Endometriosis- What’s Really Causing Your Endometriosis with Leah Hechtman – #14

0:27 Charlene Lincoln: Welcome back to another episode of Fertility Hour. Today, we have Dr. Leah Hechtman from Sydney. Today, our topic is endometriosis. Dr. Leah is working on her PhD studying the effects of endometriosis. Well, maybe you can be more specific about that. But she’s an expert in this subject so I am looking forward to picking your brain about this.

Leah is an experienced and respected clinician who specializes in fertility, pregnancy and reproductive health for men and women. She has completed extensive advanced training as a university lecturer, keynote speaker, author and educator to her peers. She is also a regular media spokesperson for her profession. Leah leads by example, remembering to live life to the fullest and believes that ill-health is merely a stepping stone to help you reclaim your true state of being.

Welcome, Dr. Leah. Thank you so much for being here.

Leah Hechtman: Thank you for having me. It’s a pleasure.

1:47 CL: So Dr. Iva Keene who I partner with and who is part of the Natural Fertility Prescription speaks so glowingly of you and so once I started looking at your work, I was like, “Oh my gosh!” This woman is brilliant and compassionate and has helped so many people in this, I think it’s safe to say, a pretty complex medical condition that’s affecting so many people.

So I took some time, I was listening to a previous interview where someone was asking you why isn’t there more research on endometriosis and you were discussing challenges in study recruitment and you were saying that you were finding that almost every woman has some endometriosis these days. Can you discuss that a little bit further?

LH: Absolutely. Just to give you a background for the listeners. So we’re looking at study recruitment for one of the studies I’m doing at the moment and we’re trying to get a control group. If you look at women between the ages of, say, 25 and 40, how are you going to make sure that they don’t have endometriosis without doing a laparoscopy? And we’re at the point where the control group is really not exactly a control group because it’s highly probable that the statistics are suggesting that almost all of them will have some mild endo.

The theories around that are that we’re all having kids much later. So, is endometriosis actually just a reproductive homeostatic mechanism in a way? Because we’re having kids later and we’re not exercising our uterus the way that we used to when we were having kids at 18, 19, 20, 21. A woman that delays having her kids till in her late 30s, the uterus hasn’t been exercised in the same way so the peritoneal fluid, the fluid that surrounds the uterus and obviously the whole abdominal area hasn’t had the opportunity to change itself. There’s lots of theories around it. I think it’s quite interesting scientifically. Clinically, it’s alarming but scientifically it’s very interesting. Obviously, I mean I had my kids late in life. I’m not against it. But I think we need to think about our women in a different context because of that.

4:07 CL: Are there still women getting misdiagnosed at this point?

LH: Absolutely.

4:14 CL: They are? Wow. Why is that?

LH: I still have the horror stories of the women coming in and they run me through their symptoms and it’s everything you can imagine. They’re just being told to have hot packs and Panadol, pain relief of some description and just “Suck it up, you’ll be fine.” Then they get told the miraculous comment of “Just have kids. You’ll be fine once you have kids,” which we now know is just rubbish. I guess it’s unfortunate because the laparoscopy is the gold standard so obviously we want to delay surgical intervention for as long as possible. But I don’t think that women are listened to. I don’t think that the severity of endometriosis is acknowledged. There are certainly lots of jokes around the medical community about if a male had endometriosis, what would they be like? And the reality is, is that men would not leave home and they would not do anything. Incidences worldwide of endometriosis of women is enormous and it far exceeds conditions like diabetes, but the research isn’t there and the medical acceptance and the medical acknowledgement of it isn’t always there as well.

5:28 CL: Wow. That’s impactful that it far exceeds diabetes. When you put it into that scope, really, it isn’t acknowledged, is it? When women are going to their practitioners and they are describing a set of symptoms, is the diagnosis of endometriosis coming up or is it “yes, you might have endometriosis but just deal with it with the over-the-counter prescription” type of thing? That’s what I’m understanding. Do they think, “Oh, this woman possibly has this but she needs to just deal…”? That part’s confusing for me.

LH: I think there’s a bit of both. I think there’s a lot of “Oh look, you’re a woman. You have period pain. Deal with it. And you’ve got IBS”, as opposed to “You’ve got digestive symptoms because you have endo. And you just have lots of urinary tract infections and you have thrush. So you just have lots of things. But they’re not actually endometriosis, and suck it up.” Or, “You have, yeah, you probably have endo but if you have babies, it will get rid of it.”

6:36 CL: I see. I’m thinking a woman listening today and she has not been diagnosed with it but she has IBS, she has like you said thrush, painful periods, things like that. I hope that kind of puts that lightbulb in her head to explore that further, that diagnosis. Because as you say, it can all be segmented. You have five different things and not knowing that it’s all related to endo.

Let’s discuss endometriosis and fertility. The fact is when women with endometriosis can and do get pregnant but what are the concerns, the limitations? Where is it where they only can do IVF to get pregnant and some practical advice around that?

LH: Look, it’s all about the staging and the grading of the endometriosis and I look at it as well as the multi-systemic involvement. So let me just backtrack. You can have a woman that has minimal pain but severe endometriosis that she doesn’t even really realize what’s happened and she can take a very long time to conceive. Then IVF ends up being her only option because the IVF is right through her reproductive cavity to the point where her ovulation ability gets compromised or other variables. Or you can have a woman where her pain is significant but the endometriosis is mild. That’s where endo is not clear and when you look at that research and they talk about the pain awareness and the pain perception of endo in women, there’s not a direct correlation. There’s not a direct “you have distinct pain so you have distinct endo” and some of it relates to the neurological fiber involvement, the severity of it, your genetics. Lots of other variables will influence it. So it’s very tricky for us to go “Okay, you have endo and you have infertility.” It’s not exactly that clear.

The unfortunate thing is if you have a laparoscopy, there is a definitive diagnosis. But then there’s the recovery from the laparoscopy and so endo women are more prone to developing adhesions which is abnormal scar formation which then grows endo. So you want to discourage the laparoscopy as much as you can but obviously, in some situations, it is needed. So once you have the diagnosis and they have their “cleanout” as they lovingly put it, where they have the surgical scraping and everything, they do have increased fertility. So there’s benefit to it in some situations. But to bring it back exactly to your question, it’s just one of those situations where we have to investigate thoroughly and we have to ask lots of questions and really understand each individual woman to understand her fertility impact.

9:26 CL: You’re discussing laparoscopy. That’s the gold standard as far as diagnosis. Is that the only diagnostic tool that’s used?

LH: Look, I think it comes down to clinical skill and this is not myself, it’s just, you know, over 20 years of practice you get good at it. I can pretty much always work out who has endo and their severity based on a lot of clinical questioning. So it’s going through all the systems and asking the things we talked about. The UTIs, the thrush, the painful intercourse, and the painful intercourse based on deep penetration or friction. The women that get hot flashes before they have a period. The women that get all sorts of progesterone insufficiency signs before they have major PMS because their balance of hormones is out. That’s really clearly diagnostic.

Certainly in Australia and I know around the world but the terminology is different. But in Australia we do an advanced ultrasound with a bowel prep. So you do a normal women specialized sonography ultrasound where it’s internal on the abdomen. But they also do a bowel prep so you do like a bowel flush like you’re having a colonoscopy and they have specialized equipment that they can detect the endometriosis a lot more carefully. Physical examination by a gynecologist can sometimes diagnose it depending on where it is. There are certainly some blood parameters. A controversial one is a CA 125 which is technically a cancer antigen marker but it is a marker of reproductive inflammation. So if you have a woman who has an ultrasound that’s inconclusive but an elevated CA 125, absolutely she’s going to have endo. But if she has an ultrasound that has, for example, a fibroid or a growth of some description and an elevated CA 125, it could just be related to the fibroid. But if a woman has a CA 125 and it’s high, I always know that there’s reproductive inflammation, so it pretty much guarantees it for me that it will be there.

Other diagnostics, you’re starting to get into more functional screening. So you can look at various immune markers and cytokines and things like that and it can give you clues. But the others are the better diagnostics.

11:45 CL: Thank you for that. Let’s discuss the link between poor thyroid function and endo. Is there a link and does poor thyroid function trigger endo or is there no direct correlation?

LH: The thing with the thyroid gland that I always respect is it’s incredibly rare to have the thyroid function be poor. The thyroid under function or over function is usually a secondary response of the body to something else. Because it’s one of the glands in the endocrine system, the endocrine system has this very clever ability that when one is out, the other goes out. So if someone has poor thyroid function, they probably have reproductive imbalance of some description. Or if they have reproductive imbalance, it will affect the thyroid. Additionally, to that, the iodine which we know is the building block for two of the main thyroid hormones is also very heavily required by the ovaries for ovulation and very heavily required for optimal uterine function, so there is a direct link in that regard. But women that have endo, because of the level of inflammation in their body, they tend to start pushing all of their other endocrine glands out, be it their adrenals or their pancreas or their thyroid. There’s just like a domino effect that tends to occur unfortunately. So I see it all the time and it may not be full-blown underactive thyroid. It might just be subclinical underactive thyroid because the thyroid has to overwork to assist in some of the other regulatory roles.

13:23 CL: I would assume always the thyroid, like you said it’s always going to be affected. So is that a very important part of the treatment, is to get that thyroid back in balance?

LH: It’s not my primary thing that I address, assuming if the thyroid is correlated with it, and let’s say it presents, like if a woman presents and she’s got Hashimoto’s thyroiditis and she’s on a thyroxine or equivalent, in that situation they thyroid is a definitive condition in its own right. If not, if I fix the endo, I’ll fix the other irregularities in the thyroid just by treating the endo.

14:00 CL: Just for our listeners in the US, you had said iodine but you have a very nice accent and you said it in some other way. Just so if you were like, “I don’t know what she said,” it was iodine in the ovaries.

LH: Sorry.

14:13 CL: No, don’t apologize. Just I wanted to clarify that. In a previous interview you discussed diagnosing and treating bugs as part of the endo treatment. Please explain that and what are bugs? Viruses or parasites? Please specify.

LH: It’s certainly a clinical area of clinical practice that I’ve changed how I support my endo women. If you saw me 10 years ago, my endo treatment is very different to how it is now. What I’m realizing more and more is that I think that endo is, as I’ve mentioned, a multi-systemic disorder. I don’t think it’s just gynecological anymore. I think it is the interplay between the reproductive system and the immune system, and that interface of that interplay directly occurs in the peritoneal fluid. So the peritoneal fluid for our listeners is the fluid that surrounds all of your abdominal area. So it’s the fluid that washes over your digestive organs, your reproductive organs, your bladder, etc. And that peritoneal fluid contains very important components of your immune system. If the peritoneal fluid itself has any imbalance, it causes disease and disharmony. We now know that endometriosis travels and is developed by imbalances in the peritoneal fluid. So what I now understand as well is that the peritoneal fluid can harbor infections and it can also be a response to an infection that might be in the digestive system or that might be in the bladder that made and aggravate or amplify or cause the endometriosis.

So what I’m realizing now is that system-wide infections, be it viruses, bacteria, parasites, whatever, are exacerbating and sometimes causing the endometriosis. So what I’m doing now with women is investigating their immune response a lot more intensely and that test that I alluded to earlier, that cytokine, that are looking at specific cytokines which, for listeners, is basically just looking at the immune system in a very detailed manner. And I’m looking at it and seeing imbalances or fluctuations in those levels can be quite a diagnostic tool for me to go “Okay, that person is actually dealing with a parasite or that person is dealing with an underlying virus.” That’s where my treatment needs to focus and by re-stabilizing the immune system, I can pretty much always get endometriosis under control now. It gets very complicated and very detailed the more I go.

16:46 CL: Yeah, definitely. I think because you have that deeper understanding and I’ve looked at it. Is that becoming more and more common that practitioners in the functional world are looking at endo as a systemic condition versus just a reproductive condition? What’s the landscape?

LH: Look, it depends on where you’re looking. if I speak to any of my colleagues, there is certainly a lot of people that are still looking at it purely reproductively. I think that the research around the benefit, let’s say, of probiotics and so the understanding of the microbiome within the uterus and the influence of that I think has been accepted for a lot longer but I think that the leap into the infective trigger, I don’t think it’s that widely accepted yet. It’s the holy grail of research where research has been trying to identify the exact change in the immune system that causes endo. And I don’t think that there is one change because I can show you a hundred papers that show all sorts of different cytokine abnormalities but it’s not all exactly the same. But what I do know is that there is a cytokine abnormality and each person will show me an individual translation of that and development of that.

18:06 CL: You are an individual in functional medicine. How do you assess it and treat it versus I guess when someone goes to just a conventional practitioner?

LH: The first port of call would be that a person would see their gynecologist, and the gynecologist management is still pretty much all pain relief, symptomatic relief and hormonal manipulation. So they’ll say go have a contraceptive pill, go have the progesterone-secreting IUD (the Mirena). And then I start escalating the interventions of prostaglandins and various steroids and different things in that regard. But it’s all about recognizing that endometriosis has a direct correlation with estrogen and it’s about regulating that estrogen, which absolutely still occurs. But when you go deeper into it, the estrogen itself feeds the bugs and so there’s this lovely dance between elevated levels of estrogen or increased levels of estrogen concentrated in the reproductive area which is endo, increasing the immune response, increasing the bug proliferation, which increases a histamine reaction in the body which is, again, another immune reaction, which increases the estrogen. And it just goes round and round in circles. So the conventional gynecologist looks at it purely in the estrogen context but what I would encourage people to do is look at the immune and the reproductive at the same time. Because I think that you miss things otherwise.

Like a patient I saw yesterday who unfortunately is now at the place where she’s had both of her tubes removed, she only has IVF as an option. She’s a 40-year-old woman that’s been trying to have a baby for over 9 years now and the only relief of her endo has been when she’s been on the pill or the Mirena, and she’s now at this point where she’s like, “Well, I want a baby. I’m going to need to do IVF. What do I do in all those situations?” And that medical model of suppressing her hormones is not an option because she wants a baby. So that’s where the other areas actually get a lot more supportive and not just blocking it.

20:13 CL: I was going to say for our audience who are trying to conceive, I mean obviously, what you’re talking about, going to a gynecologist, being put on an IUD or birth control pills, that’s not going to work.

LH: Yeah. All they end up doing is giving them pain relief management, surgical intervention to remove the endometriosis. But it doesn’t change why is the endometriosis there. So they have the surgery and it’s back within 1 to 2 months. And then they’re back at square one or worse because they’ve got adhesions, that scar tissue formation development from the surgical incision and then they’re just in this horrible cycle of, well, how many surgeries can we have without ruining our uterus and preventing implantation. And they’re just stuck – they’re just stuck in a horrible cycle and then unfortunately a lot of these women get to the point where they go, “I’m just not going to have kids because my quality of life is so poor, so I’ll stay on the pill or I’ll have a hysterectomy.” And that’s what this 40-year-old woman yesterday was told. She was told “Get pregnant as quickly as you can and then have a hysterectomy.” How is that a solution? Do you know what I mean? It’s just so drastic.

Look, if someone reaches that point, absolutely I respect it and I understand the difficulty around making that decision but surely there has to be something else. The body is too clever. It doesn’t say just remove and all good.

21:35 CL: I would imagine a woman at 40 who’s had endometriosis for many, many years, it’s going to affect that overall success of the IVF procedure. So saying that, I mean, I think it’s quite cruel.

LH: But there are other options and that’s why doing a talk like this is great and the message that you guys are getting out there is great because there are other options and there are other ways that women can help themselves. It’s not just about that. And please don’t misunderstand me. Gynecologists are brilliant and I have enormous respect for them. It’s just that their toolkit, that’s what they’ve got.

22:15 CL: Obviously, it’s not to disrespect anyone in the medical profession. It’s just I know in the United States people kind of have hit a wall. We have as far as like acute trauma type care, we have superior medicine. But chronic illnesses? There’s a deficiency and that’s where people are searching out naturopathic physicians, people who are practicing integrated medicine. And we wouldn’t need all these different types of practices if the conventional model is working in these types of conditions. It’s just not the reality.

Now this is interesting and I hope I’m not incorrect but I think it was a colleague of yours in the doctorate program who was looking at causative factors of endometriosis and started looking at high prevalence of sexual trauma in women who have endo. Talk a little bit more about that if you can. What were the numbers on that? It’s quite high, it seemed.

LH: It’s over 80 percent which is huge, huge. When you look at that and then when you look at the first statement which is that it’s probable that most women have some endo, it can’t be 100 percent of women have sexual trauma. But I do think that it’s pretty much everyone that I’ve ever worked with that has come in with severe endo has had some situation or some sort of sexual trauma of some description. I’ve never met anyone that hasn’t. I find that alarming, concerning, scary, all of that. But the research around that is very conclusive and I don’t know what I make of it. I’m very connected to the concept of mind-body medicine as well and the idea that our body stores traumas and stores emotions and everything. There’s certainly a correlation on physical level with the bug exposure from sexual contact and we know that sexual contact with a partner that is consensual but not necessarily enjoyed or not fully consensual, your chance of getting STIs and all that sort of stuff is going to be greater. Your chance of having a reaction against it is greater. We know of the emotional links with thrush and self-hatred and self-anger as being there. The question is there: Is endo correlated with some sort of challenge of sexual expression? Is it correlated with some traumas around it or some blocks that women experience? I think it’s something to think about. There’s definitely trauma around having endo and having trauma when you’re experiencing sex because it’s painful. Is that part of it? I don’t know. I don’t know. I think it’s something that women if they’re open to it should look at and certainly discuss it with someone.

Again, I was talking with another patient yesterday. Any of the assessments that a woman experiences has absolutely no semblance of sexual pleasure compared to a male going through the trauma of a semen analysis, for example. That’s where the conversation was. But a woman, it’s a very vulnerable thing to go through all the investigations and the surgeries and the ultrasounds and all that sort of stuff. it can exacerbate a woman’s experience and she can express that through her reproductive organs.

25:35 CL: I just wanted to clarify further because if someone was listening to this and said, “I haven’t experienced sexual trauma.” I guess we should define it a little more. It’s any time that sex has felt unsafe, right? It’s the perception of being violated. It doesn’t have to be raped or where someone was molested as a child. There’s a lot of gradients of sexual trauma.

LH: Absolutely. But certainly as well the most severe endo patients I’ve ever worked with have all had major childhood sexual trauma. But that doesn’t mean that that’s a diagnostic.

26:17 CL: Estrogen dominance is shown to be a factor and you were talking about the thyroid that you’re not focusing on that. But how do you work with estrogen dominance? Is it progesterone supplementation or what’s your tools and strategies around that?

LH: Just a little caveat. I don’t call it estrogen dominance because I look at it as though it’s estrogen “loving”. You tend to have two types of women so you have the women that are very thin and don’t have a lot of body fat on them but they can still have endo, but there wouldn’t be classified as an estrogen-dominant person. Versus the woman who has a lot of curves, enlarged breasts, hips, that sort of thing, and she wouldn’t look visibly as though she has more estrogen dominance. In both situations I see it as how much estrogen the body concentrates and where they displace it too. So you can have like a jar full of estrogen and you can have 75 percent of it in the uterus and that would be the exacerbation of endo. Or you can have 150% of the jar and have too much estrogen. I think there are various versions of it but I tend to see more that it’s very directly related to a woman’s weight. So if a woman has any extra body fat on her, she is storing more estrogen which tends to exacerbate, how much the estrogen is systemically.

The treatment for both is similar but different. So the thinner woman, you need to move the estrogen around the body as opposed to stop the estrogen. The other woman that certainly has more weight on her, she doesn’t have to be obese or anything, just a few kilos or pounds, she certainly needs to move the estrogen but she needs to get her body fat percentage under control because otherwise she’s got this estrogen that’s constantly feeding things.

I think the most important for both women though is to avoid exposure to synthetic estrogens. So environmental pollutants, plastics, to avoid exposure to heavy metals and things like that because they tend to exacerbate it. Then there’s the controversial soy debate and so what I tell women is to remove soy from their diet and then we can test it later on because soybean, a phytoestrogen and a very powerful phytoestrogen, I don’t want them to add more estrogen to the fire, be it a natural one or a synthetic one or a plant-based one, I don’t want to add anything to it. So I do spend a lot of time talking with women about environmental exposures and where they come from and that’s the whole detox process.

29:00 CL: How do you know where estrogen is concentrated? Is that through like a saliva test versus a blood serum test? How do you know that it was primarily concentrated in the uterus?

LH: Look, the saliva and blood piece, I’ll get to in two seconds, if that’s okay. In endo women it’s concentrated in the uterus because that’s where the endometriosis is. So it’s just where is the endo. So if it’s around their bowel or their bladder, then you know that estrogen is concentrated around there and certainly across the board you know that the estrogen is concentrated in the peritoneal fluid.

With the saliva and the blood, they’re not very good diagnostics for estrogen status. Blood is really only a few percent of what’s circulating at the time. It’s certainly not the bowel could be the estrogen in the body. Saliva, you can certainly get fractions of estrogen, so look at how it’s converting into its different forms which I find helpful. You can do urine tests to look at how the estrogen is converting and if there are elevated levels as well. I tend to not use the test so much because I prioritize others and then I’m just looking at cost balancing for people. But if people are comfortable to “Yeah, it’s interesting”, but my discerning valuable is always does it change my treatment – and it doesn’t. So if I do an estrogen fraction in saliva, is it going to change how I treat? No.

31:03 CL: We were talking about estrogen dominance. What types of foods exacerbate endo? You’re talking about soy obviously is something that needs to be avoided.

LH: I find dairy from A1 milk is probably one of the most concerning. So A2 milk where the casein molecules are a little bit different. The A2 milk I don’t find as problematic but A1 milk I do. I do find that the more vegan a woman is, the better it is. It doesn’t mean everyone has to be vegan but I do find that dairy in particular causes an enormous amount of increase in inflammation. Meat tends to aggravate some women but it depends. If they get organic meat that hasn’t had hormones and different things, they tend to be better to respond on it. Some women do react to gluten. There’s a lot of conclusive data around that looking at gluten and its role. But it’s not something that I take every woman off. Also, sugar tends to aggravate. But I think that the sugar involvement correlates directly with the immune system, so if they have too much sugar then obviously they’re exacerbating things just by inflaming the virulence of the bug.

32:21 CL: Sugar never helps, I guess, is the conclusion.

LH: Yeah, that doesn’t really help anyone.

32:29 CL: You were mentioning the A1 and A2. I’m not familiar. You were saying a smaller casein molecule? Is that something in Sydney that you can find at the store? I’m not seeing that. I might have but it’s not common.

LH: It’s not that common. It is hard to get but you can get it in the States. In Europe they don’t have to worry about it. So it’s looking at the type of cow that produces the milk. So all European cows are A2 milk. This is where I can have a patient that can have Italian cheese or French cheese and they’re fine but they react to Australian cheese. So it’s the difference between a Friesian and a Jersey cow. In the States you have a lot of A2 milk naturally so it depends on where you are. But I think it’s just about getting people to have a look where they are in the world and what their access is. But in Europe, they have nothing to worry about at all. But it’s just very interesting when you start looking at the different type of cow because certainly in Australia they brought out the wrong type and so now they’re tried to replace it and the level of inflammation in the body is quite different. So we’re just looking at the protein component within the milk and the difference between the breed of cow and how that impacts things.

33:44 CL: Going back to the estrogen question, you were saying that you don’t focus on estrogen per se but I just wanted to kind of ask a secondary question about the low estrogen. You’re saying you don’t like to call it estrogen dominance. Was that term “estrogen loving”? Was that how you said it?

LH: Displacement.

34:07 CL: Oh, displacement. I’m sorry. I was like, “Oh, that’s kind of cute.” Estrogen loving. That’s like warm and fuzzy versus dominant. Okay. But just to kind of follow up with that. You can also have low estrogen as well with endo.

LH: With estrogen? Like the blood tends to have low levels? Is that what you think?

34:37 CL: Yes.

LH: Absolutely. This is a total head mess with women because they’ll get a blood test and it will come back and even if they go through an obvious cycle sometimes as well, the estrogen doesn’t pick up that well. But they have endo and they’re like, “Well, how does this work?” And really, it’s just looking at it that the blood level is not a very good reflection and all that estrogen is concentrated in the areas where the endo is.

35:01 CL: You can go online and find quite a bit of information about endo and there’s dietary recommendations and herb recommendations and everything else. Is there kind of a safe general herb that you can recommend to people and feel okay, pretty much everyone with endo can use this and it will help with the inflammation, etc.? Is there anything?

LH: I think dietary forms of herbs, absolutely. Because when you’re getting into let’s say capsules or extracts and things like that, they’re getting very concentrated and people might have medication that they’re taking and there might be an involvement. But I think dietary ginger and dietary turmeric are phenomenal. The research around turmeric and its role as an immune modulator, as an anti-inflammatory agent, as an antioxidant is astounding, and women can make themselves those turmeric lattes where they slice up some fresh turmeric and have some almond milk and some cinnamon in it and sliced ginger. Or in that way they get the fat from the milk and so they absorb it more readily. But I try and encourage women to have like a heap teaspoon of powdered organic turmeric every day whether or not they have it in a glass of water or they put in in a latte or they make a Dal or they put it on the rest of the veggies, however they can get it in. It’s very powerful at really relieving a lot of symptoms and everyone feels better from it. It’s a very simple, easy thing that you can do.

36:35 CL: There’s one bit of I guess misconception about turmeric. I mean turmeric is used by many cultures and it’s supposed to be a very powerful herb. But there are some herb companies that say that the bioavailability of turmeric as a food by the time it goes through the digestive system, very little actually reaches where you need it to. Because I’ve used turmeric-type capsules for pain relief in my practice and people are like, “I eat it,” and I was like, “Oh I don’t know if you get enough of it that way.”

LH: You don’t get as much as you would in a capsule, absolutely. The capsules are extracting a particular phytochemical, the plant chemical and concentrating it to the equivalent of eating like a kilo of a root sometimes. You’re not going to get to that level but you’re certainly not going to do any harm and provided that you have the dietary turmeric, it’s organic so there’s no pesticides and things that you’re competing with. You have it with some form of fat. Your ability to absorb it and use it is much more efficient. But it’s definitely not going to be as effective as a concentrated capsule by any stretch.

37:43 CL: There’s a lot of articles about endo. I know people are just frustrated. They go to their conventional doctors or whoever they’re seeing and they feel like they’re still really suffering so I don’t fault anyone for going “Oh, this article says to take maca, bee propolis, systemic enzyme therapy, pycnogenol, progesterone cream, DIM. Maybe I need to do some biofeedback. Or maybe I can just do the whole lot and just kind of bombard my body.” Is there any issue with that type of self-treating? Say, you have like stage 1 endo and you’re just trying to do some natural therapies on yourself, is there kind of blind spots to self-administering treatment and herbs and things like that?

LH: I think you can make a real mess. So if you’re just a stage 1 endo, tidy up your diet. Make it really clean. Tidy up your environment. Get rid of all of the exposure to different things that will exacerbate your endo. Stop using tampons. Start using sanitary pads or menstrual caps just to reduce the chemical exposure that’s going into your vagina. Just start making some changes and very mild endo, you can really turn around quite quickly. Because if you start taking DIM for example and you’re only mild endo, you’re going to make a huge mess. You’re going to push yourself into menopausal types of symptoms depending on the dose that you take. The average person, they generally want to help themselves but too much of something can really make a big mess. A lot of people are allergic to bee pollen. A lot of people have reactions to propolis. A lot of people, if they start doing progesterone creams, there’s a reason why progesterone is not accessible around the world as readily as it is in the states, because you can really make a big mess.

I think it’s important that with something like endo, you recognize the impact of a condition like this and you seek some assistance from someone that knows what they’re doing. I think do all the dietary and lifestyle stuff that you can on your own and you’ll be surprised how much improvement you’ll make. It’s slower but you will definitely make improvement. But taking all those other things, you can make a real mess.

39:54 CL: Thanks for clarifying that. Have you received patient feedback on using things like meditation, biofeedback, etc. making a difference in dealing with this condition?

LH: I definitely do. I think that giving yourself the skills and the tools for pain management is vital. Like any of my endo women when they do go through labor, they always say to me, “Look, the endo taught me. I can do labor with no drugs, I’m fine. That was nothing.” I think that the self-talk and helping themselves work through their pain when they do experience it is very, very powerful. But also their mindset because a part of endo that no one really talks about is the emotional impact both from experiencing it, the debility to your life and the pain and things like that. But also, the chemical changes that occur from endo in your brain is very depressing. To have that much estrogen in your uterus can make women feel like they’re going through menopause, like they can experience all the dryness and the low libido and the lack of life, enthusiasm and all that sort of stuff. So they kind of don’t know what’s going on. They get very introverted and very reclusive and no one validates it. So the meditation and the positive self-talk and empowering yourself internally is very powerful and very important.

41:21 CL: You described women with endo as brave.

LH: Very. I think they’re the bravest women out there and I think that the women that have endo, again, they go through childbirth and it’s a blip because what they go through on a daily basis is phenomenal and I really hope that by doing talks like this that we get the message out there that their experience is as dramatic, as impactful as all of the very long-term chronic conditions and it needs to be understood a lot more. There needs to be a lot more research in this area and women need to be respected a lot more because their experience and their quality of life is very poor. A very severe endo patient has very poor quality of life and I think we need to be a lot more compassionate.

42:09 CL: How can people find out more about you?

LH: They can go to the website. So there’s a lot of information there. There’s a lot of articles. The website is Naturalhealthfertility.com. So there’s a lot more there. There’s all the social media things as well, if they want to have a look at all that, but there’s heaps on the website.

42:27 CL: Okay, great. Kind of the foundational tip you gave was the number one thing is the diet. Correct? You were talking about like using turmeric in your diet. Is there anything else kind of like a practical tip somewhat generally that you could leave us with?

LH: Absolutely. I think the first thing is about women feeling that they have more control with their body so that they have strategies in place to help them manage their pain, be it using heat packs. There are those fantastic things that you can get from… I think we get them from Korea here. They’re these stickers. They’re literally like a hot pack that they can put on their belly but it’s a sticker. Having things like that at their disposal so that they’re not at the mercy of pain relief medications. I remember when I was early 12-13 years of age, I had an accident with peppermint oil and I realized that peppermint oil if you apply it your belly, the essential oil like a hot water bottle and relieves the nausea and relieves a lot of the digestive symptoms of endo. Little practical things like that can make all the difference because it makes them feel like they have strategies to manage it. Really seeing their body as giving them signs – it’s out of balance, it’s inflamed, it’s not happy. Eat well, nourish your body. Listen to it. If all your body feels like it can manage that day is soups and broths and stews and slow-cooked foods, then that’s what you need to do. Don’t force it into a perceived diet that you should be eating because that’s what’s healthy. Eat what your body is telling you at once. Have the dialogue there and really nourish it. The biggest thing that women need to really focus on is moving the blood because the TCM language which I know you’re very well-versed in, the blood stagnancy component should never be underestimated because if we get the blood moving in the reproductive area through diaphragmatic breathing, through exercise, through heat applications, through blood-moving foods and herbs like the turmeric and the ginger and cinnamon, it displaces and moves everything really, really beautifully. And it’s a very empowering thing that women can do on their own. They’re having a bad endo day. As much as they want to sit in fetal position in the corner, try and move your body if you can. Have a hot shower. Have a heat application. Use the essential oils. Move the blood through your body and it will relieve a lot of the discomfort.

44:50 CL: Thank you. That was so helpful. Thank you so much for your time, Dr. Leah. I have so much gratitude for what you are doing and helping so many women. Thank you so much. Thank you for your time as well.

LH: Of course. Thank you.

45:07 CL: Have a wonderful rest of your day. Thank you. And if you liked what you heard today, we have so much more wonderful content. Please subscribe. Can I ask you, can we have a part 2 at some point?

LH: Love to.

45:24 CL: Okay, great. Because I know you’re so knowledgeable. I’d love to pick your brain on another subject. Thank you, Dr. Leah. Thank you so much. Bye-bye!