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

Endometriosis affects 1 in 10 women yet it often takes years to diagnose, and many are told their pain is “normal” or simply treated with birth control or surgery. But endometriosis isn’t just a hormone issue—it’s a whole-body condition driven by inflammation, immune dysfunction, gut health, and environmental exposures. In this episode, we break down what’s really causing it and what you can do to address it at the root. I’m joined by my longtime colleague and friend, Dr. Elizabeth Boham, Medical Director and Functional Medicine Physician at The UltraWellness Center. Here’s what we break down: • Why endometriosis is not just a gynecologic condition and the root causes most doctors miss • The hidden role of gut health, inflammation, and the microbiome in driving symptoms • How estrogen imbalance and environmental toxins (xenoestrogens) fuel the condition • A functional medicine approach to reducing pain and preventing recurrence beyond medication or surgery If you’re struggling with endometriosis or unresolved symptoms and want a more personalized, root-cause approach, you can learn more about becoming a patient at The UltraWellness Center here: https://www.ultrawellnesscenter.com/becoming-a-patient/ Visit ⁠functionhealth.com for 160+ lab tests at just $365 a year. Have a question you’d love answered on Office Hours? Submit it here (0:00) Introduction, statistics, and overview of endometriosis and functional medicine (2:27) Introduction of Dr. Elizabeth Boham and explanation of endometriosis (6:10) The immune system, gut health, and their roles in endometriosis (10:29) The gut microbiome, estrogen metabolism, and the 5R approach (16:55) Xenoestrogens and detoxification strategies (22:53) Nutritional supplements and additional detox support (25:41) Surgery and lifestyle interventions for endometriosis management (30:20) Blood sugar, insulin resistance, and hormonal balance (32:11) Prevention and recurrence of endometriosis (33:40) Summary, key takeaways, and closing remarks (38:11) Sponsor: Gratitude to sponsors

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  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, which 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.

• 0:41Dr. Mark Hyman?

  Welcome to Office Hours. This is our dedicated one-on-one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and 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.

• 1:10Dr. Mark Hyman?

  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 are prescribed birth control pills, pain medication, told surgery's the only real option. And sometimes surgery's 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. Not just a uterine condition. It's an inflammatory condition.

• 1:55Dr. Mark Hyman?

  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 and even environmental toxins in your blood sugar and stress and your overall health and terrain 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 Ultra Wellness Center. It's our practice in Lenox, 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, not just managing the symptoms, but addressing the inflammation,

• 2:38Dr. Mark Hyman?

  the hormone imbalances, the whole immune dysfunction that drives it. Because severe pain is not normal and it's not fun. And you deserve answers beyond just trying to suppress the symptoms. So, welcome Liz. Great to see you.

• 2:51Speaker 00

  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, 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, which 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 really comprehensively and systemically and, and ask that question, why? So we can treat our

• 3:35Speaker 00

  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?

• 3:43Dr. Mark Hyman?

  Exactly. Okay. So let's get into it. Like, what is it? Like briefly, like, because it's a, it's a complicated. So briefly tell us, what is endometriosis? Because it's a big medical word. Most people don't understand it. So tell us what it is.

• 3:55Speaker 00

  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 like the fallopian tubes and the ovaries. And so that can impact people's, women's fertility.

• 4:40Speaker 00

  And so it's been associated with infertility. And it also causes a lot of, of symptoms.

• 4:48Dr. Mark Hyman?

  Pain.

• 4:48Speaker 00

  Symptoms from, yeah, 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.

• 5:01Dr. Mark Hyman?

  So basically the lining of the uterus, the endometrium gets like deposited around the abdominal cavity, on your bladder, on your bowel, on your fallopian 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. It's 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, it's really unusual, but it's extremely symptomatic and painful.

• 5:27Speaker 00

  Yeah. And this thought that even 10% of women may be dealing with this. And it's tricky to, because it's, it can be tricky to diagnose. It goes often undiagnosed for many years. And, and, and what we're, 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, it can actually create their own estrogen through this process of aromatase. So we can talk more about that. But that can then create even more growth. And it so becomes often a vicious cycle, as do a lot of things that happen.

• 6:10Dr. Mark Hyman?

  And I'll only think about it as a gynecologic problem, you know, like it's just a hormone problem. And it is hormonally infected, but but there's some evidence that it's an autoimmune disease. Right. Can you talk about how the immune system plays a role in this?

• 6:23Speaker 00

  Absolutely. So we know that 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 and so in as, 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 it because of issues with estrogen metabolism and how we're getting rid of our estrogen? Is it because of 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.

• 7:08Dr. Mark Hyman?

  I find it really fascinating that it's this immune condition because, you know, we think of, you know, the uterus and and, you know, your period is mostly hormonally regulated. But it seems that this this condition is is regulated in a large part by the immune system. And 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 as a root cause of autoimmune and immune dysregulation?

• 7:33Speaker 00

  You know, we're, we always say in functional medicine, start with the gut. Right. Because because so much inflammation and autoimmunity 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 become more problematic. Right. So we we think about the the gut for all of those reasons. We know that there is, you know, women with endometriosis have a two to three times higher risk of having inflammable bowel disease.

• 8:17Speaker 00

  So it's really connected with IBS. Yes, or irritable bowel disease. And we know that women with endometriosis have a higher rate of having food allergies, food sensitivities, non-celiac gluten sensitivity, and even celiac disease. So, so there's a lot of connection. And what I thought was most fast is 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, in the vaginal cervical area,

• 9:01Speaker 00

  that that can be associated with more endometriosis, just like dysbiosis in the gut microbiome is associated with it as well.

• 9:09Dr. Mark Hyman?

  Yeah, fascinating. And, you know, we 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 thinking about like weed, weeds in your garden. And they should, they 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, the, the endometriosis. So do we, do we have any understanding about that mechanism in which, in which the autoimmune regulation, dysregulation from the gut directly plays a role in, in endometriosis?

• 9:52Speaker 00

  Well, well, there's research to show that when there's, there, 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 I'm 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, but that, I think it's, it's a fascinating area and something we can test for, right? We can, we And look at the microbiome. We can look at what balance of bugs somebody has and how pro-inflammatory

• 10:37Speaker 00

  they are and how likely are they to produce this substance called beta glucuronidase? And beta glucuronidase is this enzyme that 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, you know, one reason why dysbiosis is associated, but probably not the only reason. That's for sure.

• 11:01Dr. Mark Hyman?

  Yeah, I mean, that's an interesting point. So basically you've got these certain bugs that grow in there. They 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 reabsorb 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 extra 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 views more growth of these lesions and and then, you know, the whole irritable bowel thing is is all connected.

• 11:46Dr. Mark Hyman?

  And like you said, at Ultra Wellness Center, we do test for these things. We test for food sensitivities. 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 like, there's a real structured approach to actually healing the gut. So can you just kind of touch briefly on on the approach that we use in functional medicine to repair the gut? Because that often can really even help things like endometriosis.

• 12:14Speaker 00

  Absolutely. So that five R approach is is 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 R is remove. And that means you you want to remove foods that are causing a lot of inflammation. So, you know, an elimination diet or, you know, a great diet is Mark, your 10 day detox diet because it's it's anti-inflammatory, it removes inflammatory foods and it also supports detoxification. And so, you know, so that type of a diet, that's part of the remove. And if there is dysbiosis, we need to treat it.

• 12:55Speaker 00

  And so depending on what's going on, you know, what we find, we can treat it with herbs or even prescription medication sometimes. Or or even just things that build up the good bugs of prebiotics, which are phytonutrients and fibers and probiotics sometimes. And so that can help with rebalancing. So remove and then replace that's, you know, if somebody needs help with digestion, re-inoculate, those are probiotics. Repair, those are things that, you know, help to heal the gut lining and rebalance those. That's really just recognizing the connection between the 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.

• 13:40Speaker 00

  So that's that five R approach.

• 13:42Dr. Mark Hyman?

  Yeah, and it's getting very granular. Like I remember learning when I first started doing functional medicine about, you know, food is medicine and certain fibers like flaxseeds like were a thing. And and they really do affect this estrogen metabolism in the gut. And then the isoflavones in soy that doesn't act like an estrogen, it's sort of, it's not fair to say that it, 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.

• 14:15Speaker 00

  Those are great examples, Mark. Yeah. Because because like you said, they do, they're they're working from a couple of angles, right? They're they're feeding the good microbiome, but they're also, they they have, they can, they're they're called phytoestrogens. So they can impact the estrogen receptor and people think or used to worry that that meant they were causing more estrogen in the body. But actually, the opposite is true, right? Because it decreases your own estrogen binding to the estrogen receptor or even those xenoestrogens from binding to that estrogen receptor.

• 14:49Dr. Mark Hyman?

  We're going to get to that next. Before we jump to the toxins and the xenoestrogens, I just, you know, I just want to, you know, explain how in functional medicine, we're so specific and how we think about things and how we treat people at Delta Wellness Center, because it's really different. If you are someone out there listening who's got menstrual issues, cramps, pain, abdominal pain, endometriosis, whether you're diagnosed or not, you know, you're going to get just the standard care, which is here, take the birth control pill, or here, you know, just modulate your hormones with this or that, or we'll put you into premature menopause, you know, that's one of the treatments, which is terrible, I think, treatment. And, and, and there's some granular things we can do. For example, you mentioned this, this weird enzyme that certain bad bugs make in the gut. Well, if you, you can take an antibiotic sometimes

• 15:30Dr. Mark Hyman?

  to kill them, but you can also take a probiotic called Saccharomyces boulardii, 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 very different than what you'd 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, 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 then we're, we're sort of agnostic to disease at the Ultra Wellness 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 to following basic laws

• 16:15Dr. Mark Hyman?

  of nature, the, 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, I mean, I just, you know, treating some of the ALS, and I don't really see many ALS patients, but I was like, okay, well, here's, 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 traditional doctors. And that's, that's why I'm so proud of what we built at the Ultra Wellness Center. So before we go to kind of the next topic, I want to kind of get into the toxin thing. Now, you mentioned xenoestrogens, and this is a big one. Xeno means foreign estrogen. So talk about this idea of

• 16:57Dr. Mark Hyman?

  Estrogen metabolism, xenoestrogens, this whole theory of estrogen dominance, estrogen dysregulation, it's not just about high estrogen, it's some, this whole, 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 for us, Liz? Because I know you're really deep in on this stuff.

• 17:18Speaker 00

  Yeah, absolutely. So xenoestrogens 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, they, they, they impact our estrogen levels in the body. And, you know, it's, we've been learning a lot about this over the years, right? So BPA is kind of the first xenoestrogen we started to pay attention to, that hard plastic. But we know that xenoestrogens are in, in lots of chemicals, unfortunately, in our environment, from, from parabens to phthalates, to dioxin, to pesticides, to herbicides, and, and the

• 18:01Speaker 00

  hard plastics like BPA. And so, and, you know, this is something you want to try to decrease your exposure to as much as possible, but, but we also have to just work on supporting the body's detoxification system. We know unfortunately, that sometimes these exposures to these xenoestrogens happened when we were, when we were in our mom's belly. So when we were a fetus and, and, or 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, but what I always work with, 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

• 18:44Speaker 00

  capacity. And, and, 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 glucosinolates or sulforaphane that are in your cruciferous vegetables because they help you. Yep, exactly. Broccoli, broccoli sprouts, right? Cauliflower, cabbage, Brussels sprouts. They help your body metabolize your estrogen in a healthier way.

• 19:26Speaker 00

  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 glucuronates we were talking about before. We can measure toxin levels. We can look at how the body is metabolizing estrogen.

• 19:49Dr. Mark Hyman?

  Yeah, I think I want to double click on that because this is something very unusual. You know, maybe people heard about poop tests, but you know, one of the most enlightening things I ever learned about as I was studying hormone, 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 estrogens are metabolized. And there's no such thing as estrogen. There are estrogens and they're all different and they all have different roles. And, and we can, you know, do a 24 hour urine collection and we can see all the different pathways that the estrogen is going down, kind of like a, like a pinball machine, whether it's going down this pathway

• 20:31Dr. Mark Hyman?

  or that pathway. And it, you know, there's estrogens that get produced that are very protective and are protective against cancer, other ones that are, 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, 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 when people understand that there, there is hope and help, but it's hard to find. And that's why I think, you know, people need to understand that there is a world of functional medicine that there are clinics like ours at the Ultra One Center that do this kind of work. So let's kind of dive into the second piece. We talked about eliminating, you know, all the household cleaning products, you know,

• 21:17Dr. Mark Hyman?

  For your food, reducing toxic load, makeup. You know, there's a lot of ways and the Environmental Working Group has a lot of great resources, ewg.org on, on how to actually reduce these exposures and I'm on the board, but it's really a great resource. And the second is, um, what do you do to support your body's own detoxification pathways? You mentioned cruciferous vegetables, like broccoli, cabbage, cauliflower. Um, what else can we do?

• 21:42Speaker 00

  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, um, 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, if we're cutting back on protein or not eating enough, that can influence how well we're able to detoxify. So, um, you know, we're really thinking about it from a whole body perspective, uh, you know, regular bowel

• 22:23Speaker 00

  movements, lots of sweating, movement for lymphatic circulation and, um, and drinking sufficient water and good, healthy water, right? All those things are really important.

• 22:33Dr. Mark Hyman?

  Yeah, so important. And I think also, you know, while we, we also understand that there are nutritional supplements that help regulate these pathways, like they can help, you know, go down this, 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?

• 22:53Speaker 00

  My, you know, my favorite supplement is sulforaphane. It's, it's a glucosinolate with moracinase that then in the body gets converted to sulforaphane and

• 23:03Dr. Mark Hyman?

  That's a lot of big words, Liz. I don't know.

• 23:05Speaker 00

  I know.

• 23:06Dr. Mark Hyman?

  Can you break that down? That's a lot of big words. That's a lot of big words. What are you talking about?

• 23:11Speaker 00

  You're looking for sulforaphane. The products will say sulforaphane on them and, and

• 23:15Dr. Mark Hyman?

  It's broccoli in a pill. It's like broccoli sprouts in a pill, essentially.

• 23:19Speaker 00

  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 in my practice. We also think about methylation, you know, methylation is involved in metabolism. And so we will measure markers of of methylation from homocysteine to methylonic acid. And

• 23:50Dr. Mark Hyman?

  What does all that mean? What does all that mean?

• 23:52Speaker 00

  Yeah, all that means is how many B vitamins do you need? And if you do need B vitamins, you need them in a in a specific form that's healthier for you. Cause it's the methylfolate. So it's, you know, you don't want to just go to a regular drugstore and pick up a B complex. You really want to get a, this is where you wanna, 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. It's for some people, it's going to work way better. So that's important.

• 24:21Dr. Mark Hyman?

  And this whole thing of methylation is a key part of detox and many, many other functions. But it's like B six, B 12 folate, and then you can measure these tests, which we do. Homocysteine, methylonic acid, you mentioned, which are better than the regular blood test for folate or B 12 that you get maybe at a regular doctor. And so we can start to really dive deep on what's going on, be personally, we also look at magnesium, which plays a role in a lot of this can be very helpful. So the 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 I think this is a real big one. So we talked about the immune dysregulation. We talked about the gut.

• 25:04Dr. Mark Hyman?

  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 choose 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. That's why like these little kids are eight years old and girls are getting their period because we're living in a sea of of estrogen like compounds that are not actually estrogen, but that are mimicking estrogen and are quite concerning. So let's talk about kind of other things because, you know, This this is there's other things we can measure toxins like heavy metals. We can look at toxin levels and help people.

• 25:44Dr. Mark Hyman?

  But but sometimes people do do need to find out what's going on and surgery may be necessary, but but it's not the whole picture. So can you talk about how surgery plays a role and laparoscopic surgery can help and what what role that plays in the management of endometriosis?

• 26:00Speaker 00

  Yeah, so you know, sometimes surgery is done both for diagnosis, you know, as well as treatment. So especially if 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 if that's an issue. The 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 which is sometimes very important to do.

• 26:44Speaker 00

  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 that, you know, many women will need to go and have repeat surgery or their pain will come back if if we don't do that.

• 27:00Dr. Mark Hyman?

  Yeah. So so basically, you know, you have to still address all those other things, right? You have to address the immune dysfunction, the food sensitivities, the the gut dysbiosis, the toxins in your system, all that stuff has to get fixed. If you don't really change the whole terrain, you know, you do the surgery, but it's not going to solve the problem. It'll just come back. And that's that's a big thing. So there are also just general like lifestyle interventions that as a baseline help with hormonal regulation, you know? I wrote an article years ago, I 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? Like, that's not a design flaw. It's not like God or nature,

• 27:43Dr. Mark Hyman?

  whoever you 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 these fundamental things we're doing that are screwing up our hormone balance. And that there are very simple lifestyle things that can help correct that, not just for endometriosis, but for PMS, for periods, for fertility, all kinds of stuff. So can you break down like, what are the fundamental building blocks of lifestyle when it comes to hormonal regulation and balance?

• 28:08Speaker 00

  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, right? Those xenoestrogens, you're going to get less of the phthalates, 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. You know, that anti-inflammatory, healthy, whole foods diet is, you know, I always love starting with food. So.

• 28:44Dr. Mark Hyman?

  Yeah.

• 28:44Speaker 00

  And then really, yeah, focusing on getting a lot of those phytonutrients, such as the glucosinolates that we talked about from your cruciferous vegetables, that help your body with detoxification and estrogen metabolism. So getting a lot of, yeah, broccoli, more broccoli. But we also, you know, 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, not in the brain, actually in those neurons, right? Those neurons become more sensitive.

• 29:27Speaker 00

  And so, 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 of that pain. So, you know, stress reduction techniques, breath work, activating that parasympathetic nervous system, acupuncture. You know, there are some cool new patches that use infrared technology that, that you can place on the abdomen that can be really helpful for decreasing pain and increasing circulation to the area. And that's, I think, an important area that we need to really focus on as well.

• 30:01Dr. Mark Hyman?

  Yeah, I agree. And I think there's, you know, there's a few special foods like black seeds and soy that can be helpful. You know, when you want to customize it, but I also think that, you know, omega three fats play a big role, which is from wild fish or omega three fat supplements. The one thing we didn't talk about, which is really important, which is a blood sugar and 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 or whatever, have a lot of carbs. They end up, you know, getting loss of the hair on their body. They grow, you know, breasts. And it's like, it's not because, you know, they have some kind of tumor. It's because they have all this fat on their body. So even for women, it's the same thing. Can you talk about that whole connection of

• 30:45Dr. Mark Hyman?

  blood sugar, insulin resistance and how that affects hormones and regulation?

• 30:49Speaker 00

  So, you know, just what you, what, you know, I'll 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, you know, we know that this is

• 31:33Speaker 00

  this is an inflammatory condition and we don't want to just be focusing on the pelvis, right? 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.

• 31:47Dr. Mark Hyman?

  Even things like you mentioned, lowering stress, getting adequate sleep, exercising, all those things help reduce inflammation, help regulate hormones. You know, it's just the foundational principles of a healthy lifestyle. Hopefully people, you know, 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 Travano Center. We have a lot of great docs and. And patients 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 it in the first place? Let's just sort of go through and summarize what we just talked about.

• 32:18Speaker 00

  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, um, you know, so, so we want to think about it as this, as this whole body imbalance. And we want to work to lower inflammation and create good estrogen metabolism and a healthy microbiome.

• 32:59Dr. Mark Hyman?

  So regulate the immune system, heal the gut, get your toxic load down, like get the insulin resistance sorted, support your immune system in many ways, sleep and, you know, stress reduction and exercise. All that stuff is common sense, but it really, really works. I mean, it really does work. So, uh, you know, endometriosis basically thrives in, in inflammation and hormonal chaos in it. And then 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, you know, it's hard for these diseases to, to stay. So that's, that's the good news. So thanks for joining. I just want to kind of summarize and kind of, kind of double down on what we talked about. So people can have a good takeaway. You know, first of all, if you have this problem, you're not broken. There's nothing wrong with you.

• 33:45Dr. Mark Hyman?

  But it's an indicator that something's out of balance 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 gynecologists 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 little wellness 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, I want you to take away a few things from this conversation. First, endometriosis is real. Your pain is real. And being told just manage it is not really addressing it.

• 34:28Dr. Mark Hyman?

  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 medicine is all about. It's what the Ultra Wellness Center is all about, is getting to 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 of that. And if you don't do that, you're missing the big picture. Your body's just not messed up 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

• 35:12Dr. Mark Hyman?

  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, that's not about getting it perfect. It's just about understanding that there's consistent small steps you can do to 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 to build 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 know, you have to work with someone who knows what they're doing. You're not powerless. There are lots of tools.

• 35:56Dr. Mark Hyman?

  There's lots of answers and there's lots of practitioners who understand this from a root cause perspective. And you know, women often get dismissed in medicine. They get neglected. You deserve to be heard. You deserve to be taken seriously and 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 Ultra Wellness Center, just go to ultra wellnesscenter.com. You can check what we're doing. Come see one of our docs to get help.

• 36:29Dr. Mark Hyman?

  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.

• 37:07Dr. Mark Hyman?

  When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest, and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand-selected each and every product to meet the most rigorous standards for safety, purity, and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity or reduce your disease risk, or you're looking to improve your sleep, blood sugar, metabolism, gut health, you name it, drhyman.com has the world's best selection of top-quality, premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out drhyman.com, because when it comes to your health, nothing less than the very best will do. That's drhyman.com, D-R-H-Y-M-A-N.com.

• 37:50Dr. Mark Hyman?

  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 Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. 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 guests' 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

• 38:34Dr. Mark Hyman?

  professional. This podcast is provided with the understanding that it does not 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 UltraWellnessCenter.com and request to become a patient. It's important to have someone in your corner who is a trained licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors.