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Hello for vaginas only family. Welcome to another episode of four vaginas on Lee. This is Episode 15 to be exact. And this is part two of my enemy trio Sis Siri's Hopefully you're coming into this after listening to Part one. If not, go back to iTunes and listen to the first enemy trios this episode and then we'll glide into this one. So let's go. Hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. Hello and welcome. My name is Dr Celestine on this episode. Ah, for vaginas only. We are going to go a little bit more in depth into enemy trio sis. Mainly we're gonna talk about how it's diagnosed and how it's treated. Okay. First, let's talk about how it's diagnosed now. Enemy trio says convey simply diagnosed by having a discussion with your doctor and having a physical exam what we call a history and a physical. So by just talking about the different symptoms that you've been experiencing, how long they've been going on et cetera, and also by your doctor doing a pelvic exam, which allows us to feel the uterus and the ovaries and to identify any tenderness in those areas or any masses we can come up with the diagnosis of enemy trio sis. Now there's another way to diagnose endometriosis, which is not always needed. And that is a laparoscopy, which is going in the abdomen with a small camera, usually about 2 to 3 incision sites on the belly that are about 1 to 2 centimeters in size. And we go. We look around, we look at the uterus, you look at the ovaries, we look all the way down in the pelvis just to see if there are any implants of the enemy troops that we can see visually. Take a little piece of called a biopsy and send that to the lab for analysis to confirm the diagnosis. Now, with that being said, you know, leprosy doesn't always show you all the enemy trusses that's in there. So if you're thinking already hey, if I have this, you can go in with a camera, take it all out with little biopsies and be done. Some endometriosis implants are invisible and some are hiding under structures or connected to structures that you know you don't really want to be messed with and that you can't really see around. So the surgery is not always curative. Just put that out there before I delve into the surgery aspect a little bit more so. Those are the two ways it's diagnosed, I would say most commonly I diagnose enemy trio sis just in the office by talking to my patients and also going through some of the treatments and ruling out some of the other things that can be masking its enemy trio sis, so that we can make sure that, you know that is actually what you do have. So with that being said, you know, I do do these podcasts to give you guys information to empower you, you know, to understand your body and to know a little bit more about what's going on with it So you can have these informed discussions with your doctor. No, by any means. Am I not saying to go into your doctor's office guns blazing that you have enemy trio sis? And that's what Dr Celestine said. No, no, no There are many different things that can mask as enemy Truro sis or have similar symptoms enemy trio sis. So it's important to take the times, eh? Yeah. Talk about this with your doctor. Talk about your symptoms and talk about the things that you learned about Enemy of ATRIOs is from me or from your mother, Your sister, your friends. That's completely fine. Um, you know, but there are steps that need to be taken to make sure that we're not missing something else. For example, some other things that can, um, present like enemy trio sis is irritable bowel syndrome or interstitial cystitis of the bladder. Um, also, some STDs can cause some of these symptoms of enemy trio says So it's not always just because you have these. You definitely have enemy trio sis. But by listening to this podcast and getting a little bit more knowledge about enemy trio sis, you have a better idea of what your doctors thinking. And you have, you know, just better conversation with your doctor because you know, a little bit more as well. So let's continue. All right. So once you were diagnosed with Dimitrios is whether it be by a history and examine the office or by a biopsy from laparoscopy. There are different things that can be done for the treatment of enemy trio sis. Now the treatment route that you go down on the types of treatment that you try are really based on two things. It's based on how severe your diseases and also whether or not you want to have Children now or in the near future. So just keep that in mind when you go and you talk to your doctor and they'll probably ask you about the severity and about your desire for kids before going through the treatment options. But here they are, so first and foremost you can try what we call end said's, which more commonly are known as ibuprofen. Your Motrin is your ad veils thes, Aaron said's Now, if they are, take in for enemy true assists, specifically right before the symptoms get more severe, which is right before your period and a few days into your period. Usually they can decrease how severe your pain is now doesn't get rid of enemy trio sis, but it does help to control the symptoms. Another thing that you can. D'oh! Now we talked about the fact that these enemy trios is implants. These little spots in your belly can cause pain, and they react similar to how your uterus and your period reacts when your hormones change every month. So you know, it's not a surprise that hormonal medications can also help to control the enemy trio sis symptoms such as birth control. So for one of the main one that I think is used in the beginning, our birth control pills now the combined birth control pills. If you want to learn a little bit more about those, you can check out my birth control. You have options podcast episode, but these are the ones that have both estrogen and progesterone. Now you can take it two ways. You can take it the regular way, just like everybody else. You take one pill every day and you have your week where you have bleeding for your period and then you start up with a new pack or if your pain is still very severe. While trying that route for about three months, you can try continuous birth control pills, which is just taking it continually with no week off for your period. I mean, you will take a week off every so often because you do need to have in most cases, you need to have your period at least a couple times a month in order to keep the uterus healthy Overall. But for the most part, you won't be having your period, which decreases the hormone fluctuations that can flare up. Your enemy trios this. Okay, keep in mind there are some people that can't take birth control pills for certain medical reasons. So make sure you discuss that with your doctor if you're using that, especially the continuous form for your enemy trio sis. Okay, So you tried ibuprofen. You tried birth control pills. You know, it's not really working. What else can you D'oh. Well, some people have also tried the progesterone Onley, birth control pills that do seem to help some not just the combined estrogen and progesterone. But let's say you failed that too, you know? What the hell do I do next? I say usually, at this point, if you haven't had the lab Rosco P procedure to take a look around in the abdomen and see what's going on um, take biopsies that this is the point where your doctor would most likely do that. Um, go in, take a look around. Let's make sure that this is enemy trio sis that we've diagnosed from your history and physical exam. Let's take a little biopsy and confirm the diagnosis before we jump onto the other medications. So you're might go to your the procedure and have that done. And then there are some other medications that you can try. Once the diagnosis has been confirmed, one is called Depo Lupron. Now there are people out there that are like, What the hell are she's saying? What is this medication? And there are some other people out here listening to it like, Yep, I've tried that. So let's talk a little bit about what it is. So Debra Lupron is another hormone medication. It's given once every three months, and it lasts that full three months until your next shot. Uhm, it's an injection. But did I fail to mention that, um, so once every three months? Usually people give it only twice for a max of six months of coverage. I have seen people get it also up to a year as the maximum amount of time you can use it, and it helps by shrinking the enemy, trios his sights in your abdomen and therefore helping with the pain. Now, with that being said, it does have side effects. One of the major ones that people talk about is the fact that it thins your bones or causes something called osteopenia. Um, and because of that, if you're using it for a long period of time, usually your doctor will add on some sort of extra hormone therapy as either progesterone or a combination of progesterone and estrogen in order to decrease the amount that your bones thin out. Now that being said, you know the bone thinning usually does reverse itself, but we could never bitch be, you know, to shore. So we always give that ad back therapy with this medication. Also, a lot of people on Death Row Loop Ron experience hot flashes and vaginal dryness. Basically, what it's doing is it's lowering your estrogen, and the estrogen, like we talked about in Episode one, is kind of part of the hormonal change that flares up every month with your period that also flares up your enemy trio sis. So this medication kind of stunts the level of your extra jin. Hence the vaginal dryness and hot flashes. Similar somebody that's in menopause with low estrogen, if that makes sense. So, um, you know this medication is great, but 50 to 70% of the time after you stopped the medication, the symptoms recur within a five year time frame. And like I said, that's not a medication that you could be on forever. 3 to 6 months is most common. Rarely people are on it for a year, so it's not something permanent. It's just something you know to hopefully decrease your symptoms for 1 to 5 years. So there's that. Another injectable medication that has been used to help with enemy trios two symptoms is double pra vera, so double Rivera is also another type of birth. Control another type of hormonal medication in the progestin family and as a birth control and similar to as a treatment for enemy trio sis symptoms it's given once every three months. This medication also has some issues with decreasing your bone density. Also, you maybe taking some calcium supplements or some hormonal supplements down the line if you were on it for a long period of time. But I have seen it help with the symptoms of enemy trio sis. Another thing that's not really approved. But I have seen work as well is an I u d so that the marina you d which is a progesterone Onley form of the intruder and device, is something that your doctor may be able to try with you if other things haven't worked as well. Now, um, keep in mind that all the things that I've mentioned, the birth control pills, whether it be the combined pill or the progesterone on Lee Pil the devil a loop Ron which decreases your estrogen, which I didn't mention, it also kind of has a flare up in the beginning. So initially and people get double loop Ron, their symptoms worsen. But then we'll get better anyway, continuing on and also the I e. D. And the double prepare all of these things our kinds of forms of birth control. So if you are trying to get pregnant, um, and have a baby in the near future, these are things that will probably not be recommended by your doctor because they're also forms of contraception, which prevent pregnancy. But if you are not trying to get pregnant, you're trying to control these symptoms for however long you can. You know these are good options for you. So now let's talk about those people that want to get pregnant and maybe even be having some trouble getting pregnant because they have enemy trio sis. So in this case, the most common direct management is going to the laparoscopy surgery that we talked about earlier. Not only do you as a physician, are you able to go in, take a look around, confirmed the diagnosis by taking a biopsy, but you can also burn the little sites of enemy troops is that you see on, and that helps to decrease the amount of the enemy trellises in your abdomen, which can or has been shown to help with enemy troop with sorry to help with infertility as well. Now, with that said, you know there's not. When you go into the abdomen and you look around, you find enemy trails is there's a staging system. Okay, one through four of how much enemy dresses in the abdomen. Now I've had people come to me and say that Oh, I've had a physician go in there and tell me I'm stage four. I have the worst form of enemy, Trio says. And all these things were happening to me because of that. Um, and that's not necessarily true. The staging is really just for your physician to talkto other physicians about what they found in your belly. That does not mean that because your stage for your pain is worse than someone that has stage one. That does not mean that you have a higher likelihood of infertility because you're stage four versus somebody. That's stage one. It's really just for talking between physicians for the most part. Okay, so keep that in mind. So when we go in there and we burn certain sights for the enemy trio sis, it can help with your infertility. But you know, there's no riel gauge as to how much it helps. So if we go in and we see some things that put you at a stage four and we try to get rid of them to the best of our ability, um, because we take out a certain amount or because we're able to burn off a certain amount doesn't mean that you have a higher likelihood of pregnancy than someone that we've removed or burned out less of than you. Does that make sense? There's no way for me to say that. You know, definitely, because you do the surgery, you're gonna have a baby because we remove this much of it from your abdomen. It's just something that has been shown that if you do see some certain sites, which, yes, some are technically invisible. But if we do see someone, we are able to address it. You can have an increase, um, in your chances of getting pregnant. So that might be a route that you jumped to before any of the medications, if that's your goal. All right, so that's as much of enemy trio sis as I'm going to talk about today. Um, there there is more. You know, there's a little bit more finesse to this sometimes, and a lot of the course that you go down for treatment really depends on how bad your symptoms are. Like I said, your desire for pregnancy, what medications you can and can't take. And, um, also just what you and your doctor come Thio as an agreement as to what, um route you want to take for this So it's a process. Hopefully doesn't take the 3 to 11 years that the n i h states that it can take from symptom realizing your symptoms to your diagnosis. But it is definitely a process where you have to work closely with your doctor and be honest about your symptoms and their improvement or lack of improvement. Okay, so if you want to talk a little bit more about this, feel free to message me on any of my social media accounts or, um, write comments in the posts on Facebook or instagram. But just keep in mind that I can't really talk about specific cases. I don't know your medical history personally, although I would love to know each and every one of you like I say a lot, I don't. So I can't really give medical advice on the Internet without being your doctor. And I'm sorry about that. I know some of you have tried, and I really wish that I could help you directly. But please, please, please take this information that I'm giving you and either find an O b g Y n in your area, or go to the only joy in that you have been going to for years and talk about these things with, um, um, you know, I want to make sure that nobody's living their best life, their most pain free life when it comes to enemy trio sis. So make sure you have these discussions with your own doctor and as it thank you for listening to another episode of four Vaginas old on Lee. I hope that you know this top of Dimitrios is, although it's very in depth and full of a lot of information, some of which is not that easy to explain. I've realized while making this episode, I hope that it's given you a little bit more of an understanding of what enemy trios this is and how it affects Maybe you or the people around you. Check us out on four vaginas only on Instagram and on Facebook. Don't forget to subscribe to the podcast for vaginas only on iTunes and also to rate and comment on my podcast episodes as well. I love to hear from you guys, so I will see you guys soon in the next episode. But by