Endometriosis: Insights Into Reproductive Longevity

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

Thanks so much for having me. It’s my pleasure. Let’s talk about Endometriosis and fertility. Endometriosis is a genetic autoimmune inflammatory condition for which we don’t have 100% of the pathophysiology mapped out. But increasingly, over the last two decades or so that I’ve been in the field, we’ve come to understand that it’s an inflammatory condition—an immune dysregulation condition. Endo lesions are tissue that is similar to but not the same as the tissue lining of the uterus, which is called the endometrium, which is kind of how it initially got its name. We now know that that tissue is distinct, and in a fairly similar percentage of fetuses that have uteruses, female fetuses have endometriosis lesions, even pre-birth. Also the same. It’s like nine percent have endometriosis lesions pre-birth, and 10% of the female population has endometriosis lesions in their lifetime. But it’s a wide-ranging disease in that it can be very, very silent.

There can be no symptoms at all until people maybe discover it if they’re struggling with fertility issues, or it can be extremely painful, impacting 90% of people with endometriosis who also have digestive issues. It’s found not uncommonly outside of the pelvic area. By definition, endometriosis lesions—the little growths of that aberrant tissue—are outside the uterus. They could be all around the ovaries—fallopian tubes on the outside of the uterus. But they’re also generally in the pelvic cavity on the bowel, soft tissue, sometimes uterine, adherence to like the back wall of the pelvis or other areas, other ligaments, other musculoskeletal tissues on the bladder. But it’s also not uncommon for endometriosis to be outside of the pelvis. It’s called extra-pelvic endometriosis. These lesions can also be found on the diaphragm and the lungs. It’s been found inside the nose, on joints, and in musculoskeletal tissue. It’s a full-system disease that’s sort of been mistakenly categorized as a female period pain disease.

It’s a much more subtle system than that, although certainly, it does generate painful periods, sometimes pain between periods. The pain can be regular or irregular, and the pain can be very severe. In addition to some of the other very common symptoms, as I mentioned, digestive symptoms, fatigue, headaches, and anxiety, there is a neurologic component related to the digestive challenges when the gut microbiome is stressed by a disease like endometriosis that impacts the nervous system, which can be related to depression, anxiety, and lots of other things. The most important thing I want to relay here is that endometriosis is a full-body disease. It’s quite common. One in ten women will experience this in their lifetime, and it’s presented very differently across people. Although there are certain very common symptoms that we do see most of the time that kind of put up those red flags for suspicion.

Aumatma Simmons, ND, FABNE, MS

From what you’re saying, it’s very complex. A lot of people have heard so many practitioners classify enemy chests as an estrogen issue, even dominance. I don’t ever see that in clinical practice, so I don’t know where this idea came from that endometriosis is estrogen-related. Can you shed some light on that?

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

That’s a good question. They’re kind of historically seen as an estrogen-driven growth, like how we have some estrogen-driven breast cancers if you will. I do like to think of estrogen as the end of endometriosis and as a cousin of cancer. While it’s not cancerous, it can be predisposed to certain cancers. It is aberrant growth that essentially hijacks the immune system for its good. For these lesions, let’s say you have a lesion on your ovary or your bowel somewhere. The lesion itself produces its hormones. You do have more estrogen, but it’s not because the ovaries are producing more estrogen or even because the estrogen is not being processed optimally, although that often happens in general and certainly for people with endometriosis in many cases. But the lesions produce their estrogen, and they kind of hijack the immune system to create their blood supply and their nervous system supply. We do have to intervene there on a kind of biochemical level. However, there was a study published in Belgium in 2018 that gave us a lot more insight into whether these lesions are caused by estrogen. 

Sometimes the answer is yes. They found that there were four kinds of lesions, somewhere the estrogen receptors were upregulated to more estrogen receptors on those lesions. In some cases, it’s more progesterone receptors. In other cases, it’s both kinds of receptors. In other cases, it’s neither one. These four different kinds of endometriosis lesions in terms of hormone receptor upregulation can exist within the same woman. You won’t know what kind you have until after they are removed if histology is done, so that’s somewhat useless information. But it does kind of make sense clinically in terms of what we see in terms of women who respond to hormone suppression therapy. About 30% of women who respond have some symptom reduction or relief from taking something like hormonal birth control, which is an estrogen suppressant or Lupron, or less, any kind of general agonist or antagonist. These medications actively suppress estrogen, and they can be helpful to some people in the short term. Now, it does not do anything to cure Endo, but it can be a symptom-suppressing short-term, and in certain countries and even in the US, that can be valuable when, for example, it might be a year to two years before surgery could be accessible.

For someone who can’t afford endometriosis, excision surgery, or someone who doesn’t have access to it, is on a waiting list, or whose insurance won’t cover it until they do X, Y, or Z. There are reasons why we may want to suppress symptoms temporarily, and that’s where that comes from. Sometimes, that’s helpful. It’s not always helpful, and it’s not a cure, but it can be helpful in some cases. Similarly, it can be helpful to make sure that the body is metabolizing and processing, or detoxing if you will, any excessive estrogen or progesterone hormones in general, which are processed in two ways: through the bowel or the liver, both with less exposure to xenoestrogens, which are like chemical estrogens, plastics, and plastic water bottles, wearing plastic flip-flops, and plastic clothing. We know that a lot of exercise brands have a lot of microplastics that are absorbed through the skin, especially when you’re sweating. Avoiding those exposures to environmental toxic estrogens and then making sure that bowel function and liver function are optimized can mitigate the risk of excessive estrogen contributing to the problem. But it’s not the cause of endometriosis. Is that helpful?

Aumatma Simmons, ND, FABNE, MS

That’s super helpful. It just helps to shed light on what is a common misconception around endometriosis and potentially supporting the liver and the bowel as a part of a strategy around how we support women with endometriosis to make them feel better, but then they’re also struggling with fertility. Let’s get into the fertility side. From your experience, what’s the biggest impact of endometriosis? Why is it so negative for fertility?

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

A couple of things. One, endometriosis itself impacts egg quality, probably because of immune dysregulation. An inflammatory environment over the relatively long term. There could be other reasons that we don’t have documented yet, but egg quality can suffer in endometriosis, which sort of narrows your reproductive window, if you will, or shortens the reproductive window. shortens the ability of any given fertilized egg to become a healthy birth baby. We want to optimize egg quality to mitigate that, focus on that, and even have a conversation early on with women about endometriosis around egg freezing. Also, we do know that endometriosis excision surgery lowers a sort of autoimmune response postoperatively, and the research has been going on for about a year. In my experience in my practice, we can extend that window. 

I published a study. The case study used Vulvodynia as the model, but it’s the same kind of issue pathway physiologically that we were able to extend that window for 22 months. In all cases, it’s not to say that the window shuts at like a year or two post-surgery or post-immune regulation. It’s just that, at some point, you have to publish the paper. He’s following the case, but immediately post-excision there’s an impact on autoimmune antibody levels. Essentially, this is a reproductive immunology problem, not so much a reproductive endocrinology problem. What we need to do with endometriosis is do everything we can to regulate the immune system so it’s not essentially attacking the fetus, which happens somewhat normally with pregnancy. It helps to kind of shift the immune system to be less autoimmune in many cases. But the more we can do to optimize gut microbiome health, lower inflammation, regulate the immune system, and make the immune system less irritated by anything, by doing things like gut lining, healing, and nervous system regulation, because when the brain is activated and stressed in any way, from emotional stress to too much sugar to too many chemicals, whatever, that gets the immune system on high alert.

Those couple of things we can jigger, we want to optimize air quality with particular antioxidant nutrients, things like CoQ10 and N-acetylcysteine. There was a great paper that just came out—the first version of it a few years ago and the kind of second version of it the last few months—showing that N-acetylcysteine taken at a dose of 600 milligrams three times a day, just three days a week, because of that pulse dosage, was found to be more effective for three months. Although, again, I don’t know why you would necessarily stop at three months, except you have to publish the paper at some point. so to support both egg quality and to stop endometriosis lesion growth and proliferation, or at least try to slow down that process. There are a few other nutrients that support that as well, such as pick notional, which is older data. But I use that a lot clinically. What you want to do is both regulate the immune system and support egg quality, DNA quality, and ovarian function. In our practice, we’re also starting these peptide bioregulators, which have less data and are still sort of in the early stage of being used for this purpose. But it’s something that we’re going to use more and more on the horizon.

Aumatma Simmons, ND, FABNE, MS

Tell me more about what peptide bio-regulators are.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

These are just tiny proteins, or not even proteins or peptides. Peptides are just smaller chains of amino acids. Amino acids are like, if you think of a protein, a line of Lego blocks, or amino acids are the Lego blocks. They’re the little molecules that come together and form a protein. Those are about 50-ish amino acids. If you have tinier ones that are like five or ten amino acids, those are called peptides. These are peptides that, essentially, you would get in your diet, ideally from organ meats. I don’t know about you, but I don’t eat a lot of organic meat, and most of us don’t anymore. This is a strategy for getting organ support in almost a naturopathic way, sort of homeopathic way that likes for like support. utilizing peptide bioregulators for the ovaries in particular, but also the pineal gland. One of the problems with endometriosis and fertility challenges, in general, is that the circadian rhythm and the menstrual rhythm can become out of alignment due to stress on the nervous system. We also want to use strategies to calm neuroinflammation. We have a lot of well-evidenced strategies for that, such as things like turmeric or curcumin, fish oil, which is also valuable for pelvic pain, and then helping kind of re-nourish, if you will, using small peptides. The various organs are related to reproduction, everything from the hypothalamic pituitary adrenal access to the hypothalamic-pituitary-ovarian axis thyroid function.

Even as I was talking about before, the liver processes the hormones as well. The different peptides are related to supporting the nourishment of these different organs. The other thing that can be helpful is that we do see it used in about 12% of patients with endometriosis when you look at survey data. We don’t have clinical trials, but women are just finding this on their own and reporting it to be successful, and we’re using it clinically in our practice too. Post-op from excision surgery or if people choose not to have surgery, which is also fine in many cases, but there is a strong role for at least considering excision surgery, especially when we’re talking about protecting fertility. It’s a conversation that I like to have as early as possible with clients to see if that makes sense and have them explore their surgical options because we have strong data that’s valuable. But either way, enzymatic support. For endometriosis in particular, using Serrapeptase is what 12 or so percent of women with endometriosis report as being helpful for pain management. But what that’s doing is kind of breaking down scar tissue inflammation related to scar tissue because those lesions are messy; they’re like little fires, and so they leave sticky tracks. If this is all around the bowel or the ovaries, I like to use various enzymes, Serrapeptase is the most evidence-based, but it can also help with things like bowel motility, ovarian function, and fertility.

Aumatma Simmons, ND, FABNE, MS

To summarize, guys, in terms of conventional options, excision surgery is kind of the most commonly recommended approach. You feel like it does have enough evidence to be supportive of fertility that it’s worth at least considering or looking into with each person and of course every person. Every person needs different things. But in general, it could be very useful.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

One key thing to think about with excision surgery is making sure you shop around for a surgeon who has done a lot of this like it’s a surgery that requires real robotic skill. It requires the ability to observe the disease. The more experience they have, the better. There are more and more surgeons who specialize in this. They also have advanced techniques for trying to mitigate, like post-op adhesions, that make it less necessary to have more surgeries in the lifetime we want. The fewer, more effective surgeries, the better.

Aumatma Simmons, ND, FABNE, MS

I want to get into maybe a little bit of something around staging because that’s another big area that people are like, well, I don’t have any pain, but that doesn’t correlate. Can we talk a little bit about what is at the meeting? Is the staging done, and how does that happen?

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

Endometriosis staging is determined by how extensive the disease spread and severity are on observation. But you’re exactly right. It doesn’t necessarily correlate with symptoms. Someone can have stage one endometriosis, which might be just one or two lesions and one or two areas, and has significant pain because it depends on where those lesions are and what structures they’re irritating. If you have an endo on a nerve or your lung, even if it’s just one lesion, that could be a huge problem. then you could have stage four, which is all over the place, and larger endometriosis lesions, more cysts, and things like that. zero. One to four are the stages off the top of my head. I can’t remember the decision points, but that’s essentially what they’re looking for. How extensive is the endometriosis when it’s visualized by the surgeon?

Unfortunately, at this time, that’s the only real way to diagnose endometriosis. It can be seen on imaging, in some cases MRIs or ultrasounds. If it’s there, it’s there, but you can’t rule it out by just imagining. The only way to truly rule it in if they can’t see it on imaging is to do an excision or laparoscopic surgery. The surgeon’s skill becomes important in identifying and finding hidden endo, so you could have extensive stage four endometriosis in multiple locations, multiple kinds of lesions, and no symptoms. that’s rare. A lot of times people will have less classic symptoms, like maybe they’ll only have bowels and symptoms that they didn’t know were endometriosis. They didn’t have period pain, if you will, or they didn’t have sexual pain, or they didn’t have pain with bowel movements. If you have pain with bowel movements, period pain, or pain with intercourse, those are the more classic symptoms of endometriosis, but they’re not always symptoms.

A lot of times the first symptoms, especially for younger girls, eight, nine, and ten, the other kind point about estrogen is that often symptoms do begin to present once girls are in puberty or pre-puberty, so roughly ages eight to 12, which is another reason why it’s like, oh, estrogen is involved, but it’s more because of how estrogen feeds the flames of inflammation and gut microbiome dysregulation. That’s the reason why the staging has little to do with the symptoms because sometimes the symptoms are just hard to recognize. They’re vague. Endometriosis co-presents with things like dysautonomia and muscle activation syndrome. If you have blood pressure regulation issues, heat sensitivity, rashes, hives, or slow digestive motility, you don’t immediately think of endometriosis in most cases, especially if you don’t have period pain. That’s why it can be hard to relate staging to symptoms.

Aumatma Simmons, ND, FABNE, MS

With endometriosis in particular, I’ve heard anywhere from three years to nine years to have someone figure out that this woman has endometriosis. Are there any clinical pearls or any tools that you have that you’re like in the back of your mind when someone comes to sit with you and you’re like,  she has? Is there anything that triggers that for you?

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

First of all, the data shows it’s 12 years even now to diagnosis, which is a little better. When I started doing this in 2000-ish, it was 15 years. It’s been a long time. Here are some of the chronological red flags. One is early digestive issues; someone’s been to all the GI doctors, and they can’t chalk it up to anything except maybe SIBO because that co-presents with that. No, very commonly for obvious reasons, because right. If endometriosis grows in the bowel, there’s a little area where pathogenic or dysbiotic bacteria could certainly proliferate because it’s just a slow little area in the tunnel where there’s food and slow movement. That’s where microbes like to thrive. SIBO, when that’s when the symptoms kind of begin in middle school or high school with the periods, that’s a good sign, especially if it’s digestive. If it comes to things like anxiety and fatigue, people with endometriosis will often experience some moments sitting in a school bathroom with their heads on the toilet, trying to cool off. That’s a common experience of heat sensitivity because there’s such a relationship to mass cell activation. 

A lot of times, I find people who are quite high-achieving can mask it. It’s like they have to take a day off here. But they begin to be tolerant of pain in general. It’s not that they don’t experience it; it’s that they experience it so much that they learn how to kind of power through. Then they get a lot of adrenal dysregulation. They sort of hit a crash at some point when they’re not able to keep showing up. In my experience, that looked like things like when they’re trying to prepare for law school, they just can’t show up for that test no matter how much they want to, or they’re in high school and they’re trying to make a softball team in college or something, and they’re just struggling to show up for the practices. There’s this overlay of being able to push through very difficult, uncomfortable physical sensations and then, at some point, just not being able to overcome that. They were able to do it for ten years, and then they just hit a wall. But that’s kind of the general constellation—some kind of menstrual pain, sexual pain, bladder pain, pelvic pain—even if it’s not cyclical. 

It tends to be less cyclical in the younger years because, of course, the menstrual cycle is not so established and is then exacerbated by things like stress and a high-sugar diet, especially in someone who has also started restricting their nutrition plan kind of subconsciously. They’re like, I can’t eat this, I can’t eat this because they have sort of some intuitive knowledge that some of those things are irritating to them, which is not always accurate in terms of exactly which foods, but they know something is bothering their pain related to their digestion. As I said, it often presents more as digestive issues than as period pain in the teen years because the period is not established. It’s not consistent. Sometimes the pain is masked by birth control for a long time, which again has its place. But it can delay diagnosis.

Aumatma Simmons, ND, FABNE, MS

Thank you so much. That helps because a lot of women are going to hear this and be like, that’s me. I’m hoping that the women out there who have been suffering for a long time hear this and are like, Finally, it’s like some answer. 

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

There’s so much we can do. Sometimes, bringing awareness to it feels overwhelming. I’ve had a lot of clients feel like they go through a real emotional period of mourning when given this diagnosis. It’s kind of like if you get any diagnosis that you feel badly about, it’s just hard to give yourself the emotional and mental health support to take that in. On the one hand, it’s good news to have discovered it because then we have a series of tools to help people live very fully and very healthily. A normal, healthy lifespan and healthy fertility can be challenging, depending on when they’re discovered. If someone doesn’t discover this until their forties, it can be more difficult than if they’re in their twenties. But it still helps us to mitigate and optimize health-related quality of life for decades. But it’s an overwhelming diagnosis, and in fact, she’s spoken about it in public. I feel like it’s fine to share, but my colleague Dr. Iris Orbuch, who is one of the leading endometriosis excision surgeons in the world, just discovered herself. She had endometriosis, and she’s 48ish. 47, 48. She didn’t know she had it. It’s challenging. Don’t beat yourself up if you’re like, I can’t believe I did that. She didn’t figure it out until she figured out her daughter had it. It is because of that genetic component. Her daughter has also written pieces that you can Google and look up about her experience. But that takes the pressure off women. Look, you didn’t do anything wrong. Like one of the people, one of the people who knows this disease inside now had it herself her whole life and didn’t figure it out until her late forties.

Aumatma Simmons, ND, FABNE, MS

That’s incredible. You mentioned that there are so many things that we could do, so let’s break down some of the strategies that people can use if they have it or think they have it. I’m with you. I feel like knowing for sure helps us make sure that we’re creating a plan or a strategy that incorporates dealing with all the different layers of endometriosis because it’s not one thing. You started this talk from the beginning with the idea that this is a multifaceted disease that affects so many different systems in the body. We have to address all of them. I’m curious if you have some guidance around reproductive longevity strategies or things that people can do to start healing from this condition.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

In my institution, the Integrative Women’s Health Institute, our motto is don’t chase symptoms, optimize systems. This is so important in endometriosis because it is a multi-symptom, multi-system, highly diverse presentation experience. The first thing I do with a client is sit down and talk through her health experience in her life up to this point. Very often we’ll see things like little times when something was triggered, like maybe they got mono as a teenager, or more recently, I have people who have COVID post-COVID where things are back and exacerbated, or maybe when they were eight or nine, they started having digestive issues and they were on a lot of acid-suppressing medications or fibers or constipation medications, or this issue got worse when they started having sex or when they started having sex with a different partner, which can change the microbiome of that, not just the gut, but of the vulvovaginal region, the urogenital region. There are these little triggers where symptoms get exacerbated or where the symptoms get bad enough because it’s still a bit of a myth. That period is still sort of a bit of a common assumption that some period pain is normal.

Aumatma Simmons, ND, FABNE, MS

We say that again, which is indeed normal. It’s like, I feel like we couldn’t say this enough.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

Your hormonal right to get rid of it is not normal. It’s tricky because mild cramping is occasionally okay. But any pain where a person has to miss school or work for even one day every quarter is a red flag. 

Aumatma Simmons, ND, FABNE, MS

Or take medication to get through the day.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

Get through it. We’re not talking about, like, one morning, Advil. We’re talking about it all day. You’re kind of like you went to work, but your brain wasn’t there because it was very distracted by your body.  You were taking medication every four hours. That is something that people just don’t know isn’t normal because it’s so common and it’s not always endometriosis. But the identification of this story is an important place to start. I listen to the story because the presentations are different, and for some people, the digestive part is a driver. For other people, anxiety, fatigue, depression, or a kind of neuro-inflammation or neuro-gut dysbiosis. Communication is the bigger driver. We have to start with the nervous system. In most cases, we’re starting with the nervous, immune, and digestive systems from a system-based approach, which seems funny because you think this is a reproductive disease. 

We should be talking about hormones like we’re the hormones. But because most of the women that I see with endometriosis are under 50 if we get neuro-immune digestion and then also musculoskeletal system because if you have a growth of an abnormal tissue somewhere on your bowel, your bladder, your ovary, or anywhere, even your diaphragm, your lung, your body is going to like to liquefy the growth of something like in my neck. I would start doing this, and you would see how much pain that could cause. If I did that all the time, my jaw would be irritated. My shoulder or my upper spine, and then my hip, like it’s all connected. There’s a lot of myofascial pain that also needs to be addressed related to endometriosis. Those are like the four key systems.

Then, when you get those aligned, the hormone piece regulates itself. Or if it’s been a long time and someone’s trying to expand that reproductive window, then that’s when we think about things like peptides or even low-dose immunotherapy, which some of my naturopathic colleagues will do to kind of support health. It’s essentially a homeopathic strategy to support healthy hormone levels. This is in women who have endometriosis and are now perimenopausal or menopausal because sometimes adding hormonal replacement therapy to endometriosis is challenging. If you have those hot flashes and endometriosis, estrogen replacement therapy is not always your best bet because it’s a little bit like adding fuel to the fire in certain cases. 

That’s where it’s also a little tricky, even to do the peptide bioregulators, because sometimes turning up and strengthening that system can bring back some of the symptoms if the immune system and nervous system are not optimized. What are then the strategies? One: is nervous system regulation, which is a lot of stress awareness, what are the stressors? We have all of our endocrinology patients wear an HRV tracking watch. How is their sleep quality? What are their routines? The bowel, the hormones, and the brain love routine. What’s the morning routine? What’s the sunlight exposure routine? How are we in the darkness? Getting up in the morning and having some exposure, turning off blue light, and anything we can do to improve heart rate variability, is an objective measure of stress because stress is not just emotional stress; it’s also biochemical stress. lowering toxins, slow breathwork, looking at exercise, is it more nourishing or is it too depleting, or are we doing a recovery strategy?

Use mindfulness practices regularly, not just when the symptoms are most problematic, and even connect like there’s a lot of work I do with my clients around having the nervous system feel safe. Signals of safety. I like to think of it as one of my colleagues, and I used to call it cashmere blanket therapy. What a lot of people need is just someone to help out with their day-to-day responsibilities for a little while. That sensation of being swaddled in a cashmere blanket and eating like a grounding, nourishing soup, things like mushrooms, roasted vegetables, anti-inflammatory herbs, and spices, or if it’s summer, maybe a smoothie bowl or something like that. Then that grounded, nervous system sensation. That’s how we’ve played with it. There are lots of different things that can do that. There are a hundred different ways you can make your nervous system feel safer. Some people do need trauma, release exercises, somatic work, and things like that in the hands of a skilled trauma therapist. 

All people who work with endometriosis need to be traumatized and informed because there is a lot of medical trauma, gaslighting, and birth trauma, even when women with endometriosis get pregnant. so that has to be integrated. nervous system regulation, which in and of itself will start calming the system. Sometimes that helps the pain without doing anything. then the second level is eating for immune system nourishment, which is its highly variable, but anti-inflammatory diet, which can be anything from raw vegan to kind of Mediterranean to paleo, or in some cases, a short-term carnivore diet. I don’t think that’s sustainable, but you could think of it as a steroid shot for a few months and supporting with the micronutrients, the polyphenols, and things like magnesium for good bowel function enzymes, as I talked about for both digestion and absorption of nutrients. 

Sometimes we need to do temporary work. Nutrients, although I find that fresh, pressed fruit and vegetable juices are well absorbed and blended into soups. Soups are well observed for people who struggle with bloating and belly pain, which is CIBO or CFO. I don’t do even a short-term low-fodmap diet because, in my experience, almost orthorexia is very problematic in endo. We do a lot of work to help expand the nutrition plan by making foods easier to digest. We should eat whole foods as much as possible, eliminating processed foods and less sugar, dairy, and gluten. There is an interesting thing in Endo. There’s an older study that talks about how more dairy over time has a lower presentation with endo. But my thought on that is that probably people without dairy just eat dairy and tolerate it better because they don’t have digestive issues. 

I don’t feel like eating dairy prevents it, which is kind of the wrong conclusion for that study. dairy because it’s inflammatory, and many people are taking a break from it, which can be helpful. But by and large, I don’t like a lot of limitations.  For some people, dairy, gluten, and sugar are the only things that I eliminate relatively long-term. Then we kind of do this on a case-by-case basis, thinking about how well people break down and absorb nutrients. Then we utilize supplemental support for stabilizing lesions, things like N-acetylcysteine and Pycnogenol. Then we talked about pain management and everything from curcumin to fish oil to aspirin mediators; pelvic floor physical therapy is essential or occupational therapy for myofascial and also people not just going to PTOOT and like getting treatment but learning about how their pelvic floor muscles can relax, have the capacity to hold tension, how they relate to the hips, and how we can move. I like people to have a lot of autonomy about calming their nervous system through relaxation strategies for their musculoskeletal system that they can certainly do in a clinic and have the power to do at home any time they need it. Like right before sex, right after sex, or in the morning, they wake up stressed. When we take that systematic physiologic systems approach, I  find we can unwind to the root cause.

Aumatma Simmons, ND, FABNE, MS

It’s amazing. That’s such a great overview of where people can think about starting because it is, it’s, it’s overwhelming when you realize, like, I might have this. love it. Thank you so much for sharing. If people wanted to work with you, where would they find you?

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

The website for our institute is integrativewomenshealthinstitute.com. We’re also on Instagram @integrativewomenshealth, and they can certainly send me a message here or just email our support team [email protected]. We have professional-level training through our end-domain trust certificate program, and we have one that is open to people with endometriosis as well because very often they are more knowledgeable than their physicians in a lot of cases. that’s available. However, I also work one-on-one with clients with endometriosis as my schedule allows. Sending a note to that support email is your best bet for getting that scheduled.

Aumatma Simmons, ND, FABNE, MS

Thank you so much for being with us today. Jessica. This is super informative, and I’m very grateful that you’re able to spend time with me today.

Jessica Drummond, DCN, CNS, PT, NBC-HWC 

It was great to be here with you, and thanks so much.