12-18-23 Endometriosis with Dr Scott Morehead

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Episode Transcript

(00:02):
Mix when I was six' five. Good morning, it's Christina Wolford.
Welcome to Lady Parts with doctor RichardVillarreal of Adina Women's Health. Good morning,
doctor Villarreal, Well, good morningto you. How are you today?
I'm doing good. How are yougreat? Well, we're already laughing
today, so this is going tobe a fun show. Well, we've
got doctor Morehead here today. He'sgot me laughing already, right, so
we've got a great show today.We're going to talk about a really interesting

(00:23):
topic that affects ten to twenty percentof all women of child bearing age and
so it's it's as pretty significant topic. And he's one of our experts.
I've been a partner of doctor Moreheadsover twenty five years, right, and
so uh yeah, a great guy, wonderful physician. I went to the

(00:44):
High State University his medical school residencyand he's wonderful. So welcome and we're
glad to have you here today.Well, thank you very much. I'm
very happy to be here. Andwe're going to talk about indemitrisis. So
this is a great topic and we'regoing to see what he has to say
about it. But like I sortof touch on I mean, it affects

(01:08):
a lot of women, and ithas a lot of symptoms, and some
people have no symptoms. And sowe want to sort of go through some
things, and I'm going to justjump in every once, you know,
so often, and talk about somemyths and some facts and we'll see what
you think about this. Okay,So first of all, let's let's start

(01:29):
with what is endometriosis. Okay.Basically, endometriosis is where the indometrium,
the lining of the uterus, theindimetrial implants spill typically through the Filippian tubes
and plant in the abdominal cavity.They may implant on the pelvic sidewall,
the ovaries, the Filippian tubes,the bow, and basically what happens is

(01:53):
as the hormones and the brain stimulatethe lining of the uters to develop every
month, it also stimulates this littlemplant and something abdominal cavity. So as
the line of the uterus builds up, those implants build up, and that
can oftentimes cause inflammation, irritation,discomfort. It's typically causes more pain.

(02:15):
It's the typical symptoms would be morepain before your minsi's during the minsis and
then better afterwards. Oftentimes people willhave a little bit of less pain for
a week, two maybe three weeksout of the month. So a main
way we oftentimes first diagnosed in demetrisisis just based on history. Okay,

(02:35):
so you mentioned that you know alot of people present a lot of their
symptoms initially are just pain, butthere can be a lot of other symptoms
that people, you know, becausea lot of times we sort of don't
really diagnose this for a long longtime, and we'll get into that.
But the women present with a lotof different issues. And so I mean,
like you said, you know,with pain and discomfort, and there's

(02:57):
urinary symptoms, there's bowel symptoms,there's infertility is another one. It's basically
you know, if it's causing inflammationor irritation of the surrounding organs like the
bladder, Like you said, youmay have some urinary symptoms or you know,
nausea before menci's. If it causesenough inflammation, irritation and abdominal cavity,
it can cause some nausea. Soyeah, there are some kind of

(03:22):
veggus symptoms. It usually has ahistory. If someone comes in just they
were in the eer, they hadsevere pain. That's usually not just diagnosi
of indometriosis. It usually kind ofbuilds up with time, and it's something
we go back up with the historyand get yeah, this has been developing
for a while. So is thissomething that just ca So, like you

(03:44):
say, it's not really something thatjust comes on all of a sudden.
It's something that develops over time.So does it when does it start?
Well, it can start anytime aftera woman starts menstruating. Okay, so
oftentimes oftentimes it'll start out through theteenure will have lots of young well later
teens, yes, the tweens,betweens oftimes develop Well that's good because that's

(04:08):
when I missed some facts. SoI found like six of them that I
want to say. Okay, Sothe myth was that it really doesn't occur
in women until they get to theirtwenties. But like you just said,
the fact is that it can evenoccur in women even before the first time
they have their cycle. So Imean it starts developing very early on.
So that was great. So youpassed number one, So you're a good

(04:28):
kind of contest. So how dowe how do we know? So,
I mean, this begins early on. So a lot of these young women
come to us, you know,and they say, well, I'm having
pain, or I'm having floating,or what do we do about it?
So oftentimes we go by history.Physical exams sometimes can help you know if

(04:53):
the pain's down low and the pelvisif it's at the right time, and
that can help to diagnose that.We used to get a pelvic ultrasound.
Oftentimes the ultrasound won't exactly show indometriosis. Indometriosis to see it, it looks
like someone pepper you're inside. You'llsee little spots of the line. Like
I said, it's the line inthe uterus, the endometrium spilling out into

(05:15):
the pelvic cavity. So we maynot see it on ultrasound, but we
do an ultrasound to roll out othercauses for pain. Sometimes you can see
a cyst on the ovary that justlooks suspicious for indemetriosis. That can give
us an idea. Yeah, becausewell when they do get it, they
can you know, they grow andgrow and grow with time, as you

(05:36):
mentioned, and we have something they'recalled into matrona's, which are on the
ovaries, and that it is oneof the things that we can see on
ultrasound, but that's usually when itstarts getting big and it does cause quite
a bit of pain. Yeah,when we cut into those, it's kind
of cool because they look like chocolate, chocolate cyst Yeah, I think you
guys, sound like doctor. Kindof cool. And then it does it

(06:00):
comes out looking like chocolate and spillsout. But you know, you don't
want that to happen, but itis very cool. But as far as
diagnosing endometriosis, you know, forus, really the gold standard is to
see it. So the only wayfor us to see it is basically with
a belly button surgery or the laparoscopy. Yeah, we can do laparoscopy and

(06:21):
oftentimes two or three little incisions.Usually we hide one kind of in the
lower part of the belly button,one weight down load just above the pelvic
bone, and we put the camerain. We fill the belly up with
gas and then we can take alook directly to see if a person does
have indometriosis. At the time wecan diagnose it, we can also oftentimes

(06:44):
treat it. We can resect orburn or obliterate different ways of getting rid
of the implants of indometriosis if wewould, we haven't talked about it.
But sometimes indometriosis so cause scar tissueor adhesions. I don't know if you
want to get into the absolutely,but the recurrent inflammation and irritation that demetrosis
causes. The inflammation itself can causepain, but then also it can cause

(07:09):
adhesions and they can make like saythe ovary adhere or get stuck to the
uterus. So you know, atthe time of diagnosis, we can also
sometimes help to treat by freeing upadherent tissue, removing the chocolate assysts.
So there's all kinds of things thatwe find out. You know, a

(07:30):
lot of the people that have endomutrosis, I mean it's found even at ties
of other surgeries. So somebody's havingan appendix taking care of their having something
else and they just coincidentally say,oh, by the way, you have
endomutrosis, and so that's you know, because a lot of people don't have
pain with it. I guess thatwould be important to talk about. If

(07:50):
someone was told they had endometrosis,if they're not having symptoms, it doesn't
turn into cancer. Nothing specifically hasto be done for it. Only if
they were having particular symptoms of it. Yeah, because a lot of times,
some of the studies will show Imean, if it is found coincidentally,
you know, you have a lessthan ten percent chance that it's going
to progress and cause a lot ofproblems in your life. But it's when

(08:11):
you're already having the issues that weneed to do something about it. But
like he'd already mentioned, I mean, it can lead to issues with the
fertility pain. I mean, itcan affect all aspects of your life,
with work, with your you know, mentally because of the amount of pain,
your self esteem. It can affectyou know, your relationship with your

(08:31):
spouse, you know, all kindsof things because a lot of the women
they can't have intercourse, they can'tdo anything because they hurt so bad.
And so it's an interesting issue.I mean for us to try to treat
it is you've brought up fertility.You know. I have a lot of
young women who have in demetriosis andthey worry that that will mean that they

(08:54):
will never be able to have ababy. And that's not true. I
always tell my patient this is alittle bit confusing, but most high incidents
of people with infertility have indometriosis,but by far, most people within demetriosis
have no problems with fertility, andI can get pregnant. But that's one
reason that if we catch it early, if someone does desire fertility, I

(09:16):
think catching it early is important todiagnose it because there's many things I'm sure
we'll talk about a little bit lateron to help prevent the progression of indometriosis
slower, and we'll say that moretowards the end. But so, okay,
So that brings on one of theother myths. You know a lot
of times we'll tell patients or peoplecome in saying, well, you know
what, I need to get pregnantbecause it's going to fix my endometrosis.

(09:37):
And you know, it doesn't cureendometrosis, but it can't help it.
Yeah, it doesn't usually progress alot during pregnancy. Yeah, so it's
not really a cure, but itdoes reduce your symptoms. It's because the
progesterone in it, and so thatwe know, we'll get into it a
little bit later, but that's oneof our treatment plans. But not getting
pregnant, but the progesterone, andI guess you could use it a treatment

(10:00):
plan if you wanted to. So, you know, we mentioned at the
beginning, you mentioned some of thetheories behind edemutriusis. I mean, I
remember when we were in medical schoolthere were you know, we had like
three different theories and I think they'relike five or six now of all the
different ways that enemutrisis can get started. But I think the one that you
mentioned, the retrograde flow, isprobably the most common that everybody talks about.

(10:22):
And just the flow you know thatnormally comes out every month. It
goes backwards through the tubes and outinto the abdomen and it can just seed
in the pelvis and it can causepain. It just and it gets worse.
So but one of the other thingsis it's it's not contagious, right,
It's that you can't you don't passit on if you have intercourse with

(10:43):
somebody or you're you know, bestfriends, you know, you drink after
them, things like that, itwon't pass on. But what are some
of the let's let's talk about symptoms. Let's talk about some of the symptoms
of nutriss. You know, howwould somebody know if they have it,
or what are some of the issuesthat this can bring on, Whether it's
affecting the uterus or the bow orthe bladder or what are some of the

(11:05):
signs and some of the things thatthey're going to feel. You know,
typically it's pain. A lot ofpeople think, you know, they're told
they have irregular bleeding or the enemytrisisis causing irregular bleeding. It's not so
much irregular bleeding, it's more pain. It's from the inflammation, so pain,
cramping, bloating, just from inflammationand the abdominal cavity before the minsis

(11:26):
during the period, I have occasionallyhad people have some blood in the stole
and it makes you wonder if it'scyclical in nature. You know, they
probably have endometriosis along the bow wall, irritation of the bladder wall, cyclical
bladder discomfort could be endometriosis. So, yeah, we see that all the
time. I've seen it. I'veseen the blood in the urine that they

(11:48):
found as endometriosis. I've seen thebloating like you mentioned earlier, the nausea
and the vomiting, anguin or pain, pain with intercourse, pain with exercise
even I mean, it can causea lot of trouble. And then we
mentioned that the bad endometrisis can leadto infertility because it can really damage your
tubes. And so but like yousaid, the majority win with the demetrisis.

(12:11):
They can still get pregnant. It'sjust one that demutrisis spreads and causes
problems with the tubes that you know, they can't get pregnant and then they
need help. So let's let's talkabout the diagnosis of endometrosis. So eventually,
you know, one of the thingsthat was really interesting was I found
out that most of the women,it usually takes about ten years for somebody

(12:35):
to get diagnosed. And that's justbecause from the time that they start having
symptoms, you know, they goto their family doctors, or they go
to their chiropractors, or they goto the innurst practitioners, and it takes
about ten years for them to getto us and to finally diagnose with surgery
that they have this because you know, they've had their ultrasounds, they've had
their MRIs, they've had their catscans, and unless they've got big sim

(13:00):
those big signs like doctor Moorehead mentioned, I'm in to be traumas where they
have the big ovary insists and thingslike that, we're not going to see
anything, and so then it finallythey get to us and finally we say,
okay, you have so many symptomsof I mean, we've got to
finally come up with a diagnosis,so you know, and they're in so
much pain. Okay, let's dothis. So how do we go about
you talked about the surgery and howdo how do they get prepared? What

(13:22):
do they have to do for surgery? And what do we do once we
get in there? So it's likethe day of so yeah, we go
in there and we'll we take themto the back and then we get in
there. Okay, look and sowhat are we looking for and what are
some of the things you can dowhile you're in there? Okay, So
you know, it's a it's arelatively straightforward surgery. Laproscopy is what we're

(13:45):
talking about. Where we look inthe belly basically, you know, like
any surgery, they would not eator drink the night before surgery. They
come in that day meet with theansenthesiologist. Usually this surgery only takes thirty
minutes, maybe forty five minutes orso, depending on what we need to
do. We just basically look inthe belly. If we see the indmutrosis.
Then we try to treat it,clean things up the best we can.

(14:07):
Afterwards they'll have two or three littleincisions in the abdomen. Usually you
get back to normal activity pretty quickly. It's only a couple of days of
healing time. Really. We tryto limit activity heavy lifting for a couple
of three days, but you canbe sore for about a week or so.
But after that you're getting back toput in normal activities and then then

(14:28):
take over with some things you know, we do post operatively, and we'll
talk about that in a second,But so before that, one of the
things I want to touch on issome of the other diagnoses, you know,
because people go for years with otherdiagnosses of their pain. You know,
it's is it GI and we talkabout as a durable bowel syndrome or

(14:52):
One of the things that I thinkis probably the worst is when some of
the physicians tell them that it's allin their head. And I know you've
heard that too, and that's prettysad, but I mean, but it's
true. You know, people theycan't find anything. They said, Oh,
you've got to be imagining this pain. Well, I would think just
as a woman too, you know, because different women have different symptoms,

(15:13):
you know, during their mensies.And you know, we're one woman,
we have no cramps at all,and other women, you know, suffer
with it a lot. I couldjust see where they're like, well,
I was just I'm just unlucky.I just have bad cramps. That's what
I have, you know, Andmaybe they ask their mom or their sister
or their girlfriends, you know,and they're like, oh, yeah,
I had bad cramps too, You'refine. Quit being a baby, you
know, stuff like that. Icould see where maybe that could delay it

(15:33):
a little bit, just because thewomen just don't know, well, it's
normal. It's just part of beinga woman. But yeah it might not
be. But I could see,yeah, where that might delay them seeking
medical attention for it and thinking thatit's something worse. But then sometimes you
know, it helps to if wediagnose it. When we don't diagnose it,
we need we know, we needto look at other possible causes.

(15:56):
Right, There's other conditions that cancause how discomfort, musculous skeletal conditions oftentimes
sports medicine. There we have someterrific pelvic floor physical therapists here at Adena
that can help women out with likepelvic floor muscle spasms. You know,
there's something called adenomiosis where the lining. Intometrisis is where the lining eater spills

(16:18):
out into the abdominal cavity. Adnomosisis more where the lining GRoWES into the
wall the eaters and causes discomfort.They have a lot of uterine pain,
a lot of uterine pain pressure.So sometimes it or you know, maybe
we won't find intometrosis, or afterwe evaluate them then we do have to
look further into mouth causes. Obviouslysomething's causing the pain for a woman to

(16:44):
seek the sound, so right,and that's the same we do. We
refer some of them some of malalike the medicine people. Sometimes we send
them over to the GI people,you know, to look for IBS,
diverticulosis. I mean, there's sucha number of things that it could be.
Some times we do the surgeries,we find pelvic inflammatory disease, you
know, where they've had multiple STDsand like you'd mentioned previously, the adhesive

(17:07):
disease and other things like that.They can have a lot of scarring and
a lot of damage from some ofthese other things. So we've done we've
patient has come in she's had allthese symptoms for years, tried other things,
been to different people, They've donethings, and so you do surgery
on them, and you found theendemtrosis. So you did some resections and

(17:32):
you cauterize a few of the areas. You know, some of the areas
we can't touch, for example,if it's on the bow or the bladder,
you have to be careful. Sothen they come back and see you
a couple of weeks later after surgery. So what are some options. What
are some things that we can dofor them? Now, we can do
short term therapy, we don't haveto do anything if they don't want,

(17:52):
or we do some long term therapies, or you can even go on if
it's worse. So let's talk aboutsome non surgical options, things that they
can do to try to relieve symptomsor to help even more so with their
pain. So intemytrisis is hormonally fed. And I guess one thing, you
know, if they're having the painis and what are their goals in the

(18:17):
future. Do they want to getpregnant right away? Do they want to
you know, maybe not get pregnantright away, but optimize the chances of
getting pregnant later or are they notdesign future fertility? But I think that's
a really important point. So it'slike, what do you want to do?
So, because we have someone whoare very young that have this,
do you want to have children?Do you not want to have children?

(18:38):
You may not have somebody right nowin your life, but do you want
that opportunity? And so that's whatdoctor Moritt is here for, because you
know he's going to give you optionsand say, Okay, what work what
will work best for you? Howcan we manage you so that you have
that opportunity to have children if youwould like. So where do we go

(18:59):
with that? So if someone's desiringfertility, you know, once we've done
the surgery and everything's cleared up,it might be a good time to go
ahead and start trying. There's thatwould be a fine time. Then,
like you said, we don't necessarilyneed to do any treatments. We've diagnosed
it, we've resected or gotten ridof the majority of it, and then

(19:19):
that time might be a good timeto try to get pregnant. But if
you don't want to get pregnant rightaway, then indometriosis is fed by estrogen
the estrogen's produced by the ovaries,so anything we can do to kind of
suppress the estrogen production from the ovariescan help out. So or contraceptive pills
lotus both control pills can help tocontrol the symptoms of indometriosis. Other treatments

(19:45):
would be like depo pervera it's astrong progester or the ne expleingon implant in
the arm. Those both just haveprogesterine. They suppress the line of the
uterus. If you suppress the lineinto the uterus, you're also likely suppressing
the endometriosis. So that those hormneraltherapies will help if a person's having really

(20:07):
bad pain. There's some other typesof medicines that basically can One medicine called
loupron. Basically it would be somethingthat was used for about six months basically
shuts down the ovaries, shuts downthe estrogen, kind of helps the endometrisis
to die off ter in that sixmonths. Of course, there can be
a lot of symptoms with the lupron, basically symptoms of menopause, hot flashes,

(20:30):
mood swings. There's some other medicationswe can do to alleviate that,
but Lupron has been around for evenlonger than me. It's been around a
long long while. It can helpto treat it, or there's some new
medications that really are quite effective.They basically, instead of completely shutting down

(20:51):
the estrogen, they just lower theestrogen levels kind of like a dimmer switch.
They turn it down, not solow that that a woman has the
symptoms basically of menopause, but lowenough that some of it will help suppress
the indometrosis. Anything we do thatsuppresses the ovaries can we can bones though,
so you know, there's limitations tohow long we can use these medications,

(21:15):
depending on what we're using, whatdosage. You know, maybe six
months, maybe a year or twoyears. But then the bones seem to
come back pretty quick. They do. Yeah, it's not irreversible bone loss.
I do try to have my patientsmaximize their calcium and exercise while they're
on those medications. But it's atemporary treatment that can really provide some pretty

(21:40):
good longer term pain relief. Andit does work very well. And we've
done this for years for women,and so, you know, and the
interesting thing with what you mentioned,you mentioned a whole you know, variety
of different medications, and you know, one medication just it's not just one
medication works for everybody, right,So everybody has a different response to anything

(22:02):
that we try. So you know, a lot of times you'll come in
and doctor Morier will say, well, let let's try one of these load
dos or contracepts for you, andmaybe you don't have a great response.
He said, well let's try this, you know, and then the next
thing he tries is you're like,I have no pain, this is great,
you know. Or if my periods, you know, we put you
on the depot shot, I don'thave periods anymore. My pain is gone.
I feel great, you know.So there's all kinds of different things.

(22:25):
Other people the load does or contraceptiveswork perfect, so you never know.
For us, it's a sort ofa hit and miss. We have
to try different things. But thatthe nice thing is we have such an
arsenal of medications that we can gothrough that we don't have to say to
somebody, I'm sorry, that's allI have. So we can try all
these things on you and we'll findone of them we'll shouldn't only be worked

(22:48):
for you, so at least youknow, alleviate your symptoms enough that you
can enjoy your life, get onwith your family. You should be able
to work, you know, youknow, love your spouse, whatever you
want to do, be nice toyour kids, you know, you know,
so you don't have to yell atanybody from the pain that you're in
all the time, right, right, And so it's important and you know,
like you know, we talk abouton the show all the time,

(23:10):
it's important of taking care of yourself. And that's what this is about.
I said, you've got to makesure you're taking care of you so that
you can take care of everybody else. So these are what he mentioned are
all short term things. These arethings that we can do, and we
can do some of them for years, but they're not definitive. So if
anybody who really wants to have childrenthings like that, these work great for
right, right. So if youtell me then that I'm done having children

(23:36):
or I want to do something alittle bit more invasive, where would we
go with this? But oftentimes thenyou know, the indimitriosis is fed by
estridge, by estrodge, and soas long as the woman has over hes,
as long as she's premi and apostle, then indmutriosus will still be fed.
So the if a person is donewith child brain and having horrible symptoms

(24:00):
monthly, either by levels oufrectomy wherewe remove the ovaries or oftentimes uffrected me
with the hystrictomy, it would bethe definitive treatment. So, and you
know, I think one of themisconceptions is that's what we can do for
you, and it does. Ittakes away a lot of your symptoms.
Is it going to take away everythingfor life? Can we guarantee that,
you know, no more pain?No, we're nothing. We can't guarantee

(24:22):
that. Nobody can guarantee any ofthat because sometimes you still have a lot
of that scarring built up. Youhave other things in your body that we
can't get rid of. But asfar as is it going to progress,
probably not not. We remove those. Yeah, so we've taken care of
it and it does work and it'sproven to work. But there's there's always

(24:42):
We don't take the hisstractomy lately though, either. We try to make conservative
therapies because if we do it,astracto me sure that may you know,
no more periods. It sounds great, no more pain, that's great,
But there's always the typical surgical risks, infection, bleeding, possible damage to
other organs, organs, there's alwaysrisks, and then prolapse down the road,

(25:04):
down the roads if things fall out. Yeah, if a woman has
a hysterectomy, then you can havebladder prolapse, vaginal prolapse, rental prolapse.
Yeah, you know, so youdon't want to take it lightly.
And he's right, And I knowlistening to doctor more Ed, you know,
even in the office, he counselshis patients about this and it's important

(25:26):
because you just don't want to saywalk and say I want to direct me,
right. You know, they foundso much lately too. I was
just reading recently about you know,if we take a woman's overs out very
young, my guy, should weincrease the risk of cardia a vascular disease
so much later in life. So, you know, we really tried to
preserve the overs as long as possibleand control the symptoms because it can help

(25:49):
the pain. But down the roadit can lead to many, many other
issues if we Yeah, aggressive arethere for a reason and not just to
have kids. I mean, theyprotect the like that's why they're the longer
than we do. You know,so it keeps the bone strong because women
were smarter. That's that's one ofthe other things. You know, have

(26:10):
you seen those things when they talkabout all these silly things these guys do
where they're standing on you know,put a ladder on something. They're trying
to get something in a window andput a ladder on a ladder, you
do that. Yeah, so it'skind of crazy. But yeah, men
are sort of stupid sometimes. Butbut yes, but the women are.
They are the stronger sucks and there'sno doubt about it. But the ovaries

(26:30):
are there for a reason, andunless we really have to take them,
we don't want to take them becausethey do so many other good things for
you. And uh, but insome situations we don't have to. Yeah,
we don't have a choice. It'sa risk benefit ratio. So but
again, like you said, there'srisks with hysterectomy, there's risks, so
there can be major risks, soyou know, you don't take it lightly.

(26:52):
And we use it as the lastresort because everything else has failed and
there's nothing else that we can do. But you know, so, but
like I said, that was oneof my last missing facts. You know,
it is the historactomy go to cureeverything. No, not necessarily.
The fact is it really doesn't.If you've got bad issues there, the
issues are still there. So butagain, like I mentioned, and you

(27:15):
have to take care of yourself.And I think part of the issue of
this is you have pain, itdoesn't mean that's in your head, and
make sure you're seen, make sureyou take care of yourself, make sure
you take care of it for youand for your family. And we've got
wonderful physicians like doctor Morehead and allof our partners that will be glad to

(27:36):
take care of you. You canget in to any of us at the
offices. Just get on at Adenadot org, get on you know,
the women's healthcare site Adena Women's andwe're switching over to one phone line now
that you can call and then youcan ask for you know, the office
at the hospital or up on Blackwaterwherever you want to go, and we'll
be glad to take care of you. But we can get you in pretty

(27:59):
quick take care of these things sothat you don't have to hurt right right,
Absolutely, Is there anything else thatyou want to say to the audience.
I know he's just smiling. Iagree it's a cause of a lot
of you know, a lot ofpain for women, a lot of miss
days at work, a lot ofjust not happy days, you know,

(28:22):
several days a month where you justcan't function normally be there for your family.
So definitely, there's many things wecan do, surgical or non surgical,
that can be very effective at helpingto make you have a better life.
Yeah, so don't suffer. Don'tsuffer. I think that's the main
goal of this whole thing. Don'tsuffer. We're here for you. We
know there's issues. You know,twenty percent of women have this, So

(28:45):
you're not alone. You're not alone. It's there, the numbers are high.
So we're here to help you anythingyou need. And the light's always
on, right, that's right.I think that's the first step. You
know, tell your guyecologist, ifyou don't have a guy in collegest like
you said, go on a Dinadot org. They are so good about

(29:07):
you can kind of interview your physiciansthere. You can look at them,
you can see the pictures, youcan see how long they've been you know,
how long they've been a doctor,how long they've been with adena,
all kinds of things you kind ofinterview them there a little bit. Check
that out. It's so easy tofind a physician you Chile, your primary
care physician first, then they canrefer you somewhere. So don't sit there
and suffer. If you think thismight be happening to you, ladies soon,

(29:30):
just seek some help. aDNA dotorg. That's the first place to
start, right Doctor Villarreal, Absolutely, all right, good deal. This
has been Lady Parts with Doctor RichardVillarreal. It airs the third Monday of
every month at ten am right hereon Mix one OO six five in Chili
Cooffee. You can also catch thepodcast on iHeartRadio. Just open the free
iHeartRadio app, click on Podcasts,and then do a search for Lady Parts

(29:51):
with Doctor Richard Villarreal.