Period Pain Relief for Endometriosis, Adenomyosis, and Hormonal Imbalances | Dr. Jolene Brighten

Period Pain Main

Dr. Brighten: Okay. You play my eye.

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eye. Makeup. Okay. Yeah. Okay, let's go. Okay.[00:00:00] 

Up to 90% of teens and 80% of adults experience period pain, yet most are told this is completely normal. Let me be clear, period pain is common, period pain that debilitates you and wrecks your life is never normal. Do you know that research shows up to 20% of women experience pain severe enough to interfere with their daily life?

That means missing work, missing school, unable to go to social functions, pain that can bring you to vomiting so you can't even eat in your day. And most of these cases are being ignored. In fact, many are gaslit by their doctors and left with two options, birth control, or hysterectomy. And that ends today.

Welcome to the Dr. Brighton Show. I'm Dr. Jolene Brighton. I'm board certified in naturopathic endocrinology. That means I'm an integrative hormone doctor. And in this episode, we're breaking down what could actually be [00:01:00] behind your period pain, how to identify the root cause, what you can do about it beyond birth control and hysterectomy, and how to advocate for better care with your doctor.

Now we've been trying out the Ask Dr. Brighton segment. So at the end of the show I'm gonna take some of your questions and answer them here. Please leave your feedback. Let us know if you like this, if you want more of this, if you want us to do it differently. I'm always open to your feedback and I ask a very small thing of you, wherever you're listening right now, can you click through and leave me a review reviews, help listeners learn about the show, but also understand what they can get out of the show.

And it helps us get this information everywhere. So if you've already left a review, you are a subscriber, you are sharing this and cheering me on, I feel that love and I really, really appreciate it. So thank you so much. Now I wanna get into why we still see Doctors gaslighting women about period pain.

So there was [00:02:00] a large cross-sectional study that actually found that 80.9% of women report menstrual pain with many describing it as severe enough to interfere with daily life. Daily life. Okay. So like just being able to function day to day in teens, that number jumps to 90%. And this is where we get the narrative.

Like, this just must be normal. And I'll tell you, as somebody with endometriosis and adenomyosis, I really wish someone had told my teenage self like, this is not normal. I'll share a little bit more about my story, but I, you know, I think we've gotta start normalizing conversations around what is happening behind closed doors in doctor's office because.

Despite period pain being so common, so prevalent, and women seeking out help, they're often told, this is just how it is. Welcome to being a woman. Like your body hates you. So the [00:03:00] best thing you can do is either shut it down or cut out the parts that are causing the pain and that is problematic. In fact, like I will tell you my story now, so I actually ended up on the pill at 14.

I had horrendously painful long periods, like more than seven days of bleeding. So painful. I would vomit, I would miss school. I would be just hugging a hot water bottle and it wrecked my life and I counted it down every single month because it was the worst thing plaguing me. My doctor. Then after a few years of that was like, Hey, here's the pill.

It'll also give you great clear skin. We fixed your period. Fast forward 29 years later, secondary infertility, and we finally figure out I have endometriosis. S everybody told me period pain was normal. And everyone told me the only thing to fix it was birth control. And of course, if you read my book Beyond the Pill, you know, I found another way.

And then when I had secondary infertility, nobody even thought it could be endometriosis because they were like, you don't have period [00:04:00] pain. Yeah. ' cause they did a lot for my nutrition, my lifestyle. And I was fortunate enough that my body responded to it. No one should have to go 29 years. And the reality is, is that most women with endometriosis are going a long, long time.

Nobody should be told to suck it up, that the pain is normal and that the only options are to go on birth control and eat pain meds. Those are not options. When there is nothing else being offered to you, it's the only thing being given to you. So that's why in this episode, I am gonna break down what we should be looking at and what we should be doing about it on our own and what we should be asking our doctor.

Four.

Whew. I'm so hot.

Oh, and by the way, right now as I'm talking to you, I'm entering my second trimester of pregnancy, so the silver lining on that story. And, uh, I will say that for a podcast another day. I wanna talk to you about why does period plane happen in the first. Place. So there are three primary buckets we need to look at when someone is having period pain.

And if you're someone being, you know, there's always somebody who comes in is like, period. Pain is normal. Having a little bit of discomfort is normal. Girl, that is not what we're talking [00:05:00] about. Stop pretending. That's what we're talking about when we're talking about period pain that causes women to go to the doctor.

We're not talking about mild discomfort where you need a little back massage. Okay, so I just wanna be really clear. Ah, it's actively disrupting your life. So the three buckets we need to look at, prostaglandins, these can be a problem for anyone. And the fix is simple. So stick around because we're gonna discuss more of that.

Two is structural issues and three are hormonal imbalances. So these can be imbalances in several hormones. Um, it's not just ovarian hormones. It can be much more than that. So we're now that, okay, now that I've gone over those three, let's go, let's go one by one. Into each of these to help you understand them better.

So prostaglandins are hormone like chemicals that make your uterus contract very good thing for shedding the menstrual blood, right? The menstrual tissue as well, which is the endometrial lining. Like we need to contract that muscle. [00:06:00] Uh, but when it's, and this also helps with having a baby, it's also why everybody poops when they have a baby, because prostaglandins don't care what muscle they are going to aggravate.

Uh, but stimulate. So when you have potent prostaglandins, which are made from omega fatty acids, we'll talk more about why that matters. You get severe cramps, you get nausea and period poops or diarrhea. And so and so also, there's no shame in in if you poop during pregnancy, it's normal because those prostaglandins go high and they gotta get a baby out.

But without a baby around, we shouldn't have the high super potent prostaglandins because those also equal inflammation and more pain. Now when it comes to structural causes, I brought up endometriosis. Um, that is something that I struggle with and I have several episodes I will link to. I also have a free guide at dr brighton.com/endo flare, and it has a list of recommendations to help [00:07:00] combat the most extreme period pain.

So it's helpful for everyone. And it also walks through nutrition supplements. It even has a tons unit protocol, which is, um, it, it's a unit that stimulates, uh, your nerve so that you get out of pain. Uh, so that again, [email protected], DRBR igh htn.com/endo flare. You can grab that. Those tips in there also work for adenomyosis, or depending on where you are in the world, you might say adenomyosis, which is how it's spelled.

So it kind of makes sense. But in the United States, we say adenomyosis. So structural issues like. Uh, fibroids, adenomyosis, endometriosis, cervical stenosis, um, there's a lot of ISEs going on in my language there. These can often go undiagnosed or misdiagnosed. Endometriosis, if you don't see a specialist, odds are they're not gonna catch it because they're like, endo is just period pain.

But with endo, you're also having pain. Uh, you can have pain with bowel [00:08:00] movements, pains with urination, pain with sex, pain around ovulation. You can also have anxiety, GI symptoms, and because those tissues can be anywhere in your body, you can have other weird symptoms going on. Now, that third bucket of hormonal imbalances, we can see issues with too much estrogen relative to progesterone happening during your luteal phase.

There can be issues in your detox capacity, how your body's running, its detox. So once you. Don't need your estrogen anymore. It goes to the liver. Liver packages, it up, moves it out. Your gut and your kidneys gotta get it all the way out of the body. So if there's issues in those systems, we can also see that there's issues with estrogen, progesterone, and then thyroid issues.

Hyperthyroid and hypothyroid are associated with painful periods as well. And in some people, uh, having insulin resistance or polycystic ovarian syndrome, we can see painful periods show up, but painful periods are [00:09:00] not a hallmark symptom of PCOS. Now, if you know the root cause, that changes everything.

Okay, so let's talk about how to figure out which one of these apply to you. And what great doctors will do is they will bridge your information, your experience of living in with, in your body, with lab work and imaging and their clinical expertise to understand what is going on if your doctor doesn't care what your symptoms are.

Red flag. So I wanna help you partner with your doctor by talking about what to track, what to test. But we need to talk about something that so many women have experienced, but rarely name it until already it's done damage. And that is medical gaslighting. So I said at the top of this, we are gonna talk about medical gaslighting, and I want you to understand it because pain is one of the [00:10:00] top things that we are gaslit about.

So gaslighting is when someone manipulates you into questioning your own reality and your experience. And in a medical context, this often sounds like, girl, it's just stress. Your labs are normal, so you're fine. You're like, no, I have symptoms. I'm on my death bed. How am I fine. That's some gaslighting.

Other things you might hear is like, women just have a low pain tolerance. Women are just weaker. Uh, when it comes to period pain, like what, where, where's the, and you're at the same time you're gonna say evidence-based medicine to me. Like, where's your evidence for this? And then this one I feel like is almost ubiquitous in women's medicine.

Have you tried losing weight for real? I have pain in my uterus, in my rectum, down my thighs, in my low back. And you're just like, have you, have you tried losing weight Jo on with that? So. I want you to know though, when you hear [00:11:00] that long enough or from multiple doctors, you may start to believe that you are the problem, not your pain.

And that's not just frustrating, but it's actually dangerous. I mean, there is research showing that like women go to the ER and die of heart attacks and strokes at higher rates because doctors are like, it's just a little headache. Oh, you're just having anxiety. Like be for real. A recent survey revealed that 93% of women feel dismissed when seeking medical help.

That's like almost a hundred percent. That's ridiculous. That highlights how pervasive the issue is in healthcare. We're, and this isn't just period pain. This is like literally anything you go to the doctor for. And when you start to consider things like the, in the realm of autoimmune disease, which predominantly affects women, again, there have been studies showing that 62% of patients reported being labeled as chronic complainers by their doctors.

So not only do doctors gaslight us, but then they put really [00:12:00] bad things in our charts. Like they're con, they're just chronic complainers. They have malingering, they're uh, you know, drug seeking things that are like not true, but the doctor has a bias and they're putting labels on us. And that is really dangerous because when that lives in your chart sometimes that's all the next doctor and the next doctor the next doctor sees.

Now, as we were talking about endometriosis, you know, this is a condition that's estimated to affect one in seven women of just reproductive age. It doesn't go away just 'cause you stop cycling, but the average time to diagnosis can be as much as 10 years, sometimes like seven years. But that's still a long time.

And alarmingly, 90% of those with endometriosis feel dismissed by their doctors during their diagnostic journey. Hi, it's me. I've been there and as much as I'm like. Wish I didn't have that experience at the same time. I'm like, well, it really does fuel the work that I'm doing. [00:13:00] Uh, so a lot of this can be chopped up to medical misogyny.

And medical misogyny leads women in pain.

So there was a recent paper called Medical Misogyny Leaves Many Women in Pain, that was the actual name of the paper. And in the first sentence they said their conclusion, which was doctors are too often dismissive of women's symptoms when they present for treatment for reproductive health conditions such as endometriosis, adenomyosis, and heavy menstrual bleeding.

Yeah. So why do I say all of this? Because I want you to know you're not alone. And if you've internalized. The medical misogyny, if you've internalized the narrative, um, that you are just somehow broken, it's a you problem, but it's not a real problem. If you have been gaslit, I hope this starts to like snap you out of it.

And certainly if you are a black woman, disabled woman, neurodivergent women, you face even higher rates of medical gaslighting [00:14:00] with delays in diagnosis, sometimes spanning years above your counterpart. So just really understand me. You are not the problem here. If you are being dismissed and unheard and gaslit about things, you are not the problem.

Medicine is the problem. Doctors need to be trained better because what happens when women get dismissed? When we're dismissed? Okay, so like I had four miscarriages, three frozen embryo transfers failed and so many tears and mental health struggles because of infertility. But for other women. The misdiagnosis or no diagnosis of endometriosis, adenomyosis, fibroids, PCOS.

These may just masquerade as period problems, but without proper investigation, they go untreated. With PCOS, we're looking at cardiometabolic diabetes risk factors rising with endometriosis [00:15:00] like you have. The longer you go, the deeper it becomes. Deep infiltrating endometriosis can then start affecting organ function.

Now these also happen to present as symptoms that doctors reflexively prescribe the pill for. So, uh, failing to investigate the cause of their patient's symptoms because the algorithm somehow goes, uh, doc, I have period problems. Okay. Do you wanna have a baby? No, not, not yet. Okay, fine. Go on the pill. If and when you do wanna have a baby, we'll deal with it then.

And then you find that you have deep infiltrating endometriosis, or you have such progressed polycystic ovarian syndrome with diabetes that getting pregnant is almost impossible. And that's just the pregnancy part, right? There's so much more to living life than just having babies say that as someone who's pregnant right now.

And so, you know, and I, I don't wanna be dismissive of the fragility journey because I know it's hard and I've definitely been there, but I do think it's incredibly [00:16:00] problematic that medicine always reduces us to our fertile capacity. And just being like, whether or not you want a baby will dictate how much care you get and how quality the care is.

That's bs. Now the other thing that happens is that when you're being told your pain isn't real, this can lead to anxiety, depression, even PTSD like symptoms. You begin to doubt your own body and you start feeling self betrayal. Um, so literally being gaslit, living with chronic pain, chronic pain in general.

It leads to mental health issues. Okay? But being gaslit by your doctor and dismissed only compounds that. So if you are experiencing severe pain and your doctor's only answer is take the pill, or it's all in your head, that's not care. And that's not, that's, that's neglect. Okay? You deserve hell of a lot better.

And you deserve a provider who is curious and thorough and willing to go beyond the seven minute protocol of pumping you outta your office. I'm like, I don't wanna sound like I'm bagging on [00:17:00] doctors. 'cause it's a systemic issue. And it's an, like, insurance has designed this issue of pushing doctors, um, into these seven minute co uh, consult.

It's not something that your doctor intended to ever go to medical school just to like pump you out the door, right? Like, just to run a mill of patients. So anyhow, with, with that rant done, let's talk about like the symptom patterns, what you should track. So that you can take this data to your doctor and advocate for yourself.

I will give you scripts on advocating for yourself. So first thing is, when does the pain happen? Is it your period? Is it around ovulation? Is it with sex? Is it with bowel movements? Like when mark that down, how long does it last? Are we talking about like shooting pain that lasts like, you know, five to 10 minutes?

Are we talking about a deep ache running down your thighs? And sometimes that's going for days on end. Does pain med, do pain meds? Touch it? What alleviates it? What have you tried? What works? What doesn't work? If you're experiencing pain with sex, is it deep penetration or is it just at the [00:18:00] start effects?

That can be really helpful to know. Is it throughout your cycle or is it only certain phases of your cycle? Is the pain going somewhere else? So I talked about radiating your thighs. Is it going into your low back? Do you get nauseous? Like what are the other symptoms that accompany it as well? And how does it impact your daily life if you can't get out of bed?

You cannot go for a walk. You cannot exercise, you cannot go to school, you cannot go to work. You're not functioning. That's a red flag for your doctor and that can get you attention fast.

Now, with period pain, sometimes doing labs is helpful as in blood work, and sometimes it's less helpful looking at A CBC, which is a complete blood count, and a ferritin can be helpful if you're having heavy periods as well. So we see if there's anemia present. Looking at a CRP C-reactive protein, which is a marker of inflammation, can let us know like, is inflammation driving this?

Do we have maybe an autoimmune [00:19:00] disease going on? Is something else happening

Now, not all doctors will run an estradiol and a progesterone. I do this five to seven days after ovulation. If we guess that ovulation is day 14. This is gonna be from day 19 to 21 of your cycle. This can help us understand are there imbalances in these hormones, and we also wanna look at A TSH free T three, free T four thyroglobulin antibodies and um, TPO antibodies to see if we have a thyroid issue.

And then vitamin D can also be helpful. So I told you a little bit about like, why do we wanna look at some of these labs? I think it would be helpful to go through each one. So the C, B, C, the complete blood count that's gonna check for anemia, which can result be a result of heavy menstrual bleeding. So if you're having heavy periods, like you're changing a tampon every hour, a pad, every hour, you fill your menstrual cup multiple times a day, you're bleeding more than seven days, definitely should look at A C, B.

C. [00:20:00] Low hemoglobin or hematocrit may explain fatigue, shortness of breath, worsening period symptoms. So it's, it's, and honestly, even if insurance doesn't cover, it's usually like a really cheap lab, like around $10 cheap now. If we see elevated white blood cells on that CBC, that could signal there's inflammation or an infection.

So sometimes painful periods that seem to come out of nowhere, that can be endometritis. We've got, um, pelvic inflammatory disease, right? 'cause you're not just having painful periods, but maybe there's pain other times. So this can be a really quick lab to get us a lot of data like if you understand how these, uh, can help, then you can advocate better to your doctor. So the CB, C, if your periods are heavy enough to cause anemia, your uterine lining may be excessively thick due to hormonal imbalances. So that might be worth checking estrogen for or structural conditions like fibroids.

It's this [00:21:00] lab helps quantify that burden. Like of like how, how much blood loss are we having? 'cause that's where our hemoglobin hematocrit, our ability to transport oxygen is. It's all in that red blood cells. So ferritin. So ferritin is the storage form of iron. And it is, so it's basically like your savings account, your red blood cell is the checking account out there spending iron.

We wanna see how much is in the savings account. ' cause even if your hemoglobin and hematocrit is normal, low ferritin can signal depleted reserves. And that's very common with heavy bleeding to see low ferritin first.

And then what's coming down the line is that abnormal. C, B, C, we have iron deficiency anemia, which heavy periods and feeling exhausted, fatigue, short of breath. We, we wanna avoid that. So how ferritin can help if you're, you have low ferritin, you can also experience fatigue, worsening cramping, um, because it [00:22:00] impairs oxygen delivery to muscles, including the uterus, and that can lead to more severe pain.

We wanna look for a ferritin of 50 to 90 nanograms per milliliter for optimal energy we're not just going for like, uh, you're normal. Now the other lab I wanna talk about is the CRP C-reactive protein. That is a marker of systemic inflammation. And if it's elevated, that's assigned chronic inflammatory conditions.

We can see it elevated with endometriosis, adenomyosis, both are contributors to period pain. And there's actually an ask Dr. Brighton question where we're gonna talk about, um, chronic inflammatory condition of adenomyosis and why that matters in getting pregnant. So I'm gonna get to that at the end here

Now. While CRP can tell you that you have inflammation, it's not gonna tell you where the inflammation is coming from. It does indicate that something is ramping up in the body's [00:23:00] inflammatory response, which often correlates with things like high prostaglandins, which again, those are the drivers of uterine contraction and pain.

So I do think this is a helpful lab to have. I talked about testing estradiol and progesterone. These are your two major hormones that fluctuate across your cycle. Estrogen will be the dominant hormone in the follicular phase once you pass ovulation. Estrogen's still there, but we need progesterone to come up.

Challenge that estrogen. If we have anovulatory cycles, but ample estrogen or, um, we don't make enough progesterone that estrogen can stimulate the tissues, thicken the endometrium, and then we can have painful periods. So. Um, we wanna test this again, five to seven days after ovulation. You can do LH test strips.

You pm those like around 2:00 PM every day you get a spike. Start counting from there. We're gonna catch it five to seven days later. If you're like, I have a 28 day cycle. We'll go backwards from the, when you [00:24:00] expect your period by five to seven days, and that's roughly gonna catch it. Now, as I said, estrogen can thicken the uterine lining and make, and, and it can become heavier, more painful.

This is how sometimes PCOS can have painful periods, but again, we never say, Hmm, you have PCS, that's why you have painful periods. We need to investigate why? 'cause it's not that PCOS is causing the painful period. It is endometrial hyperplasia. Overstimulation of the uterine lining by estrogen, that is then leading to the heavy, painful period.

So we want to look at that extra layer because endometrial hyperplasia that goes on for a very long period of time is increasing the risk of endometrial cancer. So again, don't let your doctor just say, oh, it's just PCS. That's why you have painful periods. Uh, no, do a little more. Let's, let's check out why.

Now, if you're having imbalances in your estrogen progesterone, you often also have mood swings, breast tenderness. [00:25:00] Um, you can see clotting issues, seeing clots that are bigger than a quarter. We look at fibroids, adenomyosis, like what could be going on in the uterus. We, and I'm gonna talk about imaging, but we wanna always make sure that.

Uh, we're not just dismissing these things and low progesterone could possibly reduce pain tolerance. And because of the in, uh, immune system interaction of estrogen, progesterone imbalances in that could lead to more inflammation. Not usually the level we'll see where, like a high CRP, but enough inflammation that maybe we're getting more pain.

Okay, now I talked about a thyroid panel, TSH, free T four, free T three TPO, and thyroid globulin antibodies. I have other episodes on thyroid health. I will link to those that go into a deeper dive if you wanna learn more about it. Now, why this matters. The thyroid is gonna regulate your mood, your metabolism, your estrogen clearance, your menstrual cycle, your gut motility.

It does a lot. And thyroid dysfunction can mimic or worsen [00:26:00] period issues. Thyroid issues are also very common in women, especially as we pass age 35. So anytime there are symptoms, like I'm having period problems, I'm feeling constipate, so I'm having heavy, painful periods, I'm feeling constipate. Maybe your period's going missing altogether.

You have dry skin, you're having hair loss, like you're losing the lateral third of your eyebrows. Like we start thinking thyroid, we need to test for thyroid. So hypothyroidism, that is the most common form of thyroid dysfunction. It's driven by an autoimmune condition called Hashimoto's thyroiditis where you get destruction of your thyroid gland.

And because of that, people start to feel fatigued and depressed. They have cold intolerance, and you can start to have poor estrogen clearance. The thing about, um, the thyroid, like all of your hormones interplay with one another, but the thyroid. Actually needs progesterone to be used at the cellular receptor.

And so if there's too much estrogen [00:27:00] around, that can also be a problematic with your ability to use your thyroid hormone. Now, hyperthyroidism, which is Graves disease, much less common, but that can cause lighter or irregular periods. Usually people, so in, there're gonna be like cycle instability and then there's like nervous system instability, cardiac instability, and that your heart is racing, you feel anxious, you're sweating all the time, you're shaky, you um, you can feel like you're going to die.

Like it can feel like so overwhelming where you're just like, I have such a sense of dread hyperthyroidism that has to be treated. That is not something that you can just like do nutrition and exercise. Like if you are having a thyroid, um, storm, you gotta go see a doctor. So a full thyroid panel. That's gonna reveal, uh, if that hormone imbalance is going on.

And with Graves disease, there are specific antibodies, [00:28:00] thyroid receptor antibodies where they're stimulating your thyroid that your doctor can check for and be able to differentiate what it is. I mentioned vitamin D, well, it is a vitamin. It does have hormone like activity. It actually acts more like a hormone than just a vitamin.

And it modulates the immune system. It reduces inflammation and it helps regulate your estrogen and progesterone levels.

now if your doctor is someone who's like, I only check vitamin D once a year. Some doctors don't even check it. That's problematic. We will talk about that another day. But, um, if you only check it once a year, September, october is usually the time I recommend it because that's when we're gonna go into the dark months.

And if you're already low, we need to start supplementation to get you through it because low vitamin D is associated with increased period pain. So everything we're talking about right now, higher inflammation levels and prostaglandin levels, so more period pain, increased risk of endometriosis and fibroids.

Not that your Vitamin D [00:29:00] deficiency caused those, it's that if you don't have ample vitamin D, those conditions can progress. They can get a lot worse. Now sometimes, man, I don't get this. Doctors. So reference ranges of labs are just, they're based on the population who's going in, and they take the average.

And on average it's elderly sick people who are getting labs, like that's the populations that we see. And so vitamin D might be set as low as 20 nanograms per milliliter. And you're doctor's like, well, you're at 21, you're just fine. You're not, in fact, fine. We really wanna see more like 40 to 60 nanograms per milliliter.

Um, even though some labs are like 30 is sufficient. We're understanding from the research that like being at the bottom line isn't like, isn't the best. It's not gonna get you the best results. Now if you're working with a functional medicine or naturopathic physician, they may also order a Dutch test, which [00:30:00] will look at adrenal hormones, DHEA, cortisol, cortisone, uh, estrogen metabolism, estrogen, progesterone, testosterone.

It's gonna give you a whole lot of information. You know, I just wanna say, as an aside, sometimes I see people say online who don't understand functional lab testing and they've never studied it. Uh, but they'll say things like, if someone ever recommends a Dutch test, like immediately unfollow 'em, even though this lab has its certification, has studies published on it, but they'll just say like, immediately unfollow them and block them.

That is a red flag. You ain't ever gonna catch me telling you that. If someone ever says something that disagrees with me or that I don't understand, you should just unfollow them or block them. That's some cult-like thinking that is like, so I'm just like, for me, I'm like, that's a red flag to be like, I only wanna be the one giving you the information and I'm gonna decide not only that, like that I get to give you this information, but [00:31:00] who else gets to give you information?

And I'm gonna feed to you. And if anybody contradicts anything that I ever say, we're gonna just shut them down and we're just not gonna listen to them. I just like crack up by like seeing this behavior because I'm like, that is the same ego in medicine that has steered us wrong so many times in history.

Oh, I just think like hysteria used to be a diagnosis, right? Um, it used to be thought that endometriosis was like just, you know, retrograde, um, menstruation taking place Anyhow, there's just all of these things that we used to think or like, you know, oh my God, this was like five years ago still when doctors were saying nutrition does, did nothing.

Like literally it took the pandemic, I feel like, to rock everybody's world and for doctors to stop dismissing lifestyle and nutrition. Um, but before then they would've told you, unfollow anyone that says that like, you can improve your PCOS with nutrition, even though the [00:32:00] research says that you can. But they decided that you can't because their doctor that taught them said that you can't.

Anyhow, that's like a bit of a rant, but it's just still to say that like, I appreciate you and my community because I trust you to take information, ask yourself if it's true for you, and have a nuanced dialogue around it without me having to tell you, like if somebody says this, like you should immediately unfollow them.

I think about like carnivore. I disagree with carnivore, but I'm not gonna tell you to go block that person who's talking about carnivore 'cause it doesn't mean everything they ever talk about is bad information. Now that being said, if you do see condescending doctors who are telling you that things are all in your head and you're just a dumb little woman who could possibly never understand her cycle or uh, her hormones and that you should just suck it up because like period pain is natural and normal.

Okay, then maybe like they're not the best person to have in your space. Maybe Then, okay, rant over. Let's get back to [00:33:00] some solutions here.

Okay. When it comes to imaging, transvaginal ultrasound can be helpful to look for fibroids, adenomyosis, and if your doctor is experienced and skilled, they can see endometriosis. And if they're not, they're going to tell you, you can't see endometriosis that way, they're wrong. Okay? They're wrong. So a transvaginal ultrasound is a one.

It's inserted inside and it can give us a view of what is going on, getting a pelvic MRI or even a full body gel, MRI, when the ultrasound is inconclusive or when there are signs of endometriosis. So you can do what's called endo mapping can be really helpful if you're someone with endometriosis. I personally would never go to a doctor who wants to do surgery before they do imaging.

And as a doctor, I tell my patients all the time, you want someone who's gonna do imaging first and see as [00:34:00] much as they can see, will link to experts who are endometriosis surgeons, not just OB GYNs who are like, I can do an endometriosis surgery. Like it's fun sometimes, like people who, this is their life and they have dedicated, extensive training to being the best at what they do.

They do imaging first. And why do they do imaging first? Because if you can see the extent of the endometriosis, you do a better informed consent. You give the patient better information about what might need to be cut out. 'cause you should know that before you go in what the recovery might look like and anything else they need to know about the surgical procedure.

It can also make sure that they have the right providers there. If there's a possibility that you're gonna need a bowel resection, which is not that uncommon you wanna have a colorectal surgeon there, not just a gynecologist. Okay, not just a [00:35:00] gynecologist.

'cause if you have to resection that colon, you want the expert there to do that. If you know that you have endometriosis lesions that are occurring in other places of the body, you want the specialist there who's going to be able to address that if there is any. So for example, my endometriosis surgery, um, it was on my bowel.

Did not look like I was going to have to have a bowel resection. But we still had the conversation of what if we get in there, we start shaving it off, and we notice that it's gonna go deeper. You're not going home that day. You're not going home tomorrow. You're gonna be in the hospital for a while recovering from that.

That is good for you to know. But also, I'm telling you, in my experience of interviewing, not just for this podcast, but for my own surgery, and talking to providers who know providers like I've been in this ring, the best of the best are doing imaging first. And trust me, I'm waiting for the doctor to come in and leave a comment and being like, [00:36:00] there's no reason to do an imaging.

Laparoscopic surgery is the gold standard for endometriosis. And to that, I say, I'm sorry, you're not staying up to date with the research or what. The colleagues of yours who are doing better are putting out in terms of information and education. Okay? So we wanna ask for lab testing. We want to ask for imaging when these things are indicated.

But what can you do right now to start getting out of pain?

So that brings us back to prostaglandins.

. The little chemical messengers that cause uterine cramping, potent prostaglandins, which are made from omega six fatty acids, lead to pain, diarrhea, vomiting.

So how do we reduce them? We shift our diet. So prostaglandins are made from Omegas Omega six ultra processed food, super potent, painful periods bad, don't want it, right? What can we do? We start to shift to [00:37:00] omega threes because omega threes still get prostaglandin production. Not super potent, less painful.

What are we looking at now if you're vegan or vegetarian? Flax, chia, walnuts. Have Omega-3 is not totally the best sources because they also have omega sixes. You may wanna opt for an algae based supplement of Omega-3. If you are a pescatarian, we're somebody who eats fish, salmon, mackerel, sardines, anchovies, cold water, fish.

That's what we wanna we bringing in. And if you can be eating something like salmon three times a week, that's gonna definitely help. Cruciferous vegetables like broccoli, cauliflower, ar, ruga, Brussels sprouts, kale. Um, all of these are really great for supporting liver detoxification of your estrogen.

Yes, your body knows how to detoxify, but yes, it also needs inputs to do it right. Ginger and turmeric are also great things to add into your diet. They have anti-inflammatory effects. There's been research showing [00:38:00] that ginger can help with period pain. 

I have an anti-inflammatory meal plan plus [email protected] slash plan if you want to grab that. , That whole plan is really geared towards perimenopause and, , weight loss and metabolic health. But because it's talking about stress reduction lifestyle and it gives you anti-inflammatory recipes, it can actually really help here as well.

Now looking at supporting liver detox, I talked to you about the cruciferous vegetables. Those are gonna give you dim. Other things that can help is sulforaphane, which you can take in a supplement. You can get that from broccoli sprouts, just a couple tablespoons, and calcium deg glucarate, which is once your estrogen goes through to the gut.

Calcium Derate helps make it keeps sure, make sure it keeps getting outta your system. We actually put those three ingredients in the balanced women's hormone support supplement. I'll link to that so that you can see that [00:39:00] that can help with optimizing your estrogen and progesterone levels

and it has everything you need to support the three phases of estrogen detoxification. As always, you don't have to buy my supplements. You can use what's on the label as a guide. We fully have everything on the balance, women's hormone support, transparent of what is in there and the dosages. You can grab it, I'll give you a coupon for 15% off, or you can use the label to help you find an alternative if that works better for you.

Other things that can help support liver detoxification and acetylcysteine. People are typically taking six to 1200 milligrams a day and using castor oil packs. We don't use a castor oil pack over the uterus, not when we're pregnant, as I touch my belly right now, but also not when our period is heavy, but using it over the upper right quadrant that is supporting liver circulation.

It is not going to be, , a massive detox. It's just something you can do that's supportive.

Cortisol dysregulation, worsens [00:40:00] inflammation, so prioritizing rest, nervous system regulation. I have other episodes where I have talked a lot about that, so I will put those links in, but I do wanna mention it and as I said that Dr brighton.com/plan also has resources for you on that. Now, in terms of supplements, I find that magnesium glycinate 300 milligrams daily and then increasing that to 450 to 600 milligrams once daily, five days before your period can be really helpful.

Of course, always talk to your doctor before you start a supplement. That is personally something that I have done for years and I didn't have period pain with endometriosis with like what was called stage four endometriosis. It was deep infiltrating. Pretty bad endometriosis, honestly, I'm still like, how did I not have pain from that?

But, uh, you know, magnesium glycinates, one thing I leveraged Omega-3 fatty acids that are higher in EPA. Um, it can have some DHA [00:41:00] in there as well, but usually around 2000 to 4,000 milligrams. And that's on top of me eating fish three times a week. And those are two really of the key supplements that I see can be most helpful.

There's certainly others out there, but I don't wanna overwhelm you and that's a pretty good starting place. Now, I do wanna talk about some scripting because what if your doctor says, just take the pill? , And you're like, well, I don't wanna do that. I wanna know what's going on. So something you can try saying is, I appreciate that the pill is a common tool for managing period pain, but I'm really looking to understand the root cause of my symptoms, not just suppress them.

Sometimes that your doctor will get really upset if you say that to them. But I mean, it's true. You are just suppressing symptoms. So you can go on to say, to kind of dampen that, I'd like to explore what could be driving this pain, like endometriosis, fibroids, you know, whatever you might suspect is going on.

Would you be [00:42:00] willing to help me investigate that further with labs or imaging? I've read that pelvic ultrasound or you know, these certain tests or checking for inflammation might be helpful

 and ideally your doctor would wanna partner with you and explain what is warranted and what's not warranted in your case. But if they resist, you can try saying something like. I understand that this might not be part of your standard protocol, but this pain is affecting my daily life. And you need to reiterate how it's affecting your daily life.

And I don't feel comfortable proceeding without better understanding why it's happening. Like I don't wanna move forward with treatment without knowing what is happening in my body. So then I would also say to them, if you're unable to support this approach, could you please refer me to a specialist who can help me dig [00:43:00] deeper?

So you're asking them for a referral. Now at this point, if they're shutting it all down, this is when you say, can you please document my request for imaging lab work and a referral and your reason for refusal? I will be requesting my chart notes when I leave today and taking them to a second opinion.

Okay? Like that's a little strong army, but it needs to be said. And when you say something like that. That'll usually get them to be like, huh, a colleague's gonna look at this. Like a colleague is gonna question why I didn't work this up and I don't want a colleague to find fibroids and I missed it. So sometimes that can be the disruption in their pattern in terms of like how they go about their day to get them to pause and deliver more.

And if they don't take your chart notes, do exactly that, get a second opinion. So I just also want you to understand that even if you're doing anti-inflammatory nutrition, even if you're [00:44:00] going to like get worked up, even if you are, you know, waiting on lab work, you may also need to be talking to your provider about pelvic floor physical therapy.

I mean, if you're somebody who has endometriosis and you have a provider who says like, oh, you'll just have surgery and you'll be fine. No, you will not. You also need pelvic floor physical therapy afterwards to rehab that pelvic floor. You will have trigger points there. We all do. Acupuncture has been shown to be beneficial for period pain.

So even while you're working stuff up, you can be working with a pelvic floor physical therapist or an acupuncturist. Uh, occupational therapist can sometimes be helpful as well. And you can be doing things on your own, right? So there's no reason why you can't take magnesium or omega threes while you're waiting to get in for imaging.

Of course you wanna run it by your doctor, right? ' cause if you're on blood thinners, we don't wanna be on a bunch of Omega-3 fatty acids when you use caution with that, I also want to remind you that a lot of the things that you're doing at home for stress [00:45:00] reduction, for, uh, for eating in the best way possible for exercising, by the way, I found when.

After my, , egg retrievals, that's when I started having horrible, horrible endo flares. That's why I made that endo guide again, dr brighton.com/endo flare. Uh, ' cause I was like, man, like when you're in pain, it's so nice to just have something in front of you. Even though I know all of this stuff, like when I was in so much pain and couldn't get outta bed and was like, I think I might vomit.

I'm like, what can I even do to like fix this? Anyhow, what I wanna say is that all of this stuff that you're doing at home, great job. Even if it's not completely getting you outta pain, it is supporting your health. It is supporting your body. And, and just because you're doing this and it's not getting better doesn't mean that you're failing.

Okay? It doesn't mean that you're a failure. It oftentimes means that you've got something significant going on. If you can take magnesium and Omega-3 fatty acids and that reduces your [00:46:00] pain, great. Some people, it's gonna eliminate their pain. Fantastic. In those situations like. And when that happens, which by the way, it will take at least an entire cycle of you doing that.

So if you start it in your luteal phase and then you're like, my period didn't get better two weeks later, no, no friend, you gotta wait until the next period. It takes an entire cycle. But somebody who like it does get better in two weeks or even in one cycle, it's not usually that their period pain is coming from something extremely significant.

Okay, so I just wanna reiterate this because this is part of the gaslighting that gets into our head. And I, you know, I want you to reframe that pain is a message. It's not your body trying to punish you. It's your body sending up a flare of we've got a problem. And while period pain is common, extreme period pain is not normal.

And any doctor who tells you otherwise is wrong, they're just plain wrong. And you deserve to live your life fully. [00:47:00] And to feel your best and not have like a week out of every month where like you can't function. So I hope you take the tips in this. You advocate for yourself with a provider. You implement some of the things to start building your better health, and you keep a positive mindset and you keep believing in your story.

If this episode was helpful for you, please consider sharing it. If you know someone who's been dismissed told us, just cramps or like you've got, know a teen in your life where it's like things are bad and they're believing their doctor, please share this episode. We're gonna go into some Ask Dr. Brayton.

Um, and before I do, please rate, review, subscribe. Your support helps bring this message to more women who need it. So with that said, let's get into ask Dr. Brighton.

Maya asks how to increase chances of getting pregnant with adenomyosis. Okay. As someone who has adenomyosis is currently 11 weeks and some change, although this belly is seriously [00:48:00] giving like four months, it's if, if you don't know, I lost a couple ligaments during my endosurgery. My uterus is tipped forward, so it leans on my abs a little bit more.

Me and my PT try to work on that physical therapist. Um, but also this is the eighth time I've made it this far in a pregnancy. I, I have had many losses. So this is the third viable pregnancy, like fingers crossed. Um, anyhow, so my belly's like popping, um, and I've adenomyosis, uh, so, and I've diffuse adenomyosis.

So let's start there. There's focal adenomyosis. It's a spot. You cut it out. Good to go. You have diffuse adenomyosis and I like to explain like a marbled steak, you know, and you got the fat everywhere. Um, yeah, my uterus a piece of meat. Oh god. This analogy. But that's what diffuse is like. And if you went through and you cut out every little bit of fat in there, what would you be left with?

Yeah. Non-functional uterus. So with diffuse adenomyosis, we can't have that removed. So I would [00:49:00] recommend if you have focal, get to a specialist. A specialist who. What I will say is that if the first specialist is like, just have a hysterectomy, no. Go to another specialist and, and see what else can be done.

Okay. Uh, with adenomyosis, they love to jump to hysterectomy. It's like their favorite thing to do and it's not always necessary. And there are ways to control the bleeding. I find a lot with supporting estrogen metabolism. That's kind of a different question. So the getting pregnant, adenomyosis has got a double whammy.

Okay. So with adenomyosis we have poor blood flow, so it's hard to get enough blood to the placenta and to baby. And the second thing we have is inflammation. Now dropping inflammation we can do with an anti-inflammatory diet, with supporting good gut health, with making sure that we keep our stress in check.

But you may need more [00:50:00] now if you need more, you still have to do those other things. Okay? The more. This likely prednisone. So I'm on prednisone right now. I take five milligrams twice a day. That doesn't mean that's what's right for you, but I like to be transparent because I talk a lot about nutrition and lifestyle, but I like people to know that sometimes medications are warranted.

My CRP was fine, that it was like, you know, it was really something where we were like, do we, don't we? And I went with Let's do because, 'cause we really wanted to have a baby and I kept having failures, so I was like, let's try it. So we, and I will say I had my endometriosis excision surgery, so that helped greatly as well.

So with that, prednisone may be necessary. That doesn't mean that nutrition and lifestyle don't matter. They absolutely do anti-inflammatory lifestyle, not just what we eat, but also how we are living. And stress and sleep are really big ones . Now the other thing [00:51:00] for circulation blood flow. Pelvic floor physical therapy to help with circulation in that area. I also would do like hot and cold contrast and for inflammation and circulation. You all saw me with my loom box. Uh, well maybe you did, but I was heading to the clinic to get my frozen embryo transfer with a loom box on my uterus.

Not, you know, it's inside, but over. I will link to what the loom box is. I love it because I travel a lot and I can use this near infrared light therapy over my uterus, over my thyroid while I'm traveling. I also do saunas, so not right now because I'm pregnant and we can't have like extreme heat exposure.

Um, you just have to be careful with body temperature in pregnancy. But prior to that sunlight and spawn sauna near infrared four times a week, 20 minutes minimum is what I was hitting. And [00:52:00] then I would go take a cold shower. For women, we don't need as extreme cold plunges as like men do. Going and taking a cold shower can be ample enough.

And again, that's for circulation, so that's some helpful lifestyle stuff. But guess what else? I'm doing low weight molecular heparin injections every single morning because I have adenomyosis and I have a one gene of a clotting, you know, one clotting gene that's off. Okay. It's like a rare one, but still not gonna mess around.

Just keep the blood a little bit thin. I also take Omega-3 fatty acids on that. I have done clotting times with the low molecular heparin and taking, um, all the supplements that I take and I'm fine. You might not be, so you gotta proceed with caution. Make sure you're checking in with your doctor. But I also am doing the heparin for increased circulation.

My doctor also opted. For early ultrasound,

so I hope that's helpful to [00:53:00] talk about like the lifestyle things that we can do and then the medical interventions may also be necessary and they're always an addition to the lifestyle and nutrition aspects.

Okay, this one comes from Kelsey. I have endometriosis. Does that mean I have high estrogen? Should I take dim? Great question. Here's the thing about endometriosis. Your ovaries might be making estrogen and not making enough progesterone. And because you've got inflammation going on, you're making cortisol kind of into the expense of progesterone.

And so you do have this estrogen that isn't challenged, stimulating tissues. Now, endometriosis being that tricky little diva that she is, can also make its own estrogen. It can also make its own hormones and stimulate itself. So do we just dump on dim? Dim can actually be really great for supporting your estrogen metabolism through your liver.

However, that's only supporting [00:54:00] phase one. And we also wanna support phase two and phase three. So the liver has two phases of estrogen metabolism, but then we have to make sure we get it out. So with endometriosis, it's not uncommon to have gut dysbiosis. There's an imbalance of microbes in your gut. Part of why we get endo belly.

Which I have an article on dr brighton.com I'll link to. It's freaking awful. And I give you, I was wearing these pants actually, uh, when I posted my endo belly online and I looked like this pregnant, I was, there was no baby, no uterus growing. It was just knee and a lot of bloating with no gas. No, 'cause it's just inflammation happening in your gut.

Now when you have dysbiosis, those little critters can produce an enzyme called beta glucuronidase. It's part of the estrobolome. We love it until we don't love it because it's reactivating the estrogen that you're phase one and phase two already tried to move out. The liver's like get it out, and the gut's like just get in, coming back to play.

So we want to support your ability to move that out. So yes, we want to eat our fiber, we wanna have [00:55:00] prebiotics, we wanna have healthy bowel movements happening. However, we may also need calcium, deg, glucarate, because that can help with that enzyme. Basically keeping it in check so you don't reactivate that estrogen.

So. What I like as a combination for supporting estrogen metabolism and I, I talked about this earlier in the episode, what I like as a combination is DIM sulforaphane with myrosinase, which is coming from like mustard and it helps get it active and calcium DG glucarate because that's gonna take you through phase one, phase two, and phase three so that you get your estrogen out. If you are still in your cyclical years, your reproductive years as they call them.

Um. Or you're in perimenopause and you're not in the countdown of menopause, it's likely that you need, uh, to be supporting that estrogen metabolism. And that is part of why I believe that I didn't have these, uh, issues with endometriosis is because [00:56:00] when I came off the pill and my periods were horrific again, first they went MIA, then they came back and they were freaking hell making me relive like teenage nightmares.

Um, and they were so painful. I started looking at the research and it was like, okay, I need to eat more cruciferous vegetables. So I brought, I eat cruciferous vegetables every single day, cooked, and then I started supplementing and I was like taking dim and taking, uh, sulforaphane and then eventually calcium deluce.

And this is actually, this is like how a lot of my supplements get, uh, born, is that I gotta go chase down and take all these different things. And I'm like, forget that I don't have time to be choking down 500 supplements, like just to feel okay in my body. Which by the way, anytime somebody like I get judged on the internet where people are like, oh my God, like you're just one of those people that takes supplements.

I'm like, yeah, you try living with endometriosis, adenomyosis, Hashimoto's, psoriasis, like, [00:57:00] uh, autism, A DHD, and functioning fully as a human and not doing it with supplements. And if I'm doing it this way and I'm thriving, can you just be happy that I feel okay that like I am, I'm actually feeling good and like living my life like.

Yeah, but just be happy for people. So anyhow, I talked about the food, um, way, the ways that we can get this via food. So eating cruciferous vegetables. Uh, sulforaphane's gonna be specifically coming from your broccoli sprouts or cruciferous vegetable sprouts, you only need about two tablespoons of those a day.

And then you can add like, you know, some mustard, um, powder to that, that can help activate it even more. Um, that doesn't sound really palatable to me right now, but that's because I'm in my first trimester having morning sickness and calcium derate. I'll give you an article that has a list of foods.

Honestly, if you need to take calcium glu great, deg great. Your food's not gonna usually be enough with that because what you're [00:58:00] really working on is shifting your microbiome in a positive way, which can be a bit difficult to do. When you have endometriosis because you can have a propensity towards dysbiosis, but I hope that's helpful.

I, for one, would caution against just using DIM as somebody who's done them this them themselves and got a really bad headache, like pushing phase one too fast, too quick, not always gonna have the most favorable outcomes. Um, and you really only need about 50 to maybe a hundred milligrams of DIM on Amazon.

You will see supplements that have like 500 milligrams. And whenever people are like, I tried dim, I felt like garbage. I'm like, what'd take? They send me it. I'm like, good Lord, 500 milligrams. Like good Lord, that is way too much dim. We don't wanna drop our estrogen to nothing. We just wanna like coax it.

If you don't need it anymore, let's get it out.

Thank you so much for sending your questions. I really appreciate you trusting me in asking these questions. It's always a pleasure to [00:59:00] support you, and I will see you next time on the Dr. Brighton show.