In this episode, we're joined by Dr. John Petrozza to discuss the tricky world of hormones and how to stay on top of your hormonal health for optimal bodily functions.
As we swing into a new year, there’s no better time than now to start taking care of yourself. No more procrastinating or letting fear take over your worries about what may or may not be the root cause of your pain. This is the year you get smart and informed about your body and get on the path to a definitive diagnosis! Don’t know where to start? Overwhelmed by all the information on the internet? We have the perfect thing just for you!
But first, we are joined by a very special guest this week to continue to help you stay informed about your body and the tricky world of hormones. We’re joined by Dr. John Petrozza, a reproductive endocrinologist, surgeon, and Senior Medical Advisor at Uterinekind! Dr. Petrozza highlights the importance of hormonal health, what affects it, and how staying informed of your body can save you with early interventions for serious uterine conditions.
Lastly, we end on a high note. The perfect tool to get you on your way to a definitive diagnosis! U by Uterinekind is finally here!
Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Carol: Knowledge plus early intervention equals the best health possible. To preserve your anatomy and optimize how your body's systems function. I'm Carol Johnson, and this is Hello Uterus.
Today we're joined by Dr. John Petrozza, a reproductive endocrinologist and surgeon who has also joined the team at Uterine Kind as our chief Medical officer. We're excited to introduce you to him today and to incorporate his expertise and guidance into the U BY Uterine Kind app. But before we get to Dr. Petrozza, Uterus in the news.
Is there a town that doesn't have a Real Housewives franchise? I'm out of the Real Housewives wives franchise loop. But it, it started with Beverly Hills, right? And then it went to Orange County and the New York City, and I think there's Atlanta now. And also on the banks of the Potomac, we have. This set of the Real Housewives of the Potomac, where we also have an unfortunate situation.
Giselle Bryant is opening up about a health issue that totally in quotes, caught her off guard. She calls her longtime best friend and reasonably shady co-host Robin Dixon and tells her this, and I. My doctors have been monitoring me for about three years, and my uterus fibroids are so huge that they can't just remove the fibroids.
They've got to also remove my uterus, which is just like a full-blown hysterectomy. Well, it's, it's not only just like a full-blown hysterectomy like that actually , that actually is a hysterectomy, but I can't even, I can't even get beyond. My doctors have been monitoring me for about three years now.
Fibroid. Can go through a growth spurt, but I expect during that three year period of time, like did, did anybody talk about surgically removing the fibroids before they become too big to remove and then therefore require an invasive surgery that has long-term complications? This is news on Hello Uterus because we know how many people watch these shows, even if we've lost track of how many there are and where they are.
And there are some really important lessons to be learned in Giselle's experience starting. With the fact that Giselle was caught off guard, that should not happen after you've been told you have fibroids. We have talked about this on this show and we will talk about this routinely going forward. It really is on us to understand our systems and to understand how they work and to understand the conditions that can impact them.
Our goal here is to make that information digestible and easy to understand, but we can't remove that responsibility from you and no one. We actually feel that that's part of the problem in consultations is because we kind of go in, you know, deer in the headlight, tell me what I should do, doctor, and, and that's not the way to manage your health.
The second red flag in this story is that doctors monitored her fibroids for three years. Oh, and then, whoops. They're too big now to be removed. I'm not gonna hypothesize on where this went wrong. I don't wanna lay blame on anyone, and I don't know anything about the situation, but I wanna just use it as a case study, you know, along with continuing to marvel at the fact that there's a real Housewives of Potomac.
I mean, I get the whole DC angle and stuff, but I, I just, I don't know. Anyway, it's a case. My gut tells me that her doctors might not have been trained in the surgical removal of fibroids, which is called a myomectomy. There are also other treatments that they may not have been trained in, like uterine fibroid embolization, or a treatment that goes under the device name of Sonata.
These are treat. They're, they're literally surgeries. They're not things that doctors can just pick up on an afternoon on YouTube and then like go into the surgical suite and perform that operation on you. So it's really important that if you've been diagnosed with fibroids, that you understand some key things.
How many do you have? How big are they and where are they? And then get a second opinion to determine whether or not those fibroids can and should be removed. And if someone says that they're gonna monitor your fibroids, and, and perhaps that's really all you need. If you're not symptomatic, cool. But over a period of three years, I can't imagine that those fibroids did not grow, and then all of the sudden they flourished and they became too big to be removed.
It's possible. It's possible we don't understand the mechanism of action fully and, and so anything is possible when it comes to fibroids, but the real caution here is to take action and find experts so that you don't place yourself in a situation where your only option. Is aggressive, invasive surgery.
You want to intervene as early as possible, get an early diagnosis and take action so that you can preserve your anatomy. We're grateful that hysterectomy is an option for us because it is. It is a lifesaving and quality of lifesaving treatment, but it should be reserved as a last resort. We have other minimally invasive treatment options that can be utilized to remove fibroids and, and you just need to find the experts who know how to perform the surgery.
One such expert will join us after this break.
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Carol: Today we're delighted to introduce to you Dr.
John Petrozza. Dr. Petrozza is a reproductive endocrinologist and reproductive surgeon. He's the chief of the Division of Reproductive Medicine in I V F at Massachusetts General Hospital, the director of Massachusetts General Fertility Center, and the co-director of Mass Gen's integrated fibroid program after completing a fellowship in reproductive endocrinology.
And infertility at New England Medical Center. Tufts Medical School, he joined Mass Gen, which is, by the way, congratulations, the number one research hospital in the United States. We couldn't be more grateful for Massachusetts General Hospital leading the pac, so to speak in research, which we know here at Uterine Kind is one of the things that we consider most important.
Impactful on our overall health and wellbeing. And the latest role to add to his resume is Chief Medical Officer of Uterine Kind. And we also couldn't be more thrilled to have his guidance on our new app You by Uterine Kind. So welcome to Team U and thank you for spending time with us today.
John: Oh, thank you so much Carol.
And this is indeed a pleasure and I'm so excited about all the things, all the wonderful things that are gonna happen with Uterine
Carol: Kind. Excellent. So we brought you on today to talk about each one of these topics really could be their own show. So the this, we're gonna keep it to about 45 minutes, but honestly we could be here for 10 hours, if not more.
And one of the topics that we wanna start with is to just get an understanding of the endocrine system and our hormonal health. As patients, for the most part, when we walk into a consultation with doctors like you, we don't walk in with a whole bank of knowledge about, about our systems, about the body that we inhabit, you know, every day.
And that doesn't help us and it doesn't help physicians who likely. Don't have the time to teach us all one-on-one in appointment after appointment about these complex systems. And I also imagine that for adolescents this can be extremely challenging because they don't have the knowledge and then also might be really shy about discussing their symptoms and, and may not feel comfortable and may not even recognize that something's out of balance or needs to be addressed.
And we know that early intervention is really important in terms of giving us the best chance to have the best quality of life. So what is most important for us to understand about our endocrine system and our hormones in hormonal health?
John: This is a great question, and I think one way to look at the, in, uh, of the endocrine system, one way to look at it is, is it's the messengers of the body, right?
Think of a big company, right? It can't function unless there's communication between the different parts of the company, and that's what hormones are like in the human body. They allows all the parts of our body to, to communicate with each other, and they are intricately involved. Everything that the body does from how it handles stress, we probably all have all heard the concept of fight or flight.
If you're caught in a corner, you know, think, think of what it was like thousands of years ago. You're, you're a cave person and you're fighting off a dinosaur, or you're fighting off a wild animal. You have to make a decision. Am I gonna fight this animal and try to survive? Am I gonna run like heck and get away?
And that was based on your hormone response, your adrenal gland kicking in. And that hormone that allows you to make those decisions, you, you need to have adequate hormone levels to heal, to handle stress, to reproduce, and your overall metabolism is determined by our hormone. So it's a very, very important part of our body.
The issue with hormones is, is. Many of them are very cyclic in nature, so they're kind of going up and down throughout the day and there's a lot of feedback mechanisms with hormones. So if one hormone level is high, it could be having either a positive or a negative impact on another hormone. And so the complexities of how these hormones communicate are, are very intricate, if you will, from the reproductive hormone standpoint.
The analogy I make, it's almost like radio signals, right? So there's a little center in our brain called the pit twoit. And it's driven a little bit by another small center of the brain called the hypothalamus, and they communicate all the time with each other, but it's the pituitary that drives a lot of the hormones in our body.
A little tiny P like center has this massive control. over our hormones. It's amazing. It's amazing. Yeah. , it's amazing how the body works, right? Yeah. And it communicates by how much of that hormone is being released by the pituitary and how frequent it's being released. So think of it like radio signals, right?
So you have FM signals which rely on frequency, and so that's why you can hear an FM station miles away from where the radio station is. And then you have a, and radio, which is based on amplitude, how. , those radio frequencies go, which allow you to hear it around mountains and and valleys and stuff like that, but you won't hear it as far away as an f and m.
So that's how the hormones work, how high they go, and how frequently they're being released. And that's how those communications happen. Mm-hmm. . And so any disruption in those levels or those frequencies can disrupt how these hormones are affecting your body. And we'll talk a little bit more about that, but it's, it's an intricate process.
The other thing that has an impact on hormone levels, Are the things that bind hormones. So it's not like these hormones are just being released and being allowed to sort of do what they need to do. Once they enter into your bloodstream, there are other proteins, these other molecules in, in the blood that will start to bind up these hormones and say, wait a minute, guys.
Well, I'm not gonna let you have that same impact you would have if you were allowed to freely do what you wanna do. I'm gonna sort of suppress you a little bit. I'm gonna bind you up and control your response, and that's important because there are certain things that affect our bodies, certain things that we take, certain exposures that we have that can influence those molecules, those proteins, which then have an impact on our hormone.
What
Carol: would be an example of, of an exposure that would result in that protein wanting to restrict that hormone?
John: So a very common one that we probably don't think about is birth control pills. Birth control pills impact our liver, and our liver then releases more of these proteins that will bind up some of the reproductive hormones in the body.
And in some ways, this is a good thing, right? So we use birth control pills not only for contraception, but we also use it for women, for example, who. A lot of acne, and acne is often driven hormonally by the male hormone testosterone, and so birth control pills will release more of that binding protein.
It binds to testosterone in the body, and acne is reduced. On the flip side, because it's binding testosterone, testosterone is also needed for libido. And so a lot of women who take birth control pills will say, you know, My skin looks great. I have contraception, but I have no libido, and it's because it's binding up the testosterone.
So there's always a fine balance with some of these medicines that we're using, trying to get the benefit that we want, but also looking at some of the side effects that could be created by that.
Carol: Yeah, that's, it makes me think about mental health side effects when you mentioned, because we know that the birth control pills can result in that.
And as you were describing that, I was thinking, okay, first of all, thank you because you clearly described this. There are a lot of times when we don't get this information as patients, you know, and, and we'll talk about this in a little bit about the issue of gaslighting, but you know, if you go in and say, Hey, I'm mentally, I'm feeling really.
Not good, and I think it's my birth control pill. And then you hear that that can't possibly be the case. It's a low dose. It's so well tolerated. But what you're describing is a system so intricate that you know, yeah, it could be right. And if the pituitary gland. Which is in the brain is running this whole show.
Does that then suggest that these mood issues and mental health issues can be a direct result of birth control pills and their impact on the, the messaging that's going on?
John: Well, I think everything has. Potential consequences, right? So you can imagine someone who is feeling better about themselves from a skin issue, but then has diminished libido who now no longer feels intimate with their partner, then starts to feel the consequences of that relationship not being what they anticipated to be.
So there's there direct and indirect consequences to a lot of what we do. So it may not necessarily be a direct impact on the pituitary. But the consequences of that impact. And you bring up a good point. I think as clinicians, you know, we're all very smart. We've gone to school, we we're up on the literature.
Um, and, and we make a lot of, of decisions based on the information that we have, which is just general information. , right? So we look at our studies and we say, okay, um, clearly this shouldn't be having an effect on you. But then you look at the side effect list on a lot of these, on all these medicines, and there's a long list of potential side effects.
And so we tend to generalize things, which is, you know, part, part of what we do. We have a limited amount of time with the patient. We, we tend to generalize saying That can't be happening to you. It's not something that I typically see, not realizing that she may be sort of that outlier and it could be a consequence of.
we're treating them with.
Carol: Yeah. Yeah. There are outliers. I see often something referred to as rare. And I think, well, it's, it's only rare if it doesn't happen to you. within if it happens to you. Yeah. Yeah. It's, it's your personal experience. So the, the system, from what I'm understanding, it's, it is a system.
It's required for living. The body does nothing without this system. It regulates everything. Yeah. Uh, digestion, metabolism. Breathing, sleeping, reproduction. So given the challenges that the patients who come to you have with regard to reproduction, where is the the moment where intervention makes the most sense?
And are we missing that? Early opportunity to intervene, like with people discovering infertility, let's say, you know, in their late twenties, early thirties, mid thirties, was there something that could have been done in their adolescent years that would've better positioned them?
John: Yeah, that's, that's a, that's a great question and, and I think it kind of relates a little bit to the second point that you made at the, at the introduction, which was the impact it has on adolescents.
Right. Because I think for any disease that we see, especially anything that's reproductive related, whether it's infertility, endometriosis, fibroids, it'd be nice if we can pick it up earlier and, and know that this could be a potential issue that we can address either then, or at least anticipate that it's gonna be an.
in 10 or 15 years. Um, you know, speaking of hormones and adolescents, it's always a, a critical moment in a young person's life, whether it's a female or male. And there are certain markers that we know could be signs, right? So when we're looking at an adolescent girl, um, you know, there are certain milestones that we want to see that are hormone-based, these pubertal events, and if anything goes awry, Pubertal events, that's a red flag that, hey, something might be going on with those hormones.
For example, there's a certain path that we expect every girl to go through, so she'll start to go through something we call, I mean, Adar. Adar is when a woman starts to get a little bit of. Hair underneath their armpits, a little bit of pubic hair. We expect to see that within a certain age. And then after that, there's a certain timeframe that they should then go through their growth spurt.
And then after the growth spurt, there should be a certain timeframe once that starts, that the young girls should be developing breasts and then after breast develop, , we know there's a certain time that she should be getting her period. And so there are these milestones that we all know as clinicians, and if they're not happening, that's a red flag to say something is not right.
Let's look and see. And I think what a lot of young girls don't know is are those steps that they should be expecting? And it'd be nice if they did. It'd be nice if parents knew about that. I knew about it, and I can tell you it was great to know about it, but it was very anxiety provoking for me because I have two daughters and I was sort of like, okay, you know, these are the expectations that I have.
And if it wasn't happening, oh my gosh, what, what am I gonna do? You know, who's, who's gonna see my daughter? When am, when am I gonna act on it? And so I think that's information that's always important to have, um, so that people can be aware so that as clinicians, we can see these patients a little bit earlier.
Um, and these have downstream effects. If, if a young girl has very painful period, at the time that she should be having periods. That's a red flag. That's not normal, you know? And, and that means that young lady has to be seen and has to be evaluated and I think has to be evaluated fully to make sure that there's nothing going on.
And I think one of the nice things, and I think something will touch on, or what are some of the new things that are out there that can help us? Explore a lot of these issues earlier because it used to be that we would either just guess and maybe just randomly treat a young girl who had irregular cycles with.
Birth control pills and say, here, take the birth control pills, and that will make things better. Now we have some tests that can help us, um, and we have treatments that are beneficial. So, a long-winded answer to your question, hopefully, I, I, I addressed it Absolutely.
Carol: And full of, full of some really important things to, to kind of isolate and highlight, which is one, I feel like it, it's on us.
As non clinicians, as owners of our bodies or the parents to, uh, an adolescent to get a better grip on what these bodies do. I like it just, and I, I'm guilty of this. I used to live only in my head, never from my neck down. Yeah. I just was completely disconnected from my body and, and I saw going to the doctor as like, you know, treat.
Thing that I have to carry around with me all, all the time, and this thing is problematic, right? So I've turned that around largely through the work that I do and what I've recognized, which is fascinating to me, and I wish I had done it earlier. I recognize that it's much easier for me to implement changes in my behavior because of the knowledge that I now have.
Like it almost becomes. Instinctual, um, drinking water for me is instinctual now, whereas before, you know, it was just something like, if, if I felt thirsty, I would drink the water, but I wasn't conscious of it. So I think the more that we learn about our bodies, and it doesn't have to be this like. Deep, intense dive.
It's just this, this basic understanding of how they operate, the easier it becomes to take care of them. It's like, um, my plants, which is kind of funny because I think that I started to want to have plants in my house at about the same time I started to learn about my body and, and I don't know anything about plants, but I do know that it's important for me.
understand how they need to be best cared for, otherwise they're gonna die. Right. So understanding our bodies better, even at a basic level is, is just so crucial. It really just, it actually makes it more fun to live in them, in my opinion. Right, right,
John: right. The more you understand, the more you appreciate things and the more you understand when things aren't going right.
And I think one of the things that we're learning, and one of the things I'm learning, um, and I think one of the wonderful things that we're seeing with a lot of. New technologies like wearables is that it's so much better to see these changes, these subtle changes that can happen early and address it versus waiting it for it to become a major thing and then addressing it once it's too late.
And then you have a lot of consequences because you waited too long. Um, and so I think, um, I think it's gonna be a whole new error in how we manage things with wearables and knowledge and apps and all the things that we're seeing now that I. Will help things and help, uh, patients and help providers manage things better.
Carol: Yeah. Over the next five to 10 years, like I just can't even imagine what's, yeah, it's gonna be great. It's gonna be really great. So lots to look forward to there. So definitely in what you were saying earlier, just. That the need to intervene early is a responsibility equally shared among the patient or the patient's family and the physician to, you know, to be able to spot these things and to get rid of the taboo ideas of like, not talking about this stuff, you know, you know, just really kind of focus on our system and keeping it operating optimally.
Which brings me back to the endocrine system and hormones. It, the, the delicate balance that's required. So, In, in order for that to operate optimally. And I think we're seeing, well first actually, I wanna ask, ask the question, are all chronic conditions that impact the female system, hormonally dependent or hormonally affected?
Like, is that a safe statement to say? I don't
John: think all chronics. Issues are directly related to hormones, but I do think they have an impact on hormones in one way or another. Yeah, I do. Okay.
Carol: In that when we look at our environment and, and you have some background and experience in researching the environmental impact on, on the female system, when we walk into a store, we take for granted that everything that's for sale.
Save for us or you know that when, that the air that we breathe when we go outside is clean, but research is now connecting endocrine disrupting chemicals, which are so common. I mean, we're talking about thousands of chemicals that are used in these. Personal care products like body lotions and makeup and perfumes, and, and they're so, so common.
And now they're being linked directly to cancer and to the development of fibroids. So when we learn about that, and then we look at all of these conditions that people are experiencing, like fibroids and endometriosis and P C O S, how do we keep ourselves healthy in this? It seems like a battle. Like people go in and they go into the doctor and they say, you know, I have really painful periods.
I'm feeling really bloated. And they present these symptoms and then it's discovered that they have fibroids. How do you handle a situation where you're removing the fibroids and then they go out into the world and they're exposed to all these chemicals again and taking the hormone system, the endogen system, and sort of throwing it up in the air.
now, It's
John: a very difficult question to answer, right? Because I think our bodies and how they work is a combination of so many factors, right? Our genetic makeup, our exposures, like you're alluding to other medical issues that we might have. And so when you look at environmental factors, You know, one of the things that we've looked at at, at Mass General Hospital in our division for a long time, we were part of a big study called the Earth Study, looking at primarily plasticizers, bisphenol, a phalates.
Things that, um, prior to. 2000 were fairly ubiquitous. Still are fairly ubiquitous, but let's look at Bisphenol A right? Bisphenol A was in everything was in IV tubing, was in baby toys, was in plastic bottles, was in everything that was plastic. It allowed it durability and allowed it. To be molded into different shapes and sizes.
Animal studies to that point were suggested there might be an impact. We started to look at it from a human standpoint, from a reproductive standpoint, where we saw dramatic changes in numbers of eggs being retrieved during an egg retrieval. Sperm counts and things like that. So we knew it was having an impact and I like to believe that our, our science helped get bisphenol A banned in Canada and eventually in California.
And then it's very unusual to see anything that has bisphenol a in it. The problem is, is something had to replace bisphenol A, now you got bisphenol F, right? And so bis. , it's probably gonna be just as bad as bisphenol a and so, you know, where does it stop? And then it's fairly ubiquitous, right? These phalates and these bisphenols are fairly ubiquitous.
You get into a new car, you, you know, we all love that new car smell, right? But you might as well just get some raw bisphenol lane and ha because you, you're get, you're getting exposed. And when you look at the urine nationally, you know, in, in these large population studies, , there's always a certain amount of bisphenol A in our body, so it's fairly ubiquitous.
It's hard to avoid these exposures, but it's more than just an exposure to bisphenol A. So it's hard to say, well, bisphenol A is going to cause this because it's hard for us to control all the hundreds of thousands of other exposures that we have to other chemicals. Right. And could it be bad for Carol because her bisphenol a level is high?
But, oh by the way, her pesticide exposure is higher because she lives in an area where there's a lot of agriculture, and those two together have more of an impact versus someone who has a lot of exposure to bisphenol but doesn't live in a very pesticide area. So I, I think what we're gonna see as far as research goes down downstream is sort of this whole idea about metabolomics, right?
So who we are and the diseases we. are really individualized based on our exposures and how our body metabolizes those things. And, and that's gonna take a lot of work. And so you just can't do a study over six months or a year and come up with those answers. These are studies that are generational, where you look at large populations, you look at all of their exposures based on testing them for all these exposures and seeing what combinations of.
Caused that person to be at higher risk for X, y, Z disease. Does that make
Carol: sense? Yeah, absolutely. And, and those studies are not cheap. What does it cost to run a study like that? Like, hey, if I wanted to do a study on EDCs impact on the female system, how much money would I have to bring to the
John: table? Oh, you're looking at, at millions and millions of dollars.
You know, the Earth study was funded for probably 15 years, I think. Close to 15 years, you know, and you're looking at several million dollars a year, so you're looking at millions and millions of dollars. And, and ours was just a very finite study. We were looking at women coming through fertility practice over that timeframe.
So to look at population studies and to do these type of assays and type of patient recruitment, it's, it's enormous to do these
Carol: studies. Man. And then you had mentioned when we were talking before this show, the, um, an article that came out in the end of December that was speaking to a group of nonprofits that are suing the E P A because they have failed to implement an endocrine descr disrupting screening program.
I love how it, how it's like they failed to implement it. That that's actually, let's not call it, that they specifically did not implement a screening program. That would've required them to regulate themselves and, and I think it's kind of as we're out in society, we've heard, especially over the last several years within our political system, the need to like reduce regulations on manufacturers and make it easier for them to get their job done and stuff.
And I just gotta say like, you need to really pull back the reins on that pony because if you take regulations off of this industry, we're. .
John: Yeah. And it's tough to regulate now, you know, and I remember the primary investigator for the Earth study would often go to DC and, and sort of lobby in favor of regulation.
And the plastics industry has a very, very strong lobby. You know, if you think the NRA is a strong lobby, plastic lobby is very strong and plastics are everywhere you this, this makes sense to me, right? Plastics are everywhere. And so you can imagine that the lobby lobbyists behind this are very, very strong, very organized.
Carol: Yeah, which, which we need to, to fight against that. Um, the other day I walked into a convenience store here in Northern California and as soon as I opened the door, I was met with this overwhelming cleaning products, soup of fragrance. And I looked at the woman behind the counter and I just thought to myself, every day she stands here and breathes this.
John: Absolutely. You know, we have a wonderful place up here in, in Deerfield, Massachusetts, the Yankee candle, who doesn't love a nice smelling candle, right? And Yankee candle's been in in the area for decades, and every time I would go in into their main store, you're just overwhelmed by the scents. But the reason you can smell those things, the reason you can smell perfumes and had them last for a long time, it's because of small amounts of plasticizers that allow that scent.
Stand your body for a little bit longer. It's in cosmetics, it's in, um, lining of your cans, right? You open up a can of tomatoes. You feel that smooth sort of lining inside of the can that that's a plastic and so, right. These chemicals are all over and you know, dear study, Is done. And so we're still analyzing some of the data from the Earth study and a lot of papers have come out from that, from that study.
Now we're looking at a new study, it's called the Prepare Study. This is our newest collaboration, uh, with the Harvest School of Public Health. And now we're looking at per fluorinated compounds and per fluorinated compounds. It's rampant in the textile industry. It's what? Causes your clothes to not wrinkle.
I mean, it's what protects your clothes from getting stained. It's, it's in the old Teflon pan. I remember opening up a Teflon pan years ago and I said, do not use your Teflon pan in the presence of birds . And I said, oh. Oh my gosh. Are you serious that that can't be good.
Carol: It's either like, why are they gonna jump into this pan because they love Teflon?
Or what? Like what is the, what is the issue here? Oh, my. Because of the canary in the coal mine, cuz they're gonna kill the bird because yeah,
John: it's clearly detrimental, the birds and you know, what's it doing to my family? So that's our next line of study because you know, that stuff is fairly ubiquitous, right?
Yeah. Who doesn't want clothes that you don't have to iron and who doesn't want to keep their clothes from getting stained? But are these chemicals safe? Clearly not, apparently. Yeah. There's some early suggestions that it's not, at least in animal studies, and now we're starting to look at it more in.
Carol: Yeah. One last comment before we bring this back to your practice. I got a car a couple years ago, and you know, even with the stuff that that I do and the, the articles that I read, like sometimes these things just go right over my head, which shows the power of marketing. The seats in my car are vegan leather.
Okay. I mean, I guess you could call like bleach. You could call it like, uh, gentle cleaning solution. I mean, like what, what is vegan leather? It's just, it's plastic, right? It's plastic. Yeah. Unbelievable. Um, we have to get our act together here. It's like, I, I, I love humans so much because sometimes we are just, we're just thick.
And then when we start to connect the dots, we do take action at that point. And I feel like we're at the dot connecting stage and that we're gonna see some benefits here. So over time. In your practice as you've been conducting this environmental research and then also treating patients, are you seeing trends?
Are you seeing dots connect for you that, you know, perhaps aren't, you know, part of a formal study, but that you personally are seeing some trends there? Yeah, I think,
John: you know, I, I touched a little bit on wearables and I think, you know, some of our research studies that we've done on environmental exposures, which include the plasticizers.
We've had some, some of the people at the Harvard School of Health, public Health look at pesticides or environmental toxins, and of course, these studies. In addition to checking the levels of these contaminants in your urine or blood, there are wearables that we use. For example, we were doing a study, um, one of the researchers was doing a study looking at the exposure to radiofrequency, you know, sitting in front of a computer, being exposed to electromagnetic exposures can be monitored using a wearable device.
Um, a company in Western Mass devised a band, a wristband that you could wear that would give you an idea. Environmental toxin exposure. Pollutant exposure, but, but it's used in research, right? So to be able to use that in research and then a lot of the point of care testing that we've been developing at Mass General Hospital allows these researchers to do more evaluations of the end products a little bit better.
So you can imagine, I'm worried about an environmental agent having an effect on sperm. I could have guys check sperm at home. And give me readings on a point of care device versus having them come in all the time, um, at less frequent intervals to see what's happening. So I think that's, that's great from a research standpoint.
And I kind of envision having these wearables that are gonna be available to help us monitor exposures a little bit more down the future. Consumer used big trend. Patients are really wanting to educate themselves. They're all becoming Google MDs and Google PhDs, and I advocate for that. I think it's great the more you know, but I think the internet can be the wild, wild west and a lot of things are not filtered.
And I think a lot of patients come in. Misinformed. And I think it's important that they, I I, I want them to educate themselves. I want them to know what's going on. I want them to come in prepared with questions, but I want it done in a, in a meaningful way. Right. Somebody will come in and say, well, I wrote online that, you know, peanut butter, if I ate it three times a day will improve my fertility.
And I'm like, really? ? Where did, where did you read that? You know, that's, that's news to me. Or. , they'll come in and, and I'll, I'll spend 20 minutes talking about what the literature shows and say, well, that's okay, but I read on Google, or my best friend told me that I should do this and that's what I wanna do.
And it's always good to have a discourse. Right? And, and I want my patients to come in with questions to ask and a knowledge base. Um, it makes my job easier. And, and I much ma rather correct them and try to give them what I think is the right advice and the right education versus them coming in and not knowing what, what's going.
So, but, but I want them to do it in a meaningful way. And I think this is where, as we mentioned earlier, where having good information to have in advance, knowing the questions, the appropriate questions to ask in advance, having filtered good information that they can use and digest will be very helpful in advance.
Carol: Yeah. Excellent. That, that's a good segue for us to talk about a hot topic. As a matter of fact, I think gaslighting was the 2022 word of the year , I think it was. It's just a, it's pretty wild to see how something blooms like that. Like we're all coming to recognize, you know, gaslighting happens on an arc.
It can be unintentional and mild and it can be, you know, super damaging. But I, I did read a review. About you. Uh oh. Uhhuh. . Um, that, uh, and I, it really stood out for a couple reasons. It was of course a great review because that's all you get, so congratulations for that. But I thought this one was really interesting, so I'm gonna read it.
It says, for the first time in two years, it felt like a doctor was actually listening to me. He took the time and let me explain everything that has been going on and answered all my questions that I asked at the. and, and what stands out for me are two things. One is that you are a good listener. I've experienced that myself.
And the second thing is that she spent two years not being listened to. So I've noticed gaslighting is, is part of what. Inspired me to create uterine kind cuz I, myself was gaslit on celiac disease and fibroids. Two things that dramatically impacted my quality of life for over two decades. So I experienced it myself, you know, very aware of my privilege and I had access to great physicians and I, I, all of my doctors were really engaged.
But I don't know, it's probably a soup of factors that. The environment that we're in right now. But gaslighting is real. And I've noticed in our market research for uterine kind, I've noticed that doctors, and also anyone in the healthcare profession actually is not just doctors. They're understandably triggered by the word and a bit offended by the implication, and patients are like, no, it's really happening.
I'm not kidding, . So, you know, how do. Deal with this. It's feels like we're at a tipping point where patients are becoming empowered to speak out. You know, we also recognize the problems within the system of providing healthcare. Um, you had mentioned in one of our meetings that you have about four different channels of communication that you have to monitor on a daily basis.
Can we just reflect on that? Four different channels of communication? Probably somewhere between at, at a minimum, 15 patients a day at a maximum 30 to 40 patients a day. Surgeries to prepare for people to prep for surgery. You work in a area of medicine that is, Really emotionally rich, and so there's a lot of emotional energy that's going into this practice.
Like, how the heck do we improve the communication between doctors and patients, given those circumstances, how can we move through this ?
John: That is, oh boy. If I had an answer to that, we would be so much better off. You know, it's, it's tough, you know, the amount of work that a clinician has to do on a daily basis now to care for a patient, you know, for every 45 minutes I spend with the patient, there's probably three hours of work that goes into that patient.
I can tell you at the end of the day, I have to pull myself. For my work computer, just so I can get home and I go home realizing that I'm not done. And so I find myself gravitating toward my home computer to continue to work until I go to bed. And so the burnout amongst healthcare providers is high because you're, you're just living and breathing your work and not doing the other things you need to do to sustain your family, to spend time with your kids, to do the things that you wanna do, to, to sort of have that satisfaction.
a lot of it's driven by electronic medical systems, which you think would make life easier, but it's actually made life a little bit more difficult. It's pushed a lot of things that used to be covered by our front office desk or billing now back to the provider. And so it's, it's tough. And so, you know, as providers, I wanna go in and I wanna spend the quality time with the patient and not have to worry.
Oh, I gotta now write my notes and I gotta write my note in a certain way and I have to do my billing and how do I code for this patient? There are some workarounds that some people are trying to do at bringing in someone who will transcribe that conversation you have with the patient, but that's kind of awkward to have a patient and have someone else in the room who's basically a stenographer.
Taking notes of that conversation. And sometimes we're talking about intimate stuff, it's kind of awkward. Um, you know, we've gone to virtual platforms for a lot of our patient visits, which is great. I think that's improved access, but it's created a whole nother area of disconnect. Mm-hmm. , you know, I love seeing patients in person.
I feed off the non-verbal communication. Yeah. And sometimes you don't get that in a. Virtual visits. And so there are trade-offs and the communication, you know, I get now communications through emails, through patient portals, through, you know, so many different ways. And then I'm getting messages from the nurses.
So not only are there the communications directly to the patient that I have to address, but there's all the communications from the nurses who are also addressing patient concerns that are being filtered toward me, that I have to get through. I, I probably have a hundred of those, at least a hundred of those a day.
So trying to address those gets very, very difficult. So patients deserve to hear, right? If I'm a patient and I reach out to my doctor, I want to hear back within a reasonable amount of time. Definitely, ideally within a day, and, and no doubt, within two or three days, if, if I don't hear, then I start to get worried that they're not paying attention to me.
So I, I get it, but it's very, very difficult and there's no easy answer. We have a lot of advanced care providers, like nurse practitioners and physicians assistants to help us, but they're limited, right? They, they, they can only do so much, and they're more on a schedule than we are. They come in at eight and they leave at five.
You know, doctors, , we can have 'em come in at seven and stay till nine or 10. There's no easy answer. And, and I think we're struggling to try to make this work, but it's tough and we're grateful for patients and their understanding. We do a pretty good job, but I, I do worry there's gonna be a lot of burnout.
Carol: Yeah, I'm, I'm very concerned about that as well because we we're dealing also with access issues to gynecologists specifically around the country. Mm-hmm. , and, and so it is, it's creating this tension where you walk in the room and it's almost like you're pre-conditioned to expect either pushback or to expect a physician to kind of half hear you.
Say here, take these birth control pills. Right. And you know, we keep mentioning the importance of early discovery of these conditions so that there can be an early intervention, but this gaslighting situation gets in the way of, of making that happen. Are you seeing it clearly, you're not the kind of person who's gonna do that.
Are you seeing this among your peers? Like have you encountered physicians where you're. Yeah, I wouldn't probably wanna be a patient with that person or, I mean, I know I'm asking you a little bit to kind of talk trash about someone and that's not my intention as much as, as people repeat that they're being gas lit.
I feel like there's this lack of recognition that it's
John: real. Yeah. I don't think anybody that I know lights, I think everybody that I, I know really tries their. To deal with the patients. I do think we're constrained by time and the volume of patients that need to be seen and where these patients are being seen.
So as I reflect on what we did with our fibroid program at Mass General, you know, one of the things I built it around was how the breast health program was developed as a patient. You come in, you're referred, you have a breast issue. You're evaluated, your imaging is done at the same time. If you need a biopsy for some suspicious lesion, it's done at the same time.
And really, by the time that patient left that morning or that afternoon, they had a diagnosis of what was going on and they were meeting with the team to talk about potential treatments. And I said, that's wonderful. because the way medicine works a lot is you come in, we ask you questions, we come up with a differential diagnosis.
We say, these are the things that could be going on. Let's order some tests. Mm-hmm. , your follow up is in three or four weeks you come back. Okay. We found some other stuff. There's some additional tests I wanna get. Let's get those done. Three or four weeks go by, you come back, you talk about potential diagnosis, maybe treatments.
So you've lost several months just trying to come up with a diagnosis. And in some ways, as doctors, it, it's a system we're accustomed to it. It buys us a little bit of time as well to sort of wait for those results. before we have to sit down and really come up and have a big discussion with you. And so with the fibroid program, we do our ultrasounds in the clinic.
Yeah. We can do our endometrial biopsies if needed. So, and, and we have the resources there so that if someone wants to talk with an interventional radiologist about uterine fibroid embolization and doesn't wanna hear me talk about surgery or talk about medical treatments, that's okay. We have the resources that get them in and out a lot more efficiently than the traditional system can, can.
and that's important, right? Because, and, and we've shown this, we've shown that we can get them from entering to the clinic into a treatment plan much quicker than the traditional model. But what we're seeing in our, in our department, which people have noticed and we're, we're looking at, I know some of, some of my colleagues are looking at is how do certain patients get to see certain providers?
You know, why is a patient who calls and say they have fibroids being sent to me versus being sent to someone? Else who may not deal with fibroids being sent to someone who doesn't have the same clinic set up that I have, that can get them through a lot more efficiently. And so that's an access issue and that's something that we're exploring because as an academic program we're, we're very cognizant of that.
And we wanna make sure that there's equity in how patients are being seen and they're getting seen by the right people for the right diagnosis. Shared decision making is, is a big thing, and I know you, Carol, you and I have talked about this, you know, how I present something to a patient really can impact what decision that patient makes.
And it's very difficult as a provider to step back and present things in a very neutral way. I'm a surgeon, so it's very easy for me to say, Hey, you got some fibroids. Let's operate. Instead of stepping back and hearing what the patient's needs and wants are and what her goals are, and thinking about how to present the information in a neutral way.
For example, as soon as I show a patient an M R I image of her uterine fibroid, I've created a bias, right? If anybody's seen an MRI and, and I'm saying, this is normal and this is what you have and it's not normal, you're like, oh my gosh, that's inside of me. Oh, that doesn't look good. Take 'em out. And that may not be the right answer to that patient based on what her goals are.
And so, you know, shared decision making is very, very important. And, and trying understanding what that patient's goals and desires and, and long-term hopes.
Carol: Yeah, and, and as you mentioned from a physician standpoint, being aware of how something is presented to someone really impacts, you know, how they receive that information.
So you do have the potential to sort of send them down a shoot just by the way you present certain information. And it also occurred to me as you were describing the fibroid center, which sounds magical by the way. I mean, that really should be how our, he. Is designed, we see how people feel very cared for when they go in for a mammogram.
You know, it's it like nobody stress. Well, I mean, I don't wanna say that, of course we stress about it, but I notice like just little things. I know when I go in to get the mammogram, they're not gonna weigh me. You know, just the little things like I don't feel like I'm this, you know, beast that they're moving down this production line.
I feel like a human. and there's this care involved, and it struck me as you were describing the fibroid center that maybe, maybe that is one and perhaps a large part. Yeah. Of why gaslighting happens because on some level we know that there's a treatment option. Out there, or we know that what we're experiencing is not normal, right?
Or we know there's a treatment option out there. But if we're talking to an obstetrician, someone who is primarily focused on delivering babies, and we're like 19, and we're talking to them about our painful periods, that person may be most inclined to skip a definitive diagnosis and go with an assumptive diagnosis and put them on birth control to suppress their symptoms.
And then now we set up a situation. The person doesn't feel better, and in their mind they're saying, I wasn't listened to, but in reality, it's like you don't go to the bowling alley to drop off your dry cleaning. If we can get ourselves to the right place, then we can be seen by the right physician. And so hopefully we're gonna make sure that people understand, you know, the different types of doctors and, and how to, how to make that happen.
I wanna close out today with your best pep talk for people who are struggling to be heard and from the, the launching point of. They know something's not right. They have painful periods, which is not normal. Painful periods, heavy bleeding, just not feeling right, and they can't go see you this week cuz you know, maybe they're in a rural part of the country and they don't have access to you.
What is your pep? Talk to them so that they can take some action on their health and, and get on a path to wellness.
John: Yeah, I mean, trust. Trust your gut. People know when they're not feeling right, when things aren't normal. And you know, one of the things I've seen, especially with fibroids, is that people either know something's wrong and are fearful that something bad is happening or.
B, they just grow into their symptoms, you know, that heavy bleeding, oh, you know what, it's not too bad. And a lot of my friends have heavy bleeding, or I'm changing a sanitary product every hour. That's, that's been normal for me for years. It's, it's not that bad. And so I think this fear and this accepting of something that isn't normal as normal is what gets people.
Trouble basing it on what we've talked about today, which is, you know, early recognition, early diagnosis is, is the key to everything in medicine. Trust your gut, trust your instinct. Advocate for yourself, and if you can't come and see a skilled expert, because maybe you don't know who's out there as the skilled expert.
I mean, who, who in their community knows who the fibroid specialist or the endometriosis specialist? You should, but, but at the very least, your, your primary care provider should, and I think it be, whos the primary care provider, to know who these people are. And then I think what happens a lot is, you know, relationships in the, in the medical community are.
just on that people you hang out with at the tennis club. Yeah. Who you golf with. Um, you may have never been in to see how this person operates, but they're your, your buddy and so you, you know who they are and so you, you refer based on that. But it, it would be nice if we could let the primary care providers know who are the experts in the field.
Like I know in, in, in the area of Boston from a reproductive surgery standpoint, meaning, people who've gone through reproductive endocrine training who also operate, there's probably four or five of us in the Boston area, and I probably would send my wife or my daughters to any one of those to operate on because I, I know the mindset and I've seen them operate.
Wouldn't be great at primary cares. Could see that as well, but I do worry in the rural areas. . That is in the case. If you live in Idaho, middle of Idaho, you're not gonna have one of these r e I surgeons or one of these minimally invasive GYN surgeons who has an expertise in these areas. And so you're gonna have to go to a big city, but your primary care should be the one who knows that, or your primary gynecologist should know that.
Yeah, it's gonna be nice to have it more than just your buddy buddies with them, but really someone you know and trust is the person for that particular disease.
Carol: Right, which then, which means that they would have to understand the unique aspects. Um, like I'm thinking of endometriosis right now. You know, like not a lot of doctors understand, or some doctors do not understand endometriosis.
At all. And then we're in this climate of issues with pain meds and the opioid addiction problem. And so someone comes in with catastrophic pain as a teenager and they're looked at like, you know, there's nothing wrong with you like , this is, you know, why are you being like this? So education, um, we definitely need to do, and, and then also what I'm hearing you say with trust, your gut is, it's like a two-pronged message.
It's one is to get in tune with your body. Connect with those things that are going on as intense or difficult as that might be. And allow yourself to kind of be at the same level when you walk into a doctor's office. And by that I don't mean to, to say like, you know, you need to have this. Fight posture or anything like that.
What I mean is that you are the person inhabiting your body a and our human bodies are so different and like when at the top of this conversation, we talked about the intricate nature of the endocrine system and our hormones and how they're impacted and how, and you mentioned how one person is gonna have one experience based on their environmental exposure.
Compared to another person. So right then and there, even if you don't see yourself as a unique being, which I do unique and exquisite, so own that. But even if that's not your, your state of mind right now, understand that your environmental experience is unique. And so how your body is metabolizing these exposures is.
And so trust yourself, because I think the most important thing we talked about today was the need for early intervention. It's really, really critical. And so when you hear it takes someone 2, 6, 8, or 10 years to get a diagnosis, that's not early intervention . And maybe that's then why we talk about gaslighting today.
You know, maybe it's not. Really gaslighting or intentional gaslighting. It's this cascade of issues that result in a disconnect and we know it needs to be fixed. That's correct.
John: Yeah. You're absolutely right.
Carol: Thank you so much for spending this time with us today is really insightful conversation and really appreciative that there are physicians like you out there that are changing how medicine is being carried out.
John: Well, thank you Carol. Thank you for having me. Appreci.
Carol: Thank you Dr. John Petrozza from Mass Gen. We're delighted to have you. We'll be right back with ending on a high note.
We're taking over the ending on a high note today to update you on you by Uterine Kind. We're aiming for January 10th this coming Tuesday to launch the app the same day you'll hear this episode. So head over to uterine kind.com and check. There's a free full access seven day trial. We do not sell your personal information.
In other words, you're not the product, you're the boss. We do not allow sponsored content, nor will we advertise supplements or medications. We will bring you members only content. Expert interviews, round tables, webinars, ask me anything and a community feature we're building now, and you'll find comprehensive content that sits alongside a tool that helps you record detailed symptoms over time, which is the evidence your doctor uses to solve the mystery of your air quotes, bad period.
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Thank you, team. Uterine kind. Thank you, angel and Maryelle for being content maestros you both rock. Visit uterine kind.com to learn more about you and follow us on Instagram at Uterine Kind. So grateful you're here. Till next week, be well. Be cool, be kind.
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