Ep 215: When Period Pain Isn’t Normal: Endometriosis in Teens with Dr. Iris Kerin Orbuch

In this episode of Your Child Is Normal, Dr. Jessica Hochman sits down with endometriosis specialist Dr. Iris Kerin Orbuch, author of Beating Endo: How to Reclaim Your Life from Endometriosis and a key medical voice in the films Endo What? and Below the Belt.

Dr. Orbuch explains what endometriosis is, why it’s so common yet underdiagnosed, and how it often first shows up in teens—not only as painful periods, but often as chronic gut issues, fatigue, and “IBS” that never fully resolves. She shares how she evaluates patients, why excision surgery is considered the gold standard, and how she combines surgery with pelvic floor physical therapy, gut work, mindfulness, and trauma-informed care to help patients truly heal.

Also discussed:

• The red flags that period pain that starts interfering with school, sports, and social life is not normal.
• How endometriosis can show up years before a teen ever gets her first period.
• Why birth control can help symptoms but acts as a Band-Aid, not a cure, and doesn’t stop disease progression.
• How endometriosis is linked to infertility, and why diagnosing and treating it early matters.
• Practical next steps for parents: when to suspect endo, how to talk to your pediatrician or OB-GYN, and what kind of specialist to look for.

This episode is meant to give parents a clearer sense of when to worry, when to push for more answers, and how to support teens who might be living with endometriosis.

Connect with Dr. Iris Kerin Orbuch

• Website: https://www.lagyndr.com
• Iris Wings – Sanctuary for Endometriosis Surgery & Wellness 9001 Wilshire Blvd, Suite 207
  Beverly Hills, CA 90211 
• Phone: (310) 651-7333 
• Follow her on Instagram:
  • @dririskerinorbuch
  • @iriswings 
• Buy her Book: Beating Endo: How to Reclaim Your Life from Endometriosis

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Transcript

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Welcome back to your child is normal. I'm your host, Dr Jessica Hochman, today, we're talking about something that affects many girls and women, yet it is still widely misunderstood and often assumed to be a normal period of pain, endometriosis. Many people grow up believing that severe cramps heavy bleeding are simply part of normal menstruation, but for some these symptoms may be a sign of endometriosis, and understanding the difference can be life changing. Today, I'm joined by Dr Iris, Karen orba, a gynecologist and endometriosis specialist, author of beating endo and a medical contributor to the documentaries endo what and below the belt. Together, we'll explore what endometriosis actually is common early signs, especially in teens and treatment options, including excision surgery and a holistic mind body approach. My hope is that this episode helps raise awareness, encourages curiosity rather than worry, and offers validation and direction if you or someone you love has been experiencing symptoms that just don't feel normal, and before we get started, if you haven't already, I'd be so grateful if you could leave a five star review for your child as normal. Thank you so much. Now let's get into it. Welcome back to your child as normal. I'm your host, Dr Jessica Hochman, today we're talking about something that affects many girls and women, yet it is still widely misunderstood and often assumed to be normal period pain, endometriosis. Many people grow up believing that severe cramps, heavy bleeding or ongoing stomach pain are simply part of normal menstruation. But for some these symptoms may be a sign of endometriosis, and understanding the difference can be life changing. Today, I'm joined by Dr Iris, Karen orbuck, a gynecologist and endometriosis specialist, author of beating Endo, and a medical contributor to the documentaries Endo, what and below the belt. Together, we'll explore what endometriosis actually is common early signs, especially in teens, and treatment options, including excision, surgery and a holistic mind body approach. My hope is that this episode helps raise awareness and offers validation and direction if you or someone you love has been experiencing symptoms that just don't feel normal, and as a reminder, before we jump into the interview, if you haven't already, I'd be so grateful if you could leave a five star review. Reviews help more families find the show and support the mission of your child is normal. Thank you so much. Now let's get into it. Dr, Karen orbuck, thank you so much for being here. I'm really looking forward to having this conversation. It's such a pleasure. I'm so excited to be here. So tell everybody about yourself and what you do for your career. Sure. So I'm a physician who I did an OB GYN training followed by a fellowship in minimally invasive surgery, particularly focused on endometriosis. And endometriosis is all I do. It's totally a passion for me. It's a lived experience. And I am an author of beating Endo, how to reclaim your life from endometriosis. I've worked on two amazing movies that I'm a big part of, below the belt, which came out a couple of years ago with some big name producers, and also Endo, what? And I'm just like a disruptor in the field of endometriosis, and I'm a true advocate, and I'm a physician who specializes in excision of Endo, which is the gold standard. And I approach endo from a multi disciplinary East Meets West approach from the inside, mind, gut, gut, brain connection to heal the body. It's amazing, really amazing. And I'm so happy to talk with you about endometriosis, because the more I learn about it, and the more I learn about the symptoms, and also knowing that there's effective treatments that can be done to help women that suffer from endometriosis, I'm following your passion. I feel like the word needs to get out, because it's clear that a lot of people are suffering and they're uncomfortable when they don't need to be. That's 100% right? And I'm so happy to be on this podcast, because teens are my favorite patient population out of all of my patients. Because, yes, teens can have endometriosis. Yes, that's true. It's not it's not false, super common in teens, it's just missed. And I'm just curious, why do you say that they're your favorite? So I don't know if it's because I have two daughters. They're now older, but the reason teens are my favorite is because I'm picking them up so soon after they begin having symptoms, even though, let's say, I pick up a 16 year old, and they began menstruating at, let's say, 12. They're still suffering for four years like there's nothing acceptable about that. It's totally unacceptable to be in pain for four years, but better four years than the average diagnostic delay in the US, which is a decade, 10 years. And many patients I see in my office are suffering for 20 years or 30 years. So I love raising awareness in the teen population and for emergency room physicians and for pediatricians to really help pick up patients as early as possible. All right, so I can't wait to get into this so that people are more aware. They can take action. So first, tell me what is endometriosis in the first place? Sure I'm going to start with the symptoms, and then I'll tell you about the definition. I think it's a lot easier to understand. So endo is such a common disease process that affects roughly about 10% of those assigned female at birth. So it's about 200 million worldwide, and the Symptoms range and are very different in every patient, but primarily, if you think about endo from a gynecological perspective, it could be pelvic pain. It could be pain at any time of the month. It could be pain mid cycle, preceding one's period, during one's period, after one's period, it could be pain all month long. Could be heavy, bleeding infertility. It's the reason behind 40% of unexplained infertility. Largely it's gastrointestinal symptoms such as constipation or diarrhea or bloating or alternating constipation or diarrhea, or those who've been quote, unquote diagnosed by IBS at some point. There's also a multitude of urological symptoms, such as urinary urgency or frequency, like I just got to pee all the time. Patients report or feeling like they have a urinary tract infection, but the cultures are negative, and constitutionally, patients just report extreme fatigue, like they just don't feel well at all. And some people have all of those symptoms. Some people have one, some people have one from every category. Everyone experiences endo in a different way, and some are totally asymptomatic, and they only find out that they have endo when they try and get pregnant and they have infertility. But what happens is, once we start tuning patients up, they realize how they've been suffering for years. They just don't. There's kind of suffering in silence, and it's like a It's if they're looking at their mom or their aunt, there's an a genetic predisposition to Endo. So if your mom or aunt has Endo, you have a 77 zero to 100% likelihood of having Endo. So if you're having, like, really heavy periods, debilitating cramps, and your mom's like, oh, that's normal. You're like, okay, I guess it's normal. And that's where the gaslighting even begins. But it was normal for the mom, but she probably has endo which, which is totally undiagnosed. And so then the daughter just thinks, Okay, this is normal. I just need to live with it. So this time they come into my office, and I try, and I take, like, a 90 minute history with my patients, and essentially, I'm like, Well, tell me about your gut issues. Oh, they're perfect. No problems at all. And then I'm like, well, what's the longest you've gone without a bowel movement? And they're like, 10 days. I'm like, There's nothing normal about that. I'm like, How long do you strain on the toilet? Oh, it's totally normal. I'm like, do you strain for five minutes? 25 minutes, 55 minutes, and they're like, an hour. I'm like, Okay, right there. That's not normal. I'm like, do you move around on the toilet? Do you put your feet up? Do you have a Squatty Potty? Oh, yeah. Like, do you ever use a finger to push out stool? And they're like, yeah. And mind you, they begin saying, I'm normal, normal, normal, normal, normal, normal, normal. And then I really have to ask the questions in the right way to the elicit, to elicit the correct information, and then the patient starts to realize, oh my goodness, maybe this isn't normal, but it takes a lot of questioning and a lot of explanations to get them there. So what I'm thinking about is I have so many patients that come into my office that tell me that they experience menstrual pain, and I'll start off by telling them to take ibuprofen or make we'll make review the dosing and make sure they're taking enough that they're taking it early enough. We'll talk about heating pads. But I think I'm wondering, I should probably be doing a better job at following up with them and making sure that that is an effective treatment for them, because I wonder, in all honesty, how many patients I've taken care of where the diagnosis has slipped through the cracks. I'm definitely all for starting with ibuprofen, obviously with food, because a lot of ibuprofen can alter the gut microbiome also, which is like what the inflammation from the endo implants does, but alternating starting early. Just like you said, I'm a big fan of like, hot baths, heat also helps. But essentially, if their pain isn't being alleviated by all of those modalities, and it's just getting worse and worse, and it's they're, let's say they love theater or drama, and they're like, I don't want to try out for the play this year because I'm in so much pain, or I'm so excited to go to my best friend's birthday, but oh, it's gonna fall out when I have my period. So they don't go to their best friend's birthday or slumber party. When you start withdrawing from things that you love to do, your pain is too much. I mean, that's probably the easiest definition for those out there. If that's happening to you, like you really need to get endometriosis evaluated. So I this is really helpful, because I'm thinking in my head, I want to know what are the red flags where I can try to distinguish between what is normal menstrual pain and what needs to be further evaluated. And just to summarize what you're saying, it's when it's stopping teenagers from doing what they normally love to do. Yeah, I think this is the easiest way to look at it. And also. For you to keep in mind, like, let's say someone starts their period at 12, and you have a patient who comes in with their mom or their caregiver, like, at 11 or 10, and they haven't even begun their menstrual cycle. I want you to still have endometriosis as the differential, because you have to remember, right, like, the hormones start to increase, teens get, you know, under air hair, they get pubic hair. So pelvic pain, bloating, tummy aches. Where they're looking at that kid is, oh, anxiety, like it could very well be endometriosis. I I almost always hear a history of like, preceding their period. A year or two beforehand, they have tummy aches or they don't feel well, or like they're the sick kids, you know, always getting sick, always don't feel well in the nurse's office, in and out. Not all patients have to look like that, but many do look like that. I'm trying to think why, in my as a pediatrician, for why cases may get missed so frequently. And I think it's because, one, I don't really have many OB GYN to send my patients to. A lot of OBS won't see teenagers. They don't like to treat kids that are under 16, especially. And also, there's not a quick diagnostic test to say someone has endometriosis or not, right? There's no blood test that I can order, or no imaging that I can do to make the diagnosis on my end. Yeah. Well, I mean, at Iris wings, we see patients who are 10 year olds, 11 year olds, 1213, 1415, and referring some to someone to us is more educational for the patient. We're not looking to get people in the or right away. That is just not what we do. We actually want to arm the patients with information. We have so many different strategies that we use before we ever get a patient to surgery, and then whenever someone's ready, if they ever are, they know exactly where we are, and they're with a specialist who that's all we do is pain and endometriosis, but I can tell from my history and physical and my physical exam, I do not need to do an internal exam. I can even just do an abdominal exam and a really detailed history and physical and I can tell with about a 90% likelihood whether someone has endometriosis. I always do get a pelvic abdominal ultrasound just to make sure there isn't an ovarian cyst or to exclude any other reason behind it. But there's subtle clues in imaging that lets me know that there may be endometriosis or endo in the muscle of the uterus known as adenomyosis. So typically, the radiologist will read it as normal, but I like to look at the different measurements, and there's a lot of subtle findings, like, like, the the way that I asked the questions and the history that I elicit from the patient and then their caregiver, whoever's with them, by the time they leave, they're Like, you know, like, they're, they're, they're like, they're actually so grateful for the referring provider, because they have answers now. And they're like, it's not in my head, I am normal. There's nothing wrong with me. So they're, they're so grateful to have even if they're, it's not definitive. I'm, I can't say 100% because that's really a surgical diagnosis, but I can say 90 plus percent likelihood the patients are so grateful, like they're relieved, and I'm so grateful to know about you, because it's hard, because I don't know where to send the kids. So I'm so happy to know about your practice. You'll take kids as young as 10. That's yeah, that's such a relief for me to hear, to be honest, yeah, and we do virtual consultations all across the country, all across the world, because there really isn't anyone else, I think, who specializes in teens. You know, I picked up my daughter, Zendo when she was nine, and she was having a plethora of gut issues, like, a couple of years before she started her menses, and I remember the gastroenterologist at, like, top tier medical centers and the pediatricians, like, no one could offer any solution to help me. And I'm like, she's got Endo, like I picked it up in my daughter right away. She didn't have surgery until she was 18 or so, but I knew what to do to help her in those intervening years. I mean, I'm so happy that she had you so so thank you. You described the symptoms wonderfully. Can you now tell us? What is endometriosis Exactly? Yeah, I forgot to mention the definition. Thank you. Okay, so endometriosis is when you have cells that are similar to the uterine lining or similar to the endometrium, but those cells are found outside of the uterus or external to the uterus. So Endo, by definition, is not confined within the uterus. It's external too. So endo has actually been found on just every just about every organ of the body, from head to toe. Typically, we find it behind the uterus in. Like the cul de sac or in front of the rectum, by the ovaries, on the bladder, on the appendix. Typically we find it in the abdominal pelvic cavity. But it's, it's, it's found all throughout the body. It's pretty crazy. So that explains why the only way to diagnose it is from actually looking Correct. You can't search visualize it. You can't visualize it from an ultrasound or from an MRI. Am I right, correct? So some MRIs, it depends on the reader, and it depends on the machine. How many Teslas it is. So in very experienced hands, they can pick up endometriosis, but if they don't see it, it doesn't mean it's not there. And most radiologists are not well versed at reading endometriosis MRIs, and most machines aren't equipped at for looking for endometriosis. There's just such a there's such a non excitement at those diseases that affect women and trying to figure out how to help with a diagnosis, but we could pick it up on imaging, but most of the time imaging is completely normal. And can you explain more about the surgical aspect to treating endometriosis? Because I think a lot of parents, when they hear the word surgery, that can make them frightened or hesitant to pursuing seeing a doctor. So tell us about that. Why is surgery needed and how helpful it is it for patients? Yeah, so, essentially, so surgery, it's minimally invasive surgery. It's like little keyhole, tiny incisions that are closed, like with a little plastics. You can use Closure. You can use plastics closure. You can use, like medical crazy glue. It's day surgery. You go in that day, you go home that day, but we put the scope in the belly button when we look all the way up to the domes of the diaphragm, the liver, the gallbladder, the large intestine, the appendix, the small intestines, then, of course, ovaries, uterus, bladder and the gold standard of treatment, which is my specialty, is a particular kind of surgery called excision of endo so what that means is we're cutting out or excising the entire implant of endometriosis. We're removing it. We send it off to the pathologist. They then look at it under the microscope and they say, Aha, those cells are similar to the lining of the uterus. Hence, we have the diagnosis of endometriosis. So it's diagnostic and therapeutic, because what those implants of endometriosis do is they start pulling the pelvic anatomy, like either to the right or the left or to the back. So number one, there's like a tugging or a pulling that pulls on the underlying muscles and fascia, so that causes pain. And then secondly, within those endo implants, there's these inflammatory mediators, these interleukins, that are released head to toe. They go to the gut, and they set off like leaky gut. They go to the endocrine system and increase the likelihood of autoimmune diseases. They they just flare the body like crazy. So surgery removes the pain that's like, causing the pulling. And secondly, and I think more importantly, it's removing these inflammatory mediators that are releasing inflammation and wreaking havoc on the entire body. And teams tend to bounce back really well. And when you give statistics to family about how well the minimally invasive surgery works, what do you say to them? I mean, my goal is one surgery done right, like my goal is not to have patients come back. That's what happens with the wrong surgery known as ablation. Ablation or burning or laser or coagulation or cautery of Endo, is just getting rid of the superficial aspect of Endo. So if you've imagined like your fingertip is a piece of endometriosis. Burning will remove the right the white part, like of your nail. Excision will remove the entire nail, like the entire implant that's causing inflammation and wreaking havoc on the on the whole body. So patients do exceptionally well. I mean, if I had my daughter have this surgery, I mean, there's nothing without risk, but the benefit is just is it's like astronomical obviously, whether it's a teenager or a 20 year old or 30 or 40 year old, coming to my office, I'm assessing head to toe multidisciplinary like, how can I make this person better? And one of the first things I always assess for is their musket muscles. And most patients, if they're in a lot of pain, they're typically like curling up in a ball in pain, and that causes all the muscles of the abdomen, that causes their pelvic floor muscles to be super tight. So one of the first places I send my patients before surgery is to pelvic floor physical therapy, because often patients say, Oh, my, my, my right side hurts, or my back hurts, or I have pain shooting down my leg, and it's because the muscles get tight and then they're asymmetric, because if the endo implants are pulling the endometriosis, let's say to the right side, there's an asymmetry on the right side of the muscles, and it causes the muscles cause. So much pain, so I get them into pelvic floor. PT, I assess their gut, if they're describing any bloating or constipation or diarrhea, or they've been to the gastroenterologist for something, or the mom's like she was constipated ever since she was a baby. Chances are there's inflammation. Parenthetically, there was a study of female fetuses that did autopsies on them, and they found that 9% of female fetuses have endometriosis. Of the fetuses, fetuses, yes, but meaning, meaning, there's been evidence of endometriosis from birth, from birth. So you're either getting it, like I mentioned before, the 70 to 100% likelihood, if your mom, your aunt, it could be on the dad's side as well, the grandmother. I've seen it like skip generations. So there's a genetic component, or exposure in utero to chemicals. We do know that dioxins, which are byproducts of bleaching, induce endometriosis, and there's probably so many other chemicals that we don't know of that can cause endometriosis, you know. So I tune up the gut, like I test for SIBO, which is small intestinal bacterial overgrowth. We tune up their large intestine. I get them to do mindfulness meditation to get them more in, like, a parasympathetic, rest and digest state, like, I'm a really big advocate in that. And then I look for other things that coexist with endometriosis, like painful bladder syndrome. And I can go on, there's a bunch of overlapping diagnoses that I also look for. So I first, before I get a patient to the or I start undoing what I can do non surgically. And then patients are like, Okay, this is better. That's better, that sort but this is not changing. Now I can understand what getting better is, and they're like, I want to get better. What I so love about what you're describing is, I'll tell you, from my end, what usually happens is, let's say a patient comes in they have menstrual pain, I'll start them on ibuprofen. Maybe if it continues, we'll do a birth control pill, and then if it's still persisting, I'll send them to an OB, GYN, and then if they do end up getting surgery, honestly, I've never heard of all of these other modalities being introduced as treatment plans for their endometriosis. So yeah, is this something unusual that you do? Yeah, like, you know all this, you know, offering meditate, thinking about meditation and pelvic floor. PT, I love that you're thinking about the whole patient and thinking outside of the box. Yeah, I've been doing this multi disciplinary approach for over 15 years, probably 17 years, and obviously, as times evolved, incorporating more and more things to my wheelhouse. But I'm in a surgical society, and people did not they're like, this is a surgical disease. What do you mean? I remember I was, I was they asked me to give one of the, like, post graduate courses at our international meeting. And I'm like, Oh, by the way, I want a pelvic floor PT to come, and I want a physias Tris to come. And they're like, oh, there's no funding for them. I'm like, That's okay. I'm gonna find someone local, don't worry. And it was such a kick ass part, if I can say that course. And it just it was exhausting. I was so exhausting. I was so exhausted showing people what at that point I knew had been working for eight to 10 years. But more and more people are adopting it, but, but they're like, oh, surgery didn't work for you. Try pelvic floor. PT, whereas I'm like, Yeah, I know surgery is going to help you, but let's down regulate you before we get you into surgery. Let's try and identify what pain is coming from where, so you can understand your disease and your body better, so you can take ownership of it and, like, be in a partner and care for you. But, yeah, I created the iris wings sanctuary for endometriosis surgery and wellness to give a multi disciplinary approach to help patients reclaim their life. I have endo myself. My daughter has it and like, I don't have pain in it at all. I have no pain at all, and you can beat the disease for sure. Beautiful. I think that's so true. I do agree that for many surgeons, the assumption from a primary care doctor is that you send them to a surgeon, and that's what they do. You know the saying that you show them a nail, they're the hammer, and that's that's the end of it. So I really commend you for having this whole patient approach, because I do think, I think that's what's so frustrating with a lot of aspects of medical care these days, is that patients don't know where to get they don't know where to get all their support. They come out of surgery and they're looking for more. And so how wonderful that you can support patients in all aspects. Yeah, they do so so well, and that's why I wrote my book beating Endo, how to reclaim your life from endometriosis. Because when I was practicing in Manhattan for so many years, like the Manhattan, people knew like about this approach. But I'm like, we need to get this to the 50 states. I want patients to walk to their gynecologist with this as a guidebook and say, Can. I read what this doctor says, Can I have a prescription for pelvic floor PT, can I have a prescription for a SIBO, small intestinal bacterial overgrowth test? This doctor says, did it, you know, can I have a prescription and and it's, it's really working. And then the movies as well, like I we had to really figure out, how do we go around the healthcare system, because the healthcare system is really broken, unfortunately, especially for chronic diseases. So that's where the two movies came in, so people could find out about endometriosis in the mainstream and then be like, Whoa. I So identify with these patients. And that's how the awareness of endometriosis has changed, I think in the last 1015, years was like, really outside the box, thinking, yeah, how long did it take you to put a movie together? So I was really fortunate that one of my patients, probably 1517, probably 17 years ago, was a film producer, and I, she came into my office just because she was at NYU and for PAM, like, I think you got Endo, and long and short, I operated on her. She tells her story, this isn't a HIPAA violation. She's like, has TED Talks and stuff. And she then subsequently had two beautiful daughters. Spontaneously got pregnant, and she made it her life's mission to change the trajectory. And so it was with her that I kind of partnered. And in our last film, the executive producers were Hillary Clinton, may Whitman, Rosario Dawson, Corinne Fox, and then, like, we've had bipartisan funding from Congress, like, with the Democrats and Republicans, it's pretty, pretty amazing, like, we've really gotten our foot in the door. There's still a lag. I mean, it's still, it's still not enough. There's not enough funding for a disease that's as common is like diabetes, and diabetes does have a multi disciplinary approach, right? You send someone to the like, the eye doctor, to the nutritionist, you send them to the get like, you send them everywhere. And it's normal, it's covered by insurance, and it's like, of course, you're going to do all of that prevention. But Endo, we wait until they're like, you know, have no job, debilitating pain, can't have a baby. And then we start scratching our heads, like, what could this pain be like? That doesn't make sense to me. Yeah, it makes sense, absolutely, to want to catch it and treat it much, much, much sooner. Yeah. So now question for you, how do you decide who is a candidate for surgery if somebody has a small amount of endometriosis, do you let them? You know? Would you try the other options and other treatment modalities first before surgery? How do you go about deciding who is a candidate for surgery? So what's a super interesting fact about endo is that there's no correlation between quantity of endo and severity of symptoms, meaning someone could have a belly full of endo and be asymptomatic. And the converse is true. Someone could have a spot of endo and have debilitating pain. So I don't necessarily go by quantity. I go by symptoms, like how it's impacting your lifestyle, and I always down regulate my patients. Always, always, always, always, always, because I can get my patients 2040, 60, 80% better before I take them to the or. And that's telling me that all of these other conditions, like the tight muscles and the SIBO and like maybe interstitial cystitis, which is pelvic pain or bladder origin, if they have that, all of these other pain generators that happen because of endo are contributing to 2040, or 60% of pain, or 80% of pain. Then I know the what's left behind is coming from the Endo, but it's important to understand, like when patients have pain that comes here or there in time, by them understanding which pain is coming from, what source? It's empowering for the patients. And I don't want them to think, Oh, my pain's back. I need another surgery. Largely. Oh, it's the holidays. I just had cranberry sauce, which is very acidic. I just ate a bunch of fried food. I just was out with my friends. I barely slept. You know, I'm super stressed about seeing my family. There's, like, a lot of other things that are contributing to pain. So it's important for me to help my patients, like, really understand their own bodies. And I'm curious, from my own education, when you talk about nutrition, what are some general guidelines you give to patients to to help with their symptoms? So typically, I do work with a few different integrative nutritionists, so we have like data to try and figure out what's going on in their microbiome, but I really recommend patients to stick to organic eating as much as possible, whether it's fruits or vegetables, and then. Try and stick to like anti inflammatory, eating like foods the colors of the rainbow, staying away from processed food, if possible. Gluten and dairy tend to be the two biggest triggers for endo patients, but you don't want to go gluten free and then eat everything boxed and packaging with like 40 Ingredients per cracker, gluten free cracker, because that's not really helping you. Some more, home cooked, anti inflammatory eating typically tends to be the best approach. It's interesting, because the symptoms you're describing, I'll bet, so frequently get misdiagnosed as as IBS when you talk about constipation, bloating, chronic abdominal pain, it must be such a relief for for patients to when people realize that they've been misdiagnosed and that there is a path to improve. Yeah. So two things, I actually see gut issues as common, if not more common, than painful periods. In my practice, I think there's a misnomer about endometriosis being a period disease, quite honestly. But yeah, patients, I always have tissues everywhere in my office, and there's a lot of tears or tears of relief, oh, I found someone who can help me, and tears of sadness, like I can't believe I was given this waste basket diagnosis of IBS for all of these years when there is something wrong with me, so it's just there's so many mixed emotions that that happen when patients come to you and they want to know what to expect after they've been receiving treatment. What is the realistic expectation for their symptom control? It depends on a how long they've had pain before they come to me. So usually we do a pretty quick follow up at six weeks so we give them our recommendations, like pelvic floor, PT, get SIBO testing, whatever is like applicable to them. Start a 10 Minute Meditation practice and like whatever else we think will help them. We do a short term follow up six weeks later. It can be virtual. It can be in person. And based on how quickly their central nervous system calms down, that can really help me predict how calm they're going to be. Like, there's some people who will go to two PT or three PT sessions, pelvic floor PT, and they're like, I didn't even have the awareness. I was gripping and squeezing and tightening. So I often worked with somatic therapists, pain therapists, pain reprocessing, like whatever people need. We have it in our armamentarium. And if people don't want to work with a therapist, I respect whatever they do or don't want to do. But in my experience, that's been the ticket. Is having someone to talk to or somatically move through those things. You know, whether it's like tremoring helps so much sounds like all the more reason that we really need to diagnose this sooner rather than later. Yeah, yeah. Now you talked about some risk factors having it, you know, in the family, genetically? Are there any other risk factors that we should be aware of? I don't know if this is a risk factor, but it's something that I see autoimmune diseases, like in one side of a family, like, whether it's from the mom side or dad's side, this like, like, they're almost like, predisposed to an inflammatory state. And I see endometriosis much more frequently in that like, lineage, but earlier menses is a risk factor as well. That's interesting, because it's just more menstrual cycles, I believe. And I'm curious, are there any treatments on the horizon for endometriosis? Not really that I am excited about, that I know of, but one thing that I do want to mention for all those out there who are listening, who either have their daughters on birth control, or they're thinking of putting them on birth control, it is a medical management but what's important to understand birth control and all other medical management's don't stop the progression of endometriosis. They're just for symptom management, meaning, if you have debilitating tenant 10 pain with your periods, maybe it'll make it a seven out of 10, or a six out of 10, or a five out of 10. But you have to understand the disease is continuing to progress. So it's a band aid. It's a band aid, or if you have really heavy bleeding, maybe it'll lessen the heaviness of the bleeding. So that's, that's great. I'm glad that. But it's, it's a total band aid for the for for endometriosis, and it's something when I don't want someone going on the pill when they're 13 and all of a sudden they come off of it at 29 when they're ready to have a baby, and they then have debilitating periods again, and they can't get pregnant. It's just like, wow, that's if I can do the math quickly in my head, like 16 years of like where endometriosis went from super easy to treat to a lot more complicated, and it also endo decreases the ovarian function, ovarian reserve, egg quality, egg quantity. So I'm checking fertility even in my teenagers. You mentioned earlier, endometriosis accounts for 40% of unexplained causes of infertility. Yes, that is a big deal if we're not diagnosing this and we're not treating it appropriately, and we're putting kids on birth control pills and then come to find years later they can't have a kid when they want to. All I'm thinking about right now is I'm so, so glad and grateful that you're out there spreading awareness. Thank you. I know I lived through 2016, debilitating years of pain, so I'm the lived experience that nobody should ever live through the pain that I live through. And it's sort of maybe it's a blessing, because I did create this. I did pick it up in my daughter, my intuition, like, took me down the path of endometriosis, but in this day and age, like people should be picked up super, super quick. So okay, now I thought it'd be fun to do a quick lightning round of questions, where you could just give the first sentence that comes to your mind. If that's okay, sure. All right, here we go. One myth about periods that you wished you could erase forever, that you need to suffer. Some myth the most helpful lifestyle change patients tell you make a real difference. Meditation, most underrated tool for managing pelvic pain, breath work. I love this for coming from a surgeon. Your favorite simple food for reducing inflammation, maybe a supplement like curcumin, or one of those kind of supplements. A misconception about endometriosis. You hear all the time, get pregnant and it'll fix your Endo. It'll make your endo go away. That is so not true. What message do you want girls, teens and women? Listening to hear, I think, listen to your intuition, like trust your gut. I think there's no the guts really like the second brain, or like the first brain, you know, and the brain gut connection is so powerful, and if you really think that there's something wrong, but you go from doctor to doctor, and they tell you you're fine. You're fine. It's in your head. Please, trust your gut. I believe it. I believe you. Unfortunately, like 99% of general OB gyns are armed with the same outdated information I learned in my residency, like, and it's, it's so it's so sad, because General OB GYN are telling patients the wrong information. They're telling them your pain is normal, you don't have endometriosis. That's like, a given. And almost every patient who walks through my door have have been told that your pain is normal, you don't have endometriosis. There's nothing wrong with you. And I'm like, it's, it's, it's mind blowing. I always tell patients I learned more in my first week of fellowship than I did in four years of OB GYN training plus four years of medical school about Endo. So in eight years, I learned less than one week of fellowship which was focused on Endo. I would agree with you. I don't think we learned much at all about endometriosis. Where can people find you? Tell every like plug your book or tell us about your movie. And then where can they find Sure, sure, sure. So they can find me on if they want to check me on the website, which is l, a g y n, d R, L A g y n, doctor, L A g y n, d r, they can find me on social media, on Instagram. Doctor Iris, Karen orbuck, d r, I R, I s, k, e, r, I N, O, R, B, U, C, H, and then they can give my office a call. I'm in Beverly Hills on Wilshire, and I'm looking at my phone number because I don't even know my phone number of my office by heart. I think it's 310-651-7333, and we would love to see you for a consult like it's such a warm, loving atmosphere. We were just published in Forbes for, like, changing the way that for Doctor, how doctors offices are. It's like, totally Zen, totally chill. You won't even feel like you're at the doctor. It feels like a it feels like a spa, because we need to down regulate people's pain and just change how people are viewing the disease really amazing. Dr. Karen orbuck, thank you so much. This has been such a wonderful interview, and I'm so thankful for your time, and thank you for being my pleasure. Thank you for listening, and I hope you enjoyed this week's episode of your child is normal. Also, if you could take a moment and leave a five star review, wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow.