Transcript

#84 Pelvic Pain – A Fresh Approach to Endometriosis and Adenomyosis with Dr. Peta Wright

[00:00:00] Welcome back to episode of the Hormone Hub Podcast, where we talk all things perimenopause, menopause, and have the conversations no one else is having. Sit back, relax, and enjoy this episode. 

Kylie: Hello, hello, and welcome back to the Hormone Hub. In today’s episode, we are very lucky to have Dr. Peta Wright with us. Peta is a gynecologist, a pediatric and adolescent gynecologist, which I think is amazing because I’ve not come across that before. And also, a fertility specialist. She’s the author of Healing Pelvic Pain and also one of the owners of Vera Women’s Wellness in Brisbane. So Dr. Wright is [00:01:00] committed deeply to all aspects of women’s healthcare and, you know, founded the Vera Women’s Wellness Clinic in 2020. She strives to take a holistic approach to managing the health concerns of women of all ages.

Um, she’s also very highly tuned to the ways that nutrition, stress, and lifestyle can affect hormonal imbalance, hormonal balance and aims to help women work on these aspects of their lives as part of their overall health picture. So for those listeners who’ve been with me for a long time, we are definitely on the same page.

And I first heard Dr. Peta, speak at the Metagenics Women’s Wellness Symposium, which was amazing. So, and I’m sure you’re going to get a lot from what we have to talk about today. So welcome to the show. 

Dr Wright: Thank you so much for having me. I really appreciate the opportunity. 

Kylie: No, my pleasure.

So obviously, for you to get into sort of [00:02:00] gynecological health. Was there any sort of pathway that sort of triggered you to, to, to go down that route? 

Dr Wright: Um, I always wanted to be a doctor. I just always remember wanting to help people from the moment I would be like sewing up my dolls, um, when I was a child.

And then when I did medicine, I sort of, I probably fell in love with, I got into gynecology through delivering babies so that, that, being very privileged to be involved in that incredibly vulnerable, beautiful time in women’s lives when they give birth to their babies or when they’re pregnant with their babies.

That was the drawcard for me getting me into gynecology to begin with. And then over the years, when I, when I got into private practice, actually, after I had my own baby and I sort of stepped back from obstetrics a little bit more, I realized kind of potentially how [00:03:00] badly we’d all been doing gynecology for a really long time, including me.

And how it was often that women’s problems were seen as or women’s women’s problems really were seen as just to do with the uterus or the vagina or the vulva, and they kind of the conventional Western approach would be often to not take any account, uh, any consideration into the rest of a woman’s body, her nervous system, her brain, her environment, her culture.

And as I started to see more and more women, I found that I was, it was impossible for me to see someone for, you 15 minutes and just deal with the, like the gynecological issue that came because it became very, very clear to me, that everything was connected and that if we just dealt with a symptom, in, you know, often the very biomedical way I was taught, it’s like a bit like playing [00:04:00] whack a mole and not really ever getting to the root of the problem.

And so I spent a lot of time listening to the, to my clients and then realizing all the stuff I didn’t know and that I had to learn. And, so I did some extra training in nutrition and then in, integrative women’s health through a really amazing, practitioner in the U. S. called Dr. Aviva Rom, who’s wonderful, who was a midwife and a herbalist before she became a doctor.

And then after that, I kind of, didn’t see things the same way and I couldn’t go back to practicing the way I practiced. And then I found that there’s so much beauty to be uncovered in women’s lives and women’s bodies that I feel have been, kind of taken from us or taken from them. And so I kind of think a lot of what I do now.

It’s not giving anything to women, but really uncovering what’s been there all along and helping them to [00:05:00] remember the wisdom that their body holds that I think our culture sort of conditions us or them to forget. And I think that actually contributes to so many of the problems that women are presenting with, and it’s just like gynecology as a field, it just is like very much.

Pathologizing women’s bodies. And of course, there are definitely conditions that are really need, you know, surgery and intervention and medication, but I think for the vast majority of things, it’s often the effects of of lifestyle and environment. and culture that actually it’s not the woman’s bodies at all.

It’s the effect of, of, of those things on the woman’s body. So I think we, we have to remember that when we’re treating women, but yeah, and now I love, I love what I do, but I make sure that I have the time allocated to, to listen to women. Be able to hear their stories and put all the pieces together so it can get to the, to the root of the problem.

Kylie: [00:06:00] Yeah, I love that so much. And, and I think, that’s going to be music to so many women’s ears because, they are treated as symptoms or they, you know, Oh, you are endometriosis. You are, bad periods or, you know, whatever it is. And I, love the fact that you’re, you’re listening to them and having the conversation.

And I say to, women all the time, because they’re sort of like, well, what blood test do I need for my hormones? And I’m like, well, you don’t actually make a blood test because that gives us a snapshot of what’s happening in the moment. Tell me what’s going on. And you do, you get so much more from that conversation because you get the whole picture of what’s going on.

And the thing that I find really sad is, so many women who have debilitating, gynecological issues and we’re to the point where they need to take a couple of days off work each month because they’re in pain or, they’re experiencing flooding and things like that. And that is their normal.[00:07:00] 

Their sister is the same, their mother’s the same, their auntie was, were the same. So that’s just normal for them and they just deal with it. And that sort of blew my mind because I’ve always been, I guess, blessed with a healthy cycle where my period just arrives. I might bleed for sort of five days and then it goes and it’s sort of no real issues.

So until I went down this pathway, I had no idea of of what a lot of women just put up with, which really shocked me. It still shocks me. I think every single conversation I have, I’m constantly blown away with what women, are coping with on a daily basis. 

Dr Wright: Yeah, I think women, definitely there’s that thing of being told that something’s normal and that they just need to put up with it.

But then there’s also this kind of, like, I always hate it when, and I think that any symptom that a [00:08:00] woman has that is interfering with the life that she wants to lead needs to be addressed. Yes. Sure, because there’s so many things we can do and that they have options. But I also think that we live in a culture where, women are supposed to pretend that they don’t actually have a uterus or ovaries and we have to pretend that that cycle doesn’t happen every month.

We have to pretend that like the number of times I have had women say, Oh, my hormones are up and down. And yes, your hormones are up and down. They’re supposed to be up and down. It’s, it’s the society that doesn’t accommodate for that or educate. And so then women think they’re terribly drastically abnormal.

And with periods. It is an event where our energy is lower, we, most people do have some pain, it’s an inflammatory event in the body, while I don’t think that being bed bound and suffering is normal and should always be investigated, I do think that we have a [00:09:00] tendency in our society to make zero room for the, that event every month, which I actually think contributes to the pressure and the suffering that women feel because they feel so guilty that exactly the same every minute of their month, even when they’re bleeding and even when they’re having some cramps, that I actually think that if there was allowances and room for the 50 percent of the population that has a period to give themselves more time and space and nurturing during that time and for that to be acceptable, I think there would be a lot less suffering and a lot less pathology.

Yeah. And also the other thing is to that, like women suffering with things they don’t need to, but also women feeling like they don’t have a choice. I saw a lady the other day who’d had, endo, but that had been not given any choices for her treatment of endometriosis. And so it had surgeries, had, was on, you know, two different kinds of hormonal medications, which since then she’d [00:10:00] put on.

Like quite a lot of weight, like 20 kilos or something. And then she actually started Ozempic to combat the effects of the drugs that she was on, when she didn’t probably need to be on those drugs to begin with. But, and when I talked to her about this, she was like, I could tell she was totally baffled and confused because it wasn’t the advice she had.

She said to the follow up appointment, I didn’t realize I had got to choose what chain. Things were right for me. Yeah. Yeah. It was like the, it’s the thing of treating the condition, treating the diagnosis or the label of the thing that you’ve got, but not taking into account that there’s a human being at the center of that.

And so that the treatment often becomes worse than the disease you’re trying to treat. Yeah. And women do feel more broken. Yeah. 

Kylie: And that’s it. And then, you’ve got that whole, you’ve got anxiety that kicks in the whole self worth and that [00:11:00] self esteem of that, that woman, sort of drags everything down as well.

So, yeah. So what sort of, symptoms do you tend to see, what are clients coming to see you with typically in perimenopause? 

Dr Wright: Um, I would say that they might come to see me with hot flushes, vaginal dryness, lower libido, lower energy, brain bog, word finding difficulties like we were discussing earlier.

Lack of sleep. So insomnia, more anxiety, more irritability. All of those kinds of problems. I don’t know if I said weight gain. And then so I get people with some symptoms and then sometimes I get people who are just anxious about the perimenopause transition. So I get people coming and going. Am I, I’m 47.

Am I in perimenopause? Like it’s the worst thing in the world and it’s a diagnosis in itself. So I think again, well, it’s wonderful that we’re actually talking openly about this time in our lives. [00:12:00] Women understand what’s happening to them and they can put words to it and that those words can then help to explain the things that are happening and then lead to a plan if they need a plan.

And options. I also think there’s, there’s still that this tendency to pathologize even this part of a woman’s body, like, life span. Yeah. It is a natural and normal part of our life. (Kylie) Yes. Life and I think that that sometimes the medicalization of that drives me a bit crazy too. And so that then women just thinking, Oh my God, I’ve got this looming diagnosis of like

Kylie: an illness. 

Dr Wright: Right. What can I do to stop it from happening? Not a lot. No. But then I think it then speaks to the fact that there are, there are symptoms of our changing hormones and then this coincides with the time of our lives. That is, it’s that time where like we get tapped [00:13:00] on the shoulder and get told this is not a dress rehearsal.

This is the real deal. What are you doing? And there’s that spiritual, opportunity for spiritual growth and transformation that I think. That many women don’t get that and I think if women could understand that it’s this also this opportunity for spiritual transformation and growth as we enter this next part of our life, that would be a really beautiful thing because there’s a lot of beauty in that.

Kylie: And I think when you look at other cultures, they do, it’s very revered that whole menopause transition and they sort of become the wise matriarch. Whereas, yeah, I mean, I was reading an American article, not that in, in America, they’re still referring to menopausal women as crones. And I’m like, surely you can come up with a better word than that.

Dr Wright: I know. And it’s also like everything’s, I mean, there’s so much misogyny in medicine in general, but you know, where [00:14:00] men are still the standard, but in with, I also find that women who, Oh, I’ve got this lower libido and I’m like, you know, 55 and my hormones have dropped off a cliff. You’re like, well, yes, because you’re no longer wanting to reproduce.

And like, that’s hormonally the body. Plus there’s like often a long term relationship. Often women are stressed out of their mind. There’s a lot of valor. You’re exhausted, but there’s this idea again, that It’s abnormal. And because we’re measuring libido is somehow like the perfect libido is like when you’re 25 and you’ve just met someone you’re crazy about.

And like, if it’s not that, then there’s something wrong with you as well. Like that. So I just think really like with women who come to see me at perimenopause concerned on one hand, like a lot of the things that happen post perimenopause post menopause, I should say, because obviously perimenopause is like such a fuzzy word, but [00:15:00] it just means the time.

Yes, menopause. And menopause is just that time when our hormones stop being made, from our ovaries and after menopause. You know, you read all those, all the bad things that can happen, osteoporosis and heart disease and diabetes and dementia and, and you know, everything dries up and it’s horrible.

And, and I think that, oh, they’re actually, you know, that. It’s aging, right? And because our culture is so unbelievably obsessed with clinging on to that, like youth, it’s very, very scary, but I think that we need to keep into keep to understand that we can still be healthy, vibrant people, through menopause, and it’s just a really great opportunity to like check in what’s working for me, do a full health check.

What do I need to optimize in terms of diet and exercise and sleep and stress often is a huge thing. And no hormones can play a role in that. We’re using hormone therapy, but so [00:16:00] can herbs and supplements and a whole lot of other things. And it’s not doom and gloom at all. 

Kylie: No, not by any means. And then if we sort of circle back to sort of pelvic pain, a lot of women sort of become aware for the first time, maybe that they have endometriosis.

A lot of women in our community have recently had, adenomyosis diagnoses. So what, what sort of, I guess, pathways are available for women with, who are suffering pelvic pain? 

Dr Wright: So I think first of all, it’s important to say, I’ll just talk about adenomyosis for a moment.

Adenomyosis, which is the presence of endometrial cells or the lining cells of the womb that are growing in the muscular layer or the wall of the uterus. Something that’s actually pretty common in older women, in menopausal women. And, we [00:17:00] see it much more commonly now because our imaging sensitivity is so much better than it used to be.

So we’re probably picking up adenomyosis that, that may not be clinically relevant a lot of the time either. So. And one of those things that often can be as a result of sort of the wear and tear of menstruation of a lifetime of menstruation. So it’s, I don’t believe that it’s pathological all of the time, just like endometriosis.

I don’t believe it’s pathological all of the time. And there are many who have, have features of adenomyosis on an ultrasound, which they might have had and don’t have particular problems. And then I’ve seen women who have gotten really worried. Oh my God, this is a thing that I’ve got. And I think that in the absence of any symptoms, it’s nothing you need to worry about whatsoever.

It’s probably just a result of that wear and tear, probably more likely if you’ve had cesarean sections, if you’ve had like curettes and things like that, it can be associated with heavy [00:18:00] bleeding and, with more painful periods and often at perimenopause, one of the things that women can present with or part of the, what happens with the hormonal picture of less progesterone and less regular ovulation is that women start to have more heavy periods because of that.

And they might get an ultrasound and they may say there’s adenomyosis, which may or may not be contributing to the heavy periods because it might be hormonal. It might be might be a combination of things. And in that case, I would be simply treating the problem that they have got, like the heavy bleeding or the pain.

So I wouldn’t be fixated on the adenomyosis if you’re in a causal time. So if you have… periods, looking at, again, all of the dietary stuff, looking at treatments that might be non hormonal, like, tranexamic acid, which is a medication that’s non hormonal that can be really helpful for women at this time, who want not to have hormones, making sure iron’s okay, and taking an [00:19:00] iron.

Sometimes using some progesterone. So using natural progesterone, and if that helps, that’s great. It works obviously to give the lining a bit more progesterone and thin it out. And it also can help with, adenomyosis because progesterone is inhibitory to those endometriosis. And adenomyosis cells, it might look like using a Mirena, so a progestin containing intrauterine device, which is probably one of the best ways if you’re not winning with the other things that can really help.

I think that you need to like measure again and again or anything like that. So I would be treating the things that it, that it’s causing. I have seen, for example, I’m thinking about a woman who had a random bit of pelvic pain that came and then went and she never had it again, but she had a scan by her GP.

The GP said, you’ve got adenomyosis. She got referred to a gynecologist. She had no symptoms otherwise at all. No heavy bleeding, no painful periods. The [00:20:00] gynecologist did a laparoscopy and put two Mirenas in this woman who had no problems before and then came to see me because she’s since developed cramping and a lot of hormonal side effects. Out she felt like, my God, what do you mean? I didn’t have to have this again. It’s a, it’s a lesson in treating the human and not the things. 

Kylie: Yeah, that’s right. Just because she ticks a box on paper doesn’t necessarily mean that, it’s not symptom therefore treatment. Correct. 

Dr Wright: Endometriosis in midlife as well.

So in our 40s, 50s so endometriosis is again, something that we think of like a homogenous, it’s all the same thing, but it’s not again. So most endometriosis is superficial. So like 80 percent would be superficial in the uterus that grow in the pelvis. So in all kinds of [00:21:00] places on the bowel, on the uterus.

On the ovaries on the bladder and again, I think a lot of endometriosis is probably due to again, a physiological process, the mild endometriosis that we, we see a lot of, when we have a period, not 100 percent of the time, some of that blood comes out through our pelvis.

And our immune system should clean those up if our immune system is overactive or dysfunctional, it can not do such a good job and we can get a lot more inflammation, instead of it just being cleared up. But a lot of that superficial endometriosis can probably be as a result of that wear and tear and it comes and goes.

And we know by studies that when they’ve looked at inside the, pelvises of women. Who have been found to have endo if they look again in six months time, not having done anything to it whatsoever. Some studies show up to 44 percent has completely resolved by itself. [00:22:00] So it is a, it is a dynamic thing in our bodies, just like if we have a cut, our immune system will do a good job.

Some women have more severe forms of endometriosis like ovarian endometriosis or ovarian endomet, they’re called ovarian endometriomas. So it’s big cysts of endometriosis and they like stick to things and cause more pain. Although again, some women have that and have no pain. Some women have mild endometriosis and have no pain, probably up to about 40 percent again.

And then there’s, and that’s about 15 percent with your ovarian endometriosis. And then, and that can be diagnosed on ultrasound and then deep endometriosis, which is probably the most severe where we get lots of scarring, lots of, think organs sticking together, lots of information that probably accounts for about 5 percent of women with percent and probably has a lot to do with, immune system dysfunction as well.

So for women who are in their 40s and 50s who might be presenting with pain, [00:23:00] again, I would be looking at all the potential causes for pain. So, yes, endometriosis can be one of them, but so can, so the regular inflammation of the period. If you’re having a big heavy bleed, is there, you’re releasing a lot more prostaglandins or inflammatory prostaglandins.

So you can look at reducing inflammation in the body through diet, through supplements like zinc, magnesium, omega threes, curcumin, vitamin D, if that’s low as well, to help to support the immune system, looking at diets on anti inflammatory. Mediterranean style diet, lots of fiber, lots of good fats, looking at the nervous system.

So what’s happening in terms of stress in this woman’s life? Looking at the brain, is there like, and any element of pain system, hypersensitivity where the volume knob of pain gets turned up and that can often be related to stress and trauma. What’s happening with the pelvic floor muscles as well, because often [00:24:00] that is a big source of pain.

So, especially with women, when we’re stressed, we, or if we have pain in our pelvis, we contract our pelvic floor muscles when we’re often not aware of it. We often don’t have a good connection to our pelvic floor. On that ongoing over time, tension can lead to pelvic floor muscle spasm, and that can lead to more pain as well.

So I would be looking at all of those things. Really good quality ultrasound scan like a proper like tertiary level scan if it was normal if it showed everything was mobile and lovely Then I’d be really reassured that if there was anything it’s just going to be superficial endo if there is an ovarian endometrioma Or a deep lesion.

They are probably the ones that are the most likely to respond to surgical intervention But again, it doesn’t need to be surgery if that’s not what the problem Human in front of you once there are a whole lot of other things that we can do to to treat pain. And I think that’s the important thing, especially.[00:25:00] 

Kylie: Yeah. Yeah. So ladies, if you’re listening, you have choices, and I think that’s really important. And just that diet, nutrition, self care, stress management, is so important, for so on so many levels, but it really just comes back to every single time is those, those basic, you know, and I think the way we feed ourselves is the most basic form of self care.

You know, it just keeps coming back every single time to, you know, to those, those key things. Absolutely. Yeah. Well, thank you so much for, for sharing that now, Vera Women’s Wellness, where abouts is your clinic? Like if somebody wanted to reach out, where’s the best place actually I’ll put the link to your clinic in the show notes, but, yeah. Just if you could tell us where your clinic is. 

Dr Wright: So we are just outside of Brisbane. So we’re about 40 minutes outside of Brisbane. We’re in the Sanford Valley or Mount Sampson. So it’s a [00:26:00] really beautiful spot. We’re intentionally here because again, I was seeing so many women who were so rushed and stressed and seeing the gynecologist in their lunch hour, not even being able to take time out for that health appointment.

So it creates space for you to actually be forced to take some space in your life to come here and it’s beautiful and natural surroundings. We have lots of different practitioners here, which is wonderful. Yeah, so that’s where we are on our website. You’ll, you’ll put on the, in the show notes. 

Kylie: Yeah, absolutely.

And you also have a summit coming up. So the Vera Women’s Wellness Wisdom Summit on the 28th and 29th of October, which sounds amazing. So yeah, do you want to share a little bit about that? 

Dr Wright: Yes. So it is not. As unlike any other medical conference you’ve ever been to, but if you’re any, a woman’s health practitioner in any way, shape or form, or if you’re someone who’s just really interested in women’s health, it’s two days on a weekend, 28th and [00:27:00] 29th of October.

And we have, a big session on pelvic pain in the morning with a great panel. We have, workshops on embodiment, On, like somatic psychotherapy, we have Dr Oscar Seralac speaking about, the neurobiology of the maternal brain and nitrescence. We have, a beautiful, our beautiful dietician talking about intuitive eating and diet and the nervous system.

And we have a great gastroenterologist, talking about. food industry and, the gut, as well as two sessions on menopause, one by one of our beautiful gynecologists, talking about perimenopause. I think it’s called the magic of perimenopause and our yoga teacher, Sam Lindsay German, speaking about menopause as a spiritual transition as well, which is so often not spoken about.

So I’m sorry for that, too. 

Kylie: Oh, that sounds perfect. Unfortunately, I’m going to be away that weekend. [00:28:00] But yeah, if there’s, I’ll be keeping my eye out for the next one. It’s something that I would love to, to come and, be, be a part of, cause I think it’s just so important, to be having those conversations and letting women know that, you do have choices.

It doesn’t have to be this big, hard, horrible thing. It can, it’s a natural transition. We’re all going through it and, you know, we can embrace it, and, and enjoy it too, because yeah, it can be quite empowering. Now you also have a book, as well, which I wanted to mention. So, Healing Pelvic Pain.

So where is the book available if anyone’s looking for it? 

Dr Wright: The book is on Amazon, Booktopia, any online bookshops and most, in person bookshops. So like, yeah, most bookshops, Big W, all of those things in person, but online and all of the usual places you buy books. 

Kylie: Amazing. Because I’m going looking for that and congratulations on being a published author as well. That’s very exciting. 

Dr Wright: Thank you. I [00:29:00] just had too many thoughts about things and I just thought it was better to get it down and then hopefully. To be able to provide knowledge, which can empower women so that they have those choices and then they, I just am so passionate about knowledge and empowerment because, putting the tools back in the hands of women is really important.

Kylie: Amazing. I think that’s fabulous. Well, Dr. Peta Wright, thank you so much for being on the Hormone Hub. It has been, I’ve really enjoyed our conversation. So I, and I do appreciate, I know you, you’re a very busy woman and I do appreciate you giving up your time, yeah, to come and be a guest on the show.

Dr Wright: Thank you very much. My favorite thing is talking to women about their bodies. So it’s my pleasure. 

Kylie: Yeah. All right. Thanks for listening everyone. And yeah, we will see you in the next episode.

Thank you for taking the time to listen today. You can head on over to the show notes at kyliepinwill.com/podcast where you’ll find [00:30:00] all the links. Now, before we go, it would mean the world to me if you’d head on over to your favorite podcast channel, subscribe and leave a review. Don’t forget to share it with your friends.

Then stay tuned for next week’s episode and I can’t wait to see you then.