like heavy metals. We can look at toxin levels and help people. But sometimes people do need to find out what's going on. And surgery may be necessary, but it's not the whole picture. So can you talk about how surgery plays a role. Laperoscopic surgery can help. And what role that plays in the management of endometriosis? Yeah, so sometimes surgery is done both for diagnosis, as well as treatment. So especially if women are having significant pain that's not getting better, and/or they are having fertility issues, surgery where they debulk some of those, that tissue, that endometriosis tissue, to help with decreasing pain and to help with fertility. But that's an issue. But the issue is with surgery is you're not getting to that underlying terrain. You're just pulling away the thing that's causing a lot of that pain and inflammation, which is sometimes very important to do. But at the same time, we want to be working to create that terrain. So the endometriosis doesn't come back, or so that the pain doesn't come back. Because we know that many women will need to go and have repeat surgery, or their pain will come back. If we don't do that. Yeah, so basically you have to still address all those other things. You have to address the immune dysfunction, the food sensitivity, the gut, dysbiosis, the toxins in your system, all that stuff has to get fixed. If you don't really change the toll terrain, you do the surgery, but it's not going to solve the problem, it'll just come back. And that's a big thing. So there are also just general lifestyle interventions that as a baseline help with hormonal regulation. I wrote an article years ago, it was about PMS. And when I read the literature, I was like, well, 75% of women have PMS to some degree or another. I'm like, what's up with that? That's not a design flaw. It's not like God or nature, where we believe the creator created a malware in the system. And all of a sudden, these women have to suffer from this. It's because there are just fundamental things we're doing that are screwing up our hormone balance. And there are very simple lifestyle things that can help correct that. Not just for endometriosis, but for PMS, for periods, for until all kinds of stuff. So can you break down on, what are the fundamental building blocks of lifestyle when it comes to hormonal regulation of balance? You know, the first thing to just focus on is eating more whole foods that you cook at home. Because when you do that, you're going to get less of these endocrine disrupting chemicals, those Zenoestrogens. You're going to get less of the thalates, the parabens, the BPA exposure. They can show that when women, when anybody eats more whole foods that they cook at home, the amount of these chemicals found in their urine decreases substantially. So that's really a great place to start. That anti-inflammatory, healthy whole foods diet is, you know, I always love starting with food. So-- Yeah. Or really-- Yeah, focusing on getting a lot of those phytonutrients, such as the glucose scintolates that we talked about from your crucifers vegetables that help. your body with detoxification and estrogen metabolism. So getting a lot of broccoli. But we also know that stress management is very important. We know, unfortunately, with anything that creates pain, we become more sensitive in that area to that pain. So pain can be really tricky because whenever you start to have pain in an area, you become more sensitive to it. Not in the brain, actually, in those neurons, right? Those neurons become more sensitive. And so there are many things that we need to work on to help with calming down the body. So it's not so impacted by all that pain. So stress reduction techniques, breathwork, activating that parasympathetic nervous system, acupuncture. There are some cool new patches that use infrared technology that you can place on the abdomen that can be really helpful for decreasing pain and increasing circulation to the area. And that's our thing going in an important area that we need to really focus on as well. Yeah, I agree. I think there's a few special foods like black seeds and soy that can be helpful when you want to customize it. But I also think that the Omega-3 fats play a big role, which is from a wild fish or Omega-3 fat supplements. The one thing we didn't talk about, which is really important, which is a blood sugar in insulin, because people don't realize this. People don't realize this, but your fat tissue makes estrogen. And the more fat you have, the more estrogen you make. And that's why guys who are really overweight or drink a lot of beer, whatever, have a lot of carbs, they end up getting lost at the hair on their body. They grow breasts. And it's not because they have some kind of tumor, it's because they have all this fat on their body. For women, it's the same thing. Can you talk about that whole connection of blood sugar in some resistance and how that affects hormones and regulation? So just what you echo, what you said, but also insulin is a very pro-inflammatory hormone in the body. And so when you eat foods that cause your blood sugar to spike, and that causes your insulin to spike, to help keep that blood sugar normal, your body makes a lot of that hormone insulin to get your blood sugar down and more regulated. But those high levels of insulin are very pro-inflammatory. They cause us to put weight around our belly. They cause us to feel tired. That high insulin causes us to feel tired. But it is also just associated with increased inflammation in the body. And as we started this conversation, we know that this is an inflammatory condition. And we don't want to just be focusing on the pelvis. And we need to be focusing on the whole body. And anything we can do to lower inflammation in the body is really important to helping the body work better. Even things like you mentioned, lowering stress, getting adequate sleep, exercising, all those things help reduce inflammation, help regulate hormones. It's just the foundational principles of a healthy lifestyle. Hopefully people can use this on their own and improve their health. Sometimes they may need to see a practitioner and you're welcome to come see us at the El Trevaldo Center. We have a lot of great docs and pays who really are deep in on this stuff. But how do we sort of make sure people can prevent the recurrence and how do we prevent in the first place? Let's just sort of go through and summarize what we just talked about. Absolutely. It is creating that terrain in the body where there's less inflammation, where we are processing our estrogen well. So where there's good estrogen metabolism, we work to create a healthiest microbiome that we can. And the microbiome, both in our gut and in the vaginal area, we want it to be as healthy as possible, so avoiding antibiotics whenever possible, feeding the good bugs with all of the great fibers in our diet and phytonutrients. And so we want to think about it as this whole body imbalance and we want to work to lower inflammation and create good estrogen metabolism in a healthy microbiome. So regulate the immune system, heal the gut, get your toxic load down, get the insumresistant sorted, support your immune system in many ways sleep and stress reduction and exercise. All that stuff is common sense, but it really works. I mean, it really does work. So end of me, Shrio, this basically thrives in inflammation and hormonal chaos in it. And that's kind of like the world we live in, it's a hormonally messed up environment we live in and inflammatory environment. So when you get those things under control and you get metabolic stability, it's hard for these diseases to stay. So that's the goodness. So thanks, let's for joining. I just want to kind of summarize and kind of double down on what we talked about so people kind of could take away. First of all, if you have this problem, you're not broken. It doesn't work with you. But it's an indicator that something's not about. And the pain you're experiencing is not normal. Surgery is maybe part of the solution, but definitely not the whole story. There's a lot of tools beyond suppressing your hormones, which is what a lot of traditional gynecologist do with all kinds of drugs, including the pill. So I encourage you all if you're having this to work with a good practitioner, come see the Ultraman Center, track your cycles, test your gut, test your hormones, test toxins, get the hormone metabolism test. All these things are really helpful and can really guide a very specific things. And I want you to take away a few things from this conversation. Endometrocysis is real, your pain is real and being told just managing is not really addressing it. Surgery, like I said, can be an important part, but it's not the full solution and hormone therapies can be helpful. But again, they aren't the full solution. We've got to get to the root cause. And that's what functional methods all about. It's what the Ultraman Center is all about is getting the root cause. So we've got to look at the terrain, like Liz said, inflammation, immune balance, gut health, insulin resistance, estrogen metabolism, your toxic load, metabolic health, all that. And if you don't that, you do that. You're missing the big picture. Your body's just not messed up at randomly. It's responding to bad environment and bad signals. And when we change those signals, we can reduce the inflammation. We can help your body detox. We can balance your blood sugar. We can get your microbiome healthy. We can kind of calm down your nervous system. And we basically create an environment that's in your body that's not hospitable for disease. And sort of like you create an environment where disease can't grow basically. And that's not about getting it perfect. This is about understanding that there's consistent small steps you can do. Make a big difference. Eating a whole anti-inflammatory foods. The 10-day detox is great by the way. It's a very powerful way to actually help reduce inflammation. You can support your liver and your gut health. You can reduce your exposure to chemicals like we talked about. You can prioritize your sleep and stress regulation. You can start moving your body that builds more resilience. It's not just one thing. It's a whole systems approach. And that's really what functional medicine is. And yeah, endometriosis is complex. But you have to work with someone who knows what they're doing. You're not powerless. There are lots of tools. There's lots of answers. And there's lots of practitioners who understand this from a root cause-respective. Women often get dismissed in medicine. They get neglected. You deserve to be heard. You deserve to be taken seriously. When you deserve a plan that goes beyond just suppressing your symptoms. It's really about reclaiming your health, but understanding that when your body is supported properly, it has an amazing capacity to get healthy. So thanks for joining us. If you want to find us at the UltraBolinocenter, just go to ultraBolinocenter.com. You can check or we're doing comes to one of our docs to get help. Thanks for joining me for office hours. I love diving into these topics with you. Remember, you are the CEO of your own health. And every choice you make can move you closer to healing and vitality. I want to keep these episodes as relevant and useful as possible. So tell me, what do you want to explore next? What questions are you wrestling with? What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions, and keep showing up for your health. You have a question about my favorite books, supplements, or recipes. Then sign up for my free MarksPix newsletter at drheimen.com/MarksPix, where I'll share all of this information with you and so much more. You'll get emails from me every Friday with recommendations on things that have helped me on my health journey, and I hope they can help you too. Thank you so much again for tuning in. We'll see you next week on the Dr. Heimenshow. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Heimens. Please reach out, I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Heimenshow, wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Heimens for video versions of this podcast and more. We'll see you next time on the Dr. Heimenshow. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guest's opinions, neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the ultra-wellness center at ultra-wellnesscenter.com and request to become a patient. 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