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Welcome to the Healing on Purpose podcast. I’m your host, Dr. Miriam Rahav. The content of this show is meant for informational purposes only and is not intended to diagnose, treat, or cure any illness or health condition. Please discuss all information shared herein with your own personal health authority. I hope you find value in this episode. This podcast is also available on YouTube on the Healing on Purpose channel, should you want to look up any of the graphics, diagrams, or other visuals mentioned in the show. Links to the podcast and its YouTube channel will also be available on my practice website, rahavwellness.com. Please join me on my Facebook group, Healing on Purpose podcast with Dr. Miriam Rahav, to continue this conversation. Enjoy the show. Hello.
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Shalom. Peace. Shalom. Wholeness, completeness. What a beautiful and special greeting encompassed and felt intentionally in the word Shalom. Thank you for joining me right now, because right now is the perfect time The time you choose is always the perfect time to step onto and walk further on the divine path to healing on purpose. On purpose means with intention and with an awareness of what one is doing. In other words, with consciousness. You were made on purpose. You are here with me, and that is no accident. By healing on purpose, you heal so much more than your physical body. You connect to your divine purpose Healing on purpose is right for you, right for me, and right for all life. Thank you for consciously choosing healing. Thank you for taking this time for yourself. You deserve it. The world is better when you are healing on purpose. The subject of today’s conversation is endometriosis. I have a somewhat clinical definition of endometriosis to share with you. Here it is. Endometriosis. I am actually sharing out of professional literature. In preparation for today’s conversation, I did a little thinking, a little reading, a little refreshing, a little reframing, because I am a physician at the point of practice, and at At the point of practice, we get into symptoms, we get into labs, we get into how this manifestsates both symptoms and functional status in people’s lives.
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In other words, we call that clinical practice. It’s always good. It’s always healthy to go back to the literature. I found this wonderful resource. It’s a book, and it was published relatively recently. It’s good to know what’s out there in the more current literature. The name of the book is Endometriosis, Pathogenesis, Clinical Impact and Management. It’s a volume published from the Frontiers in Gynécological Endocrinology. That is published by the educational branch of an organization called the International School of Gynécological and reproductive endocrinology. The reason I’m mentioning this to you is because you can find my sources and you can do your own reading and reflection and detective work now. I might be speaking in Greek. Sometimes it’s easy for physicians to lapse into very specific physician-type language. It’s a very rich language, medical language. If you have found this conversation, this podcast, then you probably are familiar with the word endometriosis, though we’ll discuss what that means in a bit. Pathogenesis is a word describing how we get out of balance. What is that process? In this case, how do we get endometriosis? By the way, this is a big mystery I wanted to reflect on you.
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Clinical impact means how does this manifest in our lives? I found a really touching testimonial and how endometriosis affected one woman in particular that I wanted to share, and then management. What do we do about it? What I realized as I was preparing for this conversation, and I realized this This, in many cases as I prepare for conversations, that it’s just touching the tip of an iceberg. Each cell, as I have likely mentioned in other conversations, is like a planet It’s so deep, and our body, a universe. It’s that complex. There’s really no dumbing this down. I just want to say that these are conversations that hopefully spark curiosity, grow validation, create hope. I hope to interact with you as a community. I would love to hear what is helpful, what is something you might want to hear more about. But without further ado, I’m just diving in. I do want to mention, as I was just going through this book, I thought it was It’s worth mentioning that this is a collaborative effort. There are doctor researchers contributing here from Pisa, Italy, from Firenze, Italy, from Belgium, and from Salt Lake City, Utah. That just filled my heart realizing that there are beings, so many beings from around the world coming together in order to solve problems, in order to reflect on problems, meditate on problems, ask ourselves, why do we have these problems, and forge together a pathway forward.
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I really believe the best of what medicine has to offer is that community, is that convergence of people devoted to service and to helping make a positive impact on the lives of others. Sometimes when we dive into the literature, we might miss the fact that this is a collaborative conversation. I invite you to reflect with me about the wonderful work of these authors, Andrea. I might not say the names right, but Andrea Gnazzani, Felice or Felice, Patraglia, Michelle Niswell, and Robert Taylor. I just want to give these beings credit. This world is full of so many light beings who are put here to support you, who are put here to serve you. When we meditate on healing on purpose, we can connect to that truth, that frequency that we are here and that we are better together in service. That, too, is the truth of this world. There are lots of other things we might be able to get distracted by, but that truth is ever present. Endometriosis. This is straight from the book, folks. I can take no credit. Endometriosis Glypogliosis is one of the most intriguing diseases for women during the reproductive age.
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The book starts out. It was almost a century ago, so I’m dating myself. This book came out, I think, in 2021, but maybe was being written before that. In 1921, the first paper by John Samson described the chocolate cysts of the ovary. Then in 1927, there was a publication which related endometriosis to a menstrual dissemination. I can relate to that. I remember as late as medical school in the early 2000s discussing endometriosis and the working operative explanation there was that there was some of that tissue from the lining of the uterus, otherwise known as the endometrium, that somehow got out, perhaps through the fallopian tubes, retro flow of blood, endometrium, I forget the exact language, and adhered to the pelvic cavity, various locations led to increased pain, especially during the menstrual cycle. On further reflection, I’m going to go into to the first article. The first article in this book, just the title of it is so key. It’s called Endocrine Disruptors and Endometriosis Risk. It’s written by two people, Marco Palumbo and Federica DiGardo. In their intro, they say endometriosis is defined as the presence of endometrial type mucosa outside the uterine cavity. Several theories have been proposed during the last 20 years to explain the disease pathogenesis.
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If you recall, pathogenesis means the way that we become patho, patho meaning sick, but really it’s an imbalance. Pathogenesis is how, what is the pathway to becoming ill? However, a unique concern Ectasis has not yet been established. What this means is that we don’t exactly cannot fully say why we get endometriosis. This is an important conversation for me in clinical practice because I, in clinical practice, have watched step by step how women work to reverse endometriosis. I may have mentioned this concept, but when something works, a therapy works, it starts becoming diagnostic, meaning it wouldn’t work if we weren’t on the right track in terms of our thinking about this fancy word called pathogenesis or why we got this in the first place. In the clinical space of functional integrative medicine, we actually can get closer and closer to understanding through healing. If we are healing endometriosis, then that makes sense that we are understanding how it came to pass because we are healing on purpose. We’re not healing willy-nilly. In any event, it was in a five-day overview survey course that was run by the Institute of Functional Medicine that I was in 2012, 2013, when I heard a lecture about endometriosis by a wonderful integrative gynecologist, biologist by the name of Bethany Hayes.
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She pointed out something really interesting. She said that the lining, the lining of our pelvic cavity is composed of cells that she called totipotent. Totipotent describes, in my understanding, their potential to become anything, like a stem cell, like the truth of us as we are created when we are just a little ball or a morula of cells. Then we start specializing, dividing, and gaining character, like a little child who, when they develop, we say, Well, they can be anything. They can be anything they dream. Then we start making choices and carving out a path that becomes clarified over time. But these linings, these lining cells, are totipotent. What starts characterizing how they will behave is, in fact, the local micro microenvironment. What I learned from Bethany Hayes is if we have a local microenvironment that is inflammatory, well, what can cause in the abdominal or pelvic microenvironment an inflammatory process? Well, one big, big, big process that I have found in my clinical practice is imbalances in the microbiome. Imbalances in the microbiome. What is the microbiome? It is that inner, complex environment of all the different bacteria. We have the microbiome, the microvyrome, that is really designed to be diverse and lives in its own particular balance.
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Small intestine has its own environment and its own balancing act. The large intestine has another. These are kept in check by particular mechanisms, which I trust we will delve into much more deeply in conversations about bacterial overgrowth or fungal overgrowth. For the purposes of this conversation, I want to state, I have yet met a woman with endometriosis who does not have an inflammatory imbalance in their intestines. These are related because they create the climate, the inflammatory climate, and it’s one piece of the puzzle. Another piece of the puzzle is being spoken to in this article, Endocrine Disruptors and Endometriosis Risk. It doesn’t mean if we have endocrine disruptors, we’re going to get endometriosis. However, there is a relationship. What are endocrine disruptors? Here, it’s being defined. In 2012, the United Nations Environment Program and the World Health Organization prepared a report, and they start naming about 800 chemicals that are suspected of being endocrine disruptors. That means able to mimic our own hormones or alter their regulation. Able to mimic or alter. Then there’s a table, and the table starts listing some of them. They’re listing, for example, a pesticide called DDT and its metabolites.
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Then they say Pathways of Exposure. Pathways of Exposure listed here are milk and derivatives, fatty fish, living environments and workplaces. Holy moly. We’re talking about our food, folks. We’re talking about our oceans. We’re talking about all of our exposure is just in that one line. What does DDT do? It has estrogenic activity. If we have gut inflammation and we have exposure, for example, to DDT, tea that stimulates estrogen. And estrogen, little side note, estrogen is a growth factor, and that’s wonderful. It’s wonderful when we want to grow a uterine lining. However, if we grow a uterine lining, it is really to house a nice, cushy, soft landing pad for a fertilized egg. However, if that egg is not fertilized, that cushy landing pad needs to be broken down. What if we don’t have that fine-tuned balance between growth and then dissolution, the yang of growth and the Yin of going back to our baseline. We can’t do that because we have estrogen that’s made by us, and then more estrogen from our environment. That is a disruptor. Then we have something else called organochlorine insecticides. Where do we get those? Milk and derivatives, fatty fish, living environment, workplaces.
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Will that narrow the down? Then we get, oh, gosh, nonalphenols and octylphenols, detergent byproducts. We get detergent byproducts, we get bisphenol A, detergent byproducts, food chain, seafood, and consumer products. We get phthalates, plastics in contact with food. Folks, have you been able to buy food readily that has not come into contact with plastics? It gets to be overwhelming. The list goes on and on. Now, we sometimes run the danger in speaking about these subjects, meaning it’s in our food, it’s in our air, it’s in the packaging, it’s in the oceans of getting overwhelmed. I do want to mention we must know. We must know. The pathway to healing is the pathway to being on purpose, conscious, aware of what we are doing. If we don’t know, we can’t correct. There are a lot of implications here, and there are a lot of beings out there who want to tell this story and who want to work on it. We need to help each other. I want to mention here, there are so many substances, so many, out there that help our bodies break down estrogen. Where there is a problem, there is also a solution, such as what?
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Such as broccoli Sprouts, one of the most powerful hormone balancers and estrogen detox protectors, in addition to many other benefits, all the cruciferous veggies, green tea extract, alpha-lipoic acid, glutathione, tumeric, and dandelion. The list really does go on and on and on. We can really We can really do so much to help our body break down estrogens by becoming aware of exposure. By the way, the breakdown of estrogens is both environmentally and somewhat genetically and also the interaction between genetics and our own endogenous environment. In fact, there is a chart that I really love. I’m meditating on that speaks to this. But before I get granular, I wanted to share a testimony from a woman who speaks about the impact of endometriosis in her life from such a poignant human point of view. She says that she suffered from pelvic pain for more than two decades. By the way, I am reading this really beautiful human description from a fantastic book that is a collaborative effort between a medical doctor and a doctor of physical therapy. Iris Karen Orbach, Medical Doctor, and Amy Stein, Doctor of Physical Therapy. I know Amy personally. She is such a beautiful gift.
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Clearly, Dr. Orbach, who I do not know personally and would love to, is also a beautiful gift. Again, in the spirit of feeling all of these wonderful beings out there doing this work and wanting to be part of a healing of the world, of Ticun Olam, a repair of our world. They share through their book called Beeding Endo, a wonderful testimonial from Bojana Novakowitch. I hope I’m saying these names right, please. She speaks about having pelvic pain for more than two decades without knowing why. As a teenager, she was told it was normal for girls to have painful periods. When she became sexually active, she was told it was normal for sex to hurt. Then she even had a surgery called a laparoscopy, where we make a few incisions in the in the lower abdomen, oftentimes also around the belly button. We put in instruments that are both putting air into the cavity so that we have that space to look around with light and camera. That is a laparoscopy. It’s a surgical and it’s a gynecological surgical subspecialty. She had one in 2005 that came up negative for endometriosis. In retrospect, Boyana realizes that that surgeon most likely didn’t know some of the hallmarks that she might be looking for.
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Then because endometriosis that thought about and was ruled out, she was told, therefore, that the pain was in her head. I think this is a really, really important subject to discuss, and it’s one that comes up so much as people come to meet me in my practice is that when we don’t understand something, we can sometimes be tempted to as clinicians wanting to help in good faith, but not finding an explanation for a spectrum of symptoms to then say, All right, then if we can’t explain it, it’s in your head. That is a slippery slope in some ways. Sometimes we need to really expand the menu of testing and understand. In such a case, for example, we are able to do a specialty test called a DUTCH. It stands for dried urine hormone. I’m going to mess up on the acronym. I didn’t prepare that, but that is fine because the point of that test is we can actually see how estrogen is being metabolized, and we can see if there are functional hiccups in the way the body is handling estrogen and how much estrogen is there. Is it more or less of we expect?
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The metabolites themselves tell us about how our body processing. What we know is one of the risk factors, if we’re looking at endocrine disruptors, and if the endocrine disruptors are, in fact, estrogenic, that means that they’re acting like estrogen. If we have lots of estrogens, and lots of estrogens, be there native or zeno, meaning from the outside, and that’s a risk for endometriosis, even if we did that laparoscopic surgery, had all the clinical manifestations of endometriosis, which this testimonial will go into, and we don’t find it on the laparoscopy, we can still get a sense of metabolic health and say, Sorry, my index of suspicion for endo is still incredibly high, given these or those results. That’s why I think we have to do better in expanding our understanding of metabolic health, primarily to validate the truth of what the body is speaking because the body keeps the score, the body tells the truth. We, our bodies, what we call my community, they’re telling the truth, and my job is to find, validate, underscore, understand, get conscious, get on purpose so that then we can address. We have to. We have to do this.
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It’s not optional. This is the path to healing on purpose. In any event, this person was told that the truth her body was speaking to her was not the truth her body was speaking to and that creates cognitive dissonance, emotional dissonance, strife. She developed anxiety, worsening anxiety, and more pain, and felt she was doing something wrong. It became a cycle, a vicious cycle, confusion, pain, discomfort that wreaked havoc in her mind, in her body, in her nervous system or central nervous system. This is such an authentic testimonial, and this is a person who doesn’t come from a science background. She can say with complete confidence, she says, without that scientific background, and I want you women to hear this out there, there is nothing normal about knife-stabbing pain during your period, nausea with bowel movements during your period, burning, itching, tingling pain sporadically throughout your cycle. Definitely nothing normal about pain during intercourse even though women go through the painful act of childbirth, and this is all in cap letters, I just thought this was so beautiful and so powerful, Boyana says, Pain is not sinning. Synonymous with being female. Pain is not synonymous with being female.
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Possessing female reproductive organs doesn’t condemn you to eternal pain. She goes on to tell a really exciting story about her pathway out, about how Dr. Amy Stein and Dr. Orbach helped her find her pathway to truth and freedom. For any of you out there who suspect you have endo and maybe even went through preliminary diligence and were told that you didn’t, and it was all in your head, I think this is an important conversation, an important book to put your hands on. The other book that I mentioned might be a little too technical. I know we’re only scratching the tip of the surface here, the tip of the Tip of the iceberg. But what I wanted to say is this is really what I see in clinical practice. I see someone and they have a spectrum of symptoms, painful menses, painful bowel movements, worsening with the menstrual cycle, pelvic pain, and especially One of the clues that I’ve heard from my women is more pain with deep intercourse. We go looking for imbalances in the gastrointestinal system. We have discovered bacterial overgrowth. We have discovered intestinal paracetism. I would put this under an umbrella term of gut imbalance, which will call it broad spectrum dysbiosis, that imbalance in that complex inner world of the microbiome in the GI tract.
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We have found the risk factors for that imbalance, be it chronic stress, be it problems with bile acid metabolism and a bile flow, liver dysfunction. We have found some genetic determinants, some nature determinants, some nurture determinants, some imposed complications like gall bladder removal. We have found energetic components, be it that that lower part, our lower chakras, maybe not always being safe, maybe not always have been being able to determine the use of our energy, of our creative force, of our reproductive organs in one way or another. The reasons, the nuances, the frequencies, the determinants are as profound and individual as the individuals themselves, always requiring individual consideration here. But the patterns, the patterns of gut inflammation, the patterns of environmental exposures to endocrine disruptors, or maybe not lots of exposure, but a slower ability to break down the potential pattern of having maybe trauma to those regions, not necessarily physical trauma, can be emotional or it can just be that our lower chakras are centers of creativity and expression, and that our own expressing of ourselves has been not able to bloom in a way or ways that have affected us energetically in our kundalini Nini.
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So many potential conversations here, but I just wanted to open this up and see what resonates, see what helps. I want you to know that you know. If you know that you know, you will be able to find and anchor those beings, those professional beings who will know that you know and will to validate what you know and create a roadmap forward by reducing both exposure to endocrine disruptors, increasing breakdown of endocrine disruptors, healing gut imbalances, microbiome imbalances, and then hopefully at some point being able to, if needed, and this is definitely something that’s happened in clinical practice, consider perhaps a surgical intervention. What I have seen, this is another side note before we end our conversation for today, that the surgical intervention without that underlying work leads to symptomatic relief for a time. But then what I have seen, and maybe some of you can corroborate this, a need at some point down the line for a repeat surgical intervention. Sometimes because our ability to diagnose endometriosis is delayed because right now, ultimately, the standard of care is still having that laparoscopic surgery, and that’s such an invasive measure Oftentimes, this conversation happens when we are ready to step into our reproductive function.
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That’s when the stakes become really high, and that’s when we may submit to more invasive procedures. But if we work on the underlying pieces and we understand what Anna spoke to so eloquently, that it is not our lot to be condemned to eternal pain, and that that is our body speaking with us and saying, something here is not right, and it behooves us to start unraveling that and looking for practitioners like Dr. Amy Stein, like Dr. Iris Orbach, MD, like someone in the functional medicine space, the integrative gynecology space, someone who runs a Dutch test, you can go to the Dutch website and look up practitioners there and start finding out how your body is metabolizing estrogen. Or empirically, maybe consider going to some of the tools that help the body break down estrogen and see if it makes a difference. That is in the spirit of the therapeutic diagnostic. However, this conversation does not represent medical diagnosis or treatment. It just represents opening up the possibility for this pathway being imminently and readily available for you once you set your sights and your intention to healing on purpose. Until next time, lots of hugs, lots of encouragement, lots of gratitude for you being here with me.
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I’m Dr. Miriam Rahav.
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Thanks for listening to the Healing on Purpose podcast today. I hope you found this information helpful, and I encourage you to share this episode with others who may also benefit from the information shared. Please consider rating and reviewing my podcast on Apple Podcasts so more people can find this information. I also invite you to join the Healing on Purpose group to continue this conversation. I’ll see you there.