Ask Dr. A: Painful Periods are Not Normal! Endometriosis Deep Dive

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Mar 24, 2026

A deep dive into endometriosis as a systemic inflammatory condition beyond menstrual cramps. They highlight chronic pelvic pain, bloating, bowel and bladder symptoms, and why imaging often misses lesions. Surgical excision, medical suppression, and fertility impacts get attention. Practical guidance for teens, post‑surgery care, and when stronger treatments are needed is discussed.

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ADVICE

Use Progestin IUDs As First Line Therapy

Treat by giving progesterone or suppressing estrogen; progestin IUDs are first-line for many patients.
Dr. Thais Aliabadi prefers Kyleena for nulliparous patients and Mirena for those who've had children.

ADVICE

Use GnRH Antagonists For Advanced Disease Carefully

Consider GnRH antagonist pills like Orilissa or Myfembree for up to two years to lower ovarian estrogen.
Dr. Thais Aliabadi uses them for advanced disease but checks AMH first because of effects on bone and ovarian reserve.

ADVICE

Check Ovarian Reserve Before Suppression

Check AMH before estrogen-suppressing therapy and discuss egg freezing for low ovarian reserve.
Dr. Thais Aliabadi routinely measures AMH and recommends freezing eggs earlier for patients with diminished reserve.

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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.

Subscribe to SHE MD Podcast for expert tips on PCOS, endometriosis, fertility, hormonal balance, mental health, and more. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women’s health and well-being.

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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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