Olivia Culpo on her Engagement, Endometriosis, and Being Your Own Advocate

Mary Alice Haney:
Welcome to SheMD. I'm Mary Alice Haney and I'm joined by my co-host, Dr. Thais Aliabadi.

Dr. Thais Aliabadi:
Today we're so lucky to have my beautiful and sweet patient, Olivia Culpo.

Mary Alice Haney:
Olivia is an actress, model, influencer and endometriosis advocate. She spent 12 years without a diagnosis before she found Dr. A. We're going to talk to her all about her journey with endometriosis, her engagement, fashion, everything. We shot this around Christmas, so there is a big fat Christmas tree in the background. We hope this episode is helpful to anyone whose pain is being dismissed because here at SheMD, our goal is to give you the tools to be your own health advocate.
Hi, Olivia.

Olivia Culpo:
Hi, how are you guys?

Dr. Thais Aliabadi:
Hi cutie. How are you?

Olivia Culpo:
Hey, I'm good. How are you guys?

Dr. Thais Aliabadi:
Oh my God. Is that your house?

Olivia Culpo:
No, this is, I'm in San Francisco, so this is our rental that we have. But yeah, I have a little tree.

Mary Alice Haney:
Oh my God. I know. It's not a little tree. It's a big tree or you might be-

Olivia Culpo:
It's not that big actually, but I'm glad it's giving big. Actually, it kind of is, but I haven't decorated it yet.

Mary Alice Haney:
So we're a little teeny bit late today because this is a very big day for Thais.

Dr. Thais Aliabadi:
First of all, thank you for doing this for me. I think since the first day I met Olivia, I don't know what happened, but I was like, please, if you have a platform, if you have a voice, make sure you talk about endometriosis. And you're one of my very few patients who actually kept her promise because people come, they feel better and they disappear. So thank you. I know you've always talked about it. You did it on your show, you do it on your social media, and I think you've helped so many women. So thank you for being here.

Mary Alice Haney:
We're very excited.

Dr. Thais Aliabadi:
I'm not surprised that you're here. You're amazing.

Olivia Culpo:
But of course.

Dr. Thais Aliabadi:
This podcast is especially significant for me. And I'll forever remember 12/12/23 because today I went to court and I adopted my little Coco officially.

Olivia Culpo:
Yay. Oh my God, I just got chills. That is so exciting.

Dr. Thais Aliabadi:
It was the most emotional day, and we had 40 of my friends and family show up and the judge was like, no, you guys can't come in. I said, friends, but I've never in my life seen friends like this. You can't all come in. This is a wedding. But she finally gave in and we all went in. So it was an emotional day.

Olivia Culpo:
She did?

Dr. Thais Aliabadi:
Yeah.

Olivia Culpo:
That's amazing.

Mary Alice Haney:
And for the listeners that don't know, Coco is Thais' foster daughter who she brought home from the hospital and she adopted her officially today. So we're going to always remember this day that we had you in the podcast.
And Olivia, I'm going to fashion geek out with you because we were just talking before you joined. We were saying, you're so drop dead gorgeous and everybody, you see that. But it is the way you carry yourself, it is the kindness that you have in your heart and it's your style. And I know that you're so stylish because you wore my brand Haney three times when it first started.

Olivia Culpo:
I did.

Mary Alice Haney:
You were like, so this picture, and I know that the listeners can't see it, but this was a party that Forward had for me in the Hamptons on that yacht. And you came and you wore that red jumpsuit, which was amazing. And then this you wore in Paris to the Hater Ackermann Show. Can you see that?

Olivia Culpo:
Yes, I remember that. It was the best.

Mary Alice Haney:
Yeah. And Celine Dion saw that picture of you and had her stylist call and said, I want that outfit. I want you to not make it for anybody else. And so she ended up grabbing it. And then this was a Rolling Stones.

Olivia Culpo:
Yes, I remember that. Oh my God, I love it. I love it. That was like before the monochromatic jogger set was the thing with heels. I feel like that first and it was so comfortable. So I'm glad Celine Dion approved.

Mary Alice Haney:
I'm glad she did. She's like, oh my God, first of all, she's like, I don't think I'll ever be able to wear it quite like that. But you just got back from a fun trip and you just got, are you newly engaged? Have you been engaged? Like what's...

Olivia Culpo:
Newly engaged. Well, actually, oh my god, it's not really newly as of April. I'm so excited. Yes, we're planning our wedding and everything to follow, which I'm really excited about. And yeah, it's really exciting times. I'm thrilled.

Mary Alice Haney:
Well, my two boys, Christian, your fiance Christian McCaffrey is their favorite McCaffrey that shows you. I could talk about Chanel and say that properly, but when it gets to football, I'm like, they are like, "Mom, no way. No way. You are not having her on your podcast. Like no way. Do you know that her husband is the best football player." And I'm never cool in any way, shape, or form. But so anyway.

Olivia Culpo:
That's so funny.

Mary Alice Haney:
Can you tell us, Thais and Olivia, can you guys tell us how you guys met and your journey with endometriosis? And I think most women don't understand that endometriosis and PCOS, and we'll talk about the differences, causes fertility issues. And if you don't figure it out when you're young, you can have major fertility issues when you get older. That's something I've learned from working with Thais, but can you talk to the listeners and tell them about your journey and how you guys met and what happened with that?

Olivia Culpo:
Absolutely. So we met through mutual friends. My best friend Kristen and I did Sports Illustrated together. And then she was like, I have this really great guy, you have to meet him. And I was like, I'm not dating any athletes. No athletes ever. She's like, come on, just give this guy a chance. He went to Stanford with my husband, he's a great guy. I was like, okay, he went to Stanford, maybe he's fine. And then of course on the social media era, you just stalk these people. And the first thing I noticed was that he was really close with his family. I'm very close with my family. That's always a great sign. Comes from a really great family. And so I agreed to meet him. And then the rest is history. We're really happy. That was almost four years ago. So it's flown by.

Mary Alice Haney:
Before that, had you already dealt with your endometriosis and I know you guys are thinking about starting a family or are you thinking about starting a family and did you think about that when you were younger? How old were you when you started having issues or thinking, oh, I might have endometriosis?

Olivia Culpo:
From the first period I ever had, I had very abnormal symptoms and they were embarrassing. I was afraid to talk about them with anybody, even my own parents. My symptoms were very embarrassing to me at that time. So I think that's probably why I empathize with a lot of people out there who maybe don't want to talk about their endometriosis, but it's also why I feel even more responsibility to use my platform because it's not easy to talk about these issues that we have. They're very intimate. But anyway, I always had my problems with endometriosis. The debilitating pain happened and continue to progress as I got older. And that's when it really started to affect my day-to-day life and where I really could not function, I could not function. It was the most pain I've ever been in my entire life. And that's when I had to kind of share it with my partner because it affects every single day.
You really can't get out of the house some days because the pain is so excruciating. So those are the moments that really bonded us. And I will say his mom had really painful periods and I always joke with her, well, we don't really joke, but I always tell her how appreciative I am because she taught all of her four boys that when you have your period, when it's that time of the month, you do everything for the woman of the house. And because of that, when I had my period with Christian, he would draw me a bath, he'd bake me cookies, he'd ask me anything that I ever needed, and he still does that. He's the best partner, the best example. He saw it firsthand from his mom and I give her all the credit in the world for just raising exceptional boys. And I'm so grateful not only I have him as a partner, but I'm so grateful that he's an example to so many men out there because that's how it should be.

Mary Alice Haney:
It should be that. And from a mama with boys, I always say we talk about things like that. We're like girls have periods and it's a menstrual cycle and that is a vagina. I remember McLean saw me naked when he was little one time and he turned his head around and he's like, is that your vagina? And I was like, that's vagina. And he goes, did I come out of that? And I was like, yes, you did. And he goes, it's magic. And I was like, it is magic. You're right about that. It's amazing.

Olivia Culpo:
That's amazing.

Mary Alice Haney:
That's so cool. And then how did you find Thais? And so you mean to tell me that from the time you first had your period until, because you met Christian, what, four years ago? Up until that point you were just dealing with debilitating periods?

Olivia Culpo:
Yes, and Dr. A or Thais, I always call her doctor, she would be able to tell us more about the science behind that. But basically as your periods get worse and the endometrial tissue buildup after every period, every single month that you have, the pain gets worse and worse and worse because there's just more tissue. So when you're first starting out with your period, yes, you have this abnormal growth sometimes. I definitely did because I have rectovaginal endometriosis, so my symptoms, I could see them since I was very young.
So anyway, I didn't really experience the physical symptoms from a very young age. I could see that I was bleeding in areas that I shouldn't be bleeding in basically when you have a period. So when debilitating pain though happened more as I got older, in my late, I would say twenties is when it got really, really, really, really bad to the point where I was unable. It was just getting in the way of my everyday routine and everyday life. And it was scary. It's the type of pain that scares you because you know that there's something wrong and there's no answer. And at the time nobody knew what was wrong with me and I was also very embarrassed of my symptoms. So it's kind of a whole, sorry, it's like a myriad of issues and problems that I went through to get to where I am now.

Dr. Thais Aliabadi:
I think I met Olivia, correct me if I'm wrong, I think it was in 2020, no? And I remember when I met her, she was complaining of 10 out of 10 period pain. What I want our listeners to understand is prior to seeing me, how many doctors had you seen?

Olivia Culpo:
At least 12.

Dr. Thais Aliabadi:
And what did they tell you?

Olivia Culpo:
Everything under the sun. The worst was, I mean the worst thing. Okay, rectovaginal endometriosis. So it's like cross between your vagina and your rectum, obviously. They're like, are you sure you're wiping correctly? Are you sure that you're really having these symptoms? Are you sure that your pain is that bad? Painful periods are normal. No, I can't give you an ultrasound right now because you're bleeding. Maybe come back in a month. Let's just put you on birth control. Have you tried hormone pills? There were people that were trying to rob me for my money and then there were people that just simply thought I was overreacting, which is so, so painful. I mean, you're sitting there and you literally, I remember feeling like I wanted to, I felt like I was going to die. I was in so much pain. And it's in that lower back, we call it butt lightning, but it's the worst pain ever. Imagine getting-

Mary Alice Haney:
Butt lightning. I think let's make that... Honestly, I've actually heard women describe it like that, but I've never heard it's called butt lightning.

Olivia Culpo:
It is.

Mary Alice Haney:
So I love it. Butt lightning. That's a great word for it.

Olivia Culpo:
Worst butt lightning. And they're just like, and you're hot, you're hormonal, you're sensitive, you're in excruciating pain, and then someone's going to tell you that you're overreacting or that you're lying or just making you feel insane. So anyway.

Dr. Thais Aliabadi:
So she came to my office complaining of I think obviously severe, painful periods. And I think you also had painful sex. No? Was that one of your symptoms?

Olivia Culpo:
Not actually, thank God.

Dr. Thais Aliabadi:
Okay, good.

Olivia Culpo:
That would just be the cherry on top. But I think more because mine's localized more in the back. I never really had that, thankfully.

Dr. Thais Aliabadi:
So basically for our listeners, one message I want to give is that if you go to the doctor or if your periods are painful, it's not normal. I wanted a billboard for my birthday on the 405 freeway that said, painful periods are not normal. So that's the first message that people need to understand. And if you have painful periods and you go to doctors, you're a good example because you're someone who, you have a platform, you have money, you have insurance, you have access, and yet you are getting dismissed for so many years. On average, patients get diagnosed at age 32. So average age of diagnosis for endometriosis is around 32 because these patients either start having debilitative pain that they can't function, so they bounce from doctor to doctor until someone diagnoses them or they end up in a fertility clinic because they can't get pregnant.
One of the lucky things with Olivia was when I met her, she had a lot of eggs, but not all endometriosis patients have her situation. So it's important, I've talked to Olivia about egg freezing. Every time she comes to my office, I'm like, great. So are you married? Do you have a partner? Are you going to freeze eggs? This is a discussion I have with every single patient, and if you've been to my office, you will know that egg freezing or at least getting your egg count checked is mandatory. Olivia has a lot of eggs, but a lot of people at her age because of untreated endometriosis are left with no eggs.

Mary Alice Haney:
Heartbreaking. You think of these girls that if they had been treated and it took you 12 years to get treated, I read that somewhere that it took you 12 years to get your diagnosis. And like she says, you're Olivia Culpo, you have all the resources in the world. And imagine these women in places in the United States that don't have access to a doctor like Thais or have access to doctors that are amazing. But you say you would absolutely be able to put fertility doctors out of business if you could get every girl with the painful period into your office.

Dr. Thais Aliabadi:
Once at age 20. Oh, that's all I need. Every 20-year-old to come through my office one time, I tell them what they need to do and they can go live their life. The reality of it is painful period is the most common symptom of endometriosis. Painful sex with deep penetration is also a common symptom. A lot of patients have bladder infections, recurrent UTIs. These are patients who get their bladder gets irritated and they bounce in and out of doctor's office, they get prescribed antibiotics without a positive culture and they go home. So I get these patients to my office and they come and say, well, I've had nine bladder infections this year. As soon as they say that, I'm like, it's probably endometriosis.
And usually the next question I ask them is, show me your positive urine culture. If you've had nine UTIs, you must have had some cultures and they can't show it to me. So UTI symptoms, bloating, severe bloating with your period, painful sex, painful, chronic pelvic pain. The most common cause of a chronic pelvic pain in a woman in her reproductive age is endometriosis. What's shocking to me, Olivia, and patients always ask me this is here you have the top cause of pain in a young woman, yet it takes doctors nine to 11 years to diagnose it.

Mary Alice Haney:
But why? Why is it so hard to diagnose? How did this happen?

Dr. Thais Aliabadi:
Is it hard? It's not. You diagnose it. If you send Olivia into a crouch, she's going to pick out all the endo patients. So it's not, you just have to listen to your patient. So I don't know what the issue is. I don't know if endometriosis patients take a little bit more time, you need to take care of them. Some of them need surgery, they bounce in and out. Your body is not a light switch. It takes a while to treat these patients.

Mary Alice Haney:
What about the clotting? Is there clotting or bleeding that comes with that too?

Dr. Thais Aliabadi:
So endometriosis can also affect the wall of the uterus. A lot of patients also have adenomyosis, which can cause heavy painful periods. And so by doing surgery, you remove the implants that are outside of the uterus, but you can't really remove the ones that are in the wall of the uterus causing the heavy period, miscarriages, painful periods. For those, you need progesterone suppression. So there are so many different ways we can treat these, but I'll go over all of that. But I just want to, for me, it was so good to have Olivia here because she's a perfect example of someone who goes to the doctor, does her part to find out what's wrong with her and still gets dismissed. And I always say, if men had endometriosis and they would have pelvic pain, the level of your pain, Olivia, once a month, that would affect their egg count and egg quality over time. Do you think they would get dismissed?

Olivia Culpo:
I know. That is so true and I have thought about this obviously so much. Why did it take so long? And I do think some doctors are just simply not, they don't have the training so they don't know. And then I think other doctors don't want to believe that it's something that they're not aware of because they want to maybe keep you as a patient. I had a lot of doctors who just said to me, just take six Advil the day before you're going to get your period. It will lighten the bleeding and it will help. And it's like, okay, that's a no. What about my liver, for example? Why would you ever? So things like that. I don't know if they're necessarily bad doctors or they just don't have the training.

Dr. Thais Aliabadi:
Or the time.

Olivia Culpo:
Or the time, that's the other thing too. Or a lot of doctors just wanted to push birth control on me right away, which I think obviously if I had started birth control, not everybody has the same reaction, but maybe I would've stopped bleeding. Maybe that would've subsided my symptoms and held them off for a little bit. But then also I had a cyst on my ovary that would've gone completely unnoticed if I hadn't had my surgery. So who knows what that would look like now five years later after I already had my surgery, for example. There's so many things. There's just so many bad doctors, which is the other reason why I'm so passionate about speaking to the doctors who are saving lives and who we need so desperately like you.

Mary Alice Haney:
Thais, walk us through if you are listening, what are the symptoms of endometriosis, what do you need to know that you can take to your own doctor to say, I have endometriosis. And you said you had surgery, so is that the only cure for it?

Dr. Thais Aliabadi:
No, absolutely not. So like I said, endometriosis, the most common symptom is painful period.

Mary Alice Haney:
What is endometriosis?

Dr. Thais Aliabadi:
Very good question.

Mary Alice Haney:
Thank you.

Dr. Thais Aliabadi:
So think about in simple terms, from the day we get our period, which is about 12 and a half to the day we're menopausal, which is about 51 and a half. Our ovaries are trying to get us pregnant. They secrete a hormone and they stimulate the lining inside the uterus called endometrium. The cells inside the uterus respond to that hormone. The lining gets thick and juicy, ready for that embryo. And when we don't get pregnant, the lining sheds as a form of period. This happens month after month, year after year. 10% of women in the world, close your eyes and think of 10% of women you know you guys. Every time I go to a party and I'm like, oh my God, there's like 20 people here with endometriosis, undiagnosed probably. So 10% of the population has these endometrial cells or cells similar to it outside of the uterus around the tubes and ovaries, which we call endometriosis. If these cells are inside the ovary, we call it an endometrioma. And if they are in the wall of the uterus, we call it adenomyosis. The condition is called endometriosis. So once a month when these ovaries are secreting hormones, these little endometrial cells outside of the uterus also get stimulated. And that's the easiest way I can explain it. I hope it makes sense. And when we don't get our period and our lining breaks down, these cells also break down thinking they're in the uterus, but they're outside of the uterus. Blood is an irritant. You're not supposed to have blood outside of the uterus, inside the ovary, inside the wall of the uterus, around your tubes and ovaries. So blood is an irritant and it starts an inflammatory process in the pelvis. That inflammation chronically month after month causes scarring of the tubes, adhesions or scar tissue formation in the pelvis, and eventually it will cause chronic pelvic pain. So it starts with painful periods, maybe a day before, and then after a few months, it's couple of days before and then couple of days before, two days after, and eventually it turns into a chronic pelvic pain and you have pain all month. So this is the simplest way I can describe endometriosis. One thing to remember is that endometriosis causes infertility in many different ways. Number one, this chronic inflammation could affect blood flow. It does affect, I want people to listen to this. Endometriosis does affect your egg count and your egg quality. So you can have endometriosis and show up to my office undiagnosed with zero egg count, I can fix everything you have. I cannot give you your egg count back, and I can't make the quality better. So it's our mission in life to protect-

Mary Alice Haney:
Those eggs.

Dr. Thais Aliabadi:
Precious eggs. That's basically so egg count and quality can go down. You can get scarring of your tube. So if your tubes get blocked, you don't get pregnant. And some people think that when the egg gets released from the ovary, we need the tube to grab onto the egg. So inside the tube it can meet with the sperm, but when you have so much inflammation in the pelvis, the inflammatory cells don't let the egg make it to the tube. So that's another maybe reason why patients are not getting pregnant. That's why when people do IUIs and they go to the doctor with endometriosis and the doctor takes the sperm and puts it in the uterus, they're not solving the problem. The problem is the egg going from the ovary into the tube and all that inflammation in the pelvis. Also, for patients who have adenomyosis, the wall of the uterus is very abnormal. So when they get pregnant, they're at a higher risk of having a miscarriage. So I watch my endometriosis patients very carefully. The reason Olivia has been doing so well is because she's had progesterone suppression. Is it okay to discuss that?

Mary Alice Haney:
Oh yeah, yeah, yeah.

Dr. Thais Aliabadi:
So with a progesterone, she has a progesterone IUD in place. Not only it acts as a birth control, which is a very common birth control for women to use. But progesterone, IUDs calm down the wall of the uterus, the adenomyosis, the endometriosis in the pelvis, because remember, these little implants grow with estrogen, but their growth slows down with progesterone. So what I do in my practice, when someone has endometriosis, you always start with least aggressive treatment to the most aggressive. Least aggressive treatment being a combination low dose birth control pill or a progesterone birth control pill. You can do progesterone injections for birth control. You can do progesterone IUDs that I really like because they're local, they don't have too many systemic effects. And then you can go to medications like Orilissa, Myfembree, and these medications lower your body's estrogen. So in one way you can suppress it with progesterone in another way, you can lower your body's estrogen. Both ways work. Sometimes I do Orilissa and an IUD in a patient with severe disease. And the last resort for us is always surgery. Surgery is very technical, so not many people know how to do it. It's laparoscopic, it's outpatient. You have to not ablate or burn it. You have to actually grab it and cut it out. One day I will show you, maybe we can show it on this podcast. I did a laparoscopy on a patient with another surgeon who was assisting me. And when we looked in, she's like, oh, there's no endometriosis. I'm like, oh, absolutely there is. I'm going to find it. It took me 20 minutes. I could not find these dark brown spots that are very common. But there were these tiny filmy white scars that you really need a magnifying glass to go near it to be able to identify it. And when I said, I want to resect this area, my friend was like, there's no way this is endometriosis. I'm like, oh, yes it is. So we did it. I sent it to pathology, and of course it came back stromal endometriosis. So the stromal endometriosis lesions are extremely difficult to find. So these are patients who have the diagnosis of endometriosis, they do undergo surgery and they still wake up and the surgeon looks at them in the eye and says, what, Olivia?

Mary Alice Haney:
You don't have it.

Dr. Thais Aliabadi:
You don't have it. So if I could have a microphone or a, what do you call it? Megaphone.

Mary Alice Haney:
Megaphone. You have one right now.

Dr. Thais Aliabadi:
I know. But I would go in every little girl's home, every teenage girl's room, and I would say, if you have painful periods, there's a solution. Women need to be their own advocate. I think Olivia was her own advocate. She went doctor to doctor until she got her answer.

Mary Alice Haney:
And Olivia, so you finally, you met Thais, then you got surgery for it. So yours was so severe, it sounds like. And then did you wake up after that and where you just like, oh my God, thank God. I mean, you must have been...

Olivia Culpo:
Yes, definitely really excited. So, well, when I first went to Dr. Aliabadi, which was kind of funny, she was probably the third doctor I went to this week. Christian was calling all the people he knew in the sports world, trying to get somebody to help me because I was so in so much pain. It was hard for everybody to see. She did one ultrasound and saw that I had an endometrioma right on my ovaries. So I just ran off that. She's like, oh, you have endometriosis. And endometrioma is one of the only things you actually can see on an ultrasound. But for the most part, also to anybody listening, not all endometriosis is going to show up in an ultrasound that you would get at your doctor. You have to get a laparoscopic surgery because it's in the back of the uterus. It can be on the lining of the rectum. It can be everywhere. I mean, it can be on your bladder, it can be on the most, like near your appendix, everywhere. Tell us all the places you've found endometriosis.

Dr. Thais Aliabadi:
Everywhere. You can have it all the way up to your liver. You can have it on your bowel, on the bladder, on the rectum, behind the uterus, anterior to the uterus, around the ovaries, around the tubes, everywhere. And we stage endometriosis surgically one to four. So one message and Olivia, you're so smart. I mean so much about endometriosis. I feel like I wish you were a doctor because a lot of patients come to me, they're like, well, my doctor said your ultrasound is normal, so you don't have endometriosis. False. Majority of patients with endometriosis have completely normal ultrasound findings. So this is a diagnosis that we get with laparoscopy. But if you assume you can treat, you don't need to do surgery on these patients. Does it make sense?

Mary Alice Haney:
Yes. But you are diagnosed with endometriosis. Usually you have to get surgery, right, to keep-

Dr. Thais Aliabadi:
Not always, because if you put these patients on progesterone, birth control progesterone, IUD, and their pain goes away, you don't have to go chasing after it. When I met Olivia, she already had an endometrioma, which is a sign of a more advanced disease in the pelvis that needs to be addressed. And that's what we did. And she's been doing well. There's one more thing I want to say. There are doctors who operate on their patients annually. I had an endometriosis patients come to me and she said, I'm like, why are you here? She's like, I'm here for my 12th laparoscopy. And I was like, excuse me. She's like, I get him every year. She was going to lunch with her aunt. And I was like, no, why? She's like, why do you think? Because unless you suppress endometriosis, it will come back. If you resect colon cancer in a patient, do you ever tell them, all right, sir, you're good to go.
I'll see you in six months. No, because he's going to come back in six months with cancer everywhere. So what do you do? You resect the colon cancer and you give him chemo. Endometriosis is not cancer, but it does need hormonal suppression until menopause. So when you resect the endometriosis, you have to suppress these patients because a lot of them will bounce back six months to two years on your chair with the same symptoms. I've had patients where they go to their doctor, they do endometriosis surgery, they remove an endometrioma, they don't put that progesterone IUD. They don't start progesterone afterwards or Orilissa or Myfembree or some form of suppression, and literally two months later, their endometrioma is back.

Olivia Culpo:
Yeah, that's one thing that I want to scream on a megaphone too, because it is kind of not annoying, but I wish people were more educated on that part too. People are like, oh, you're better now. You don't have endometriosis anymore. It went away. Yay. It never goes away. It's a lifelong commitment of repressing it. And so eventually, for example, when I want to have kids, I'll get off of the IUD, I'll have to probably deal with some unbearable pain and then hopefully get pregnant. And then once I have my kids, I'll probably have to get another surgery and then get back on the IUD. But I have kind of a roadmap and everybody out there with endometriosis, I wish that was something that they knew because it's not one and done. It's not like one surgery and you're done forever. It's not just get on birth control and then you're done forever most likely. Maybe you have a miraculous situation, but more than likely it's a lifelong thing that you have to continue to suppress. Otherwise, you'll just be right back to square one.

Dr. Thais Aliabadi:
And what I do with someone like Olivia. I do believe, Olivia, I'm confident you're going to get pregnant. She's had her surgery, she's been suppressed now for many years. So her endometriosis, symptomatically, it's controlled. Her egg count is amazing. The inflammation in her pelvis is down.

Olivia Culpo:
Thanks.

Dr. Thais Aliabadi:
So probably a couple of months before, oh yeah, I'm confident. Couple of months before she wants to try for pregnancy, we'll just pull her IUD and I always tell patients, I don't want to pull it and have you wait for six months. I'll pull it when you're ready to go. And then I'll have them try. And if you take a hundred couples, 50% of them get pregnant in the first six months they try. 90% get pregnant for the first year.

Olivia Culpo:
Wow.

Dr. Thais Aliabadi:
So I usually tell my endometriosis patients, go try for six months. You need to have sex three times a week. It's a homework.

Mary Alice Haney:
I've seen Christian, that's not going to be hard for you. Let me just say that. I'm just going to put that out there in the world. That is not going to be a hard situation. Let's just put it out there.

Dr. Thais Aliabadi:
So you have sex three times a week. You give yourself six months, and then if you get pregnant, which I'm sure you will, because you're young, your eggs are healthy, your egg count is amazing, your endometriosis is suppressed. And that is exactly how you take someone like Olivia, hopefully out of the hands of fertility specialists.

Mary Alice Haney:
Well, can we just talk for... I know, yeah. Can we give a big round of applause for that? Because that is, I remember I had my first baby at 34 and my second one at 35. And then I tried, I got remarried and we had five kids together, and I tried to trick him in my forties to have another one, and I wasn't able to.

Dr. Thais Aliabadi:
It gets hard.

Mary Alice Haney:
When you're young, you try so hard not to get pregnant, and then when you're ready to get pregnant, it's not as easy as you think it is. So I love hearing that for you. I love hearing that for you. That's amazing. Just talking about, thinking about all this. Have y'all decided, have you picked a date? Have you picked a dress? Can we talk about fashion? What's happening?

Olivia Culpo:
Oh yes, of course we can. So the wedding is going to be early summer. We're in the middle of figuring out and finalizing the dress. I am working with a designer that I can't mention yet, but I'm very excited.

Dr. Thais Aliabadi:
You have the best style.

Mary Alice Haney:
You do.

Dr. Thais Aliabadi:
So I can't wait to see you.

Olivia Culpo:
Oh, thank you. Well, this is actually Christian, so he has good taste.

Mary Alice Haney:
That's the true boyfriend sweater. That's really what it is. It's an actual boyfriend sweater.

Olivia Culpo:
Can you believe this fits him? I'm just like, well, actually, you know what? It doesn't fit him. He buys all of these European nice brands and he thinks that he's an extra, extra large. The reality of these European Pradas and stuff, he doesn't fit into them. So then they become mine because he's huge.

Mary Alice Haney:
So one thing that I didn't know about you when I was researching before the podcast, and I'm sure that Dr. A doesn't know this either, but when you were Miss Universe, you're a cellist.

Olivia Culpo:
Yes.

Mary Alice Haney:
Look at that face and she could also play the fricking cello. I didn't know that. How old were you when you did that?

Olivia Culpo:
I started in first grade. So when I was six years old. My parents are both musicians, so we all played instruments. I'm one of five, so we all just kind of grew up. It was one big band camp.

Mary Alice Haney:
That's amazing. I know, I think about that sometimes. I'm so not musically inclined, so it's not a thing for me. Olivia, in terms of thinking about where you are now, and we have so many listeners that I think look up to a lot of our podcasts and guests, and if you could think about your journey with endometriosis or your journey, just kind of where you are right now, what would you want to tell someone listening?

Olivia Culpo:
I would tell the person, that person first and foremost, advocate for yourself. You are not crazy. And just keep your head down and keep advocating for yourself. Don't take no for an answer. And then secondly, I would tell them to rely on social media. Honestly, that helped me so much. Crying in the back, unable to go about my day, feeling gaslit by everybody around me saying that it's not that big of a deal. Painful periods are normal or like, oh yeah, I hate when I get my period too, but you still got to go to work. It's like in those moments, I couldn't. I was in so much pain and nobody knew what was wrong. So I went on YouTube, I went on Reddit, I went on Instagram, I went on Facebook and I found these support groups and I diagnosed myself through these forums. I was like, this is what I have. This is me. I'm not crazy.
And so anywhere you can find support. Whether it's a friend that, whether it's me, whether it's Dr. Aliabada, whether it's this podcast. Something, because you can't get through these things alone and I don't think you should. And I'm so happy that I can be that for people, and I'm so happy that I have Dr. A that can be that for me and that we can all support each other. It's the only good thing about all of this. So we have each other.

Mary Alice Haney:
And you're in this amazing happy... You've been very, very vocal about past relationships and some of them haven't been as supportive as what you're going through now. And I also really respect how you have been very vocal about it because I think so many young girls are living right now in this world, and sometimes social media is a great thing and sometimes it's not. But just in this world of, oh, this is how it's supposed to be. What would you tell anyone listening about that? They see you now and Instagram feels like this beautiful fairytale and it is. You're living in this wonderful relationship. I am too. And so is Thais. We're so blessed to have these magic relationships, but that has not always been the case for me. And that has not always been the case for you, and you've been very vocal about that. What would you tell a young girl listening right now about that?

Olivia Culpo:
I think everything happens for a reason, which I know it's so cliche to say, but looking back on everything that I've gone through and all of the horrible people that I've come across, it makes what I have now so much more special. It makes me appreciate what I have so much more. My gratitude is off the charts because of the bad times. And if you are going through a bad time, this is just a chapter in your book, it's just a moment in time and you will look back and be grateful for it. It's so hard to know in the moment. So just stay strong and keep trucking along. Everything works out how it's supposed to and just keep reminding yourself of that. It's so hard going through it, but it will all make sense.

Mary Alice Haney:
And did you just all of a sudden wake up one day and just get the strength to be like, no, back up buddy. I mean, was there a moment, was it a couple of lessons that had to happen or was there just like the stars shine down that day?

Olivia Culpo:
Well, okay, well that's actually a good question. With my one relationship was extremely toxic, which I have talked about before. And it really was like an epiphany. It was an epiphany that I had in a moment. I remember I was on my knees praying to God, please give me the eyes to see and the ears to hear, please get me out of this situation. I was in a really toxic, toxic situation and it's a story that people, a very similar story to a lot of women out there, which is why I share it.
And anyway, in that moment, it was like the wool came from over my eyes. I could finally see, and I was like, you know what? I'm done. I'm actually moving out of this situation. And I removed myself from a really scary place and I'm really proud of myself for that. But a lot of women who go through these really toxic situations can speak to the same thing. It kind of is like a miracle that you experience because you're in a sense addicted and stuck in a very tumultuous merry-go-round and you can't get out of it. You can't imagine your life anywhere else and you get stuck.

Mary Alice Haney:
No, I think that's amazing. I think that that is such a powerful message and that's what we're trying to do on this podcast is to empower women. We want to empower women to be their own health advocate, and you kind of can't be your own health advocate if you're not taking care of yourself in your relationships too. I think that we talk about it all the time. If you are sad or depressed or in an abusive relationship, you can't take care of your health because you can't even see the forest from the trees. So I think just you talking about that so openly is really amazing. Now let's just get girly for two minutes because we don't want to take up too much more of your time, but can you tell us what is your exercise routine? How do you take care of your body?

Dr. Thais Aliabadi:
And your skin?

Mary Alice Haney:
And your skin? Tell us everything.

Olivia Culpo:
I know when I had to start my [inaudible 00:39:19], it was like, is this going to keep me young forever? We're like, no. But skin, I'm crazy about skin stuff. I would say the most important thing for skin is sleep, happiness, gratitude, not over cleansing is something that I think is really important. I think you don't want to break down the skin barrier. You don't want to dry out your skin. And I feel like I've had moments where I'm breaking out and so I think to over cleanse my skin and then it actually ends up not working. So I use a cleansing balm or a lotion based cleanser. Those are my two tricks. I think a retinol is important after 30 or 27, let's say. Workouts, I like just standard circuit training. I also love working out in a group if you have a workout buddy. So find a workout buddy, find some retinol, drink some water and you'll be great and be happy. Get a gratitude journal.

Mary Alice Haney:
And do you eat everything? Are you conscious about what you eat? Do you intermittent fast? Are there any secrets that you have on that end?

Olivia Culpo:
I will say there were times in my life when I was really diligent about my diet and what I ate and I did not break the rules. I am not like that at all anymore, and I'm so much happier. I don't know. I personally stick to 80/20 and honestly, the 80/20 rule. Meaning 80% of the time I'll eat... Honestly, it's more like 70/30. 70% of the time I'll be really great and then 30% of the time I just kind of eat whatever I want, but in moderation. I want to feel good. And I think part of feeling good is not only indulging in the things that you want to indulge in, but also not overdoing it. You don't want to indulge the point that you feel sick and disgusting anyway. So listen to your body. When your body's telling you not to eat anymore, don't eat anymore. But if you want a piece of chocolate cake, have some chocolate cake.

Mary Alice Haney:
Have some chocolate cake.

Dr. Thais Aliabadi:
It's so inspiring to look at you. You're beautiful, you're happy. There's a glow from inside of you. And I think like you said, it's all gratitude and having gotten yourself to a place where you have a nice partner and you are pain-free and I mean you're living your best life and I'm so happy for you and with your wedding coming up and I can't wait to deliver your little munchkins.

Mary Alice Haney:
I know.

Olivia Culpo:
Thank you. That will be fun.

Dr. Thais Aliabadi:
We need a little Olivia running around.

Mary Alice Haney:
A little Olivia. Yes. Although I will tell you, being a mom of boys is not bad either. I mean, it's pretty fun too.

Dr. Thais Aliabadi:
Of course.

Mary Alice Haney:
I know it's pretty fun too. Now, Olivia, are there any projects that you want to talk about? Are there anything coming up in the works that you're excited about?

Olivia Culpo:
I have a film that just came out called Clawfoot and I'm getting married. Hopefully we have a Super Bowl on the horizon. I mean, that's what I'm manifesting. I don't know.

Dr. Thais Aliabadi:
That's exciting.

Mary Alice Haney:
Were you a football fan before?

Olivia Culpo:
I was. Not as much as I am now, but yes. I feel like honestly, the rules are tough. Do you guys watch football?

Mary Alice Haney:
Yes, I do.

Dr. Thais Aliabadi:
I don't.

Mary Alice Haney:
I know she doesn't at all, guys.

Dr. Thais Aliabadi:
I don't do anything you guys.

Mary Alice Haney:
On Sundays, I'm like football all the time. Like I said, I was like a God in my own house today because I had you on the podcast. They were like, you don't understand, mom.

Olivia Culpo:
That's so funny. Oh, he's right over there. I should have had him come say hi, but.

Mary Alice Haney:
Give us the best piece of advice anyone has ever given you.

Olivia Culpo:
This is easy. My mom, it was when I was going through a really hard time and I didn't see a way out and she said, work hard and be a good person. And whenever I feel like my ego is getting too big or the world is beating me down in one way or the other, I just remember that and everything is put into perspective. Work hard and be a good person. Simple and easy.

Mary Alice Haney:
When it was all said and done and you finally diagnosed, you had the surgery, tell us what that felt like.

Olivia Culpo:
Total miracle. When I could go about my day pain-free, when it actually worked, I felt so lucky and such an immense amount of gratitude. Which is why I love being able to pay it forward in whatever way I can. I want women to feel pain-free, I want women like me who had no answers to finally live the life they want and then pay it forward again to the next generation.

Dr. Thais Aliabadi:
You know what my dream is, and I'm going to make it happen. I'm going to say it on this podcast, it will come true. I want the first Lady of United States. I don't know which year. I don't care who it is. I want her to go on mic on national TV and say, painful periods are not normal.

Olivia Culpo:
That would be amazing. Maybe it will be you. Maybe you never know. Stranger things have happened.

Mary Alice Haney:
Actually, it's going to be me. I really want to be First Lady. My husband wants to run for president at some point, and I always said I'd be a great First Lady. I don't want to be president, I just want to be First Lady. It's just I don't want that experience or that on my shoulders.so let's just say that on this podcast pretty soon, Mary Alice will be first lady. I will get up there and I'll say painful periods are not.

Dr. Thais Aliabadi:
And I'm going to send you a daily script.

Mary Alice Haney:
Okay. Olivia, you're the best. Thank you so much.

Olivia Culpo:
You guys are the best.

Mary Alice Haney:
You really are.

Olivia Culpo:
Thank you so much.

Mary Alice Haney:
Thank you for using your voice. And you are going to change so many people's lives by hearing your story because you're not crazy. And that is the message that women get so much in different parts of the healthcare system and it's why we wanted to start this podcast. We want to put the power back in the woman's hands and say, it's okay that you don't know my diagnosis. I do. This is what I have and I need you to fix it, and this is what you need to do to fix it. So it's just about, it's not to make-

Dr. Thais Aliabadi:
Self-advocacy.

Mary Alice Haney:
Yeah, self-advocacy. So thank you.

Olivia Culpo:
Thank you guys.

Dr. Thais Aliabadi:
I'm so proud of you.

Mary Alice Haney:
Thank you.

Olivia Culpo:
Thank you guys.

Mary Alice Haney:
So Thais, how does the listener know if they have endometriosis, if they have a painful period? What are the symptoms?

Dr. Thais Aliabadi:
The most common symptoms are painful periods that could be heavy, painful sex, mostly with deep penetration, severe bloating associated with pain during their period, recurrent bladder infections, chronic pelvic pain, pain with bowel movement, sometimes pain with urination. So any kind of pain in the pelvis needs to be worked up as endometriosis in a woman in their reproductive age. So I'm not talking about a 6-year-old postmenopausal woman with pelvic pain. I'm talking about women in their reproductive age with pain in the pelvis. It's endometriosis until proven otherwise.

Mary Alice Haney:
And what is the difference between polycystic ovarian syndrome, PCOS and endometriosis?

Dr. Thais Aliabadi:
Two complete the different conditions. Endometriosis is when cells similar to the endometrial lining are outside of the uterus and they cause an inflammatory process in the pelvis. Polycystic ovarian syndrome is a condition that affects 15% of women, and these women tend to have more follicles in their ovaries. There's a certain look to the ovary, and these patients have androgen sensitivity or extra testosterone in their body that can cause irregular periods, acne, weight gain, hair loss, facial hair, body hair, and different symptoms. It's important to know that even though PCOS and endometriosis are two completely separate medical conditions, 40% or approximately half of patients with PCOS also suffer from endometriosis. So when I see a PCOS patients, I always make sure I ask about painful periods, painful sex, and all the other symptoms of endometriosis. The last thing I want to leave our listeners with is if you go to the doctor and your symptoms are dismissed, please look up an endometriosis specialist near you. Go to someone who's done this, who knows how to do the surgery, who's dealt with endometriosis, and I will promise you that going to see relief. Few more points. Egg count is very important. I've had 14-year olds in my office with severely painful that I do an egg count and their egg count is as low as a 40-year-old. So it's important to diagnose these patients. Endometriosis symptoms can start as early as age eight, right? So by 14, they could have had it for many, many years. So it's important if you're a mom, you have daughters at home with painful periods, make sure you ask your pediatrician to do an egg count. But if your pediatrician is not willing to do it, at least by age 18 with painful periods, you need to check an egg count. And if it's low, it would be great to see a fertility doctor-

Mary Alice Haney:
And freeze your eggs.

Dr. Thais Aliabadi:
Yes, they don't freeze under age 18, but after 18, if the egg count is really low, you can absolutely go and freeze your eggs. And I want patients to remember this.

Mary Alice Haney:
So right now, there's no real test for endometriosis. There's not a blood test.

Dr. Thais Aliabadi:
We don't really need a blood test to diagnose endometriosis. We just need doctors to listen to their patients and do not dismiss the symptoms of painful period or other symptoms of endometriosis. I've taught my urology friends that when you have a young girl who comes to your office with recurrent bladder infections, think endometriosis. I've taught the GI doctor that if you have a patient that comes in with lower abdominal pain, you don't need to do a colonoscopy in a 17-year-old, it's probably endometriosis. So I think these podcasts, patients like Olivia, Halsey, all the people who have used their platform to bring awareness to this condition and educate women will help push this message forward. And eventually we'll have the...

Mary Alice Haney:
We are going to fix it.

Dr. Thais Aliabadi:
We're going to fix it, and we're going to have everyone talk about it.

Mary Alice Haney:
On today's episode, we learned all about endometriosis and how to diagnose yourself, all the tips that you need from Dr. A, what to bring to your doctor. You do not have to live in silence. Painful periods are not normal, and we want you to know that. Well, she's amazing. I mean, she's as beautiful as she is outside as she is inside. And to use her voice and be so open about endometriosis and all of her symptoms and all of that is incredible.

Dr. Thais Aliabadi:
Incredible. I mean, a lot of patients get diagnosed with endometriosis, and when I ask them to use their platform, they shy away. So I have so much respect for Olivia for using her platform to bring awareness. I always say, even if you can help one little girl, one person in your life, then you've done your job. And with her and her platform, she's going to help thousands and thousands of girls. So I'm really excited.

Mary Alice Haney:
She's so in love and so happy, and I love seeing that too. And that's also a great thing. I like to see when good things happen to good people.

Dr. Thais Aliabadi:
But in reality, let me tell you something. When patients have chronic pain, do you think she would've been here today? No. Because when you don't feel good about yourself, when you're constantly in pain, she's lucky. There are a lot of patients with endometriosis who are addicted to Vicodin and Norco because of pain. And so then they go to the doctor and you look up their medication list and there's Norco and Vicodin and Percocet, and immediately as a doctor, what you say, she's a drug seeker, right? She's not a drug seeker.

Mary Alice Haney:
She's in pain.

Dr. Thais Aliabadi:
She's in pain. And you people are not diagnosing her. That's why she's using this because she has nowhere else to go. So when you spiral down to that point, how could you find this life? That's so heartbreaking with these endometriosis patients. That's why I really want to scream. I really want to do. The number of patients I see on my exam table crying every day when I tell them they have endometriosis, you know what the first thing they tell me is I feel validated. That's what they tell me.

Mary Alice Haney:
Yeah, you have to listen.

Dr. Thais Aliabadi:
That's the first thing, almost every single one of them says that. It's like for years, I thought in my heart with my gut that this is my diagnosis. And let me tell you what irritates me so much. Patients come to my office after having seen 12, 13, God knows how many doctors in Beverly Hills. I tell them, you have endometriosis. They call me back a day later. They're like, I want to go for another opinion. And I'm like, okay, where are you going to go? Because whoever you're going to go, I want to be best friends with that person. Do you know what I'm saying?

Mary Alice Haney:
Yeah.

Dr. Thais Aliabadi:
And that's the problem. And sometimes they go from my office with the right diagnosis to another doctor, and the doctor says, no, you don't have it. I was at a party few weeks ago and a friend of mine came up to me and she's like, you know this girl I met yesterday, I went to this party. Her husband was there. She didn't come to the party. And so she asked where his wife was and the husband says, well, she's been doubled over in pain. She has so much, her periods are so debilitating, she can't get out of bed. And my friend says, have you seen Dr. A? And he's like, oh yeah. We went to her a few years ago. Her egg count was low. She diagnosed her with endometriosis. But the patient didn't believe me because her other doctors told her she didn't have it. Fast-forward six years, she has no eggs. She's in bed. She can't come to a party. She's struggling with infertility. And that's exactly-

Mary Alice Haney:
Did they come back?

Dr. Thais Aliabadi:
No. No, not yet. But it's too late, right? When you don't have eggs, what am I going to do?

Mary Alice Haney:
I know.

Dr. Thais Aliabadi:
My point is, it's so important for patients to know what the diagnosis is, what their symptoms are. This is not rocket science. Do you know what I'm saying? I'm not talking about something that's out there. It's just common sense. If you have painful periods, it's endometriosis. If someone's telling you it's not, go find another doctor. It's very simple. It's not that complicated.

Mary Alice Haney:
So you think every single person with painful period has-

Dr. Thais Aliabadi:
No, but every single person with painful period needs to be ruled out for endometriosis because the price you pay is so, so big. You don't want to lose your eggs and you don't want to lose your egg quality.

Mary Alice Haney:
Well, how do you rule out endometriosis?

Dr. Thais Aliabadi:
By going to an experienced physician. And you know what? The easiest thing I can say for listeners, if you have a doctor that doesn't believe in you, if you can't afford seeing an endometriosis specialist and you have painful periods, go on a progesterone birth control pill, that's the easiest thing you can do. Go on a very, very low dose combination birth control pill. You can go on any form of birth control pill, anyone. You can go to Planned Parenthood and get birth control pill, do that for a few months. Your body's not a light switch. It will take three to six months for the birth control pill to kick in. So don't take it for a month and come and tell your friend it didn't work. You really have to be patient. Do it for a few months. If you're pain-free, stay on that birth control pill until you're ready to have a baby. Check your egg count every year.

Mary Alice Haney:
How do you check your egg count?

Dr. Thais Aliabadi:
It's a blood test called AMH, anti-Müllerian hormone. You can also do an ultrasound and do a follicular count and count the number of follicles. I like doing the blood test. You can do it at any time in the cycle. It's very accurate. It's covered by insurance. Do your egg count, go on a progesterone birth control pill. So I'm telling you what to do. You can do what I'm telling you with your primary care doctor, with your Planned Parenthood doctor. It doesn't matter. If you go in armed with your diagnosis and you say, honestly, you can use my name, say Doctor A diagnose me with endometriosis. I need birth control pill. I need to do my egg count. And then follow your own journey. Every year do your egg count. If you see a declining go freeze eggs. The problem with egg freezing is-

Mary Alice Haney:
Not covered by insurance.

Dr. Thais Aliabadi:
Not covered by insurance. When women are young and their eggs are good, they don't have money, they can't afford it. When they're old and their eggs are old and the egg quality and quantities down, that's when they can afford it. So until we get this procedure covered by insurance-

Mary Alice Haney:
Does the birth control pill stop the inflammation? So stop the eggs from dying?

Dr. Thais Aliabadi:
Absolutely.

Mary Alice Haney:
Okay. So that's something you can do. If you can't afford to freeze your eggs, you can absolutely get on one of these progesterone birth control pills and then just kind of follow your egg count.

Dr. Thais Aliabadi:
Yes. Progesterone birth control pill, combination low dose birth control pill with estrogen and progesterone, that's fine too. If you want to have a progesterone IUD, great. Do not use a copper IUD, which is the non-hormonal IUD. If your doctor wants to offer you a non-hormonal IUD and you already have painful periods that could push you in the emergency room. Copper IUD, do you know which one that is? It's a 10 year IUD is very commonly used.

Mary Alice Haney:
So it's fine if you don't have endometriosis.

Dr. Thais Aliabadi:
Bravo. But even if you don't have endometriosis, it can make your periods a few days heavier and crampier. So there are doctors who use these copper T IUDs for endometriosis patients and they really end up in the emergency room. So when I see them, the first thing I do is I at least pull the copper T IUD out. And then I offer them either a progesterone birth control pill, a combination low dose birth control pill, a progesterone IUD. And I watch them for four to six months, if they still have pain, then I consider other medications like my Myfembree or Orilissa, medications that lower their body's estrogen. So estrogen feeds endo. By lowering estrogen, you slow down the growth of these endometriosis implants and if all fails, then you find yourself a doctor who's experienced an endometriosis surgery and with an outpatient laparoscopic surgery, usually the downtime is three to five days.

Mary Alice Haney:
And insurance covers that?

Dr. Thais Aliabadi:
Yes, absolutely.

Mary Alice Haney:
And with endometriosis, does it stop when you go into perimenopause?

Dr. Thais Aliabadi:
Yes. When you go through menopause, there are no more estrogen.

Mary Alice Haney:
Right. But what if you're on hormone replacement?

Dr. Thais Aliabadi:
Usually I watch patients. Some patients have adenomyosis and when I put them on hormone replacement, they still have breakthrough bleed or they have pain or pelvic pain. Then one option is at that point, if the uterus is abnormal, you can do a hysterectomy and then go on hormone replacement. But usually after menopause it's not a big of a deal. My most concern is with fertility-

Mary Alice Haney:
Right, when they're young.

Dr. Thais Aliabadi:
Issues that come with endometriosis and the chronic pain that comes with it. I want to add one more thing. Majority of patients with endometriosis also suffer from SIBO. Have you heard of SIBO?

Mary Alice Haney:
Yes. I didn't know that.

Dr. Thais Aliabadi:
It's SIBO, small intestinal bacterial overgrowth.

Mary Alice Haney:
Why?

Dr. Thais Aliabadi:
Because of that chronic inflammation. I honestly, the pathophysiology of it, I don't understand, but endometriosis causes a leaky gut. I think it's because of all that inflammatory process in the pelvis. These patients usually complain of bloating, bloating, bloating, bloating. They go to the doctor, their GI doctor diagnoses them with SIBO, treats them with SIBO. They come back two months later, they're back to square one. Why? Because their endometriosis is not suppressed. So usually what I do in my practice is I suppress their endometriosis, watch them for four months. They do a follow-up with me in four months if they're still bloated at that point I treat them for SIBO. They don't need to take a breath test to diagnose SIBO. You can just go ahead and treat them and if their bloating goes away, then I know the bloating was because of all that inflammation from endometriosis and they do not need treatment for SIBO. If that makes sense.

Mary Alice Haney:
We're going to do a whole episode on SIBO because I feel like I'm hearing that all over the place.

Dr. Thais Aliabadi:
Its everywhere.

Mary Alice Haney:
It's just rampant right now. So we're definitely going to do that.
To find more information on endometriosis and Dr. A's action plan, visit our website at shemdpodcast.com and follow us on social media at SheMD Podcast. Don't forget to click that subscribe button on YouTube or wherever you get your podcast so that you never miss an episode.

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