ACOG's New Endometriosis Guidelines: What Changed & What's Missing?

Send us a text with a question or thought on this episode ( We cannot replay from this link)Endometriosis care has been trapped for years in a confusing loop: patients are told diagnosis requires surgery, then they are told to “try hormones first,” and nobody clearly explains what success is supposed to look like. We sit down with Dr. Jeff Arrington, advanced minimally invasive gynecologic surgeon and endometriosis excision specialist, to unpack the updated ACOG endometriosis guidance and ask the uncomfortable question: did the update actually move care forward in the ways patients need?We talk through what guidelines are intended to be versus how they function in real life, from residency training to insurance decisions. Then we dig into what the new document gets right: a more accurate definition, better inclusivity, attention to delayed diagnosis, and a clearer push toward shared decision-making. But we also name what’s missing, including a deeper discussion of management, clearer referral triggers, and practical direction for clinicians who do not treat endometriosis every day.A big focus is diagnosis and imaging. We explore symptom-based clinical diagnosis, why “just call it endometriosis” can be misleading, and how a history-guided exam plus endometriosis-focused ultrasound staging or MRI can help assess severity, reduce surgical surprises, and support true informed consent. We also lay out a patient-centered way to choose among observation, symptom-focused care, or surgery, with honest risks and benefits, including why pain can persist even after excellent treatment.If you want clearer language, better options, and a care plan that respects autonomy, hit play and share this with someone who needs it. Subscribe, leave a review, and tell us what you want future endometriosis guidelines to prioritize.Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)A stent in a vein can sound extreme until you hear the step-by-step reality. We sit down with Dr. Brooke Spencer, a board-certified interventional radiologist and a leading voice in complex venous disease, to unpack what iliac vein stenting is, how she approaches it in practice, and why the workup matters just as much as the procedure. If you are searching for answers around chronic pelvic pain, pelvic venous disease, or venous compression, this short conversation is built to replace fear with clarity.We talk through how access works and why Dr. Spencer often uses the saphenous vein in the thigh, what a venogram can reveal (and how vein spasm can change what you see), and how intravascular ultrasound (IVUS) helps measure the inferior vena cava and iliac veins with precision. You will also hear why she evaluates beyond one narrowing, since many patients with iliac vein compression may also have renal vein compression, often discussed as nutcracker syndrome.One of the most useful takeaways is her reasoning on pressure measurements and collateral veins. The iliac system can decompress through countless collaterals, while the kidney behaves like an end organ with a more direct drainage pathway, which can make renal pressures especially informative. We also dig into why symptoms can show up far from the pelvis when blood reroutes through less-talked-about pathways, and what that can mean for people who feel like their symptoms do not fit a neat box.We close with honest context on stent longevity, modern venous stent design, and why stent sizing often surprises patients. Subscribe for more quick expert answers, share this with someone who is stuck in the “no clear diagnosis” loop, and leave a review so more people can find it. What question do you want us to bring to the next Quick Connect?Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)IVF can feel like a cruel tradeoff when you’re living with endometriosis or adenomyosis: you’re doing something hopeful for your fertility, and suddenly your pelvic pain ramps up. We sit down with Dr. Sadikah Behbehani, an OBGYN and reproductive endocrinologist trained at McGill University and the Mayo Clinic, to explain why this happens and what it actually means for your long-term endometriosis plan.We talk through the two biggest drivers of IVF pain flares. First, endometriotic implants can be packed with hormone receptors, so the very high hormone levels used in ovarian stimulation can make those lesions more inflammatory. Second, the ovaries physically enlarge during stimulation, which can pull on ligaments and irritate areas where endometriosis sits near the ovaries. Dr. Behbehani also shares a reassuring point: while symptoms can worsen temporarily, there isn’t data showing IVF makes endometriosis “spread” to a higher stage.Then we get practical about strategy. Should you do egg retrieval before endometriosis surgery, or clear disease first to protect quality of life? We cover what happens to AMH (anti-Müllerian hormone), why egg count often drops after endometrioma surgery even with careful technique, and why age remains the strongest predictor of egg quality and pregnancy success. If you’re balancing pain, timelines, and tough decisions about repeat IVF cycles, this conversation is built to give you clarity you can bring straight to your doctor.Subscribe for more quick, expert-led answers, share this with someone navigating endometriosis and IVF, and leave a review so more people can find the show. What question do you want us to tackle next?Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)What if the reason pelvic pain won’t budge isn’t another mystery lesion, but a pressure problem hiding in plain sight inside your veins? We’re back with Dr. Brooke Spencer, board-certified interventional radiologist and venous disease specialist, to talk through the questions that come right after diagnosis: when iliac vein stenting makes sense, what a high-quality workup looks like, and why May-Thurner syndrome, nutcracker syndrome, and pelvic venous insufficiency can mimic everything from endometriosis to bladder disease.We get concrete about the procedure itself: venography, intravascular ultrasound (IVUS) measurements, how hydration can change vein sizing by millimeters, and the real-world risk profile patients worry about most (migration, clotting, back pain). Dr. Spencer also shares what she’s seeing with newer venous stent techniques, why EDS fears don’t always match the data, and how a newer non-opioid pain option (Journavx) may change recovery for people who have already been through too much.Then we connect the bigger dots: positional pelvic pressure, POTS-like symptoms, mast cell activation and histamine pathways, long COVID inflammation and microclotting, and pelvic floor varices that may contribute to pudendal neuralgia, vulvodynia, and painful intercourse. We also talk about building better patient education and access through the Sapphire nonprofit and why multidisciplinary decision-making matters, especially for younger patients and severe disability. If this conversation helps you, subscribe, share it with someone stuck in the chronic pelvic pain loop, and leave a review so more patients can find these leads.Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)What if the “mystery” behind chronic pelvic pain isn’t another diagnosis—but a blood-flow problem that was never fully evaluated?In this episode of Endo Battery, we sit down with Dr. Brooke Spencer, a board-certified interventional radiologist and venous disease specialist, to explore the often-overlooked world of vascular compression syndromes and pelvic venous disorders.We break down May-Thurner syndrome (iliac vein compression), Nutcracker syndrome (left renal vein compression), and pelvic venous disorders—including why the term “pelvic congestion syndrome” can sometimes create more confusion than clarity.Dr. Spencer explains how impaired venous flow can cause blood to reroute through collateral veins and why vascular problems may show up as symptoms that seem completely unrelated to the vascular system—including pelvic pain, nausea, hip and back pain, bladder and bowel symptoms, leg discomfort, fatigue, and other difficult-to-explain symptoms.We also discuss the potential overlap between vascular compression, hypermobile Ehlers-Danlos syndrome (hEDS), POTS, dysautonomia, and long COVID, including how venous pooling and impaired venous return may contribute to symptoms such as brain fog, headaches, fatigue, heat intolerance, and orthostatic symptoms.And then we get practical.What can standard imaging actually see? What can it miss? Why might venography with intravascular ultrasound (IVUS) provide information that other imaging does not? And how do physicians determine when venous compression is clinically significant enough to consider treatment such as a venous stent?We also talk honestly about the evolving evidence surrounding venous stenting, patient selection, treatment thresholds, and why long-term data—particularly in younger patients—is still developing.If you have endometriosis or chronic pelvic pain and have ever wondered, “Does endometriosis really explain all of this?” this conversation offers another piece of the diagnostic puzzle—not a promise of a hidden diagnosis, but a framework for asking better questions and knowing what may deserve further evaluation.This episode is about expanding the differential, understanding your vascular anatomy, and becoming a more informed participant in your own care.Subscribe to Endo Battery for evidence-based conversations about endometriosis, chronic illness, pelvic pain, and the complicated systems that can intersect with them.Charging our lives when Endometriosis drains us.Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)What if the question running through your mind every time a new symptom appears isn’t “What is this?”—but “Am I in pain, or am I in danger?”When you live with chronic pain, endometriosis, pelvic pain, EDS, PCOS, Hashimoto’s, MCAS, or other overlapping conditions, your nervous system can learn to treat every new sensation like an emergency. After years of delayed diagnosis, medical trauma, and having your symptoms dismissed, that fear makes complete sense.But what if there’s another way to respond?In this Quick Connect episode of Endo Battery, we’re joined by Dr. Taylor Reyes, a licensed physical therapist and board-certified functional manual therapist, to explore the connection between chronic pain, the brain, the nervous system, movement, and healing.We unpack the “onion layers” of healing and why symptoms can change, move, or show up differently as your body and nervous system evolve. Dr. Reyes explains how to distinguish pain from signs of true medical danger without dismissing or minimizing what you feel.We also explore a powerful cognitive behavioral therapy grounding statement:“I’m in pain, but I’m not in danger.”And we get practical about what you can actually do when pain shows up—including gentle therapeutic movement, working within a pain-free or tolerable range of motion, understanding the difference between sharp pain and safe discomfort, and using a forceful exhale to create core support and make movement feel more comfortable.Plus, we talk about another layer that can complicate the picture for many people in their late 20s and 30s: perimenopause, changing hormones, and new or shifting symptoms.If you’ve ever felt afraid of your own body because you don’t know what the next pain, sensation, or symptom means, this conversation is for you.In this episode, we discuss:• Chronic pain and the brain• Pain neuroscience and the nervous system• Endometriosis and chronic pelvic pain• EDS, PCOS, Hashimoto’s and MCAS• Why symptoms can shift over time• The difference between pain and medical danger• “I’m in pain, but I’m not in danger”• Retraining chronic pain patterns• Cognitive behavioral therapy and pain• Therapeutic movement and pain-free range of motion• Sharp pain vs. safe discomfort• Breathing, exhalation and core support• Pelvic health and physical therapy• Perimenopause and changing symptoms• Building trust in your body again🎧 Press play, subscribe to Endo Battery, and share this episode with someone who needs a different way to think about chronic pain.And if this conversation helped you, leave a review—it helps more people find the information, validation, and community they deserve.Endo Battery is here to help you recharge your knowledge, challenge outdated thinking, and navigate endometriosis, chronic pain, pelvic health, and life with chronic illness.Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)We talk with Dr. Jennifer Gaudiani about why neurodivergent people with chronic illness can miss hunger cues, struggle with meal planning, and feel overwhelmed by fullness. We connect the dots between sensory experience, shame, and restriction, then look at how treating ADHD can make nourishment feel more doable. • how neurodivergence changes hunger cues and interoception • sensory factors like texture, smell, and fullness that can drive avoidance • why the system is built around neurotypical expectations • how shame builds when bright kids cannot fit the mold • the focus myth of restriction and the real cost of malnutrition • why disordered eating is biopsychosocial, not an appetite problem • how ADHD treatment can reduce self-medication through restriction or caffeine Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)Does endometriosis really “come back” after surgery?And what if what we call recurrence isn’t always recurrence at all?In this episode of Endo Battery, we sit down with Professor Gaby Moawad, a globally recognized leader in robotic gynecologic surgery and endometriosis management, for an honest conversation about one of the biggest questions patients face after treatment:Can endometriosis come back?Dr. Moawad explains why endometriosis recurrence remains so poorly understood, why researchers still struggle to clearly define different disease subtypes, and how genetics, inflammation, immune factors, gene expression, and the extent of disease can all influence what happens after treatment.We also unpack the difference between recurrence and persistent endometriosis, why surgery alone may not be the entire long-term treatment strategy, and why patients deserve realistic information instead of false reassurance.If you’ve ever searched:• Does endometriosis come back after surgery?• Can endometriosis return after excision?• What causes endometriosis recurrence?• How successful is endometriosis surgery?• Can endometriosis be completely removed?• What happens after endometriosis surgery?• How do you prevent endometriosis from coming back?This conversation is for you.Because managing endometriosis isn’t just about treating today’s pain. It’s about understanding the disease, knowing what science actually tells us, and asking better questions about your long-term care.🎙️ Listen to the full conversation on Endo Battery.Subscribe, share, and leave a review so more people living with endometriosis can find evidence-informed answers.#Endometriosis #EndometriosisAwareness #EndometriosisSurgery #EndometriosisRecurrence #ExcisionSurgery #ChronicPain #EndoWarrior #EndoBatterySupport the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)Your doctor says your endometriosis “isn’t that bad” and you try to believe them. Then you learn the truth: organs fused together, years of pain explained in a single moment, and a realization that the system didn’t just miss your diagnosis, it trained you to doubt yourself.We’re joined by Deb Stark, founder of Wulf Woman, who shares the turning point that changed everything: bringing her surgical photos to an endometriosis specialist who could immediately name what others overlooked. From there, we talk about the brutal gap between what patients experience and what many clinicians are taught, why people end up having to convince doctors to investigate chronic pelvic pain, and how “normal tests” can still coexist with severe endometriosis.Deb breaks down how she turns scattered endometriosis research into practical education, including tools for consultation questions, surgery preparation, and informed consent. We also dig into her Wulf Woman Endometriosis Surgeon Directory, a community-powered project that helps patients research providers using public sources, PubMed work, treatment approach clues, and real patient experiences without pay-to-play listings. Along the way, we explore symptoms that don’t always get linked to endometriosis, like itching and histamine issues, plus the role of pelvic floor therapy, EMDR, and nervous system healing after years of chronic illness.If you’ve ever felt lost, dismissed, or overwhelmed by conflicting advice, this conversation offers a clearer path forward. Subscribe, share with someone who needs better answers, and leave us a review with the biggest takeaway you’re bringing into your next appointment.Support the showWebsite endobattery.comInstagram: EndoBattery

Send us a text with a question or thought on this episode ( We cannot replay from this link)We talk with pelvic health occupational therapist Karla Ehlers about why uncertainty can dysregulate the nervous system and make pelvic pain feel even harder. We share a clearer map of fight or flight, shutdown, and social safety so you can choose support that actually matches what your body needs. • noticing early signs of dysregulation and building functional awareness • understanding sympathetic activation, dorsovagal shutdown, and ventral vagal safety • choosing grounding tools when anxiety spikes and safe movement when you feel stuck • using co-regulation and group support to create nervous system safety • recognizing neuroception and how clinics, partners, and family cues affect pain Do you have more questions? Keep them coming. Send them in, and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at indobattery.com or visiting the Indobattery.com contact page.Support the showWebsite endobattery.comInstagram: EndoBattery