Medical Management: Progestins and Suppression

In this episode of SHE MD, Mary Alice Haney sits down with Dr. Thaïs Aliabadi to break down endometriosis, an often misunderstood condition that goes far beyond painful periods. Dr. A explains why endometriosis is a systemic inflammatory disorder, the wide range of symptoms it can cause, and why so many patients are dismissed or misdiagnosed for years before getting answers.

They discuss how endometriosis presents, from chronic pelvic pain and bloating to bladder, bowel, and even mental health symptoms, and why it can’t reliably be detected through standard imaging. Dr. A also covers how the condition can impact fertility, ovarian reserve, and overall quality of life if left untreated.

The episode also walks through treatment options, including hormonal therapies, IUDs, medications that suppress estrogen, and the importance of finding a highly trained surgeon for laparoscopic excision. This conversation offers both validation and clear guidance for anyone struggling with symptoms and looking for real answers.

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What You’ll Learn

• Why painful periods are not normal, and when to take them seriously
• The most common (and often overlooked) symptoms of endometriosis
• Why it can take up to a decade to get properly diagnosed
• How endometriosis affects the gut, brain, and mental health
• The connection between endometriosis and infertility
• Why ultrasounds and tests often miss endometriosis
• The difference between hormonal treatments and surgical options
• How to advocate for yourself and find the right specialist

Key Timestamps

(0:00) Introduction to SHE MD

(2:33) What Is Endometriosis?

(4:33) Key Symptoms You Shouldn’t Ignore

(7:58) Stages of Endometriosis Explained

(8:53) What Causes Endometriosis?

(13:10) Painful Sex Explained

(23:56) How Do You Treat Endometriosis?

(26:18) Stromal Endometriosis Explained

(28:05) Understanding Endometriosis Treatment Options

(37:50) Why Removing Endometriosis Helps Fertility

(40:09) What Happens During Perimenopause and Menopause

(47:47) How Tamoxifen Affects Endometriosis

(49:14) Questions From Listeners

Key Takeaways

• Endometriosis is a systemic inflammatory condition, not just a reproductive issue.
• Pain is the most common symptom, including painful periods, sex, bowel movements, and urination.
• Many patients are misdiagnosed with IBS, anxiety, or “normal cramps” before receiving the correct diagnosis.
• Diagnosis often takes 9-11 years due to lack of awareness and limitations in imaging.
• Endometriosis can impact fertility by affecting egg quality, ovarian reserve, and the pelvic environment.
• Laparoscopic excision surgery is the gold standard for treatment, but requires a highly trained specialist.
• Hormonal treatments, including progestin IUDs and medications that suppress estrogen, can help manage symptoms.
• Early diagnosis and treatment are critical to prevent disease progression and long-term complications.

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