Welcome to another episode of The Dr. Brighten Show! This week, we’re delving into one of the most misunderstood and underdiagnosed conditions affecting women globally: endometriosis. Joined by world-renowned minimally invasive surgeon Dr. Ramiro Cabrera Carranco, we uncover groundbreaking insights about this multisystemic inflammatory disease. With over 200 million women affected worldwide—and nearly half undiagnosed—this episode is a must-listen for anyone seeking to better understand endometriosis or support someone navigating it.
If you’ve been told that your pain is “normal” or suspect endometriosis might be part of your story, don’t miss this empowering conversation. Together, we break down myths, explore advanced diagnostic tools, and provide actionable steps for improving quality of life.
You’ll Walk Away From This Conversation Knowing:
- Why endometriosis ranks among the top five most painful conditions and what that means for patients.
- The staggering 10-year diagnostic delay and how to shorten it.
- The innovative “endomapping” imaging protocol that could revolutionize how endometriosis is diagnosed.
- How 70% of women with a family history of endometriosis are likely to inherit the condition.
- Why pain during menstruation is never normal and could be masking something more serious.
- The critical connection between diet, inflammation, and disease progression—including specific foods to avoid.
- How 50% of women with deep endometriosis also face infertility, and what can be done.
- The link between chronic misdiagnosis as IBS and undetected endometriosis.
- Why pelvic pain and painful intercourse are not issues you should ever ignore.
- Advanced surgical techniques that avoid unnecessary procedures like ileostomies, improving recovery and quality of life.
- The role of hormones and why birth control is not a cure, despite common misconceptions.
- Cutting-edge supplement strategies for ovarian support, anti-inflammatory benefits, and fertility preservation.
What You’ll Learn in This Episode:
In this episode, Dr. Cabrera and I explore the latest breakthroughs in endometriosis care. From the importance of multidisciplinary teams to the rise of patient-centered treatment protocols, we discuss everything from initial symptoms to advanced surgical approaches. Learn about the game-changing use of imaging like gel MRIs and the life-altering benefits of a comprehensive care team that includes surgeons, dieticians, and pelvic physiotherapists.
We also dive into nutrition’s role in disease management, debunk myths about “normal” period pain, and highlight the importance of informed consent when considering surgery or hormonal therapies. Whether you’re newly diagnosed, struggling to find the right care, or supporting a loved one, this episode is packed with the insights you need.
This Episode is Brought to You By:
- Dr. Brighten Essentials use code POD15 for 15% off
Thank you to our sponsors for making this content possible and accessible to all!
Links Mentioned in This Episode:
- Dr. Ramiro Cabrera’s Institute: Doyenne Institute
- Supplements Discussed: Vitex, Cat’s Claw, Omega-3 Fatty Acids, Magnesium Glycinate.
- Books: Beyond the Pill by Dr. Jolene Brighten
- Podcast Episodes: Check out the endometriosis excision surgery prep protocol
Be sure to subscribe, leave a comment, and share this episode with anyone who could benefit from it. Together, we’re changing the conversation around women’s health!
Transcript
Dr. Cabrera: [00:00:00] There are over 200 million women affected and almost half of the patients that have endometriosis are not even diagnosed. They only have the symptoms and sometimes they normalize the symptoms. Patients still believe that pain during menstruations and menses is totally normal. But patients that have different quality of life is affected by the pain, or even sometimes they are misdiagnosed with IBS or other diseases.
Dr. Brighten: So we talked about pain. But there's more than just pain. So let's talk a little bit about the symptoms. If somebody's like, I think I might have endometriosis, what are the signs that they could be looking for?
Dr. Cabrera: Dr. Ramiro Cabrera Carranco
Dr. Brighten: is
Narrator: a renowned minimally invasive surgeon specializing in endometriosis and laparoscopic surgery
Narrator 2: with over 15 years of experience treating complex gynecological conditions
Narrator: recognized globally for his innovative techniques and compassionate approach to women's health.
Narrator 2: He combines cutting edge surgical solutions with a focus on his patients, physical and emotional wellbeing.
Narrator: As a leader in his field, he has been [00:01:00] awarded for his excellence in laparoscopic surgery,
Narrator 2: presented at international conferences and authored key research that advances the treatment of endometriosis.
We used to
Dr. Cabrera: think it was the normal endometrium that was outside the human uterus. Now it's totally wrong. Now we know that endometriosis is a multisystemic inflammatory disease. disease of the whole body. That's why you have to understand that endometriosis is caused by
Dr. Brighten: endometriosis being, you know, in the high ranking, it makes the top five of the worst pain conditions.
It's really sad that women go so long without a diagnosis. On average, how long does it take a woman to get diagnosed? It
Dr. Cabrera: takes up to
Dr. Brighten: Welcome back to the Dr. Brighten show. I'm your host, Dr. Jolene Brighten. I'm board certified in naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist.
As always, I'm bringing you the latest, most up to date information to help you take charge of your health and [00:02:00] take back your hormones. If you enjoy this kind of information, I invite you to visit my website, drbrighten. com, where I have a ton of free resources for you, including a newsletter that brings you some of the best information, including updates on this podcast.
Now, as always, this information is brought to you cost free. And because of that, I have to say thank you to my sponsors for making this possible. It's my aim to make sure that you can have all the tools and resources in your hands and that we end the gatekeeping. And in order to do that, I do have to get support for this podcast.
Thank you so much for being here. I know your time is so valuable and so important, and it's not lost on me that you're sharing it with me right now. Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. All right, let's dive in.
Dr. Ram Cabrera, welcome to the show.
Dr. Cabrera: Thank you very much. And it's a pleasure for me being here. So we can help a little bit more [00:03:00] patients as you probably have seen there are over 200 million women affected. And it's a pleasure for me to give some information to these, to these women.
Dr. Brighten: So when you say 200 million affected, we are talking about endometriosis.
And that is what we're going to talk about. Everything today is going to be endofocus. So for anybody listening, if you have this, you definitely want to listen to this interview, or you may want to pass it along to any of your other friends. Because as you said, 200 million people walking around, that's a lot of women.
How many of them are actually diagnosed?
Dr. Cabrera: Well, that's a really interesting question. By shame, uh, almost half of the patients that happen in the maternity are not even diagnosed. They only have the symptoms and sometimes they normalize. the symptoms. In countries like Mexico or other Latin American countries, patients still believe that pain during menstruations and menses is totally normal.
But as you probably have seen, patients that have a different quality of life or the quality of life is affected by the pain. Or [00:04:00] even sometimes infertility or even sometimes they are misdiagnosed with IBS or other, uh, or other diseases may have the disease and they are not even diagnosed with it. So one in each 10 women around it have endometriosis and the diagnosis in 2024 is easier than it used to be before.
So let's start with this and it's really important for any patients that have endometriosis. pain during menses or this pain is sometimes affects the quality of life or you have to take medication for this type of pain, you have to listen to this, to this key, key podcast.
Dr. Brighten: Okay, so you brought up period pain and how some women believe it's normal, but there's actually doctors who will reinforce that and doctors who will say, Period pain is normal.
What would you say to them?
Dr. Cabrera: Well, uh, as I always say to all, all the patients, all doctors are really good doctors. There are no doctors who want to harm a patient, I can assure that. But their expertise, that's why I even use this [00:05:00] as an example. My father and grandfather used to think that pain during menses was normal, because that's what we used to get educated in the university.
Uh, there's, uh, pain is not like, uh, another sign, it's a symptom. That means that you cannot measure pain. If someone tells you I have a lot of pain, you cannot put like a, I don't know, a stethoscope or a, or something to check the, the, the human, uh, temperature or, or the human, uh, like, uh, uh, so we can measure something.
In pain, you have to believe in the patient. And endometriosis used to be diagnosed only by surgery. So to get a diagnosis of endometriosis, you have to go under surgery and that was really, really hard. So, uh, many doctors, uh, when they used to perform an ultrasound or just a normal, uh, physical examination, they didn't check that there was nothing, uh, that was affected and used to think that the patient had the, pain in their brains or just think that it was psychological.
[00:06:00] Now we know that, that this was totally wrong. Uh, I even have to say that, uh, now in the 2024 days, we have something that's called a high quality treatment and diagnosis. So now we know that pain sometimes, uh, it's really, really hard. Even in the meteorosis, uh, it's in top rated as the number, uh, I think three or four in the top rated.
top 10 pain in the world. So it's something that's really important and we have to believe in our patients.
Dr. Brighten: Absolutely. So believe women. Yeah. Check every doctor listening, please. If your patient says they're in pain, I think, you know, sometimes that whole notion of like symptoms are in a woman's head, pain, pain is normal.
It creates bias in a provider, and I think by them asking more questions, like, How often are you in pain? How long does the pain last? Does it make it so you can't get out of bed in the morning? Are you able to cook for yourself? Are you able to go to work? Like, how does it actually impact your life? Yeah.
[00:07:00] Endometriosis being, you know, in the high ranking, it makes the top five of the worst pain conditions. It's really sad that women go so long without a diagnosis on average. How does it, how long does it take a woman to get diagnosed?
Dr. Cabrera: Well, even in first world countries, we already have, uh, these, uh, on their paper, it takes up to 10 years to get diagnosed in around, uh, five to seven specialist doctor.
That means that they can go to a normal OBGYN or they can go into a bowel surgeon or whatsoever. And they start getting misdiagnosis because remember, uh, in the old days, uh, it's not that a doctor is bad, it's that in the old days, the only way to diagnose endometriosis was through surgery. Yeah. Uh, in my yin, we cannot.
So, thanks to God, now we have a special protocol that's called an imaging protocol study that's called endomapping. Endomapping is the newest protocol in imaging studies. As we have, I don't know, any type of new cellular phone or any type of new [00:08:00] technology like our laptops. We can do an audio podcast and anyone can see it worldwide.
Now we can do a proper diagnosis of deep endometriosis with just the imaging. By shame, many doctors still don't understand how this works. It's not a normal transvaginal ultrasound or a normal MRI. It's a special protocol with a bowel gel, vaginal gel, and even some medications for the, um, bowel not to move.
For the
Dr. Brighten: spasms, because it's not fun. I recently went through this. I know,
Dr. Cabrera: I'm so sorry.
Dr. Brighten: No, no, but like, you know, when you compare, and I'm getting ahead of myself here with us talking about imaging, but when you compare, um, And a gel MRI, which is going to be gel inserted into the rectum and the vagina. And that's only like five minutes.
It's super quick in the MRI machine for that piece. Uh, but when you compare that to laparoscopy, which is a surgical procedure, this is far less invasive. The recovery time. It's not like I, you know, had to be in bed for a few days [00:09:00] or anything. I got up, I went to the bathroom and then that was it. So. It is far less invasive.
I want to go, I want to go a lot deeper in the imaging, but before we get there, you know for people who are new to this, I want to start at the top of Symptoms, so we talked about pain. Yeah, but there's more than just pain as you said women can be misdiagnosed with IBS So yeah, let's talk a little bit about the symptoms if somebody's like, I think I might have endometriosis.
What are the signs? that they could be looking for.
Dr. Cabrera: Well, for this, you have to first understand what's endometriosis, and that's the most important key aspect about the disease. Even when any patients come to my appointment, I take a little bit of time to explain to all patients what's endometriosis in 2024, because it has even changed.
The new, the new, uh, diagnosis and also what, uh, the pathology sometimes, uh, is, uh, it have even changed around the world because we used to think it was normal endometrium that was outside the human uterus. Now [00:10:00] it's totally wrong. We think, uh, now we know that endometriosis is a multisystemic inflammatory disease of the full, whole body.
Dr. Brighten: Okay, I want to pause right there and really have people take that home. Endometriosis is not a reproductive disorder. It is a systemic inflammatory condition affecting anywhere and everywhere in the body.
Dr. Cabrera: Yes, and even if you only have it like in the ovary or sometimes in the bowel, it affects everything.
totally the body. That's why you have to understand that endometriosis is caused by endometrial like cells. This is really important. It's not the same cells as the normal dimetrium that are born and grow outside the human uterus. Yes. It can reach to any organ and sometimes a person can die. patients do believe that it's caused by retrograde menstruation.
Now, even though we are not certainly sure about where does it come from, we do believe that in the retrograde menstruation is not the only cause. We even have seen that in menstruation has epigenetic cause. That means that the [00:11:00] theology sometimes can even be by a hereditary diseases. That means that if your grandmother, a mom, aunt, sister have pain during menses, have, have infertility, have had even a uterine fibroids or myomas, you may have the genes to have endometriosis and you have to suspect it.
That's it. So, uh, depending in the size, and also the localization of the endometrial like cells, that's the symptom that it cause. And the most important part is that if you have, uh, endometriosis in other, in, in any organ, it cause a dysfunction of the organ affected. So if you have endometriosis in the bowel, what does it cause?
Dysfunction of the bowel. And you can have bowel distention, that means abdominal distention. Known
Dr. Brighten: as endobelly by many patients. I've been there.
Dr. Cabrera: And you can have diarrhea or constipation that enhance during menses. And you can even have, you have a really big knot, imagine like a rock is stuck in the, in the bowel.
Then you have a, something that's called pericarditis. pain during, during [00:12:00] edification or going to poop so that many patients have, Oh, I have a really bad IBS and you didn't have IBS, you have a really big noddle in the, in the bowel. It might be that noddle is in the bladder. Then many patients have a, you know.
Pain during nutrition or during urination. And also you may have urinary frequency or sometimes even have like symptoms of a urinary tract infection.
Dr. Brighten: Yeah.
Dr. Cabrera: So many patients come to my, to my clinic and they have like, oh, I have every, every time I have my period, I have an IUTI. And you're like, wait, have they ever done a a, you know, like a, a, a culture to see the, the, if you have a, a, you're an example.
So we can see. the, the, the bacteria and it's like, no, they have never, they just give me antibiotics. It's like, then you didn't have a UTI, it was an endo nodal in the bladder. And imagine if that, uh, also it's affecting the reproductive organs, then you have something that's called infertility. If you have a big endometrioma, Imagine a big cyst in the ovary, [00:13:00] it's not the same, say, the same cells as the normal ovary.
So the ovarian reserve goes lower and also the quality of the eggs. My sister used to have a really bad case of deep endometriosis. That's why I take in my lifetime. to endometriosis. And my sister underwent too many IVFs, and by shame, they lost the embryo. Now we know that if you have adenomyosis, that is, these endometrial like cells that are born into the muscle layer of the uterus, it causes a bad implantation or not a normal implantation.
And if the reproductive doctor doesn't see it, then they just charge for the IVF. And then you just lose the embryo, you get me? Also, if they understand that you have a big endometrioma and they not check the, the ovarian reserve, and they try to do surgery on you, then you will lose more ovarian reserve.
Yeah. You get me? Well, that's why,
Dr. Brighten: you know, anyone who's listening and we're, I'm going to talk more about how to find a doctor, but it's so important because I have seen patients with endometriomas [00:14:00] Their gynecologist rushes them to surgery and says, Oh, you have to have this removed, but they are not a specialist.
They end up taking more of the ovary than probably what's necessary and it compromised their fertility and they didn't have that discussion. They didn't have the informed consent of the provider saying, Maybe you want to do egg freezing first. Maybe you want to consult with an expert in endometriosis or even a reproductive endocrinologist.
Somebody else's second set of eyes, a second opinion to help guide you. So I find that very problematic.
Dr. Cabrera: And this is as, as you were saying, now the newest clinics that are really, uh, even with the new certification, NICU, and every certification that try to improve the quality of treatment for endometriosis patients.
We try to demand the clinics of reproductive medicine to have an endospecialist, because 50 percent of women with deep endometriosis have endometriosis. So just to remember, and this is for patients that are seeing this podcast, we have a, like a [00:15:00] pneumothenic to remember what's the symptoms of deep endometriosis can, can be.
So first symptom is this, is dysmenorrhea. That means pains during, during menses. Mm-hmm . The second symptom is dys ria. That means, uh, pain or any symptoms and the pain in the premenstrual period for the urinary tract. That means any symptoms for IUTI or whatsoever. The, the third is dyspareunia. That means pain during, uh, sexual activities.
So if you have a deep dyspareunia, that means that you have pain during deep penetration. That's not normal. No. Uh, some, uh, Latin American countries, um, uh, try to explain this, uh, by saying that sometimes it's the size of the penis of the, of the, or That's
Dr. Brighten: very rare.
Dr. Cabrera: And this is really bad. Yeah. Yes, uh, the size of the penis or whatsoever doesn't cause the pain.
It's more common that one in each 10 women have endometriosis, and if you have it right in the back area of the uterus, then you have deep dyspareunia. Also difficulty to get [00:16:00] pregnant. That means 50 percent of patients with infertility, and the last symptom that is the worst of it, it's something that is called chronic pelvic pain.
Yeah. So, uh, this is really bad and that's like the complication of deep endometriosis. That's when the medical system failed. Uh, patients stay 20 years with deep endo, many surgeries without diagnosis, you get me? And that's what they develop even sometimes, uh, something that we call central sensibilization and peripheral.
And it's really bad because these things takes too long for a patient to, to recover. So now you understand a little bit better how we have to treat endometriosis and how to, to even a diagnosis. And now I think that's really important for patients to understand that not because you're in a super advanced clinic.
I don't want to say any names or they're charging a lot to you.
Dr. Brighten: We're not going to do any call outs, but if you want to call out in the comments, we're not going to judge you for that.
Dr. Cabrera: But it's really important that even if you are in the top world countries, like the U S and [00:17:00] Canada, or I have been even in Europe, and sometimes you can visit these clinics that are top.
renowned. If they don't have an endometriosis multidisciplinary treatment care, like a really good one that is even certified, it's probably that they will not do mapping. They will not check the ovarian reserve. And it's something that we have to change. That's why it's really important for them to understand and hear high quality information.
Dr. Brighten: Absolutely. Okay. So we've gone through the symptoms. Yeah. So if you are having pain with intercourse, if you're having pain at all, throughout your cycle. And it's not just around your period. Ovulation can be a really common time. So ovulatory pain, especially because so for everyone to understand, estrogen likes to spike.
Well, it has to spike right before you ovulate. That's what tells the brain that the egg is ready. And with those Creeping up estrogen levels, those tissues, just like your uterus can respond, these other cells floating wherever they may be in the body can also respond to that estrogen. And so paying attention to your symptoms, I would say track your [00:18:00] symptoms, write down the pain scale, if it's a scale 1 to 5, 1 to 10, worst pain of your life being that top number, and really quantifying how it affects your body.
Yes. And taking that to a provider, how does someone find a provider? What should they be looking for to get this diagnosis? Because, you know, you're going 10 years. 5, 6, 7 different doctors. I mean, gynecologists after gynecologists not giving you a referral. What, uh, how can we help patients today get to the right people to support
Dr. Cabrera: them?
Really hard.
Dr. Brighten: Maybe they could all just come to you.
Dr. Cabrera: That's impossible. By the way, Shane, right now, worldwide. We have, as I was telling you before the interview, there's new certification process like master surgeon, I care better and many other, uh, certification process that help us understand what's a high quality treatment.
And we have, it's not just a doctor, uh, even though I dedicated my life because of this. family that have endometriosis. It's not just me. I'm not the hero. The full team is the [00:19:00] hero. You get me? Many patients are like, Oh my God, you're the best doctor ever. It's not just me. It was a really high quality treatment that was made by a full team of doctors.
So it's not a provider. That's the most important thing. It's a full team. So, like my institute, an institute is a, we have even a neuropath that if someone just, just take care of pelvic nerves. We have the one of the best colorectal surgeons worldwide for deep endometriosis in the bowel. We have a urologist that understand endometriosis.
You get me? We have a cardiothoracic surgeons when the endometriosis can be extra pelvic and it can get even to the lungs, heart, and even the diaphragm. So now you understand that it's a full team. It's not just surgery and hormones or whatsoever. We have a special nutritionist that I was telling you before.
So patients that have endometriosis has gone, has, have to go through all the process. So we have to change the diet, supplements that make an anti inflammatory diet and [00:20:00] supplement. And we have even someone with a master degree in anti inflammatory diet. So now you understand. And patients that develop, imagine having endometriosis for 10 years.
20 years, 15 years. You think that the, the, the human pelvis is the same as a normal human being? No. So the pelvic floor is contracted, that's caused, that's something that is a complication of endometriosis, that it can cause also pain. So endometriosis cause pain and also the myofascial pain, that means pain in the muscle area that, that, you know, suspend all the organs.
And if you do not do physiotherapy, even with the best surgeon, you will still have pain. So this is really important because it's not just to get to a perfect surgeon, it's to get to a perfect team. And each patient is a universe. So not, it's not like a cooking recipe. It's not the same to all patients.
Yeah. So you have to give to each patient. patient an individualized treatment. If they want to get [00:21:00] fertility, if they do not want to get more fertility, then we change treatments. Now you understand a little bit better how to get to them.
Dr. Brighten: Yes. Okay. So, um, I just have to tell you, this is the moment I like fell in love with you because I have always in my practice said, Endometriosis takes a team.
Dr. Cabrera: Yes.
Dr. Brighten: I will not work with patients who do not have an endometriosis surgeon, who do not have a, and, and whether they need the surgery or not, they need the consult, they need to have, you need to find that good person before you actually need them, uh, but also having a nutritionist, and I saw your integrative approach, and I was like, this is what women's health needs.
Has needed for so long and there is not a lot of surgeons out there who are doing this who are have put together the clinical team that you have so, um I do want to praise you for that but also my husband knows as I was like looking through your instagram and reading about your institute and all that and I was like Um, i'm in love with this doctor.
Like he is changing women's medicine, especially I mean every [00:22:00] endometriosis doctor patient deserves that kind of care, that holistic care. So I want to talk more about that. But before we get there, I want to talk about the imaging. So somebody finds the team. Now it's time to work up. How do we investigate?
So as you were saying, we don't have to always do surgery. We talked a little bit about the MRI, but what are the different tests that are available to evaluate? Do you have endometriosis? Make that diagnosis and really do a comprehensive intake of that individual.
Dr. Cabrera: So this is, I think, the key of this podcast.
So you're hearing this and you have seen tomatology that made you suspect that you have deep endometriosis or you have endometriosis. The most important part is the diagnosis. is to find someone that can get you to high quality diagnosis, high quality diagnosis in 2024. That's called endomapping. Okay.
So before any surgery, this is really, really important. You suspect the disease by clinical symptoms. So you go to your [00:23:00] provider and they should always tell you that they will do a high quality advanced imaging study, it's called endomapping, or whatever they want to call it in each country. But they have to offer you even a full body, even abdominal ultrasound with transvaginal, not just transvaginal, done by an expert in deep endometriosis imaging.
You get me? Or if they do not have that, because in the U. S. they are really, really, uh, not, uh, good with imaging through, through ultrasound, they should provide, uh, an MRI with a special protocol to see the disease. Yeah. Um, uh, before going into this, we have to remember there are three, uh, three types of endometriosis.
The first is peritoneal disease. That means that it's so superficial that you can only see through laparoscopy. This is really important. And so little because remember that the disease starts really small, even sometimes in a cellular level. Yeah. You get me? So if it's really small in that stage, you can only see it through [00:24:00] laparoscopy.
The second stage is called deep endometriosis. That means when it can grow into any organ and that's when we can and we must diagnose it before going into endometriosis. any type of treatment, hormonal, medical, surgical treatment. And this can only be done in true centers of expertise. And it's mandatory to do it.
The third type is something that's called ovarian endometrioma. That means a chocolate cyst, a complex cyst, however they want to call it. And this is really important because many patients will go to a normal transviral ultrasound. They see the chocolate cyst, you have endometriosis, let's go into surgery.
Dr. Brighten: And
Dr. Cabrera: this should never be done. And I will repeat, this should never be done. If you have a chocolate cyst, you have up to an 80 percent chances that you have deep endometriosis in other organ. Wow. And they should always see it before going to surgery. So, in high quality treatment, you have a deep endometrioma, they should give you an endomapping before going to surgery.
Dr. Brighten: Yes.
Dr. Cabrera: So, with an endomapping, with a special [00:25:00] protocol, we can see something that's called the ancient score or classification. Mm hmm. That, that score, as I probably, you can see it in the screen right now. In the screen, they will put the ancient score, and we can see the disease, the amount of disease that you have in the bowel, bladder, or other organs.
That means not the same to have little cells in the bowel or a big, you know, nodule that can reach up. 20 centimeters you get me. And the same is the treatment. They should always see the nodule before going into any surgery. And the most important part I think right now worldwide is to get to someone that can get you the endomapin with an NCN score.
And by obvious reasons, if you have endometriosis in the lungs, Or in the, the African or in the bowel or in the, in the bladder. They should always provide a multidisciplinary team.
Dr. Brighten: Yes.
Dr. Cabrera: You can suspect it before surgery. So now it's not what, let's go into surgery and see what we can find. No, and this is something that you should put like in reps, uh, something capitals, [00:26:00] even if we go under surgery.
The human eye cannot see through tissue, so when we enter we will only see the superficial layer of the organs. So we cannot see the size of the nodule, we cannot see the layers of the organ affected. If you have adenomyosis, we cannot see through laparoscopy because it's inside the muscle layer of the uterus.
So if you have a bowel nodule, sometimes we can only see the superficial layer of the nodule and we cannot see through all the layers. That's why endomapping is not a suggestion, it's mandatory. You get me? Oh yeah. I think that's, that's really important for them to understand how can we can even suspect and approach in a multidisciplinary way.
Dr. Brighten: Okay. So we're going to go for imaging. Transvaginal ultrasound. Yes. Which people are always like, Oh, is that, it's easier than a pap. People are always worried about it. Like if you get a pap smear, if you've done that, no, this is a cakewalk compared to that. I know. So there's the internal, which is, uh, so transvaginal ultrasound for everybody who doesn't know it's a wand inserted into the vagina, [00:27:00] then an abdominal ultrasound, and then ultrasound.
Also, the endomapping, which is going to be the gel MRI that we talked about. Yes. And that will help you see the deep infiltrating endometriosis. Yes. Which it's no coincidence that those letters spell die. Oh my god. As like it spells D I E and that's how you feel when you have that kind of pain. Like, I'm like, I've never related to an acronym more.
Dr. Cabrera: Oh my god. Like I've never even thought about it. Really good that one.
Dr. Brighten: Oh, so good. So, uh, with the deep infiltrating endometriosis, you know, the, the superficial, there's going to be different treatment options, but let's talk about this because a lot of women, they're, they automatically go to hormone therapy often.
Actually where I want to go with this right now is that the birth control pill is often prescribed and doctors will say. This will stop your endometriosis from progressing. This, you know, I've even heard doctors say this is the best cure we have for endometriosis. Oh, yeah. It's so problematic. And, uh, we gotta talk about why [00:28:00] that's problematic.
Dr. Cabrera: Well, this is really important. And just by the definition as we started, it's not the same cells as the normal endometrium. So, any hormonal treatment, you have to understand that sometimes these cells, and we published that, I think, in 2021. We published, uh, because we made studies for these endometriotic nodules, and we found out that it's not the same thing just because one reason.
They don't even have the same hormonal receptors. So that's why many women, they will have, uh, you know, when we start oral contraceptives or the pill, they will feel better. Some of them, because they have. But some of them, the endometriotic nodules doesn't have, and we didn't even knew. Yeah. So if we provide, and sometimes they even have the side effects that sometimes they're awful.
Uh, then we, we know that some, poor of the women, we put them into hormonal treatment and the endometriotic nodules, these, they didn't even have hormonal receptors. So now we know that this is really bad. Uh, it's not that we do [00:29:00] not know. So, um, we have to provide hormonal treatment for our patients, but we have to individualize each case.
So, if we see that you have more side effects than beneficial effect, then the hormonal treatment is not working. You get me? Sometimes, in the U. S. and Canada, they still provide, and I will suggest to never do that unless you're with a true endo expert, uh, something that's called a hormonal castration.
Dr. Brighten: Yeah.
Dr. Cabrera: Or pseudomenopause. Wait.
Dr. Brighten: So everybody hears that hormonal castration. Yes. It's a temporary menopause. Yes. Uh, I just really want to underscore that because I put myself through that for two months. So
Dr. Cabrera: sorry to hear that. I
Dr. Brighten: mean, I am a doctor, so I actually used an estradiol patch while I was on it. I made sure I had like saffron so my mood wouldn't tank.
Like I did a lot of things. I still stayed with progesterone. Yeah. There was, I was like, I'm not going to cold. Yeah. But it's only because. I'm a hormone expert. That's like what I do. Otherwise, yeah, everyone's like, nope, you just go on it and, uh, you're, you just bear through it. And I was like, it's the holidays.
My children deserve the full holiday experience, [00:30:00] not a, you know, a crazy mom. Cause you, you can feel crazy when you lose your hormones with it. I mean, because it's like you do the injection and then like a week, two weeks later, you're just suddenly in menopause. There is no like, Oh, perimenopause. Yeah.
It's
Dr. Cabrera: not like, like, you know, like this. It's like, like a rocket. Yeah. It made
Dr. Brighten: me a better doctor for everybody in menopause and I'm like, and because I'm my own guinea pig, I'm like, I definitely figured out some things that can really help.
Dr. Cabrera: Yeah. But I, if I will suggest this, if you're with an endo expert and she suggests this, then you should try it.
But if not, uh, this is really bad because one, it's not the same cells as normal endometrium. So there's no hormonal cure for deep endometriosis. My grandfather and father used to think by going into menopause, because there was no more menstruation, and remember all doctors, not bad of them, they used to think that endometriosis was caused by the menstruation itself.
So they used to think that by taking away the menstruation, like with [00:31:00] an hysterectomy, by getting pregnant, or with hormonal castration or menopause, They used to think, I didn't want to say brands.
Dr. Brighten: Yeah. I mean, but we can talk about the drug. I think, uh, it's totally fine to do that because this is what patients are going to hear, what they're going to be offered.
Um, and it helps them navigate that. So we're not like, it may be good or bad. It may be, you know, right for you or not right for you. for you. Yeah. We're not promoting anything. It's just more education.
Dr. Cabrera: But, but as an education purpose, Lupron or Lisa and other, other new GNH analogs, eh, we already know that they will never even cure the disease and not even, eh, stop progression.
When we were making these studies about the, the hormonal, eh, receptors, we found out that even they produce their own aromatase. That's something.
Dr. Brighten: Smart Like that. Right? But awful . That's
Dr. Cabrera: really crazy. But endometriosis can produce its own hormones. Yeah. That means that I, even after menopause, even if they take away the both ovaries, even if they [00:32:00] take away the full uterus whatsoever, they endometriosis tissue tends to grow by itself.
Dr. Brighten: Yeah.
Dr. Cabrera: So it's like, it's not cancer. But it acts like a cancer, you get me? That's why my grandpa used to believe that it was like a benign cancer. Yeah. So this is really important. If anyone will ever suggest Lupron or ELISA, tell them to inject them themselves. I will, I will say that joke to my, to my patients because now we know that it provides more side effects than beneficial effects.
Sometimes they can even lower your barium reserve more and cause osteopenia and osteoporosis. So, uh, thanks to God, you're a doctor and you supplemented with estrogens. Yeah. But many of them, they will never knew that, uh, osteopenia and osteoporosis can be caused by this. And I have seen patients with even 18 years old that they put them one year in pseudomenopause.
Mm hmm. This patient went with, you know, low, uh, low, uh, bone mass and even have [00:33:00] fractures.
Dr. Brighten: Which is so problematic because it's that age when we actually build our bone density for our life. So you really, it's very uphill battle for you once you approach menopause. And that's why with these drugs, you know, That are going to shut down your cycle.
They're not advised to go beyond six months, but it can be pretty horrific. You know, I'm a 43 now and praise. I've never had a hot flash. I've not had any perimenopause symptoms and, but B when I went on Lupron, I had a hot flash, you know, the insomnia, I took oral progesterone to help me sleep and a bunch of other things, but, um, You know, it really was like there, this is so difficult.
The other thing that, um, I was still eating the same and I was exercising, but the visceral adiposity, suddenly I'm having belly fat and I'm like, what is happening? And I'm like, well, I know what's happening, but it's so important, I think, for fertility patients to understand that when you get that visceral adiposity, You can't just go into an embryo transfer or trying to get pregnant.
[00:34:00] It's harder because that fat is so inflammatory and it can cause insulin resistance. It can set you up for gestational diabetes. So there's a lot of problems I think also that aren't discussed when somebody is going through fertility treatments. And so we're going to talk more, if everybody's like, say more, we will say more about fertility.
But, um, I want to go back. So we. We've talked about some of the medications that could be used, but really if you're going to consider the medication route, we need to have that mapping because you said the medications won't touch deep infiltrating endometriosis. Even,
Dr. Cabrera: no, even endometrioma or even peritoneal disease will never be changed by medication.
So we know that we will never do surgery in 200 million women.
Dr. Brighten: Yeah.
Dr. Cabrera: But depending in the endomapping, we will see the amount of disease and also, uh, the, we used to use staging of the deep endometriosis. We used to stage. Yeah. Let's talk
Dr. Brighten: about why that's old school. Oh, yeah. This is
Dr. Cabrera: really important. And this is really old school.
It's what my [00:35:00] father used to, to do is like, you know, using the first iPhone or something. He
Dr. Brighten: better not listen to this. You've been calling him out a lot. I know. No, but he,
Dr. Cabrera: he used to be the president of oncology in the full country and he can tell you perfectly that even if he was. probably the best oncologist in Mexico.
He was not an expert. That's it. You get me? So now they understand a little bit better how it works. So what we have to change about this is that by doing the endomapping, we can see the amount of disease that you have. A state system used to be all because for using stages, stage one to stage four, it has to be.
after surgery. It was a scoring process, uh, that remember that the human eye cannot see through tissue. So we used to think, Oh, they have a big endometrioma and some attachment to the bowel, but we cannot see the amount of bowel nodule that you have. So saying to my sister, like they used to say that they have like a stage four.
It didn't help my sister to anything because she can say, Oh, thank you. That means that I have in every place. And now, now what? [00:36:00] But by the NCN score, we can see if you have in each organ and the amount of affection in your organ. And with these, we can approach in a multi primary team, you get me? So if they're giving you the staging system, I give it to.
But I, the most important staging system is the NCAN score. You should mandatorily ask for an NCAN. Like, oh, I'm going to do surgery. I'm going to do a marijuana treatment. Wait, wait, wait. What's my NCAN? No, you have stage four. No, I want an NCAN. You get me? Because with this, they will help you with a multi primary approach.
Dr. Brighten: And you were saying, you said, So, um, I'm going to send the imaging to a radiology expert who has the eye for this. So, what is the ENSEAN score? So, break it down. And why does it even matter to a patient? Oh,
Dr. Cabrera: it's really important. The ENSEAN score was, uh, the ENSEAN is just the name of the hotel. When many radiologists worldwide understand that they have to do a learning process to to see the deep endometriosis.
So you can have the best radiologist, I don't know, in the USA, but he's the best radiologist for brain cancer. That's the one who will never see [00:37:00] endometriosis, you get me? The one that has had a learning curve of 15, 20 years to see the disease is the one that will see the disease. Yeah. You get me? So, uh, the NCN score was created.
uh, in, in, in, in Europe to understand the disease before going surgery. So they understand that before going surgery, surgeons must, must knew that they have a really small nodule or a really big nodule. That totally changed the way of surgery. If you have a really small nodule, you can even just shave the nodule.
If you have a big nodule in the bowel, you have to do a bowel resection. And by knowing the exact localization of nodule, you can understand what, how are we going to win. reconnect the bowel, because uh, in the newest way of surgery, that's why this is my specialty, in bowel surgery, if you have a big nodule then you have to do a quick primary anastomosis, that means to put back together the intestine, not do an ileostomy like my grandfather used to do.
So, in the old days, if we touch the intestine, we have to do [00:38:00] the, the, the function of the intestine. So, we have to do an ileostomy. So, you might have deep endometriosis, you went to surgery, now you, you went out with an ileostomy, that's even worse quality of life. Now, experts, we can provide even a good surgery without giving any, uh, ileostomy or any other type of complication during surgery.
Did I explain myself well?
Dr. Brighten: Oh, absolutely. Perfect.
Dr. Cabrera: So the Ensian score is really important.
Dr. Brighten: Yeah. So, so here's what I'm hearing though, is that, um, you know, a pilot would never fly blind. A pilot has their instruments, they have their checklist, they would never fly blind. Yes. Why would a surgeon? And what this mapping and this Ensian score provides surgeons is the tools and the instruments to really navigate this individual's body.
Yeah. So that you don't get into surgery and you're like, surprise! What is this? Yes, we didn't know we didn't see this coming
Dr. Cabrera: and that's happening worldwide
Dr. Brighten: Yeah But by doing this mapping and getting the correct scoring you can provide a better informed consent and that I [00:39:00] think is really important Having that conversation ahead of time with the patient so that they have appropriate expectations You know having your doctor go in and then being like sorry we had to cut cut apart your bowel and you're like, thought I just had this thing on my uterus or on my ovary.
Like I didn't, I wasn't prepared for this. Or
Dr. Cabrera: they didn't do anything. That, that's true. In the US, what they do is that they enter, they didn't knew that you have, you, you have a big endometrioma. They enter, Oh my God, there's bowel disease. Well, we didn't knew. So that's it. And that's the end of surgery. So patients go not just through one surgery, they start getting through five surgeries.
And as you probably understand, more surgeries, more, more complications, more fibrosis, more pain.
Dr. Brighten: Yeah.
Dr. Cabrera: So it's not just making 20 surgeries to get you up for endometriosis. Totally.
Dr. Brighten: Nobody wants peek a boo in their body. Yes. Nobody wants it. Now
Dr. Cabrera: you understand why it's mandatory, a high quality diagnosis.
And now we should talk about a little bit of high quality treatment. Yeah. That's really important as well.
Dr. Brighten: First I want to ask though, we've talked about [00:40:00] the delay in diagnosis. Yeah. Does delay in diagnosis increase the likelihood someone will develop deep infiltrating endometriosis? Yes,
Dr. Cabrera: I think this is the most harmful thing or aspect about endometriosis.
Remember that now we believe that the disease is totally epigenetic. That means if you have endometriosis, you can air endometriosis to your daughter by 70 percent chances. Okay. This is important. Yeah. 70
Dr. Brighten: percent passing on in the landing. Yeah. So imagine
Dr. Cabrera: that your, your daughter is now developing in your uterus.
So she, her uterus is being developed and now she's in the moment we're speak as the cellular level of the uterus is getting put together. They can get the, the cellulars of the endometrial like cells outside the uterus. You get me? So when they are born, they don't have any symptoms, but some patients even have symptoms since the first menses.
because they already have endometriosis in a cellular level. Cellular level means that you cannot see it. So now imagine [00:41:00] in the adolescence, how many things, how many things do you think it's inflammatory for an adolescent?
Dr. Brighten: Almost
Dr. Cabrera: everything.
Dr. Brighten: Yeah. I'm like, Oh man, my, my audience knows my confessions. I thought crumb donuts were an acceptable lunch as a teenager.
Oh, so sorry. Yeah. So sorry. Sorry, that was like, I call it a metabolic obscenity. I literally cussed at my body with the food I was eating. But now you
Dr. Cabrera: understand, imagine the U. S. eating hamburgers, eating a pizza, eating, you know, like what we're used to eating in Mexico, tacos, you know, everything. So imagine this adolescent with already the cellular level of disease getting inflammatory diet.
Then what's going to happen? We are going to get an inflammation process. So by getting it before, uh, you know, the first thing, our aspect of this is superficial. And then imagine the inflammatory process going, uh, day by day. every month. And now you can imagine how the nodules can be developed. And it's not by retrograde menstruation.
It means that you get the nodule and then start growing, [00:42:00] and you already have it in the bowel, in the bladder, in the diaphragm. So now you understand why nutrition is one of the main aspects. You want to change the quality of life or the progression of the disease? Change it for your, for your daughter.
Just change the diet. You get And with this everything will be better because they will be healthy and the endometriosis tissue will never try to develop. So this is important as well in delaying diagnosis. If we can only diagnose in the teenage years, change the quality of life, change the diet, then they will never get deep endometriosis, no more five centimeters in the bowel.
We will never have to do a bowel resection, you get me? Or a big endometrioma that will cause the loss of function of that ovary.
Dr. Brighten: Yeah. And it's very refreshing to hear the prevention and hear you talk about diet. My first period was horrible and my periods were the more than seven days of bleeding so heavy, like nothing contained it.
Um, so much pain. This is like back in the day, like where you had heating pads with [00:43:00] cords, but no, no extension cords. I was like laying on the floor and this school, uh, three years later I was put on the pill. I did the pill for 10 years and I just basically didn't have a period. Um, and I look back. So now that I've had the mapping, cause I, you know, didn't really have a, so I'll explain how I didn't really have symptoms, but when I look back, even while I was on the pill, where I see where my endometrial lesions are.
So being on ligaments, I'm like, I did have pain, but we thought it was my iliopsoas, like I did have pain. We thought it was other things. I am so blessed that I had a bunch of, uh, so I get on the pill, I end up with digestive issues, I start changing my diet, I decide to study nutrition. So here I am eating six to nine servings of vegetables a day.
Very anti inflammatory diet. Yes. Doing that for decades. So, you know, when I came off the pill, periods came back horrible, pain was horrible. I did a lot of things to help with that. And so here I am and people are like, how did it take 29 years for you to get the diagnosis of endometriosis? I'm like, [00:44:00] nobody caught it to begin with.
Then, I got my diet, my lifestyle so dialed in, I I really didn't have faith that doctors were going to be able to help me with my period pain, so I hacked it all, I did it myself and it really, in some ways, it worked against me in terms of delay of diagnosis, but yet, I think without that, I wouldn't have my two children, I wouldn't have the quality of life that I have now, and so I just want to share that story to echo what you're saying that nutrition is so powerful and I think that, you know, had I not been like, you know, religiously counting vegetables and 25 grams of fiber a day and doing all of those things, I think that it would be a very different story by the time I was 25.
Dr. Cabrera: And even a worst case, you get me, or you can even develop a worst case just because of the diet that you used to have. So this is really important because a patient can only understand by just menstrual education worldwide. If anyone understand, had ever heard the word endometriosis in the full world, there will never be endometriosis stage [00:45:00] four, as they used to think, or like a deep endometriosis in the bowel, in the bladder, in the biaphragm.
There will be really low cases. So they will never need the endometriosis. The, we will never need the capacity for 200 million women. Now we don't have the, no, no specialist worldwide. That's why I even have to travel worldwide to do surgeries. I have done surgery in India and in many country, probably now in the world.
But it's not because I'm a really good surgeon. It's because there are really few that can do these type of surgeries. You get me?
Dr. Brighten: Well, you are a really good surgeon and that is why I, you are very humble. And I think that's always a quality to look for in a doctor, but I'm not going to be humble for you.
I'm going to brag for you. Okay. Uh, that's going to happen. We've alluded to the dietary changes. Like I just had a little rant about that. Okay. Anti inflammatory diet. Let's break it down. Like what should people be doing to stay healthy? They suspect they have endometriosis, they know they have endometriosis, and of course we want them to work with a dietician, with a nutrition expert, to help guide them.
It's easier said than done, right? But let's still give some parameters, some ideas [00:46:00] of what people can be doing.
Dr. Cabrera: This is really important. In our center, in deep endometriosis centers, we always have a nutrition expert with a master degree in anti inflammatory diet and supplements. So, uh, an anti inflammatory diet is not the same as being vegan or a healthy diet.
This is important. I didn't even knew, as an expert in endometriosis, that I know broccoli can be inflammatory. I used to think by my grandmother when they told you Okay,
Dr. Brighten: I'm a cruciferous fan, so you're going to have to explain that. Yeah,
Dr. Cabrera: but you get me. Many I used to think that my grandmother, when I was sick, is like Eat healthy.
Okay. So broccoli and lettuce and whatsoever. You get me? Like beans. Mexico beans every day. So now we know that beans, broccoli and many other, uh, like, uh, like things that you think that is healthy cause inflammation in the bowel. Even sometimes the, the, the, the microbiome that it's living in your bowel, if it's not a normal microbiome, then you will have an inflammatory process.
About this, there, there was a publication I think last year [00:47:00] about something that not many. Okay. people understand. They used to think that because of a, uh, bug, endometriosis was caused. They didn't, they didn't understand it.
Dr. Brighten: Wait, can you say that again? A
Dr. Cabrera: bug? Yeah, a bug, like a, um, uh, a bug in the intestine.
Dr. Brighten: Oh, a block, a block in the intestine. No, a
Dr. Cabrera: bug, like a, um, a bacteria in the intestine. Oh, a bacteria
Dr. Brighten: in the intestine. Yeah. Oh, you're just like, that's a cool little slang, a buck, I like that. I know, I'm sorry. I know, you don't have to bother. They,
Dr. Cabrera: they used to think that, uh, um, a bacteria caused endometriosis, but they didn't understand that the article was saying.
So they, they in, I think that in a thousand patients with endometriosis, they used to check the, the box that was living in the, in the, in the intestine. And they found that it was almost the same in the bacteria and in the intestine. So they used to believe that there was. the cause of endometriosis. So there was a big movement in social media about this.
I have a lot of patients like, oh, so endometriosis was caused by, by this bacteria. Like no, wait, see the [00:48:00] article really well, read it. What he said is that inflammation, that means a microbiome, that is a, that is a biosis, that means that it's not a normal bacteria in the intestine, cause more inflammation and that cause more inflammation to the endometrial like cells and tends to grow.
You get me? So, if you have ever seen that article, endometriosis is not caused by, uh, uh, thyroid and intestine. It's caused by inflammation. You get me? That's enhanced endometriosis. So, that's really important.
Dr. Brighten: So, Dr. Fasano, I don't know if you're familiar with his work, he came up with the theory of how we develop autoimmune disease, which is genetics, intestinal permeability, and a triggering event.
Is it possible that this bacteria could play a role in a triggering event? And that's what's going on. So it's triggering the inflammation, it's triggering what is happening.
Dr. Cabrera: So now you understand, many patients just by hereditary process, genetics, you may have endometriosis. Did any inflammation process diet in microbiome?
You get me? It can cause more [00:49:00] inflammation. And that cause enhancement of the disease. That means progression. And now you understand how endometriosis works worldwide. So now put that into, you know, we can just change that. There will not alcohol, drug consumption or any, you know, like even cigar or tobacco usage.
Yeah. Then if you can change that worldwide, there will be no inflammatory process. But everyone, even including myself, I have ever drink a tequila. Come on, I'm Mexican.
Dr. Brighten: Yeah, I mean,
Dr. Cabrera: you have to. That's normal. You get me. So now you understand how you have to change even education for patient for deep endometriosis.
Dr. Brighten: Yes. So, you know, as you are talking about this, something I want to bring up is small intestinal bacterial overgrowth or SIBO. We see this a lot with endometriosis. It is something that, you know, patients often get diagnosed with IBS. I am always like, let's look, is there SIBO? Is there endo? Because if you've got both of those, you won't, you won't be able to address one or the other.
Without, you know, addressing both. We have to be looking at both. [00:50:00] That's definitely an instance where broccoli is going to be problematic. So these people, they can't do cruciferous vegetables. So the, what are called the high FODMAP foods, um, that could cause a lot of bloating, inflammation in the intestine.
And so if somebody is listening to this and they're like, I don't do well with those foods and I've been treated for SIBO, like, you know, I see people that have been treated a dozen times. I'm like. I always fall back, and my husband will tell you, he always laughs at me, to Albert Einstein, legitimate genius, saying, the definition of insanity is doing the same thing over and over.
So why is it that you are just getting Rifaximin, you're just treating SIBO over and over? How often are you seeing this like gut endo connection in your practice?
Dr. Cabrera: Well every day. It's really hard sometimes as an endo expert because we have seen the worst cases scenario. And by shame, many doctors still do believe they want to help patients.
patients because all of us want to help patients. But if you don't have the expertise, you will end up, you know, uh, not harm the patient, but just leaving the patient with 10 more years of [00:51:00] misdiagnosis. You get me? So if you have these type of symptoms and they have, uh, tell you, Oh, you have IBS, you have IBS, you have a bad case of IBS, but that IBS enhanced during menses, that's not IBS, that's endometriosis.
You can have both. And it's true.
Dr. Brighten: I don't know. Sometimes I say, like, IBS is the you haven't figured it out yet diagnosis, because, uh, and I've, there's a couple episodes we have got with gastroenterologists on the podcast who've said the same thing, where they're like, people are too quick to jump to IBS.
Yes. Too quick. No, you
Dr. Cabrera: just touch a bowel and, ah, you have IBS, it's not, that's the worst doctor ever, you get it? Yeah. And that's happened all the time in Mexico and Latin American countries. It
Dr. Brighten: happens everywhere. They don't
Dr. Cabrera: know what you have. You have IBS. And just take this and go away and they start, Oh, it's again that patient that called me every day because they have pain, Oh, send her another painkiller.
And it's really bad because the patients start getting gaslighting, you get me? And they do not, they don't believe in their pain. So that's something that it's really bad because they will only enhance, you know, [00:52:00] the time of diagnosis and the disease will be even worse at that time.
Dr. Brighten: Mhm. It's also something that patients will call but lightning where they get an electrical shock into their anus and they've, you know, I've had patients where they're like, my doctor just says it's part of IBS.
I'm like that pain in your rectum is endometriosis proven otherwise. Like it might be just the way your nerves are wired. It might be It might be, you know, where your uterus is sitting, but when you have a pain that takes your breath away, we don't just call that IBS and walk away from it. Uh, foods that you would recommend people do incorporate that are anti inflammatory that can support.
Dr. Cabrera: Well, that's really important as well. It's not more like food, it's more supplements. We were talking about this. We know that magnesium, uh, curcumic? Curcumin.
Dr. Brighten: That's what we call it. I think you call it curcuma? Curcuma. You can say it better than me. There is
Dr. Cabrera: even new roots that we were talking about herbal treatment like, uh, the, [00:53:00] uh, in Spanish it's called like the curcuma.
cat nail, I don't know how to say it.
Dr. Brighten: Oh, cat's claw.
Dr. Cabrera: Yeah. Really good. Uh, and there's really a lot of supplements that they, that the, the nutrition experts should provide. You get me? Because they know that with this, uh, like, uh, uh, bite expiry. It's really good as well. So there are really, really many supplements that help the patient.
There's even something that we call the, the ovarian support. Ovarian support sometimes when you have an endometrioma, we have even new technology to develop. We cannot never, never get back the ovarian reserve. Because that making a new ovary. Remember the ovarian reserve is, is, uh, a special number and it's not, uh, a infinite number of ovum.
Dr. Brighten: Yeah. So we're talking, uh, anti malarian hormone we can measure the AMH, yes, ovarian reserve. And that's basically, as science knows it right now. We have All the eggs we are born with and they drop off through our lifetime. I'm hoping science proves that wrong one [00:54:00] day and we can revive with some stem cells, but as of right now.
Probably yes. Yeah, I think so. There's interesting research on rampamycin coming out and I'm waiting for those clinical trials to see those, uh, but I digress. Um, so you were talking about ovarian reserve, but I just wanted to clarify that, what that was for people listening.
Dr. Cabrera: Oh. This is really important.
Many patients, I will tell you in the three types of endometriosis, they will be diagnosed as that's the most being diagnosed endometriosis, the ovarian endometrioma. So if you have a cyst, a chocolate cyst, a cyst of endometriosis, the ovarian cell may be reducted. So in Latin America, in the US and in other countries, what it happens, and it's really harmful because I have patients even younger as 11 year old, they do an ultrasound, they found an ovarian mastectomy.
So the normal ob UN gets a little bit like, you know, like anxious. It's like, oh, this is normal. A normal cysts. So they do something, it's called, uh, the eh uh, C eight 120 pipe. Mm-hmm . That means, uh, an ovarian cancer marker. Yes. [00:55:00] So in endometriosis, that's an inflammatory disease. this marker grows up. So the normal OB GYN is like, Oh, this is a not normal cyst.
It looks bad. And then I do an ovarian mortgage that went up. Oh my God, it's ovarian cancer in a young patient with pain during menses, but it's okay. So they think that it's a cancer. So they go to the oncologist. That means my dad. You get me? By that, there is no Dad, are you listening?
Dr. Brighten: Yeah.
Dr. Cabrera: That he always sees cancer.
So what do you think the ecologists will think? Yes. It's cancer. The
Dr. Brighten: bias is there.
Dr. Cabrera: So what's going to happen? They will go on their surgery without mapping. Because there was not mapping, there was only ovarian markers and the ultrasound. So the, the oncologist enter and see a big mass and everything attached.
What do you think that the oncologist will do to the ovary?
Dr. Brighten: Yeah, they're going to take it. Yes. Well, and to be fair, ovarian cancer, I mean, by the time we catch it, it is usually, it's bad. It's really bad, yes. And so to be fair to the oncologist, [00:56:00] but back it up, this is where multiple consults matter, having that second opinion.
Yes.
Dr. Cabrera: And remember the incidence. I
Dr. Brighten: mean,
Dr. Cabrera: the incidence of endometriosis is one in each 10 women. The incidence of ovarian cancer, thanks to God, is not the same. You get me? So we should always think that an ovarian endometrioma is benign. And the most important part, and now you understand, they just mutilate the patient.
So they just take the full ovarian reserve and reduct it to half. So imagine this poor patient, the, the, the quality of reproductive, uh, quality of life for that patient will be totally lost. That means they are already sentenced to go to a reproductive clinic, the amount of money that costs and the amount of psychological issues that it costs.
You get me?
Dr. Brighten: Oh yeah. No, I know this. I know.
Dr. Cabrera: So now you understand what's happening worldwide as we speak.
Dr. Brighten: Yeah.
Dr. Cabrera: They are, they're mutilating patients. They didn't went to an ovarian reserve before going into surgery. So if you have an ovarian endometrium, I think this is a key point. Please, in my mandatory thing, you should ask for a [00:57:00] endomapping, but.
Before going to any surgery you use, uh, they have you, they should give you an ovarian reserve by anor or hormone. And that means the A A MH? Yes. And also, eh, do a, a ultrasound to see the amount of cus that you have mm-hmm . So this should be mandatory. And if you have a lower ovarian hormone before going to surgery, you should, uh, get air retrieval increasing.
Dr. Brighten: Yes.
Dr. Cabrera: Did I make myself clear? You did.
Dr. Brighten: And we have a whole episode with Dr. Debbie Cassis. Yeah. Which you may know, and she talked all about egg freezing. So if people want to know about that, we'll go deeper in that. Uh, the, uh, anterofollicle count you were talking about looking at the ovarian reserve, that goes back to a trans vaginal ultrasound.
If you get that done day two, three, four of your menstrual cycle, that's when you would do that. You could in theory also, if you're doing it with an expert, have them also include looking for the endometriosis in that imaging.
Dr. Cabrera: Yes. And that's really important. I know. And this is mandatory. That's what we call [00:58:00] high quality diagnosis.
I think that's made clear right.
Dr. Brighten: Yeah. And you were talking about supplements and that's how we got on talking about endometriomas. So the cysts on the ovaries. Is there a supplement protocol you use around that?
Dr. Cabrera: Yes. But remember that our supplements are, are always individualized by our is a nutrition specialist.
I hope that you will meet that is Dr. Ariadna.
Dr. Brighten: Oh, I will. I've already been chatting with her on Instagram. She's
Dr. Cabrera: amazing. And she got a master green and. inflammatory diet. By obvious reasons, I'm a surgeon, so I never do the diet. I will never prescribe the diet because I even get my cereal burned if I try to make one.
So now you understand, right? So surgeons, uh, make surgery, but all our patients go through Dr. Ariadne, which is our nutrition specialist, and he individualizes each, each protocol. It's not like a cooking recipe. So it's not the same supplements to all patients. Okay.
Dr. Brighten: Yeah. Uh, but you did mention, so you mentioned Vitex, Cat's Claw.
I love Cat's [00:59:00] Claw as an anti inflammatory. Magnesium. Magnesium. Usually I'm using glycinate over citrate because if you're somebody who has elevated prostaglandins with endometriosis and you already have pooping problems and period problems, citrate can make your bowel move. Citrate's like the cheapest and easiest to find.
If you get diarrhea, it's really bad. Um, but I take a magnesium. Glycinate that um, I actually took last night because I'm like I know my period's coming and so I take 300 milligrams at night And then usually another like I'll do it like 600 milligrams the day of my period and I ramp that up. Um, So, and I'm just trying to, Oh, Omega 3 fatty acids.
Oh,
Dr. Cabrera: amazing. Yes. Yes. Omegas, even, I was thinking also that many patients go with inositol, that's called in Mexico.
Dr. Brighten: Yes.
Dr. Cabrera: That it's also helping for inflammation process. And, and now, uh, it's, it should, it should be treated. talking in another podcast, but patients with low ovarian reserve, we're trying to do the ovarian support.
And even sometimes something that's the newest things to do. [01:00:00] That is a plasma reaching plackets for the ovary. Yeah. The PRP injection into the
Dr. Brighten: ovary.
Dr. Cabrera: And now we know that these help, not the quantity of eggs, it's the quality. So by good surgery to remove the endometrioma and many other stuff, help
Dr. Brighten: Can you just do the PRP, like, can you do the surgery and then inject PRP into the ovaries?
Good, because then you're under and you don't have to worry about it. Yes. And so what people, so they understand what this is, take your blood, they spin it down, they grab the plasma, which is full of growth factors. I mean, so much. And I also tell people to like go on a protocol of like, you know, CoQ10, omega 3 fatty acids.
It's an acetyl cysteine, uh, vitamin C, vitamin E, all of these will be in your plasma as well. So when they do the injection, you're actually getting these nutrients direct into the ovaries. So with that, um, I love the idea that you could have your endometriosis surgery, then also have the injection while you're put under.
That's [01:01:00] brilliant. No one has said that. Uh, if you are doctors listening, please do this. This is like such a brilliant thing. I have, um, I've had PRP done for several things. One time I was in a car accident for my neck. Um, but, um, my uterine lining as well, doing uterine PRP, which is non invasive, you know, in terms of like, no one's putting a needle in, it's just a catheter.
Um, so I love all of that. Ceratopeptidase, do you ever use that? It's an enzyme?
Dr. Cabrera: Oh, I think that Dr. Ariadna have ever used it. Yeah. Obviously by reasons I do not prescribe them. But yes, uh, I think that the most important part, because many patients like right now, like just say like, oh, I would do this. Wait, wait, let me do this.
We are
Dr. Brighten: doctors, but we're not your doctors. So consult your doctor before you start anything. And remember that, yeah,
Dr. Cabrera: the most important part is if you have endo, it's not the same supplements for all of them. Remember some, some supplements have side effects. Yeah. Or if you, it's not like just taking vitamins, like many patients understand if you have a, the need for [01:02:00] this type of supplements that it will make you very, if not, it was like nothing.
You will just spend money like nothing. So this is important as will also
Dr. Brighten: say supplements can be really important. They're always part of nutrition and lifestyle protocols. Yeah. And if you are undergoing surgery, um, I encourage people to look at what is your goal? So if you're going to go into surgery, we want to do supplementation that is directed towards healing.
Yes. We need some inflammation post surgery. It's how the body heals. So we don't want to be doing mega anti inflammatories. And, um, and then, you know, but if the goal is like after surgery, you're wanting to go, you know, into IVF or go that route, you have to be thinking about your egg reserve. You maybe, so you need to be on CoQ10 for like three months before and this is where it gets really nuanced.
You have to think about your goals. You have something to say though. I
Dr. Cabrera: think that you've reached a point that, uh, the diet change, depending in the, in what we're going to do, if you're just in treatment for hormonal treatment or just [01:03:00] medical treatment, it's a different diet that if you're going to do to a bowel resection, you get me?
Because we need proteins to get like the bowel. attached to itself. So if you have, I know, uh, uh, something that you have, uh, uh, less nutrition or you're on, uh, not with a good nutrition and you go under a bowel surgery, it will open. So even the, the wounds, you need that different nutrition during surgery.
And then post surgery, we have a different nutrition for each patient. So now you reach a point, it's not the same nutrition every day.
Dr. Brighten: Yeah.
Dr. Cabrera: Now we understand a little bit better.
Dr. Brighten: Absolutely. And it's something that I like to say, these therapeutic diets, they're for the healing phases of our life. They're not lifelong.
And so for people to understand getting to your lifelong diet, um, yeah. It's, it just don't be dogmatic and stuck thinking this is the only way because it may have to change depending on what arises, what comes up in the future.
Dr. Cabrera: Yeah, and I think this is mandatory for them to understand. And also it's mandatory for them to [01:04:00] understand what a good quality of surgery is.
I know that many patients, even as I told you before, they go to the best hospitals here in Mexico City. Yeah. say brands. There are hospitals, you know, that is for like high class or maybe like for high society and they charge a lot even for surgery. And there are, they think, Oh, so this should be the best surgeon ever in the world.
Uh, if your surgeon do OBGYN like stuff, like a C section or if he's doing like a reproductive medicine of he's doing menopause, he's not an endo expert. That should be mandatory to say. Endometriosis experts do dedicate our lives just to endometriosis. And we should always have high volume. We, the amount of surgery that we do is not a normal surgery.
We are called pelvic surgeons and even extrapelvic because we can treat endometriosis in each organ affected. And by shame, this is something that needs [01:05:00] a learning curve. A learning curve, as you as a doctor understand, a learning curve for anything in our lives. It's like playing the piano. Even if you take 10 years of lessons, sometimes if you don't have the skills, you will never be Mozart.
You can play Coldplay. You get me? It's the same as surgery. You can
Dr. Brighten: play Coldplay. Yeah.
Dr. Cabrera: Mozart,
Dr. Brighten: you are not. Yeah.
Dr. Cabrera: But now you understand, it's the same with surgery because it's a skill and it's a human hand skill, even with the brain. So by shame, we do need more surgeons that can provide adequate surgery.
And it's not just to call a colorectal surgeon in the middle of the OR because of an emergency. That's not a multidisciplinary team. Now you understand where it is. But the most important part is to get into surgery. you must get the endomapping and get to a proper surgeon that makes sure he can treat endometriosis in any organ that you have or have a team.[01:06:00]
That's something that should be a key point as well.
Dr. Brighten: What is the most unexpected place you've seen endometriosis lesions?
Dr. Cabrera: Oh my god, now you're getting into a really interesting place. Well, I just did a case a month ago in the pericardium. That means that we took In the heart, yeah. Yes, in the heart. I have seen endometriosis by shame in the brain, nostrils, in the spleen.
And we have one of the few cases, they used to think that pneumothoracic was not in every organ because there was no cases of a splint, and we have a case of a splint in the human dermis. What else? So the
Dr. Brighten: dermis, the skin.
Dr. Cabrera: Yeah. But by your research, this is extrapelvic disease, and this is the, like, the rarest cases in incidence.
Thanks to God, the brain is one of the less, uh, affected, but do remember that, uh, endometriosis is mostly in the reproductive organs, but, uh, we have now an incidence that you have endometriosis, you have a five to 37 percent chances to get in the bowel. Yeah. So it's the most, [01:07:00] uh, extra, most common, uh, site of extra pelvic disease, the bowel.
Dr. Brighten: Yeah. I mean, that's a lot of places for it to show up. And I think that people should really be paying attention to other areas where they might have pain, discomfort, and really advocate for themselves. You've brought up, and I do want to get to more fertility speak, but you brought up menopause multiple times.
Yes. What can menopausal women be doing? Cause perimenopause can be a time where endometriosis really flares. Yeah. The fluctuations of hormones and a lot of doctors, like you said. They're like, you're in menopause, you're fine. It's an absolute myth that menopause, PCOS, that a lot of these conditions go away just because your ovaries are no longer popping out eggs monthly.
Dr. Cabrera: I think this is mandatory to, to say, uh, there are myths of endometriosis. And one of the, the biggest myths is that if you get into menopause, even by induction or by a natural menopause, the disease will go away. Remember that all doctors used to think that endometriosis was caused by menstruation itself, by going a [01:08:00] retrograde way.
So menopause is nothing but a natural change in the human body in which the ovaries stop ovulating and that's it. But endometriosis itself produces these hormones by these enzymes called aromatase. So endometriosis produces its own hormones. own strogens and also progesterones. So endometriosis can grow itself after menopause.
And as you were saying, during menopause, there's a wave of everything, you know, like they over spike the last, uh, strogens that they have, like the last chance you get me. And sometimes if you have a bowel nodule or something else, you will get a lot of inflammation and then you will have a lot of symptomatology.
And doctors used to, uh, to say the patient harmfully that it was because they were going crazy.
Dr. Brighten: Yeah. And it's really
Dr. Cabrera: bad.
Dr. Brighten: We know it. There's still some of those doctors out there side eyeing you. Yeah. So, I, so, I appreciate that you bring this up because, So often, and you, you brought up this other [01:09:00] myth that taking out the uterus would actually cure endometriosis.
A lot of women end up with hysterectomies and there's new research coming out showing that they were unwarranted and unnecessary. The patient was never told this. They end up in menopause. And so the guidelines for hormone replacement therapy say you can give that woman estrogen, but she doesn't need progesterone.
And that's where I always put my foot down on an endometriosis patient because I'm like, if you only give estrogen. Those lesions still exist. They didn't go away. You have to still give progesterone regardless of the uterus.
Dr. Cabrera: Yeah. And also this is really important because as you were saying, and our myth is something that it's really bad that it's an hysterectomy cures endometriosis.
Endometriosis by definition, it's outside the uterus. If you have endometriosis in the lung, what does hysterectomy do to the nodule in the lung? Yeah. Please. It's like even logically, but some doctor used to believe this. Some still do. Yeah. Then
Dr. Brighten: the other myth you're you brought up, which is like, just have a baby.
That'll cure it.
Dr. Cabrera: Yeah. In Latin American countries, because we are a little bit with machismo, [01:10:00] they used to believe that the seed of the man cures the woman. Oh,
Dr. Brighten: isn't that so nice for men? I
Dr. Cabrera: know. And now we know that, no, it does help with symptoms by every reason, because because when you're pregnant, do you take alcohol?
No. Yeah. And you, you try to eat healthy and you end up, you know, with a healthy diet and you try to take care of yourself because you have a newborn.
Dr. Brighten: Yeah.
Dr. Cabrera: But, uh, do remember that endometriosis, uh, will get, uh, lower inflammation levels if you behave, if you take a non inflammatory diet. Yeah. So they have less symptoms.
But right after two years after the baby is totally normal, they start taking normal, uh, diet and day by day. Okay. They will get symptoms again because endometriosis will never taken out, you get me? So now we know that, and this is something that is the hardest point of endometriosis, if there's a cure.
So now we know there's no cure for deep endometriosis.
Dr. Brighten: Yes.
Dr. Cabrera: We know that we, we take away the nubble, the chance of recurrences, if we do a [01:11:00] proper excision therapy, you get me, surgery. Which is going
Dr. Brighten: to be cutting it out.
Dr. Cabrera: Cutting, cutting it out, you know, it's not burning. And please, if someone tells you that they're going to do ablation, if I can, you know, ask for Christmas a present, that should never be ablation surgery because ablation will never take away the tissue.
That means that they will only burn it. burn it, and that cause more inflammation, and that cause more pain. So ablation surgery, if you have ever heard, run away. That's it. Then excision. Excision, that means to take away even with free borders, like in oncology. this cause less recurrence. That means that we take that tissue away.
It can never recur because it's totally outside of you. But the problem about this is that endometriosis starts as a cellular level and the human eye cannot see cells. So if we leave one cell and you start getting more inflammatory process that these cells can grow away, it can grow back. You get me? It was never growing.
the same, the same disease. So this is important for patients to understand. There's [01:12:00] something it's called recurrence. Recurrence means that there's in a new spot. So I have endometriosis in the lung. The lung was, it's like an example. I take away that part of the lung and now I get in the, in the leg. Oh, that's recurrence because that wasn't before.
You get me? Yeah. But if I have endometriosis in the backside of the uterus, and now it recur, it wasn't recurrence. That's, that's a persistence. That means they didn't, didn't even take it away, and it stayed all the time there. Yeah. Did I make myself clear?
Dr. Brighten: Absolutely. I do, do you know what a dandelion is?
Oh, yeah, yeah, yeah, yeah, yeah, yeah, yeah, that's how I like to think about endometriosis because the excision surgery can get the one and it goes down deep at the root and it pulls it out. But the seeds have already spread. And so even when you do the surgery and this is I want people to really understand there is no cure for endometriosis.
However, there is absolute possibility of remission of symptoms and improving your quality of life. And that is the goal. So, but even as you do the surgery, And you're removing those [01:13:00] lesions, as you said, it's on the cellular level, you can't see it, it hasn't grown yet, but the goal is, how do we make it so that it doesn't grow?
How do we make it so that you can control things? Yes. I, I want to just ask, are there any other myths we haven't touched on yet?
Dr. Cabrera: Yeah, there are many. Oh, here it comes. I love it. Oh, well, the most important part, I think that we have all of them covered is the, the retromenstruation by hysterectomy, the, the, the bad thing about the, having just pregnancies or even menopause.
But right now they're trying to, oh, it's really bad, but in Mexico, because we have a lot of patients even in high. class society that do believe that the metrosis is caused by, you know, like, uh, they have a bad eye or someone make a spell to them. So they go to these, uh, not, uh, medical treatments. So now in Mexico, there's something really famous that is to put in an obsidian egg into the vagina.
Dr. Brighten: Oh, yes. The, the yoni egg.
Dr. Cabrera: Oh, [01:14:00] something like that. And this, uh, make the, karma, or I don't know, like the center of the universe put together. It can cure cancer, it can cure endometriosis. So I have a patient that have an endo, like a really bad endometriosis case in the bowel. And because of reasons, she was like, no, I will try, try other therapies.
Perfect. And she came back with the egg. Seven days the egg was stuck inside of her. So you can understand the amount of infection she got and by reason, and obviously an egg cannot cure it.
Dr. Brighten: And these stones are sometimes porous. Yes. So that could lead to an infection, which could lead to pelvic inflammatory disease, which then compromises your fertility.
Even more. And yeah, even more. The other thing, and I want people to understand, I think that the best is the marriage of science and spirituality and that you bring those two together, but not forego one. without the other. I think really, I'm just like a buffet fan, not for eating for infectious disease purposes, but like the idea of a buffet.
You know where you [01:15:00] have like, or tapas, maybe we should call it tapas, where you have all the items and you can pick and choose what is best for you.
Dr. Cabrera: And there's even not like medical treatments for endometriosis that are proven to be. a good treatment like acupuncture. It's a proven treatment for deep end stress pain.
Dr. Brighten: We
Dr. Cabrera: have even sometimes a mindfulness because remember that stress levels you already know someone they stress has higher inflammatory process that someone without stress. The treatment about like overweight and obesity and things like that that helps the patient get less inflammatory process. That's it.
So if you have a really stressed day do mindfulness So, we know that you can do yoga, you can do whatever you want, but it doesn't cure endometriosis. You get me?
Dr. Brighten: Yeah, absolutely.
Dr. Cabrera: That's something that's important, yes. Yeah,
Dr. Brighten: I think, you know, because the other thing is there's um, yoni steaming or the vaginal steaming, which I've seen people say, so you sit on a pot of herbs and you're like, Um, I do have to say, so [01:16:00] I never had used it after the birth of my second son, like I couldn't, even the peri bottle with saline water hurt, everything hurt, I was having so much pain, like I had a vaginal birth, and I was like, I'm just going to try this Yoni steam, and it was so painful.
so soothing and relaxing to the tissue. And I was like, okay, this is lovely. But there are people who say like, this is a cure for endometriosis and I'm like, we can respect cultures, we can respect practices, but we have to know the limitations of everything. Just like we have to know the limitations of pharmaceuticals, of nutrition, of surgery.
We have to understand everything has a limitation. It doesn't mean you can't integrate those things.
Dr. Cabrera: Then you I think that you made a point. There's no like a total infinite, you know, like something that cures, like it's the conjunction of everything. And I think that you make even the most important part of endometriosis treatment, that even if you go under surgery with the top of the world that I know who he is, but do the best surgery ever, you get me?
That's not the cure. Uh, to get rid of the pain, you have to [01:17:00] go on the physical therapy, sometimes in a neuropathiology. And this is really important, because when you start getting pain, even your brain changes.
Dr. Brighten: Yes. That's
Dr. Cabrera: something that a woman doesn't understand, a patient doesn't understand, and even doctor doesn't understand.
Mm hmm. When someone had pain during 20 years? Come on, you will never have the same neurotransmissions, you get me? Patients will undergo to anxiety and depression, over 70 percent of them. And by just having depression, you will have more chronic pain. So what do we have to do? Change, uh, you know, the way of neurotransmission in the brain.
Dr. Brighten: Yeah.
Dr. Cabrera: And that's something that's called central sensibilization and peripheral sensibilization. That's a complication, the worst complication of endometriosis is not infertility or getting endometriosis in the brain. in the, in the lung. It's central and peripheral sensibilization, because even if you underwent to a full abdominal surgery and they take out every organ, you still will still have pain.
Dr. Brighten: Yeah.
Dr. Cabrera: Because that the pain now is sensibilized. So the human brain, the only information they will [01:18:00] receive, because they have received that for 20 years, is pain. Even if they do not cause pain, that's called alodinia. So we have to change the brain, and by changing the brain, you cannot change it like a, like a switch.
You have to change it by many months of treatment. So that's, I think, that the worst complication of endometriosis is central and peripheral sensibilization, in which we have one of the best experts worldwide, Dr. Sierra, a neurobiologist. So now you understand, if you have a friend or a woman that have endometriosis for many years.
It's not just getting surgery, it's to do a full treatment, do you get me?
Dr. Brighten: Yeah, and that's why I also just loved everything about your clinic because you, you know, support physical therapy. I wrote this book, Is This Normal? And physical therapists are like, I've always recommended this because you say it like for every condition, like physical therapy, physical therapy, you know, and it's something that came to my mind when you said the Yoni egg, because I'm like, Uh, women with endometriosis can be so [01:19:00] hypertonic, so tight in their pelvic floor muscles because they've been in so much pain that they can be more likely for it to get stuck and it can cause more harm than good because it's reinforcing that.
Um, but then also that you take into account the nervous system and how the nervous system has learned pain and pain is its default state. And so you have to retrain it and relearn it. And I just love that complete integration. I want to get into the fertility topic because I promised it so many times.
Um, and people are probably like, get to it already. Okay. So you said 50 percent of infertility cases have endometriosis.
Dr. Cabrera: Yeah.
Dr. Brighten: What is going on there?
Dr. Cabrera: Oh my God. This is, Oh, you're going to get the best podcast ever. You're like,
Dr. Brighten: okay, I will brag because yes, I'm bringing it. No,
Dr. Cabrera: because this is, I used to be the director of reproductive medicine in Mexico.
And this is hard because you're getting into an industry of billions of dollars. Yes. So [01:20:00] let's start with this. 50 percent of patients that have infertility, uh, you know, have endometriosis in some kind of degree. So, uh, you have gone through this, uh, how many, how many patients have these, uh, you know, like infertility issues and the amount of money around it.
You get me? Just by getting to the fertility clinics, it's not cheap and all of them are private. There is no public aspect about fertility. The second thing is that imagine the amount of money around the pharma industry. Oh, those
Dr. Brighten: fertility drugs, you're spending like sometimes thousands of dollars a week.
No way. And then you
Dr. Cabrera: just put that in many women. Remember that one in each 10 women have the gap in endometriosis, and many of them may suffer from infertility. So now you understand a little bit better in putting into numbers the amount of money that is around it. And remember that by shame, money moves the world.
Dr. Brighten: Yes.
Dr. Cabrera: When I went into the director of reproductive [01:21:00] medicine in Mexico, the first thing I used to put as a mandate is to put it to every endometriosis clinic, to any fertility clinic in Mexico, to do endomapping.
Dr. Brighten: Yeah. But
Dr. Cabrera: some of them didn't want to because they started seeing fertility as a monetary process.
Yeah. You get me? So this is bad. But worldwide, Many, uh, peritility clinics, even really renowned, they remember that it's money for, for everyone. Yeah. The, the doctor, the, the pharma industry, everything else. So there's little incentive. Yes. So now there is, it was really hard because I found, uh, you know, not, not many doctors want to do it.
And I was like, what? But, but this is not good for patients. Yeah. If you do not diagnose endometriosis, then if you try to do an IVF and they lose baby, they lose the ember. Then you will only get more money. And I was like, Oh, my God, now I understand. One thing that you want is to get more money. Then I know that not many doctors will do this, but many of them, they [01:22:00] understand that they have endometriosis.
Mm hmm. Maybe by I will say that probably not being a good, uh, expert in deep endometriosis, the reproductive doctors used to think that that's incurable. So let's just do IVF until she gets pregnant. Yeah. Do you get me? And many of them probably are not doing by the money, but some of them are doing this.
And even the pharma industries, when you're started like, Hey, let's do IVF. Let's check if they have endometriosis before going to IVF. It's like, no, no, no, let's get this and I get more money. And you get more money as well because they get incentives. So now we're trying to change this. You get me? Because now if you have any type of infertility, Except for male infertility by obvious reasons.
But if you have any type of infertility, they should always get an endomapy before going to the IVF. Why? Because if you have an ovarian endometrioma, the ovarian reserve and quality of the eggs will be lower. If you have endometriosis in the bowel, then, or adenomyosis, you have less chances to get pregnant [01:23:00] by an embryo transfer.
You get me? Yeah. Now we know you have a really big case of deep endometriosis in the intestine, bladder, whatsoever. It's where to get all the tissue that was causing inflammation. And you can imagine the amount of inflammation that's causing human pelvis and all the amount of, uh, chemicals to say to the, uh, to the cytokines.
I don't know how to say it. Yeah. Uh, this type of, of inflammatory, uh, substances are against fertility.
Dr. Brighten: Yeah.
Dr. Cabrera: So if we take away that amount of, of inflammation and then there's no more, you can get easier, easily pregnant. Sometimes even without the IVF, I have had many patients that was even with the embryo already and they, um, in the, in the reproductive, uh, Expert was like, there's no way you can get pregnant.
And then after surgery. If there was a too well patented, a normal test, they can get pregnant without even IVF. So they asked me, how did I [01:24:00] get pregnant? Like I know it's probably, it's a, you know, a miracle. And I know it's not a miracle. It was because they were, they was not doing the endomapping. If we release the disease, they get less inflammation, then you get better quality of eggs.
And just with one egg, you can get pregnant. You get me?
Dr. Brighten: Yeah.
Dr. Cabrera: So I think the most important aspect, if I can give like a key. point of this is an individualization of the process. That means if you have a, you, if you have infertility and you have some suspicion of endo pain, then ask please your provider to get an endomapping.
And by this, they will see, Oh my God, they have endometriosis everywhere. Please go to an expert because if you get a high quality treatment, you get, they get easily pregnant without, you know, losing embryo. Because losing embryo, as my sister underwent, it's also psychological loss. Oh,
Dr. Brighten: it's hard. And you think you did everything wrong.
You go, you trace all of your stops. And I was actually, um, sharing with my audience. So I've had, I've had failed frozen embryo [01:25:00] transfers and infertility is walking around thinking you're fine. You've, you've worked through it. You've talked to your counselor. And then you, you find yourself like. Stumbling into the maternity section at the, you know, at the department store and you're just in tears having a panic attack.
And it is something that I think even when you have a baby in your arms, there's still the trauma that you have to process. And so this is a very serious, you know, thing to consider. What I'm hearing endometriosis can compromise the egg quality. It can compromise implantation. What else can endometriosis do to really sabotage fertility?
Dr. Cabrera: Well, uh, bioreason can cause, uh, the, the, the tooth, the salpings, to get obstructed. Yeah, so the fallopian tubes. Yeah, fallopian tubes is totally obstructed, then you cannot get natural pregnant. Yeah. So many women, uh, doesn't know, but the, the, the fallopian tubes are really, really, really, uh, It can easily be harmful.
So they're really, uh, how do you say it? Like when [01:26:00] you have like something that is really, really delicate. Yeah, sorry, forgot the word.
Dr. Brighten: No, that's okay. You've been talking a long time to me, so you definitely get some slack.
Dr. Cabrera: But, but you can get, you know, like a delicate, the, the, the salt beans, it's really delicate.
And imagine the big, not only around the ovary can easily eat. it or cause additions or cause a null. And that can cause obstruction. And because of this, then you cannot get normally pregnant or natural pregnancy. So it can cause everything. It just even changed the microbe in the vagina, eh, by inflammation.
You get me? So that's why many. A woman with endometriosis can have a lot of infections in the vagina because there's, you know, inflammation everywhere. So it can cause, uh, just the only factor that doesn't affect endometriosis is the male factor that needs the sperms. But everything else is affected, totally affected by deep endometriosis.
Uh, the, this incidences that will cause you even like, uh, you know, like a [01:27:00] terror movie. The incidents that we know that endometriosis was in 10 women was 50 years ago. Probably it's more. And now we know that the same incident, I've seen 50 percent of women remember that incident went, that when we used to diagnose endometriosis by laparoscopy.
Yeah. The new incidents, we don't know it.
Dr. Brighten: Yeah,
Dr. Cabrera: because not many countries are doing like our research and they don't have
Dr. Brighten: funding women's research. Shocker
Dr. Cabrera: I was saying my best friend even the mattress was for male something that tells you that they will cut a testicle Yeah, or they can cut your penis and they or do you have pain during sex and the with torsos will be cure like It's a hundred years ago.
Dr. Brighten: Oh, you're not wrong. If there was
Dr. Cabrera: endometriosis in Trump, in, you know, in Donald Trump or in any president. Like Vladimir Putin had endometriosis and, ah, I have to cut that testicle. No, no way. There's a cure right now. Oh,
Dr. Brighten: absolutely. I mean, we got Viagra covered by insurance, but. I mean, you have to fight just to get a diagnosis for endometriosis.
Dr. Cabrera: It's really bad because I'm a man, [01:28:00] obviously, but it's really bad that I have even to see it that it's just, uh, uh, sometimes because it's, uh, uh, you know, like, uh, uh, this is that it's affecting, you know, patients with uterus, uh, that it's just totally affecting even the, the diagnosis and correct treatment because they're not funding it.
Dr. Brighten: Mm hmm.
Dr. Cabrera: So sometimes, uh, that's why this is mandatory, because we can help patients to get quite high quality information. Absolutely. So thank you. Yes.
Dr. Brighten: So. If endometriosis affects egg quality, should somebody do the surgery before going for an egg retrieval? Oh,
Dr. Cabrera: really?
Dr. Brighten: Because egg retrieval, you're going to get exposed to all these hormones and that can make more lesions grow.
You might have to have a second surgery. So it feels like, you know, in some instances, it might be better to do the egg retrieval. And then, have the excision surgery, and then go through, uh, the frozen embryo transfer. What's your opinion? Now you
Dr. Cabrera: get into the million dollar question.
Dr. Brighten: Yeah.
Dr. Cabrera: And the answer is really, really easy.
It's individualization of the case.
Dr. Brighten: Okay.
Dr. Cabrera: Because if you have [01:29:00] really low ovarian reserve, but you have a 20 centimeter endometrioma, they can't even get a retrieval. You get me? But if you have a really small pneumotroma and good quality reserve, please don't go on the reserve only if you have symptoms.
You get me? Yeah. So it depends what the patient wanted at that point of life. The second thing is the ovarian reserve and the third thing is the amount of endometriosis that you have. Yeah. So for these three reasons, you should have an endomapping. That means the amount of endometriosis and ovarian reserve done by an anti Mullerian hormone and also And how
Dr. Brighten: often should the AMH be done?
Mm hmm.
Dr. Cabrera: The imaging? The
Dr. Brighten: AMH? Oh, it depends on
Dr. Cabrera: the size, but we do it every six months.
Dr. Brighten: Okay.
Dr. Cabrera: That, so with this we can see the, you know, the reproductive outcome. So sometimes if we have a really bad case of deep endometriosis, but the endometrioma is not that big and the barrier reserve is low, then we send it first to first in X, you get me?
We do surgery, and then if the patient wants to get pregnant, we transfer ember. That's the best case scenario, you get me? Sometimes if we have [01:30:00] a really big endometrioma, low barrier reserve, we have to do surgery first. They cannot even do the, you get me, by a super skilled surgeon that will not take away the ovary.
Because I've seen surgeries that they enter to the endometrioma, Oh, I have done two surgeries. 20 of these every day. Oh, perfect. You enter and they just start burning the ovary. And you're like, Oh my God, he just killed the last of our reserve that the patient have. You get me? So that's why high quality skills during surgery, it's mandatory.
So this is important.
Dr. Brighten: Okay. But no endometrium. They have deep infiltrating endometriosis.
Dr. Cabrera: Yeah.
Dr. Brighten: Well, in that situation.
Dr. Cabrera: Without endometrioma?
Dr. Brighten: Without the endometrial mind.
Dr. Cabrera: It depends totally in the OR man, in the anti hormone. Okay. If they have low, then they should go on their Nia first. Okay. If they have normal, they can do surgery first.
Mm-hmm . Because we are in without end endometrioma, we'll never touch the ovary, uh, without touching the ovary. We'll never touch the Arian Reserve. Okay. Did I make myself clear? Yes. You did. Yes. Perfect.
Dr. Brighten: A MH you said if it's normal, people listening right now are [01:31:00] like, what? What is normal?
Dr. Cabrera: That's, uh, that's in a table.
I know, como tabla, uh, how do you say? Yeah, yeah. There's a range? Yeah, there's a range. There's a range between women and also in the, in the age. So if you have, I know, 15 years old, you should have a hormone of eight. If you have 15 years old, you should have four years old and you have one, wow, you have a lot of hormone.
You get me? So it depends, but the, the, like the cutting rate is 2. 0. Uh, but it depends in the rate. Yes.
Dr. Brighten: Yes. Well, that's helpful. People who undergo surgery. Uh, can they get, get pregnant the next cycle, then they do the frozen embryo transfer the next cycle? Oh my god, you're
Dr. Cabrera: doing really good, good questions.
Well, it depends if we touch the uterus or not, if we perform also myomectomy and I do think that you should put this as a key point. point. We know now that uterine fibroids, that means myomas, yes, comes up to 80 percent in coexistence with adenomyosis. And if you [01:32:00] have adenomyosis, you have a 94 percent chance of having the meteorosis.
That means that if you have a uterine fibroid, it never comes along. So if you have a big fibroid and they're, I'm going to do a surgery of the fibroid, you should always do a mapping. That's something that you should put.
Dr. Brighten: That's, uh, so black women in the United States have the highest incidence of fibroids.
Is there a correlation with endometriosis?
Dr. Cabrera: If you have fibroids, you have up to 94 percent chances to have endometriosis.
Dr. Brighten: My goodness.
Dr. Cabrera: Remember please this, because many patients in the U. S. go with the OB GYN, they see fibroids, surgery, and they enter surgery, it's like, oh my god, you also have endometriosis.
Dr. Brighten: Yeah.
Dr. Cabrera: And they should have diagnosed it before going to surgery. Because if you diagnose endometriosis before going to surgery, you can treat both of them in the same time.
Dr. Brighten: Okay.
Dr. Cabrera: So now, coming back to the question.
Dr. Brighten: So if you touch the uterus, don't touch the uterus. So if you,
Dr. Cabrera: if you do a myomectomy or do something that is called a myomectomy or whatsoever, if we touch open the uterus, you have to wait six months to get pregnant.
Okay.
Dr. Brighten: Okay?
Dr. Cabrera: Even with the breast surgeon, just by safety, [01:33:00] if you do not touch the uterus and you just remove the endometriosis from the bowel, you can get pregnant in the next cycle.
Dr. Brighten: Okay.
Dr. Cabrera: You get me?
Dr. Brighten: Yeah. And I'm just curious, statistics, uh, what's the incidence of women getting pregnant following an endometriosis surgery?
Oh, this is amazing. Which is going to vary by age, right? Yeah. Because, you know, once you get into my age bracket, in your forties, the quality of the eggs can be compromised. Yeah. But I'm just thinking like, you know, In general, if somebody undergoes that surgery, what, does it increase their chances?
Dr. Cabrera: Of course.
Uh, we know now that thanks to doctors like Gaurav Raman, that's one of the best surgeons worldwide as, as our center. He has done many research about after surgery with a really high quality, uh, he has seen that, uh, up to four, up to 70 0 have a better chance of reproductive outcomes. And it's not to get pregnant because remember, you're getting pregnant.
It's not, it's not, uh, tell
Dr. Brighten: people why it's not just getting pregnant. Cause most people don't get this. Many,
Dr. Cabrera: many, uh, reproductive clinics, they have [01:34:00] like, I have a pregnancy rate of 80%. You're like, Oh my God, they have a lot of pregnancies. Now the most important part is take a home baby.
Dr. Brighten: Because
Dr. Cabrera: take a home, it's not the same thing to get a beta positive.
That means that you get a pregnancy test positive. And then the, the, the reproductive clinic is like, Oh, I'm the best. And they didn't lose the baby two days after, you get me? So to get a, take a home baby, that means that you get through the process of getting pregnant and you didn't, you know, have complications and you take your baby.
That's the true pregnancy rate of a reproductive center. So we know now that the. the pregnancy rate goes higher and also to take a home baby, because by shame, as you can understand, and I think this is important, if you have adenomyosis, you have more chance to get a complication during pregnancy than if you have abnormal fetus.
Dr. Brighten: You
Dr. Cabrera: get me? So,
Dr. Brighten: but with adenomyosis, you know, we've mentioned it several times, we haven't defined it. So for people who are not familiar with it, what [01:35:00] is adenomyosis? Uh,
Dr. Cabrera: as I told before, but I will tell it again, adenomyosis means that you have this endometrial like cell that is not outside the uterus, it's born into the muscle layer of the uterus.
Dr. Brighten: So
Dr. Cabrera: this causes inflammation in the muscle and, uh, it causes dysfunction. The muscle of the uterus is dysfunctional. Uh, the function is during menses to contract itself and that costs less, uh, bleeding during menses. So if you have a inflammatory tissue in the middle of the layers of the muscle, it tends to contract.
So it costs pain and also it costs more bleeding. The clinical suspicion is super easy pain and more bleeding. So any blood clot means that if you have blood clots during menses, you may have adenomyosis. You get me? Yeah. And the problem about this is that because of inflammation, it can cause inflammation into the endometrium.
And because of this, implantation can be, uh, affected.
Dr. Brighten: The clots, are we talking little clots? We talking large clots?
Dr. Cabrera: Right now we know that if you had large clots, uh, it's totally abnormal.
Dr. Brighten: Yeah.
Dr. Cabrera: So please. So we
Dr. Brighten: usually say like a quarter [01:36:00] size, but you guys don't have quarters here. So it's about like that size.
Yeah. Basically though, uh, women, um, they will describe it as like, Oh, little jellyfish. I pass it. And I'm like, if you ever pass a jellyfish, that is not normal. Um, so with adenomyosis though, I, you know, I'll sometimes say like, if you see a piece of meat that's marbled with fat, that's kind of adenomyosis.
How can you remove that without compromising the uterus?
Dr. Cabrera: Oh, that's really hard, but you're getting into surgical skills. Top world surgeons, what we do. And I even described. Technique, uh, with Dr. William, uh, we found that we can, uh, do a tourniquet in the uterine arteries without compromising them. You get me?
It's Yeah. Doing a surgery in your, in your leg.
Dr. Brighten: Yeah.
Dr. Cabrera: So you do a tourniquet that bleeds less bleeding. So we do a tourniquet in the uterine artery and also in the arteries of the ovaries. So the, that means that the uterus get less blood. Mm-hmm . And then we can cut the uterus in half. take, remove the most, uh, the most, uh, [01:37:00] quantity of tissue, but diffused, it can never be cured.
So we can only do something that's called adenomyomectomy. That means to take out the most part of the tissue without harming a lot of the uterus. Yeah. You get me? But still, we have to really do, uh, really advanced surgical skills so we can put back together the uterus in a Osada technique that, that it's for.
doing the special technique to do that in myotomy and the uterus not to open during pregnancy. This is really
Dr. Brighten: hard to do. Absolutely. I, I would imagine, you know, and for people who, you know, when you want a baby, you wanted a baby yesterday in your arms, it's like the most impatient feeling in the world.
And so I, you know, I imagine there's people who are going to want to rush and be like, well, I'm just, you know, I want to get pregnant. I've had this surgery and that's something you said is that for it to be safe and for people to understand The uterus has to grow and expand but if it still hasn't held from a surgery, yeah, you
Dr. Cabrera: can open
Dr. Brighten: compromise the pregnancy But you could also compromise your reproductive health for life like your
Dr. Cabrera: [01:38:00] life
Dr. Brighten: your your life Yes, and you might lose your uterus you might lose that ability and so really just to have that caution Do you recommend people have repeat imaging before trying to conceive to make sure everything is healed correctly?
Dr. Cabrera: Well, before conceiving, we do also, after surgery, do a proper imaging study, sometimes by MRI or sometimes by transvinyl ultrasound. But we also have a reproductive clinic, a really good one, you get me, that they're even known because most of the women with endometriosis will have low ovarian reserve. So they have to have a really good reproductive surgeon with a specialty or expertise in low ovarian reserve.
And that's the one who recommend us during surgery to put the PRP
Dr. Brighten: in
Dr. Cabrera: the ovary.
Dr. Brighten: Yeah. I know. I love that you're using that. Do you ever use anything like near infrared light therapy, uh, hyperbaric oxygen therapy? Yes,
Dr. Cabrera: but in reproductive outcomes. They will go with their reproductive surgeon and then their specialist and they will suggest what they should believe [01:39:00] that will help the ovarian reserve.
Okay. There's many, many, many, many things that they want to get their reserve quality and quantity better. But remember that by shame, we cannot get back the ovary. The ovary is lost. We cannot get it back.
Dr. Brighten: Yeah. Well, it was, uh, so I use near infrared light therapy on my pelvis. I have a little box I travel with and I use that and it helps a lot, especially with menstrual pain.
It helps tremendously.
Dr. Cabrera: Oh, that's good as well, but it depends totally on each woman. Yes.
Dr. Brighten: Yeah. Of course, because That's the other thing, right? Because how extensive it is, uh, will dictate the symptoms. And if it is very progressed, there is no amount of what you eat, how well you sleep, or any of those things that are going to make those lesions go away.
But at the same time, how well you eat, how well you sleep, all the things you do will help the outcomes of a surgery. So it's not to say like throw up your hands and forget all of that. But again, it's that integrative approach. I am, um, I'm curious, IVF does not always work for women with endometriosis, [01:40:00] even after they have, uh, you know, procedures, so they have excision, they go through those things.
What other things might they consider?
Dr. Cabrera: Oh, sometimes even other factors, eh, for reproductive outcomes, the most important part is the ovarian, eh, factor, because by shame, endometriosis cause totally loss of the ovarian reserve and quality. But, uh, sometimes, eh, In reproductive clinics, they don't see that they have in the majority other organs I know in the appendix or mm-hmm
Or this type of tissue still, uh, develops the OSI and affects totally the, the, even the transportation from the lum to the, to the inside of the, the fbr. So, eh, I think that,
Dr. Brighten: wait, let me, you just, you just said a lot of technical terms.
Dr. Cabrera: No,
Dr. Brighten: the egg. Going to the fallopian to being able to meet sperm.
Everyone's on the same page. Sorry. You can do doctor speak and I'll be your translator.
Dr. Cabrera: But this is really important because if you do leave any nuttle that goes, uh, totally against fertility. So, uh, I think if [01:41:00] you have fertility issues, the most important part to get to the diagnosis, you get me? And that's it.
Dr. Brighten: Yeah. So, and what you're saying is that. Just because there's nothing in the pelvis doesn't mean a nodule elsewhere isn't influencing reproductive outcomes. So we want to dig deeper.
Dr. Cabrera: And something that's really important, and something that you said before, now we know that patients that have had this biosis or the microbe mystic, totally changed.
It changed also fertility because it causes inflammatory process. A body inflammatory process may grow endometriosis. So now we do not know that, uh, we didn't knew that we have to treat everything at the same time.
Dr. Brighten: Emma and Alice are two tests, uh, I've discussed these in other episodes that are being done for endometritis.
Yes. Um, at the same time you get that biopsy, you can get the receptiva.
Dr. Cabrera: Yeah.
Dr. Brighten: What do you think about that?
Dr. Cabrera: Uh, it, it's good, but promise if you have adenomyosis, Uh, and they didn't diagnose. [01:42:00] Sometimes, uh, the Reva Yeah. Can be changed and they don't know why. Yeah. And they think all only in something is called ities.
In Metritis, uh, remember no metritis is by, uh, a bacteria or sometimes, uh, intra intracellular orgasm like Chlamydia or Nigeria.
Dr. Brighten: Yeah. Uh,
Dr. Cabrera: that's in, in Latin America is really common. Mm-hmm . Yes. And you can, it's
Dr. Brighten: actually, so I think it's important people understand STIs are actually really common.
Everywhere. Yeah, everywhere. Uh, which is, they're just not commonly talked about. And with that, this can disrupt the microbiome of the uterus. Yes. So these biopsies are going to look at, do you have pathogenic organisms, but they're also going to look at, do you have enough lactobacilli. Yes. The gut, you know, you mentioned dysbiosis.
We want lots of variety there. The uterus, we want lactobacillus like 90 percent and everybody else get out. Like that we want very little variety. And then the Receptiva, that is going to be a marker that tells us about inflammation and that maybe hints towards endometriosis. Yes.
Dr. Cabrera: And this is really [01:43:00] important because if you, they didn't perform this and they try to transfer an embryo and you have a dermatosis and this marker comes negative, then you may lose the embryo.
Yeah. So it's the conjunction of everything. As I told you before, he's sending the individualization of cases. So it depends in the amount of endometriosis and the meiosis and even everything. And that's why endoclinics and reproductive high quality clinics have everything for you. That's it.
Dr. Brighten: Yeah. What are you most excited about in way of endometriosis technology?
Things that are coming out on the horizon. What are you most excited about? It's
Dr. Cabrera: hard. I think that, uh, the cure for endometriosis will be developed when we have genetic cure for diabetes and hypertension and other diseases. Uh, we know that it's a polygenetic disease, you know, and some, uh, I know if you have polyps.
seen the last, the last article about the clusters of endometriosis. That means that endometriosis doesn't cause a migraine or like a, uh, thyroid dysfunction, [01:44:00] but many patients have these types of diseases because at some point it can, it may have conjunctioning on chromosomes. That means that patients that have hypothyroidism of thyroiditis or they have a migraine or other inflammatory diseases like, I don't know, arthritis or whatsoever, they may have more chance of having endometriosis because they have the, the, the inflammation gene, you know, like, uh, exploded.
Dr. Brighten: We also see it. So most hypothyroidism is caused by an autoimmune condition known as Hashimoto's. We also see PCOS and endometriosis go together. ADHD and autism in women with endometriosis and really, um, any autoimmune condition. Migraine,
Dr. Cabrera: something that's really interesting. I have patients that have migraine every day, every day.
So migraines
Dr. Brighten: is something neurological, right? But could be inflammatory or how you respond to your hormones. Or
Dr. Cabrera: the endometriosis tissue that cause inflammation, release the cytosines, and then it can just, you know, trigger another disease. So now we know that this [01:45:00] type of diseases will be probably cured when we have genetic treatment.
Still, until now, we do not have treatment for, like, uh, for cancer or sometimes even, uh, I know, uh, diabetes or whatsoever. Probably in the less They probably in 10 years, we will have it.
Dr. Brighten: If they fund it, but you know, I want to bring up, you mentioned the cytokines. These are inflammatory chemical messengers of the body.
If you've ever had the flu, you know, these, because this is why you're cranky. You're tired. You just like don't feel well. This is also why an endometriosis fatigue is huge. Uh, depression, anxiety, mental focus. Uh, but also we, you know, we can sometimes see women being misdiagnosed with other conditions because they said like fibromyalgia and being told like you have something else going on.
And your endometriosis can't cause this.
Dr. Cabrera: Yes, I think that you just reached another key point. Oh my God, this will stay in five hours. But this is really important because as [01:46:00] I told you in the beginning of this, this interview, endometriosis is a multi organic, multi systemic disease. And just because of the inflammation process and the cytosines, the number one symptom of endometriosis is not the disease.
pain is fatigue.
Dr. Brighten: Yeah.
Dr. Cabrera: Fatigue is the most common symptoms in patients with endometriosis. There are patients of endometriosis that doesn't even have pain. But when you ask, are you like with chronic fatigue? It's like, yes, like if I was sick and they understand why it's really easy when you have a flu, you have a, you know, a sore throat, you feel fatigue.
You just want to sleep. And it's because of these inflammation process goes through all the body. And then you, feel like this. Even sometimes they have been changing in the human core temperature. So it's really, really strange how it works. But, uh, I think, I do think that at some point, uh, we will find, uh, not a cure, but something that will control, you know, the fatigue.
We know now that endocannabinoids, like CBD and all that, help a lot with chronic pain. pain and it'll also help with [01:47:00] inflammation. We know now that many other new drugs for inflammation help for the process of fibrosis around the meteorosis, but there's still no, uh, like a cure or recipe for them. So the most important part, the newest thing is to get to an endocenter.
That's it. Yeah.
Dr. Brighten: Are you using low dose naltrexone, LDN, in your practice?
Dr. Cabrera: No, still not.
Dr. Brighten: Yeah, you know, there's a compounding pharmacy here. Really? Oh, that's really important. We're going to have to talk about that. Yes, yes.
Dr. Cabrera: There's a lot of stuff that we should be, like, researching. But the most important part, I think, that the research should be gone in information because if we catch the woman in an early age and we treat them well, the endometriosis will never grow.
You get me? So I think that, uh, most of the funding of endometriosis should be in an investment in education of women and men. And the second thing, it will be in, about the treatment, probably genetical.
Dr. Brighten: I love this. This has been a fantastic conversation. You're going to change the lives of so many women listening.
I hope, yes. You absolutely will. And you are. You're changing [01:48:00] lives every single day. So thank you so much for sharing your time so generously with us. It has been such a pleasure.
Dr. Cabrera: No, it's been my pleasure. And I think that the people points should be always heard. If we can only reach 200 million, uh, then people like my sister will never go on their five surgeries or something like that.
So your case is also something that thank you very much for sharing for patients, because I know you have. been through pain. You have been through many things that many other human beings don't, doesn't even empathize or don't understand. It's like, Oh, uh, they lose an IVF, poor of them. It's not, no, it's something really important.
And the pain is sometimes really, really hard. people doesn't understand how much the pain can grow. And I think that by just changing the information that we reach to our patients, it will help them. Like patients right now, if you have any pain, they will all make up endo. And if I have may endo, they will ask the provider, I need an endomapping and I need an endomapping and you will never, uh, you know, stop until you get it.
And then that will [01:49:00] change the way of the disease. So thank you very much.
Dr. Brighten: Yeah. I just want to end anecdotally. Uh, well, This story that there is no pain management really in the United States for placing IUDs, doing colposcopies, doing endometrial biopsies. And when women took to TikTok and they started sharing their stories, they first were met with gynecologists telling them to shut up, that they don't know medicine.
They don't know better that like, this is just the way it's done. And they kept pushing. And then doctors like myself and others started amplifying their voices. And now we are seeing. Gynecologist saying I never knew it hurt patients so bad. I'm changing my practice And so I say this because when you advocate for endomapping for yourself You change the entire health care system for every woman who comes next and it is Really our patients who have the opportunity to create that change in the world and they do that by being informed by physicians like yourself.
So thank you so much.
Dr. Cabrera: Thank you. Thank you very much. And thank you for everyone that make this possible. And I [01:50:00] think that the last, uh, the last thing you said, it's amazing because if a patient started, you know, uh, the yen, the yen, the name it's may, uh, it's in France, it's in French for the most intelligent woman.
That's what that is. So that's why I, I put the name of that. What we are trying to create this
Dr. Brighten: job. I love that. Yeah. We're trying to create
Dr. Cabrera: the first thing that we do is to make the patient, you know, aware of the disease and make them an expert just by good information. They will never do something is called like low quality.
You get me? So if you make, uh, you know, like, uh, no, like an endorsement, you, if you make a little bit more, uh, enhance up the quality of information, then you overcome the disease. So that's why we're trying to inform patients.
Dr. Brighten: You're incredible. No, thank you so much.
Dr. Cabrera: Thank you so much. And thank you. Thank you everyone.