How Can I Treat My Endometriosis? | Dr. Jessica Drummond

So welcome everyone to another Women to Women podcast series in which we talk about trauma, weight, adrenals and hormones. Today I'm excited to actually interview someone I have never interviewed before. And this is Jessica, Dr. Jessica Drummond. And what I love about what we're going to talk about today is endometriosis. There aren't any experts around that really can kind of get to the heart of it. Clinically, we don't have many answers other than surgical interventions and medications and birth control pills. I'm excited to dig a little deeper into this.

She's CEO of the Integrative Women's Health Institute and bestselling author of two books, Outsmart Endometriosis and Clinician to Coach. She holds licenses in physical therapy and clinical nutrition and is a board certified health coach. So welcome Jessica. Thank you so, so much for joining us today.

Thanks for having me. It's my pleasure to be here and.

For teaching us about endo. So how in the world did you get interested in endo?

Well, I've been a practicing clinician, starting with physical therapy and women's health and pelvic health specific physical therapy since about 1999. So my initial practice was in sports medicine and orthopedics and in physical therapy at that time, especially women's health, physical therapy was really a specialty branch of orthopedics. So I got into it through working with women that had shoulder issues due to breast cancer, surgeries or spine and pelvic pain related to birth, labor and delivery, postpartum recovery, pregnancy and similar things like rib cage issues due to breastfeeding. And for from there deepened my skills in pelvic health to work with more complex pelvic pain. So endometriosis, interstitial cystitis, vulvodynia, often all three can play together. And so what I realized through our physical therapy tools, we had a lot of success with really relieving the symptoms of chronic pelvic pain, including that related to endometriosis. But there were kind of the subset of patients who really would plateau, wouldn't get full relief. And at that time, so this was probably about 15 years ago, there were very, very few tools beyond opioids was really the biggest strategy. And obviously that was not a great strategy, internal stimulators, which were problematic. The surgeries were not nearly as good and sophisticated as they are now. And so around that time I had a baby myself and had my first kind of introduction to functional and clinical nutrition because I had some postpartum recovery issues. I think probably knowing What I know now what probably happened was I had a reactivation of Epstein Barr virus and was just super fatigued, way beyond what you would expect. But it was my first baby, so it was just kind of like, you're tired is normal, you know. Right. So I. But eventually I, you know, got very well and learned a lot about clinical nutrition and went back to school and got a doctorate in that. And I realized that anytime you optimize the hormonal system, the gut microbiome, the nervous system, specifically autonomic nervous system, that was helpful for our chronic pain patients. I came back to my practice with a lot more skills and also at that time, so 10, 15 years ago, there was a significant evolution in how we began to treat pain. We had a new understanding of pain, being that it was sort of brain driven.

And that changed how you approach pain because you suddenly had a lot more tools for modulating the nervous system. You know, with nutrition, lifestyle medicine, movement, mindfulness, that really helped the symptoms of endometriosis. Now ultimately, it's still a disease state that has some genetic underpinnings, inflammatory autoimmune driven. So in many cases, surgery can be very appropriate. But now we had a lot more tools for getting to the symptom drivers because a lot of times prior to that, women would have surgery and not have relief or even feel worse because there was no understanding of kind of the broader context of when and how to approach surgery.

So there were many questions. I taught for the Institute of Functional Medicine this weekend. We did the hormone module. And of course there's many questions that come from the audience about issues around endo. Many years ago I was treating a patient actually who had endo and there was some research, not a lot at the time, that endo and systemic candida actually go hand in hand. I always called the women that had endo little Pillsbury doughboy, kind of puffy and swollen. There's a huge relationship between the gut microbiome. Now what we know is also there's a microbiome in the uterus and there's a microbiome in the vagina. More than likely we're going to find out that there's the microbiome of the lungs as well. I mean, those organ systems. So what you're saying, true, is that it's more than likely, although we don't know the cause of endo, it's related to.

Disturbance in the immune system. And also autoimmune issues are related as well. So it's very exciting that we're starting to see things in a different way, because so many women really suffer from endo. So if you see somebody, along with kind of the structural pieces that need to change, what about some of the interventions that you do for people with endo and how long does it take?

Yeah. Endometriosis, just to clarify what it is, is a disease process where you've got lesions of endometrial like tissue, although not actually the same tissue as inside the lining of the uterus. But that was originally where the name came from. I like to think of it as a benign cancer because these are benign lesions. They're not cancerous, but they can grow and proliferate all over the place. By definition, they are outside of the uterus. So doing a hysterectomy is never the right treatment for endometriosis. They're outside of the uterus, but they can be on reproductive organs, fallopian tubes, ovaries, outside the uterus, bladder, bowel, lungs. Women have collapsed lungs from endometriosis. The endometriosis has been found in the nose and the knee can be anywhere systemically. I think that's an important thing for women to understand because there is a lot of myths around. We'll just take the uterus out and the problem solved. But that's never actually the case.

Now, adenomyosis, which is related, is a uterine condition. It's actually. It's sort of like endometriosis inside the muscle lining the uterus. In some cases, hysterectomy is a reasonable option for that. So what I think of is, okay, we've got these lesions growing wherever they're growing. There's no good imaging or lab testing at this point that's consistently reliable to tell us necessarily where these are. The only way to see them is with a skilled laparoscopic surgery. And so we have to make a lot of assumptions. Prior to that surgery, we also used to think that these lesions were primarily estrogen driven. And we know from some good studies done in 2018 that that's not necessarily true. These lesions can estrogen driven, they can be progesterone driven, they can have progesterone receptor upregulation, they can be both, they can be neither. And you could have multiple kinds of lesions in the same woman. Again, unfortunately, there's no way to know what these lesions are except for post surgical histology. And so by then, it sort of doesn't matter because the lesions have been taken out. So that, I think, is helpful to explain why, in many cases, estrogen suppression, therapies.

Women can still have breakthrough pain with birth control pills or other estrogen suppression medications. But some women do have some short term relief from those, which can be a valuable part of the toolbox. Instead of thinking hormonally with this disease process, I actually go more to the nervous system. We know that pain is driven by a decision made by neurotag. So this is not a conscious decision. You can't like think yourself out of the pain. It's not all in your head like this is real pain, but it's driven by a number of factors that the nervous system has to take into account to then make a decision about whether or not you're in danger. So there are signals of danger and signals of safety. And what we want to do is flood the nervous system with signals of safety. So nutritionally that means things like a food plan that helps balance the blood sugar so we don't have big swings of reactive hypoglycemia or high blood sugar. It's good bowel movements, good consistent bowel movements. So a healthy and diverse gut microbiome. It's, you know, good hydration and good liver processing of both, you know, our normal hormones and exogenous estrogens. So estrogens that are from, say, chemicals in the, in the, you know, makeup we wear or water we drink or air we breathe. So it's all these sort of biochemical signals of safety. Then there are the emotional signals of safety. Who is on your team? Do you feel really confident in the people you're working with? You're a nutrition, your health coach, your gynecologist, your physical therapist. Similarly in pelvic physical therapy. So, you know, we can always walk around with a pelvis here. There are all these muscles of the pelvic floor that have innervation from the spine. And think about it, when you've been in chronic pain from some growths somewhere in and around off in your abdominal pelvic region for probably since you were about somewhere around 8 to 10, is when the digestive symptoms of endometriosis generally present, and then period pain or mid cycle pain, or constant pain or irregular pain. It's highly variable experiences. If you've had a chronic pain, just like if you had like a big gash across your shoulder from something, you know, a tree falling on you or something, you would tense up those muscles naturally as a protective mechanism in that area. So the same thing can happen in the pelvis and pelvic floor. You can have muscle tension that we have to practice relaxing. And the other Most common thing I see is very often these lesions or the inflammation or adhesions associated with them are growing on or around the bowel. And that slows motility and sets people up for things like chronic candida sibo, which is small intestine bacterial overgrowth.

Challenges in the microbiome, both of the small intestine and the large intestine. Optimizing digestive function includes a structural optimization of that function using things like visceral physical therapy or ginger artichoke supplements, things that help with motility.

Twisting yoga exercises, self manual therapy in combination with a really supportive food plan that feeds a healthy gut microbiome. So really it's layers of nervous system, digestive system function, and then making sure our hormones aren't wildly swinging with a good balanced blood sugar and healthy adrenal function. But I don't like to go too far in one direction or the other in terms of estrogen suppression or progesterone amplification, because that can be problematic depending on the kinds of lesions that are in each client.

I do have to tell you, I test hormones pretty regularly and it's really unusual for me to see somebody who's not progesterone deficient, estrogen dominant. And oftentimes I do use progesterone and I oftentimes will test people afterwards. But it makes a huge difference for many of these people. And also understanding kind of in the, in the systematic approach that adrenals trump everything, they trump thyroid, they trump hormones. So making sure that the adrenals are stabilized and also doing a stool test, you know, to find out, parasite, do they have small bowel overgrowth, do they have, you know, yeast overgrowth? Because all those things when treated literally can be unbelievably game changing for people, which is so wonderful because then they're not having pain. Also for those people that are trying to get pregnant, there are types of pt. There's a company in Florida, Clear Passage Therapies, I don't know if you know them, that have a significant amount of literature in peer reviewed journals looking at the use of that type of manipulation to help with what we call adhesions that oftentimes come when those, you know, endometrial implants start to bleed with cycles, if you're still having cycles. So there's so many things, and that's the exciting part, you know, your work is kind of getting the word out there is you don't have to suffer anymore and, you know, taking the uterus out sometimes if you've got lesions in the, in what we call the omentum, that the area around or on the bowel, they still cause cramping, you know, and still cause discomfort. So that's fabulous. So it's. Yeah, science has come a long way, thank God, from back in the day when they just slapped you on high doses of breast control pill or took it out.

Absolutely, yeah. Because really neither of those things are useful treatments. It is, you know, as I said, short term hormonal suppression can sometimes be a helped and helpful symptom band aid. But that's not a, that's not the treatment. That's just, you know, giving us some symptom relief which can be super valuable for women's quality of lives in the short term. But we really want to dig deeper. You know, essentially all of the clients that we see with endometriosis, we do stool testing, we do organic acids testing. How well are you absorbing any nutrients so your body can heal itself? Because it's just, you know, it's a really, it's a multi system disease process. It's not really just a kind of women's reproductive issue. Although that's how it's how it's framed.

Oh, absolutely. You know, the other thing that I also do in my practice is I'm also looking at ACE scores. You know, what I'm finding is there's a huge relationship and I see it so often, I actually even spoke about it on stage this weekend, is I see very huge numbers of women that are adult children of alcoholics.

Can I say there's a link? Has there been any study done? No, I can just tell you clinically, over 4, 40 years of practice, I see it often when I'm digging a little deeper. So, you know, is there a relationship between the immune system and when we start to have, you know, what we call retrograde menses when the periods are going backwards up the fallopian tubes, perhaps, we don't know. But that may be one of the contributing factors to the endometrial implants. We don't know.

Right. And we do know that retrograde menstruation is not the cause of endo that's been clinically disproven. But aces, you know, any kind of the, you know, childhood trauma, sexual trauma is absolutely a risk factor for any kind of pelvic or sexual pain. And I absolutely agree with you. You know, clinically we can't overlook the emotional factors, the trauma. We have to be very trauma informed because almost all of our clients, I mean, you know, there was a Study done even on perfect history. I mean, you know, even really, there was a study done on practicing physical therapists. 80% of female physical therapists have been sexually assaulted or harassed at work. 80%. So that's just a microcosm of America and the world. You know, people have trauma. And I think you're right. Like, we just have to get better and better as physical practitioners to be mindful of the emotional piece. Even if we aren't the one to address it, we kind of bring it into the conversation for sure.

And I think it's so important because so few people even know what the ACE scores are. And I'm thinking to myself, it's the largest study in the history of medicine, it's an ongoing study and it's still not used very often. And having been in practice for so long, I absolutely see the relationship. Is that what caused the problem? Absolutely not. But is it a contributing factor that if we don't deal with it, it contributes certainly to adrenal issues? For sure. So it's. Yeah, you're absolutely 100% right. And what I love about what you're saying is it gives women choices and hope for being able to do something instead of, you know, so many people. Well, you've got endo and, you know, just close the door on having children and you're going to have to have pain the rest of your life and let's put you on, you know, God knows what. And it's like, oh my gosh, that's so outdated.

Yeah, for sure. Absolutely. And you know, the interesting thing about endo as a gen, because it does have a genetic underpinning, is that you see it running in families, which is potentially helpful but can also be problematic because, you know, your first place. An 8 or 9 or 10 or 11 or 12 year old girl learns about her menstrual health, her, you know, normal periods is from her mother, her aunts, her sisters, her grandmother. And when they start hearing stories that, oh, everyone in our family just has painful periods, just get used to it, that's kind of a problem. So fortunately, I think what we're seeing now is definitely driven by millennials and Gen X. A lot more conversation that's comfortable around period tracking and what's normal with healthy periods and menstrual health. Because there was kind of generations of silence that now mothers that are in their 30s and 40s are much more comfortable sharing their histories with their daughters and are recognizing now that even if what they experienced, they thought was normal or common doesn't have to be. So they are, I think, essentially giving their daughters the kind of the support to actually seek care and treatment, to not just feel like they have to live with it.

You know, I think one of the things that I've taught a lot of my mothers to do is to have it be a celebration. So it's a huge rite of passage and we don't ever acknowledge it. So what I did for my daughter, actually, she'd shoot me if she ever. I ever told this. So don't anybody tell her I said this. But I got her at the time we're getting the. You know, the pharmaceutical companies came and did little packets with the birth control pills. So we got this beautiful yellow. Just a little bag and put tampons and pads in there and also a little calendar so she could kind of figure out when her cycle started. And also talked to her about what a big deal it was. This is an amazing event that's going to be with you for so many years to come versus going to see. Somebody said, oh, my God, my daughter started a period and she started the curse. And I had to just tell her, just go upstairs and lie down. That's just like, please don't do that. But it can be a wonderful thing. She actually still uses that little bag, which is hysterical. And she's 31, so that's great.

You know, it made an impression. Dinner, and we got this beautiful nightgown for her and things like that. And that's what really should happen. You know, we can't predict what their period's gonna be like. So I. You mentioned that it's really important. So how long does it take for people to kind of get better? What would you say, kind of timing wise?

I think we're still at the phase where we're always doing symptom management, no matter what the approach is, because this is a disease state that we sort of don't have a quote unquote cure for. But I really believe that people can learn all the tools and skills they need to control their symptoms, mitigate their symptoms for pretty reasonably in three to six months. We like to ideally see people for about two to three months prior to surgery if they're going to have surgery. If they need surgery, it's not required 100% of the time.

And similarly, one to three months post surgically. So I think realistically in the neighborhood of three to six months for most cases.

And if you want to learn more about you, how can they get ahold of you and learn more about the work that you do.

The main connection to our institute is at the Women's Health. The integrativewomenshealthinstitute.com is our website, integrativewomenshealthinstride.com and on Instagram, ntegrativewomenshealth. You can follow us, send me messages and learn more from there.

Awesome. Well, thank you so very much. And here's to faster recovery. If I can wish anything on you.

Thank you so much. I really appreciate it.