Endometriosis Testing, IUD Lifespan & Pubic Hair Myths

In this listener Q&A episode, I answer common questions about endometriosis diagnosis, the saliva test for endometriosis, pubic hair removal, and how long IUDs last.

We discuss whether there’s a reliable non‑surgical test for endometriosis, how the newer saliva‑based Endo test works, and how it compares to imaging or surgical diagnosis. I also explain what endometriosis is and why it can cause chronic pelvic pain, inflammation, and scarring.

We cover the health myths around pubic hair shaving — including whether removal is medically necessary — and review evidence‑based timelines for copper IUD and hormonal IUD duration, including how long different IUDs may remain effective.

If you’ve been searching for clear answers about endometriosis testing, IUD replacement timing, or vaginal health myths, this episode breaks it down in plain language.

You can write to us at Questions@GynoInfo.net

And follow us on Instagram @gynoinfo

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Burkey, the podcast dedicated to teaching everyday women what they need to know about their body and how it works to successfully deal with the healthcare system and communicate with their doctors. Each week, I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. Gyno Info will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree, one episode at a time. So now let's begin. Welcome back to Gyno Info, the podcast about women's health in normal, everyday language that normal, everyday women can understand. No special medical words and no doctor speak. A special welcome also to those of you who just discovered us and are listening for the very first time. Please take a moment now to subscribe to Gyno Info. If you do not, then you might have a hard time getting back to this episode. In case you had to interrupt in the middle and would like to finish the episode later on, you cannot count on the internet algorithm to send it to your feed anytime soon. This week I'm going again to answer some questions that you, the listener, have been writing to me at questions at gynoinfo.net. You can send me any questions you have yourself to this email address, as long as they have something to do with gynacology or women's health or medicine in general. Here's the first question. Is there a blood test for endometriosis? No, there is no blood test, but there is now a saliva test, a spit test. First a few words about what endometriosis is. It is the lining of the uterus or the so-called endometrium that is not growing where it is supposed to grow. It is supposed to grow inside the uterus from where it is being shed later as a period every month through the vagina to the outside world. Instead of inside the uterus with the endometriosis, the endometrium, the lining of the uterus grows inside the belly, anywhere on the surface of the pelvis or the abdominal organs, such as the tubes, the ovaries, the uterus itself, or the bladder or the bowels, or the lining of the belly, which is called peritoneum, or the wall of the pelvis, which is what the lower part of the inside of the belly is called. It can also grow inside the ovaries, or inside the uterus, or as far away as the lungs. In all those places, the lining grows and sets just like it does when it grows inside the uterus. But instead of the blood going to the outside through the vagina, like with the period, the blood goes inside the belly, causing a lot of irritation, inflammation, and scarring and pain. When it bleeds inside the ovaries, it blows up those ovaries with sacs filled with old blood, so-called chocolate cysts. When it grows inside the uterus, inside the wall of the uterus, then it is called adenomyosis, then it causes kilograms and super heavy bleeding. It can even grow as far away as the lungs, as I mentioned. Then people cough up blood with every period. Traditionally, endometriosis could be suspected because of the typical symptoms, which I will discuss in my podcast on endometriosis. But the diagnosis was only made for sure by surgery and taking biopsies to be examined in the lab under a microscope. More recently, doctors felt comfortable making the diagnosis of endometriosis based on specialized MRI exams or by ultrasound examinations. But now there's also a saliva test, a spit test, the Zivik endotest. It uses artificial intelligence, AI tools, and RNA sequencing on spit samples to detect the disease, and it is over 95% accurate. It costs almost$1,000, which is super expensive, but is still many times less expensive than surgery, plus anesthesia, plus the time spent in the hospital. In most countries, it needs a prior approval by the insurance companies before they will agree to pay for it. That is not required for more traditional methods, usually, of diagnosing endometriosis, such as surgery, MRI, and ultrasound. For women who are willing and able, the test is available to be done at home after a brief video consultation. You don't even have to go to a doctor's office first. Doing it at home is a positive for many women. If they do a test at home that shows that they have endometriosis, then they can go with the test result to their doctor and demand treatment without having to convince them first that their pain is real or worse, being told that all will be better once they have their first baby. Which is something that women, even in this day and age, still are being told by, in my opinion, pretty stupid doctors, because it's not even true. A positive is also the fact that the test is very accurate. The endotest misses the diagnosis in less than five out of a hundred women, which is much better than surgery, which depends on actually seeing even tiny areas of endometriosis that are often well hidden somewhere in the pelvis. It also calls false alarm, making the diagnosis of endometriosis when the woman doesn't have it in less than five in a hundred women. But the endotest has one major drawback, which is one of the reasons it is not yet approved in a number of countries. All the endotest does is give the answer to one yes or no question. Is there almost certainly endometriosis in a woman's body, or is there not? It does not say how much endometriosis there is, where the endometriosis is located, and how it looks like. For instance, if there are any endometriosis chocolate cysts in the ovaries, or if there is already a lot of scarring. When a diagnosis of endometriosis is made during surgery, usually big areas of endometriosis are cut out right then and there, and smaller areas of endometriosis are destroyed with laser or cottery, two methods of burning the endometriosis and destroying it so it can no longer grow and get worse. The endotest only gives the diagnosis but no other information. It is especially useful, though, when MRI and ultrasound do not show any definite areas of endometriosis, but the symptoms point very much to endometriosis. After the endotest confirms the diagnosis really is endometriosis, then treatment with specific endometriosis medications can be started without having to first go through expensive surgery. What the different treatment options are for endometriosis, I will discuss in my podcast, especially dedicated to endometriosis. The endotest saliva test for endometriosis is available in many European countries, part of the Middle East, in India, in Canada, in Brazil, but not in the US. Now to the next question. Should I shave? All my friends seem to shave their pubic hair, but I find that such a hassle that I do not really like doing it. Well, I hear you, and I actually don't shave either. Nor do I use chemicals, wax, laser, or so-called sugaring to remove my pubic hair. For the exact same reason that you mentioned. But also because my husband would be horrified if I did that. When I asked him sometime about whether he would want me to shave, he said, absolutely not. I do not want to have sex with a Barbie doll. But shaving is definitely a generational thing by now. When asked by Lise Prudson how he felt about pubic hair removal, he answered, I don't like having hair in my mouth, and if she wants to spend me some time down there, she should shave. There is actually no medical reason at all to remove pubic hair. It became fashionable in the Western world several decades ago, when bathing suits became smaller and smaller and turned into tiny thong bikinis first on the beaches of Brazil. Dark bushy hair sticking up around these tiny little thong bikinis was not considered particularly aesthetic or beautiful. That was when people started talking about and practicing so-called Brazilian waxing. I suspect it has also to do with internet pornography, especially related to pedophiles who get turned on by hairless children. Over time, more and more women began removing their hair to keep up with the current trend, and it became the new normal. In my practice, I rarely see a woman over 50 who removes her pubic hair unless she is newly single and back on the dating scenes. There are also some cultures throughout history, from the ancient Egyptians on to many present-day Asian and Islamic cultures where body hair removal was and is a normal practice. But there is no medical reasons to remove pubic hair. In fact, it acts as a natural protective barrier against dirt and bacteria. This was especially important in history during the times when women were not wearing underpants. Underpants in Western Europe are a fairly recent fashion, perhaps for the last 200 years or so. For the thousand years before that, underpants in women was considered immodest and too manly. There was always a certain resistance against body hair removal and for body positivity and being natural. Resistance that forgive the pun waxed and waned over the last 50 years. Sometimes it focused more on eyebrows, sometimes more on the armpits, and at other times more on pubic hair. In the last couple of years, an increasing counter trend has started on social media against the expensive, time-consuming practice of pubic hair removal under such hashtags as Bush's back. It will be interesting to see where that trend goes. A world-famous painting by the mid-19th century French painter Gustave Courbet called L'Origine du Monde, the origin of the world, hangs in the Musee d'Orsay in Paris, one of the most famous and important art museums in the world. In the picture, the woman looks incredibly feminine and sexy, and certainly is not shaved. This would be my front page picture if I were to start a campaign against pubic care removal. But back to your question. Shaving or otherwise removing your pubic hair is very much a question of fashion, culture, and the times and region of the world you live in. There's no medical reason to do it. There are even some valid medical reasons for actually not doing it. And it looks like you will be in good company that seems to be growing right now if you choose to rebel against body hair phobia and honor your body as Mother Nature made it. You can keep your body healthy and clean without removing your hair, wherever that hair grows. Now here's the next question. How often do I need to replace my IUD? It was very expensive and hurt quite a bit to put it in, but now it's working great for me, and I would like to keep the one I have for as long as I possibly can. That's a perfectly reasonable and understandable question. The answer actually depends on the one hand, on the type of IUD you have, and on the other hand, there is also a difference between what it said on the package insert, that is, for how long an IUD is approved by the government medical agency of a given country, and what medical science says about how long an IUD actually works. That can actually differ quite a bit. The reason that is important is because the insurance of the company that produced the IUD will refuse any medical liability for problems with its products if the IUD was left in place for longer than the manufacturer recommended. Curiously enough, the expiration date can vary between different countries for the very same type of IUD if you just read the package inserts. I'm going to give you the information on both copper and hormone IUDs separately, about how long they can be left in place according to drug company recommendations and how long medical science says that they remain working. First, let's talk about copper IUDs. For all about copper IUDs, check out episode 112 that I posted in October of 2025. The approval time for a copper IUD varies from 3 to 10 years for the time being, varying between models and country that they're sold in. The most commonly used model worldwide is called Paraguard or Copper T380A. It is approved in most countries for 10 years, but in many European countries, including Switzerland, right now only for five years. Scientific evidence shows effectiveness for up to 20 years. So if you're approaching menopause, you would certainly not want to remove it just because 10 years have passed. You can safely wait until you no longer need birth control and then take it out once you have entered the menopause. Also, most IUD complications show up in the first few weeks after they are put in. The chances of problems developing after several years of no complications are minimal unless you catch an STD, a sexually transmitted disease. Now for hormone IUDs, the situation is even more complex. There are more different brands and different sizes and different amounts of hormones in them. In addition, the time that they are approved for also depends whether you are using it for just birth control or as treatment for either heavy menstrual bleeding or as part of menopausal hormone treatment. Here on this slide, you can see that for birth control, they are approved from anywhere between three to eight years, depending on size, amount of hormone, and brand. For hormone treatment, they are approved for only five years, though they may actually last longer in some women, depending how fast the hormones are used up. A sign that the hormones in the IUD are used up will be a return or an increase of bleeding. For birth control, on the other hand, not for treatment, hormonal IUDs can last longer as well. Even after regular periods start up again. The fact that there is something in the uterus keeps the fertilized eggs from settling in the uterus and starting to grow into a baby. Older models of IUDs had neither hormones nor copper in them. They were nothing but plastic and it worked just fine. You can learn all about hormonal IUDs and the many things they can be used for in episode 113 from October 2025. I call hormonal IUDs a Swiss Army knife because of their many uses. Now this brings me to the end of this episode. Remember that if you have any further questions about the topics I talked about today or any other topics that have to do with women's health, please don't hesitate to send them to me at questions at gynoinfo.net. Again, that's questions at gynoinfo.net. If you like this episode, please give us a lot of likes and share it with your friends, family, and coworkers, or anybody else you can think of. And please also make sure that you click the subscribe button wherever you listen or watch GynoInfo so you can get back to it easily whenever you want. And the more people subscribe, the easier it will be for others to find us in the future. Thank you so much. Until next time. Until next time, thank you for listening. And remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you, not to judge you. And also, regular well-woman visits are always a good idea that you should make time for. You deserve it and you owe it to yourself and you owe it to your body and your health. This podcast is part of Pride House Media, hosted by me, Dr. Berkey, produced and edited by Josh Rosenzweig, original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at gynoinfo and on LinkedIn at gyneoinfopodcast.