Doctor Reacts to Lili Reinhart and Breaks the Endometriosis Diagnosis Myth | Dr. Jolene Brighten

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Dr. Brighten: Endometriosis isn't rare. What's rare is getting taken seriously, and that is usually until you know exactly what to say. If you didn't catch the news, Lily Reinhardt just joined a long list of celebrities who have been diagnosed with endometriosis. She recently shared that she was finally diagnosed after years of being misdiagnosed, dismissed, and told to just manage her symptoms.

. In fact, in her post, she highlighted three hospital visits, multiple urologists and gynecologists, and not one of them seriously considered endometriosis as the underlying cause of what I was experiencing.

And here is what hits me the hardest. If this can happen to someone with resources, visibility, influence. Imagine what happens to the average person who doesn't have time, money, energy, or other resources to push back and to keep following through with visit after visit. And listen, when a celebrity gets diagnosed with Endo, it's headlines [00:01:00] everywhere.

But for about the 200 million women worldwide with endometriosis, the attitude is more like, well, that's just part of being a woman. And so I want to acknowledge that because I've heard from the Endo community, it's sometimes frustrating to see the world lose their mind when a celebrity gets diagnosed with endometriosis, but then act like.

You know, 200 million of us don't even exist. And to be fair to Lily, she is an actress. And so she isn't. And to be fair to Lily, she is an actor. So I can only imagine the doctors who were like, yes, nice show. Oh, I'm sure you're in pain, and dismissing her

next.

This is the hundredth episode of the Dr. Brighton Show, and I started this as an effort to put the medicine in your hands and help you understand your body, while also [00:02:00] giving you tools that you need to thrive and to heal yourself. So, hey, listen, leave me a review if this show has helped you in any way, but I feel like this is the perfect episode for number 100 'cause we're gonna talk about endometriosis.

And when it comes to endometriosis, this is not about one doctor being bad. It's an about an entire system where endometriosis is under recognized, completely dismissed, symptoms get minimized, pain's just normal. That's the way it is. And people get bounced between specialties. That is if they even get a referral and.

If you've been with me for a minute here, you know I've walked this road personally and professionally, so I'm going to give you a practical plan today.

Because if I can go 29 years as a 'cause, if I can go 29 years not getting diagnosed [00:03:00] and I'm a medical professional and they're dismissing medical professionals and people with significant influence, like, listen, none of us are being spared when it comes to the collateral, which is just ignoring women's pain.

So here's where we're going. In today's video, I'm gonna give you tips to manage your endometriosis. So you are gonna get some tips to get out of pain today. I'm gonna give, I'm gonna guide you on the exact steps to get your diagnosis. Let me just do this over, I.

So here is where we're going. In today's video, I'm gonna give you some tips to help you manage your endometriosis, things you can do at home starting today, guide you on the exact steps to help you get a diagnosis, help you navigate conversations with doctors who would [00:04:00] rather gaslight you than believe you, and give you the care you deserve.

And we're gonna go through imaging. If you know someone who could benefit from this, please, please share it because the only way we're gonna ever change care for women for the better is if we're working together and we're sharing information. Now before I talk about how we get diagnosed, we need to clear up one of the most confusing and frankly harmful things women are told about endometriosis.

And listen, if you suspect endometriosis, this next three minutes could save you from years of struggling. So listen in.[00:05:00] 

The only way to diagnose endometriosis is through surgery. Exploratory surgery. I've been told that by physicians themselves. And so you debunked that. Any doctor who's telling you, I cannot diagnose you with endometriosis on as I do surgery,

Ep100 Front: is

Dr. Brighten: is a doctor that doesn't have enough experience. Because I think that if you have.

I agree with this 100%, and you've probably heard this before, maybe even from your own doctor,

and you've probably heard this before, maybe even from your own doctor.[00:06:00] 

Oh, I need to say who this.

Ep100 Side: is. Okay,

Dr. Brighten: clip is from the Lana b Nasser vision, and I agree with this doctor 100%. I will tag everybody in the link below to, I will tag everybody. I will tag everybody in the description below so you know where all these clips are coming from, but I agree with this 100%. Let's talk about imaging.

So firstly here is the reality. The definitive diagnosis has traditionally meant [00:07:00] visualization or, and or biopsy via laparoscopy. Las lapar

Ep100 Side: laparoscopy

Dr. Brighten: is a minimally invasive surgery where they insert a camera, where they make several incisions, they have a camera, and they're operating without opening up your entire abdomen.

But in recent years, clinical diagnosis has been well recognized as has, oh my God.

Ep100 Side: But these

Dr. Brighten: days, clinical diagnosis is valid and we have imaging options, and this is what I think is important for you to understand. Treatment should not be held hostage until surgery, especially when symptoms and imaging strongly suggest. Endometriosis or [00:08:00] related conditions like adenomyosis, which is something that Lily Reinhart mentioned.

She got diagnosed via MRI. I'm gonna talk more about that.

So when you meet with a skilled clinician, they can build a high confidence working diagnosis using your symptom pattern. We're gonna talk about what you need to track today. Your response to different treatments, exam findings, and if they're skilled, they can do imaging. They can do a transvaginal ultrasound, a wand is inserted into the vagina and visualize your lesions there.

If you have stage three or stage four endo, you should be able to see this on an ultrasound if you are skilled enough, if you have the skills to actually observe endo. And if you don't. This is probably not someone you want operating on you. I would say if somebody isn't skilled enough to do the ultrasound on me and to visualize endo and see where it all is, and they're also not willing to do imaging before [00:09:00] surgery, that is not someone I would choose for surgery.

Ep100 Front: I.

Dr. Brighten: But as a patient, you deserve relief and a plan before a scalpel ever enters the chat. So I want to talk specifically about imaging, what you need to know, but first, I think it's really important that you understand that the symptoms you present with can change how long it takes for you to get diagnosed, and this is absolutely wild infuriating.

Uh, just in maddening. So there was a recent 2025 study and what they found is if a patient presents with infertility, the median delay to diagnosis is about three years. But wait for this. If the patient presents with dysmenorrhea, that is pain with your periods, the median delay is about 12 [00:10:00] years. So on average, we are seeing women can go 10 years before they get the diagnosis.

And if it's period pain, it may be longer, but if it's infertility as your symptom, you may get diagnosed sooner. And I'm not telling you to tell your doctor you're struggling to get pregnant just to get a diagnosis sooner. But what I am saying is those patients do tend to get diagnosed faster. But listen, your pain is enough, your symptoms are enough.

You deserve to be believed with the symptoms you have. So in Lily's story, she talked about pushing for an MRI and that MRI showed adenomyosis also sometimes called a mosis. Now that is when there is uterine lining infiltrating the muscles of the uterus. Your uterus is a big muscle. You've got, you've got that uterine lining in there.

Now you've got painful periods, inability to contract efficiently. So the periods are, they can, some things eat long. Um, you can [00:11:00] have a lot of clotting. There can be really heavy periods as well. Now, when it comes to imaging, this is where a lot of people get misled or discouraged, and you may have been told.

Your ultrasound is normal, so you don't have endometriosis, and that's not, that's absolutely not how this disease works. So I want you to understand that imaging can rule in endometriosis, but the lack of endometriosis on imaging doesn't mean you can rule it out. Stage one and stage two endometriosis, that is superficial, that is on the peritoneal lining of the abdominal cavity, may not show up in imaging.

And a standard pelvic ultrasound not done by an expert may miss the majority of endometriosis. And this is just really important to understand because imaging can identify deep infiltrating disease. If the right person is looking for it, and if you've got stage three, stage four, you've got a lot of scarring [00:12:00] going on, you are gonna see things like your bowels being adhered to your uterus.

Hi, that was me. Uh, your ovaries might be stuck. Like things are not looking normal and, uh, the, this, the normal anatomy is not there. Now we're gonna talk more about symptoms you should be looking for. However, I want you to understand that if somebody is having pain with urination, pain with bowel movements, obstructed bowel movements, so it doesn't feel you, like you in, you completely evacuate your bowels.

Um, if you're having, uh, you know, changes in urination, these kinds of things, that's usually a sign of deep infiltrating endometriosis. And that's usually something that can be caught when you have imaging.

I will say, and if you've seen my personal story, that your ultrasound and MRI are only as good as the clinician and radiologist who is interpreting them. Endometriosis imaging is a skillset. It's [00:13:00] not, um, you know, it's not just by default. You'll see it on a scan and if your clinician doesn't have the expertise, they may miss it.

That happened with my MR. I sent it to someone different. They saw, they saw everything. What was wild about that is that I don't read images for a living, and yet I could see my adenomyosis and the radiologist told me that like I was just basically a dramatic patient who was like seeking attention. And I was like, no, but like bro, if I can see it like something's wrong with you, like get a new career.

Now there is something specific in the world of endometriosis called endo mapping, and this is where they actually map the disease. They don't just tell you about like, oh yeah, like I suspect this will look like a stage three or stage four, which is what you get after. You have surgery [00:14:00] done, what they'll actually look at is they'll map the disease and tell you like what organs are involved, and they will tell you about the deep infiltrating lesions, specific locations they're in, endometriomas, what you need to know about that.

And that is done using a gel MRI. So gel is inserted into the vagina, into the rectum. Thus expand the tissue so that you can visualize it better. The MRI is done. It's sent to a specialized radiologist. They give you an EN Zion score. The ENION score tells you a lot more about the disease than the stage does.

The reality is, is that a lot of us have staging, um, that doesn't match the symptom PRI presentation. You might have stage one and you have the worst pain in the world. Someone may have stage four. And they have like no pain and it makes no sense. 'cause as Dr. Melissa McHale said on the podcast, like literally, endometriosis has no rules.

And that's lame because it'd be really nice if it followed some rules for our sake.[00:15:00] 

So can you diagnose endometriosis via clinical symptoms? Yes. Can you start treatment based on clinical symptoms? Yes. Can you diagnose endometriosis using imaging? Yes. And imaging. Should be the first line. So ultrasound, imaging or, um, doing MRI, doing the endo mapping that I talked about. That should be first line before surgery comes into the equation.

'cause this helps them prep for surgery. Make sure the right people are in the room. Make sure that you know what to expect. If you need bowel resection, that's not being down for a day or two, that's being down for like. Months, some in some instances, right? And so, um, as someone has been through excision surgery, it is a good two to three weeks of recovery, but you only feel like majorly down for the count, uh, in, in the less severe [00:16:00] cases for like a couple of days.

Whereas if they're really extensive cases where organs are having, you know, tissues removed, bowel resections are being done, that's gonna be a much longer period of time. You need to prep for that, okay? You have a life to live. Now my caution to you, MRI comes back saying normal. Uh, ultrasound comes back saying normal CT comes back saying normal.

No evidence of endometriosis. That doesn't necessarily mean you do not have it. It might mean the imaging wasn't done right. The imaging machine wasn't, you know, uh, quality enough that there wasn't a specialized protocol. There wasn't a radiologist who actually knew what they were doing, knew how to identify the disease.

Ep100 Side: So.

Dr. Brighten: Let's talk about how to ask for the right imaging,

especially because doctors love to deny SR labs, don't they? Labs and imaging all the time. So when you're advocating for [00:17:00] yourself, here's the language I want you to use. Firstly, I am requesting endometriosis. Firstly, I am requesting imaging for endometriosis. Uh, yeah, I'd like an ultrasound, an MRI. Is it possible to have endo mapping?

Ask, does the radial.

Ep100 Side: the radial

Dr. Brighten: Ask, does this radiology center have a specialist in endometriosis imaging? Is the person who reading my report specialized enough? They might tell you they are. The guy who read mine and got it all wrong was like, of course I'm an expert in this. And I was like, man, little humility would go long way buddy.

Ep100 Side: Ask,

Dr. Brighten: will the radiologist evaluating my scan be looking specifically for deep infiltrating endometriosis? You wanna make sure they're looking for that, that they're gonna be taking into account organ involvement. Can you send this radiologist who re. [00:18:00] If there's like, no, we don't got a guy for you. We don't got a gal for you.

Can you send this to a radiologist who regularly interprets endometriosis scans? So asking them if they tell you no, like, you know, or, or this person's pretty good. Be like, is, is it possible to like get someone who's doing this all day, every day to read my scan?

And going back to Lily's story, she saw multiple specialists. She had, you know, uh, multiple tests. She was diagnosed with interstitial cystitis, very common misdiagnosis for endometriosis, and still no one connected the dots. And [00:19:00] it wasn't that. And she wasn't sent to actually get imaging until she advocated for herself.

This is not a patient failure. This is a system failure of not listening to women. And I just always think about this when every woman with endometriosis is telling the same story. That's a clear indication that something is wrong with the medical system, not with the women who have endometriosis. And why do we all have the same stories and yet nothing has changed for decades.

So what do we do if a doctor is dismissing us? I wanna talk about this because I think it's really important to have language. Because you may not even get to the place where you can ask about imaging because they're already dismissing you and telling you things like purities pain is normal. Lily, like a lot of people got told just to take the pill.

I'm so sick of that. I wrote a whole book about that, like, [00:20:00] this is lame. Stop telling women just take the pill and actually do your freaking job and work them up. So you need to tell a doctor very specifically that your symptoms are impairing your quality of life. And then ask, what are the next steps in a structured evaluation?

Whatcha going do to rule this in? Rule this out. If they are just like still kind of brushing you off, ask them, can you document in my chart that I requested an endometriosis evaluation and that you declined it? And you can say, can you please put your reasoning for declining it?

And if that's not prompting them, I would ask them, what is your differential diagnosis for these symptoms and how are we ruling these in and ruling them out? Because sometimes you have to use doctor language to prompt their brain to go a little deeper with you, and that's lame when you're tired and you're in pain and you don't feel good.

And I apologize that that's the way the system is, but I hope this language will help empower you. [00:21:00] And if you still feel like you're not getting anywhere straight up. If you are not comfortable evaluating suspected endometriosis, please refer me to someone who specializes in pelvic pain. Endometriosis,

Ep100 Front: your

Ep100 Side: your

Dr. Brighten: genital disease.

Ep100 Side: Like

Dr. Brighten: Ask for a referral to someone else. So we're gonna, we're gonna ask them to please work us up. We're gonna ask them to document it if they don't, and then we're gonna ask for a referral.

Ep100 Side: Now, I

Dr. Brighten: I talked about tracking symptoms. We're gonna talk a little bit more about symptoms coming up, but I want you. Just before we get into the symptom part, to think about tracking a symptom map over your entire cycle, so if that's like. You know, 27, 30 days. Track your symptoms daily. Where's your pain?

Where's the pain [00:22:00] located? Like, is it in the bowel? Are you having bladder symptoms? Um, scale of one to 10, 10 being the worst. Pain, where are you at? Fatigue, bleeding pattern. Are you pain with sex, ovulation, pain, hip, back, nausea, migraines, like any, any symptoms that are coming up. And then anything that makes it better or worse.

Ep100 Front: Okay.

Ep100 Side: And

Dr. Brighten: A good doctor will recognize that endometriosis pain isn't always just severe cramps. Endometriosis symptoms aren't always pain for many, there is a pattern, cyclical flares, bowel and bladder triggers that come up around your period. Deep, pelvic, aching pain that's radiating. So, uh, the pattern matters greatly.

It's not just about is your pain super bad or not. And then bring receipts to your visit. A one page summary, uh, just bullet points, not a novel, but [00:23:00] like a one page summary timeline so that you can convey your information as concise as possible and get the help that you need.

Ep100 Front: need, and

Ep100 Side: And then

Dr. Brighten: always asking for more targeted evaluations.

So having imaging, we already talked about it, labs to rule out other causes. Um, meeting with other specialists. So if they're like, oh, I think you have gastroenter symptoms like this is IBS, can I meet with a gastroenterologist? You may have to go through multiple specialists and you, this is what's lame about women's medicine.

We know that gynecologists will fail us just as much as our PCP will fail us just as much as the gastroenterologists fail us, us. But like, you don't know, I swear. Like I was just in Vegas for a conference and I feel like it's just like, basically like pa playing like, uh, I don't know. My Vegas games. I'm just gambling though.

And we gotta gamble on which specialist is gonna actually understand endometriosis and like is gonna, it's gonna [00:24:00] click for them and they're gonna help you.

Now one completely just MVP of the endometriosis world is the pelvic floor physical therapist. So Lily me mentioned this incredibly important and often overlooked aspect of endometriosis, and she said pelvic floor therapists were the first ones to suggest endometriosis. So let's talk about why that happens, what that means, and why.

Insurance carriers, if you're listening to me, every woman with endometriosis doesn't matter. This stage doesn't matter if she's had surgery, she needs a pelvic floor physical therapist on her team.

Ep100 Side: So

Dr. Brighten: sometimes our symptoms of endometriosis are actually rooted in pelvic floor dysfunction. That is very common because it's a response to chronic pain [00:25:00] and it doesn't always mean that it's the root cause, right? There's still endometriosis. We have to be looking at all of those. So I want you to understand this.

You can treat pelvic the pelvic floor and still need to have excision surgery. Still need to work on your diet. Still need to address endometriosis as a whole, systemically as a whole is. That's driving the pain loop.

Ep100 Side: And

Dr. Brighten: even after excision surgery, pain can persist due to pelvic floor dysfunction and trigger points.

Whenever a woman says to me, oh, I stopped using tampons and my period pain ease, so tampons are toxic, I'm like, hold up. Actually, tampons are usually bearing down on a trigger point in there somewhere, and so that's a good sign. I need to send you to pelvic pt. And this leads perfectly into like the next misconception I wanna talk about with endometriosis, because not everyone with endometriosis has the classic pelvic pain symptoms.

So let's talk about [00:26:00] symptoms people don't associate with endometriosis. And let's start with fatigue.

Ep100 Side: This

Dr. Brighten: just that, um, I can feel like a direct attack on your womanhood. I was, um,

Ep100 Side: I

Dr. Brighten: was very fatigued and was fainting backstage in my concerts and I was bleeding. I was pissed off at the whole world. I was like, why is every to me, what do I do to deserve this? In that process of having everyone pick me apart and feeling so insecure, I'm saying like less of a woman.

Ep100 Side: 'cause

Dr. Brighten: I couldn't be intimate with my boyfriend 'cause I couldn't go out when my friends wanted me to because I was dealing with digestion problems and bleeding problems and fainting and all the other amazing things that come along with having and though, um,

Ep100 Side: Um,

Dr. Brighten: it was really.[00:27:00] 

Ep100 Side: Raise

Dr. Brighten: your hand if you've ever had to cancel plans because of your endometriosis. It's me. Hi. I'm definitely one of those people and I'm sure you are too. And it's not just pain. As Hal was saying in that clip, she had fatigue. She also found like less of a woman because she couldn't be intimate with her partner.

She was having dyspareunia pain with sex and she was also having digestive issues. So this matters because fatigue and all these other symptoms are super common and they're super disruptive of our lives. So let's go through a list of things you should be aware of that are signs of endometriosis, and if you've got them, your doctor should know about them.

So if you have cyclical or unexplained fatigue, fatigue that's getting worse around ovulation, around your period, that could be [00:28:00] a sign of endo. I had no idea how tired I was until two weeks post, uh, excision surgery and suddenly I had so much energy and I was like, I thought it was fine.

Ep100 Side: I

Dr. Brighten: was not, in fact, fine bowel symptoms, so constipation, diarrhea, pain with bowel movements, gas, bloating, endo belly, where we look like four months pregnant, sometimes six.

It can be that bad. Getting diagnosed with IBS when you actually have endometriosis is very common, so bladder symptoms, urgency, frequency, burning it, it feels like you have a urinary tract infection. A lot of women get diagnosed with chronic UTIs. Or like Lily Reinhardt, they get diagnosed with interstitial cystitis and they get told, sorry, nothing you could do about it.

Ep100 Side: Now,

Dr. Brighten: how's the, uh, just like, bless her for sharing. She had pain with sex, especially deep penetrative sex where you are hitting trigger points or maybe there's adhesions not allowing your organs to [00:29:00] move appropriately. In that situation, that can cause tremendous pain. We can also see ovulation pain. Back in hip pain, sciatic pain, pain rating down, down the thighs, the legs into the stomach, making you nauseous, making you wanna throw up heavy bleeding, spotting, clotting.

Uh, these can be endometriosis on their own or it's cousin riding shotgun adenomyosis.

Ep100 Side: adenomyosis. As

Dr. Brighten: I mentioned before, those who are experiencing infertility or recurrent pregnancy loss, they tend to get diagnosed sooner with endometriosis. It's not true for everyone. If you feel inflammation flares that are like systemic, so you are having brain fog, headaches, nausea.

You feel like you have the flu cyclically, so what gets called the period or menstrual flu symptoms. I did a whole episode talking about that and the histamine component. Remember, well, maybe you don't remember. I'll remind you or I'll use you the first time. [00:30:00] Endometriosis can interact with our mast cells.

They can cause more histamine in the body. Some are cranky, we're irritable. We feel sick. It's, it's a horrible feeling.

Ep100 Side: So the

Dr. Brighten: the big takeaway for you is that and, and any doctor listening.

Ep100 Side: listening.

Dr. Brighten: Endometriosis is a whole body inflammatory disease. It's not just a bad period. It's not something that like, we only feel bad three to five days outta the month.

We usually feel da bad every single day of the month, and maybe we get three to five days of feeling good outta the month. So if your primary symptom is fatigue, track it. Track when it spikes, what is it paired with? Are you having other symptoms like in your pelvis, bowels, bladder? Does it cluster around ovulation or is it just when you're bleeding?

Knowing the patterns is really important because again, your pain not, may not be so severe that it makes your doctor pause, but the pattern, the pattern definitely [00:31:00] should. You know, before we go any further, if you're in pain right now, I definitely wanna help you and I sat at the top of this. I was going to help you.

So I have a free endometriosis flare toolkit with the same strategies I share with my patients to help calm inflammation, reduce pain. You can find it at dr brighton.com/endo flare. So that's D-R-B-R-I-G-H-T-E n.com/endo flare. E-N-D-O-F-L-A-R-E, and these are things that I use that have helped me immensely as well with my endometriosis and adenomyosis.

Now you can go grab that guide right now, but I'm gonna give you some tips in just a second to help you get outta the pain in this video. So you walk away with something really tangible. But first I want to give you four [00:32:00] clues. You are with the right. Doctor in this whole conversation of endometriosis.

So, you know, we often talk about red flags. We wanna talk about some green flags. So here are four green flags. You got the right doctor. So you're in the right room. If they're talking about differentials, not being like, it's anxiety, you're just stressed. Oh, period. Pain, that's normal. No, they're talking about like, okay, let's rule out fibroids.

Let's see if there's, um, adenomyosis going on. Like they're asking you about your family history and trying to get that differential, like the other conditions, it could be dialed in. Number two, they can explain medical management versus surgical options clearly. And they don't get mad when you ask clarifying questions.

They shouldn't just be like, oh, just take the pill 'cause that's what works for my patients. They shouldn't be like, oh, it sounds like you just need to have surgery. Let's get you scheduled. Everything should be a [00:33:00] conversation in partnership.

Number three is they don't pressure you to just go on pills or start a major medication like Lupron, which is gonna shut down your ovaries as your only answer. If they're telling you, well, all I got is the pill, like, what do you want me to do? Or you know, if you really cared about being out of pain, you would just do these monthly injections.

No, that's not for you. If they're talking about more options and the pill is one option and Lupron is one option, and there's options being laid out with a discussion for you to choose green flag,

Ep100 Side: if

Dr. Brighten: they can discuss excision and how they're gonna.

Ep100 Side: okay,

Dr. Brighten: Last green flag, they discuss excision, not ablation. Okay. Ablation, runaway, walk away, no run. You gotta run. So they can discuss excision and who needs to be [00:34:00] on the team and the way that they're gonna make sure they have the right people in the operating room with you. And they're very honest about what they do and don't know, and what they're able to do and what they're not able to do.

Like they recognize their limitations and they tell you who's gonna come in for those things. So for example, if they're like. Oh, we're gonna like do, we're gonna do surgery first. We need to get imaging done and we wanna make sure that we've got, you know, the colorectal specialist in there, or like whatever specialist we need.

But also I think it's really important that we have a nutrition plan for you because the patients who are using diet to like support their health, they recover better. I will link in the show notes to the episode on prepping for endometriosis surgery. Exactly how you do that. When they say that to you, za, they're not an expert in nutrition, and they say to you like, I've got this handout, and perhaps we wanna get to working with someone that can guide you in that.

Great. They recognize like, this is, this is where, you know, my lane [00:35:00] ends, but I'm gonna get you to the next person. So you're in the, in the person of that lane who can support you.

Okay, so with that being said, let's go into like three statements that you can start right away that can help support you. Remember, I'm a doctor. I'm not your doctor. This is not individualized medical advice. This is information to help support you. Endo sister to Endo sister.

Number one is one of my favorite supplements for endometriosis, and that's n-Acetylcysteine, also known as NAC, that is gonna support glutathione, which reduces oxidative stress. When you have endometriosis, you have oxidative stress, reactive oxygen species, you have inflammation. NAC has been studied for reducing endometriosis, lesion activity, and [00:36:00] pain.

So this is about calming inflammation at the cellular level. Typically, what I'm using with patients and myself, 600 milligrams twice daily, but sometimes. Even three times a day, I, you know, I hate taking supplements all the time. I try to take 'em just morning and night, make it easy. But sometimes we do need that third dose to really get the effect that we need.

Now, tip number two would be an anti-inflammatory diet, not perfection. Okay. But like. If you're in a flare, you need to be gentle on your system every day. We need to prioritize protein. We need to get Omega-3 fatty acids. We need to have cooked vegetables, gentle on our digestion and fiber five. And ample fiber, at least 25 grams to help move out estrogen.

We no longer need to support the microbiome so that it can process histamine. We've gotta reduce ultra processed food and definitely alcohol has got [00:37:00] to go during flares. Alcohol hates you, okay? It hates you and it loves your endo, and they live to party together. Who's partying when you drink alcohol?

You and your endo.

Ep100 Front: Mm.

Dr. Brighten: Who's partying when you drink alcohol? Oh. Alcohol in your endo. It ain't you. You like it like, you know, 10 minutes of a good time and then like, you know, what is it Like 10 weeks of like flares and feeling awful? So alcohol has to go during a flare, ultra processed food. We need to reduce omega six fatty acids.

The fastest way you can do that in your diet is reducing ultra processed food. So I'm not talking about a protein powder, I'm not talking about processed food in general. 'cause sometimes you need that, especially when you fill well to make yourself food. I'm talking about ultra processed food, talking about high Omega six fatty acid profile that pushes really potent prostaglandins.

That is what causes our bowels and our uterus to contract like crazy around our period and the pain to just be off the chain. So we're gonna go up in omega threes. If you need to supplement, make sure you're getting a [00:38:00] high quality third party tested, good manufacturing practice, uh, supplement. And then it's not coming with like a thousand or more pills in a bottle and the bottle's not clear.

'cause that will oxidize and that could make periods worse potentially. So instead. We wanna look for those things in Omega-3, but if you can eat more cold water, fish, salmon, mackerel, sardines, uh, those will increase your Omega-3 fatty acids that can help shift the prostaglandin profile. I.

Ep100 Side: I. Avoid

Dr. Brighten: extreme restriction. I don't care what the keto queen says. I don't care what the intermittent fasting people say. Everybody thinks they can cure our endo. Oh my God, I'm so over it. They can jog right on. If you're being restrictive, you already have a systemic [00:39:00] inflammatory disease, which is endometriosis.

You are sending dangerous signals. I want you to send safety signals and I have lots of nutrition [email protected] that you are welcome to grab.

Now speaking of safety signals, so pain gets amplified when your nervous system is stuck in fight or flight. And so when you're in that sympathetic overdrive, so we've gotta shift into parasympathetic activity, that rest and digest phase. And in addition, your adrenal glands, which are part of the HP access, hypothalamic pituitary adrenal access.

They're producing cortisol in response to the inflammation of endometriosis. They're already working over time. They do this in autoimmune disease. Endometriosis is a whole hell of a lot like an autoimmune disease, so [00:40:00] this is also happening. This is why we have to tonify that nervous system. So, gentle movement.

Movement or walking. Yes, we love that. Do I want you exercising regularly? Yes. But if you're in a flare you're not feeling well, just get some light movement in. If you heard my episode with Dr. Anna Sierra, who is a leading expert in endometriosis surgery, we talked a lot about the vagus nerve. The vagus nerve innervates your reproductive system.

It also innervates your heart and your brain and your gut, and it is all about getting in that parasympathetic activity. So you can use a vagus nerve stimulator, you can do deep breathing, you can do humming. We have episodes on this that I will link to. And then the last thing I would say. I always want you prioritizing sleep, but if you are in a flare, permission to sleep, your body needs rest.

It is working over time and I know we went through quite a bit of stuff there, but listen, this isn't about doing [00:41:00] everything and doing it all perfectly. It's about doing simple acts that lowers the body's threat response so it doesn't think you're constantly in danger, even though endometriosis sure does make us feel like we're in danger.

Now there's something I feel like every person with endometriosis needs to hear.

I.

Like it's a endometriosis, get a fair ride.

Ep100 Side: Like

Dr. Brighten: it's a disease that no one ever asked to get, nothing that they've done in their lives would've ever

Ep100 Side: [00:42:00] led

Dr. Brighten: them to have endometriosis. Um, and it, it so debilitating, but it just drew me to want to help.

Ep100 Side: want to

Ep100 Front: help

Ep100 Side: do more, provide

Ep100 Front: more care

Ep100 Side: more care for people with endometriosis.

Dr. Brighten: That clip is from Dr. Hazel Wallace,

so for telling my husband.

Ep100 Side: That

Dr. Brighten: clip is from Dr. Hazel Wallace's account from a clip of her podcast. I will link the doctor in that episode.[00:43:00] 

Ep100 Side: That

Dr. Brighten: clip is from Dr. Hazel Wallace, an episode of her podcast. I will link her below. I don't need to say [00:44:00] that clip is from Dr. Hazel Wallace's podcast.

And it's a sentiment that I hear from so many endometriosis experts. Endometriosis isn't fair. It's a, it's a disease. No one ever asked to have.

Ep100 Side: and

Dr. Brighten: you didn't cause this. Not with stress, not with food, not with not, not with,

Ep100 Front: okay.

Dr. Brighten: and you didn't cause this. Not with stress, not with food. Not because you didn't balance your hormones or optimize your gut. Right? It's not because you ignored your body. And I think this is really important because [00:45:00] we often are made to feel like it's all our fault. Like we didn't do something right. But the reality is, is that you deserve care and clarity and compassion, and if you've been dis.

And if you've been dismissed before, that doesn't mean that you were wrong or that you did something wrong. And I hope from going over Lily Reinhardt's story and you know, you hearing bits of my story that you understand that like you can have all the knowledge, all the power, all the influence, all the money, all the time, the resources in the world, and still get dismissed.

It's not something that you did wrong.

Ep100 Side: Now

Dr. Brighten: listen, if this episode has helped you, please share it with someone who needs to hear it. If you want support during flares, the toolkit is yours, dr brighton.com/endo flare, D-R-B-R-I-G-H-T-E n.com/e NDO, FLAR. E and if you wanna deeper dive into endometriosis diagnosis, [00:46:00] treatment options, including medications versus surgery, please check out my interview with Dr.

Melissa McHale here on the Dr. Wrighton show.

That clip of Housie came from, endo found. I appreciate them sharing that. Okay, I'm done.

Ep100 Front: Okay.

Ep100 Side: Let's

Dr. Brighten: get it processed. Let's see how fast we can go.

Let's see how this goes.[00:47:00] 

Literally, um,

it was interesting to hear how, um.

Cynthia and them were both like, yeah, Gabrielle Lyon and Molly Molo were really [00:48:00] bad. I'm like, it's so weird. Yeah.[00:49:00] [00:50:00] [00:51:00] 

Endometriosis. Ah.

Endometriosis and A DHD, and when it's my time, I will absolutely be on HRT. And here's why I.

First thing, if you have endometriosis and you're considering hormone replacement therapy and your uterus is gone, they'll often tell you that you don't need progesterone. They're wrong because those endometriosis lesions are still lurking somewhere and they still need.