In this week's episode, we want you to have the best quality of life possible. Dr. Vimee Bindra, a world class excision surgeon, the gold standard treatment for endometriosis, joins us to discuss what to look for in a doctor, why endo needs to be taken more seriously, and the path to follow for relief. Consider this a consultation with one of the BEST endo surgeons on the planet. Thanks for listening UterineKind!
We all have the right to a high quality of life, but when pain gets in the way, that quality of life can quickly go downhill. Endometriosis may cause severe uterine pain that affects one’s personal health, self-image, relationships, career...let's face it, endo has no boundaries. This week's episode is a reminder that quality of life is as important as quantity.
Starting with this week’s Hear Me, Hear Me! Are you and your doctor a perfect match? Chances are you might not be! To overcome your uterine pain and transform your quality of life, find a doctor who has gone the extra mile to specialize in some aspect of chronic uterine conditions (We LOVE our OBs, but fibroids aren't babies!). Get the details on what to look out for when seeking a gynecologist. After listening to our expert guest this week, your standards for gynecologists will be raised. We are joined by wonderful gynecologist and excision surgeon Dr. Vimee Bindra, who focuses ONLY on endometriosis in her practice. Our conversation dips into why specialization in gynecology is important for a patient’s quality of life, all things endometriosis, and a detailed walk-through of excision surgery–the gold standard for the removal of endometriosis.
Lastly, we end on a high note from the UK. Ziggy Stardust returns in this CAT-astrophic tale! And over a decade later, can you believe that?
Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Carol:
You're worthy of excellent care. You deserve to be heard. It's not all in your hand and you aren't required to suffer. I'm Carol Johnson, and this is Hell uterus.
Let's reset how we view our life. Is it quality or quantity? Sometimes it seems it's just about quantity when it comes to the years between the onset of menstruation and menopause. Just make sure that they're there, make sure the person is alive during that period of time and just put a great big gold star on the calendar in and around the age of 55 or so and shoot for that. Essentially anything between the ages of, let's say, ten, 11, 12, and 55. Just deal with it. Yeah, we're not going to do that anymore. That is not okay. It's weird. It's just weird. There's a lot of strange things happening that involve how the lives of uterine kind are perceived and whether or not we deserve to have a normal, healthy quality of life during the prime of our life, during what is essentially half our life, if not more. Yeah, we do. We absolutely do that's a ton of years. Well, one surgeon is taking control of endometriosis and raising the bar for what patients should expect from their care teams and what patients are deserving of in terms of their quality of life. Your quality of life matters. Not just your quantity of life, your quality of life, it matters. And you deserve to be able to be healthy and well. And it's not normal if you feel pain or exhaustion or anxiety, if you have symptoms, any symptom other than a little bit of cramping and discomfort a few days before and the first day or so of your period. Anything beyond that is not normal. We'll say it on every episode. And I know that you will not get tired of me saying it because you understand how important it is for us to keep saying this is not normal, because lots and lots of people out there are acting as if it is. And we're going to make sure that that stops. So today we have joining us from India, Dr. Vimee Bindra, to share her best practices for treating endometriosis. And while there is no competition out there in the world for who is the best endometriosis doctor on the planet, if there was, Dr. Bindra would be leading the pack. She focuses only on endometriosis. She is an excision surgeon extraordinaire. And our conversation today is going to give you some insight into excision surgery and also consider it a free consultation with Dr. Bindra. So stay tuned for that. But first, uterus in the news.
Participant #1:
So Scotland decides Spain is getting way too much attention from me and the world and goes and does something that is so awesome, they got serious about ending period poverty and the US can too. Scotland has made period products free and accessible, stocked in schools and located wherever you need them. And you don't need to pay for them. You don't need to pay anything. Here in the United States, not only do we have to pay for them, we have to pay tax on them. You've got to be kidding me. It's so ridiculous. But in Scotland. So exciting. Here in the US, an estimated 16.9 million menstruating people experience period poverty. Can you imagine that? Let's condemn it. Actually, almost 17 million people can't afford period products. Twothirds of lowincome women can't afford adequate menstrual products and have to choose between food and sanitary supplies. Another survey conducted by Codex found that a third of respondents report having the school work or appointments due to lack of menstrual products, not because of pain, but because they can't get pads, tampons, menstrual cups for their period. This is absurd. If Scotland can make menstrual products free, the world can make menstrual products free. Just do it. Some of these decisions, I get that it's complicated and there's lots of red tape and administration and stuff, but I want to live in a world where decisions like this, really easy decisions to make, they're just made and done because you know it's doable, right? We know how to manufacture the products, we know how to distribute them. So the only thing that we have to stop doing is charging for them. And if you have to companies like Codetechs and other companies that make their living by making these products, go figure out something else to make, evolve pivot as they say, and do something else. And let's just keep improving society rather than holding it back because we don't want to let go of our money or a publicly traded company or whatever. Period products should be free. That's what I'm going to say. They should be free. And so yay Scotland. I'm really excited to hear that. It's like there are amazing things happening when it comes to uttering kind and having people put forth effort to take care of us and to right the wrongs that are happening. It's out there. But then on the other side of it, we're also getting a glimpse of the dark underbelly of grossness that seeks to control uterine. Kind 2022 has certainly put a giant floodlight on how women and menstruating people are viewed in the United States. Where bodies to be controlled or sex objects, essentially. And when too old to be a sex object, like 22, 23, you better be pregnant and at home, right? Certainly not taking away a corporate job from someone who has a penis. And God forbid that you're not cool with that. Someone like Andrew Tate, who is vying for lead misogynist globally will hunt you down. And I don't say that lightly. He really may hunt you down. That's the kind of creature this thing is. Who is Tate? An MMA boxer, shocking. Who got deplatformed this week for saying women should be owned, controlled and deserve rape. And I'm not exaggerating that's exactly like he's proud of this. I don't suggest you go find this. Just consider this news, and I'll tell you in a second why you need to know this and why I'm telling you this. But it's pretty easy to go and hear Andrew Tate's opinions on things. So he fled the UK for Romania because the UK was charging him with, among other things, crimes, sexual assault. Then Romania went after him for trafficking. And now he's in the Middle East, which is a good fit for him because he thinks women can't and shouldn't drive cars. He thinks we can't drive cars. He's that guy. The women can't drive. Oh, bro, that is like, what are you, from the 1920s? And he thinks that they shouldn't drive, basically, because they can't drive. Right. So Middle East. Good fit for him. As an aside, I generally keep it pretty focused on science and uteri here. We try to bring a little bit of laughter and some smiles, kind of lighting it up, along with all the talk about endo and cloth and surfaces. So I'm going to resist, and let me tell you, this is really hard. I'm going to resist going into details about what I would do to Andrew Tate if I had all the powers of a judge. That would help because I'd make sure that he didn't see the light of day. But anyway, I'm not going to go into like I said, I'm not going to go into details about what I would do. So, the day before, Tate was permanently kicked off Facebook and TikTok, and this is why I'm telling you this, my youngest asked me if I knew him. My youngest is 15, and he called him what he is, a scared little baby who has to puff up to camouflage his self hatred. And then he said, oh, and Mum, he's a super bad misogynist. So, in our household, you can imagine how we talk about stuff. He's learned a few things, my youngest, and had a good take on Andrew Tate. So, anyway, he brought this guy to my attention just before Tate was deplatformed. And then that night, I saw a video on Twitter, and it was a teacher who said on her first day, an eleven year old boy challenged her in class and asked why she wasn't home in the kitchen. That would be my last day as a teacher, might be my last day as a free person, I don't know. But the video went on, the boy was like, you're wrong and men are right. And so I don't know why you're teaching me because you're not qualified. Use the word qualified, but essentially you should just be pregnant and at home. And I think I've told this story before on this show. Whenever something like this happens where there's, like, a ground swell, after Roe v. Wade was repealed, there was this surge of energy to protect the rights of uterine kind. Well, you're always going to have a complimentary surge of misogyny when that happens, and that's what we got. But good news is that Tate was deplatformed. Bad news is he's got this community of people and he charges them $50 a month so that they can go listen to him spew about how terrible women are and how pathetic, et cetera. And it's getting into the minds of very young children. So talk to your kids and make sure that you bring up these conversations and that you talk to them about people like Andrew Tate and explain the why. Why is he doing it? It's not just that he's a bad guy. We have to explain why he's doing it so that they understand and that helps them tell a story to their friends. So if they meet one of their friends in the playground and they're like, no, Tate is the best, if they just say Tate is a bad guy, but they can't explain why, then they're likely going to just either be quiet or they're going to agree so that they don't get their butt kicked on the playground. So make sure you explain the why. And I don't need to tell you why. I know that you know. You know why. Oh, man. This kind of talk is everywhere these days. Essentially, it's weaponized influencers. We're seeing this rise of influencers that are in nature, evil. Keep an eye out for them and call them what they are, but definitely don't ignore them, which is why I wanted to make a point to talk about it on today's show, because we can't ignore them. They love that. That allows them to operate without any eyeballs on them. So when we pay attention to them, we get them dep platformed. Your time will come. You're just the kind of guy that ends up in a ball of flames. I mean, we don't have to do it to you. You'll do it to yourself. And that's going to be a great thing. And we're not going to stand for anybody like him or any spawns of Tate. We're just done, right? We're done. We're done with that stuff. All right, after a quick break, we will be back with a Hear me, hear me question that will change the way you vet your physicians.
Angel: Help bring an end to endometriosis by participating in the Rose study. The study of menstrual blood may hold the key to the y of endo. From there, treatments are born. Participate in the Rose study today, visit heliotros.com and click on the Rose Study blog for more information or simply google rose study for endometriosis. It's the first link. Please participate if you can. You could hold the key to the future for all uterine kind. Thank you. Now let's get back to the show.
Carol:
Hear me, hear me from stage name angry Uterus How do I figure out if I'm with the right doctor? Well, the way for me to answer this question for you. Angry uterus is in effect to introduce our expert guest on today's show. I want you to listen closely to this bio. Advanced laparoscopic and histoscopic training from Claremont Frond, France. Graduated medical school at RJ Carr Medical College in Kolkata. Post Graduation in Obstetrics and Gynecology. Diploma in Advanced Gynecological. Endoscopy from Beams hospitals in Mumbai. Advanced reproductive technology training from Ruby Hall Poon and also from Homerton University Hospital in London, a master's in hospital administration and a fellowship in cosmetic gynecology from American Aesthetic Board in Dubai. Okay, so you notice that curriculum vitae I did not end that or begin and end it with simply a doctorate degree with a focus in obstetrics and gynecology. Our guest on today's show has invested in her skills and expertise and essentially has created a new kind of doctor, a new kind of gynecologist, I should say. One that has chosen a focus, an area of specialty. It seems obvious the reason why this is needed. Our bodies, those who have a uterus, we're complicated little creatures. It seems like up until recently, we've been looked at as sort of automatic generators of periods and babies, right? There's just really not a lot to do. Well, that's because people weren't looking. And it's because we're not so great at standing up for ourselves and expressing our symptoms in general. Not everyone. Some people are excellent at it, and I'm in awe of you. So what this bio says to me is that the time for specialization is here. We need specialized doctors to treat uterine and uterine adjacent conditions, and we need them to train on laparoscopic and historoscopic surgeries. And we need those who have an affinity for robotics to train on robotics. And we have to get serious about elevating gynecology, elevating it and then separating it, separating it from obstetrics and really kind of creating. In my mind, I see three sort of verticals obstetrics gynecology and then specialized gynecology. That is by the very nature of being specialized. It's a surgical focus. These are surgeons, and we need those surgeons. So that's the kind of bio that you want to be looking for. And I asked you to listen closely, because by understanding the different types of gynecologists that are out there, you will be able to better vet your doctor and determine if you're with the right person. You can compare your doctor to our guest today, Dr. Bindra, and see how do they measure up. When was the last training that they had? Was it like, 1981? If so, that's a problem. Do they have any fellowships? Have they specialized in anything? What's a fellowship, you ask? Hey, look, this is like a hear me, hear me within a hear me, hear me. A medical fellowship is the training a doctor embarks upon to become a specialist in their chosen field. So to practice as an OB GYN in the United States, you have to have a bachelor's degree, typically in the sciences. You need a degree from a medical school which takes four years to complete, and you need three to seven years in internship and residency programs. Then one can choose a fellowship if one can handle more school. And that fellowship takes that physician into a specialty. If your physician has opted to not specialize and you're experiencing bad periods and period pain, you want to find a gynecologist who chose to focus on the dime, not the OB, and who has completed a fellowship, ideally in minimally invasive gynecologic surgery or migs, as we call it. Now, there are doctors who, for instance, they don't have a fellowship in migs, but they have a fellowship in Euro gynecology that's super great. Any of those types of specializations will tell you as the patient that this physician has a lot more experience than your traditional guide in taking someone through a diagnosis and then through to treatment rather than just medical intervention. And medical intervention is aka. Take these birth control pills, grab yourself a hot water bottle and get some idol so angry uterus. You just need to look at their curriculum, VTE their bio, if you will, and it's okay to vet to that degree. This is your body we're talking about. Your right to excellent quality of life is the same as anybody else's, right? You have it and it's yours. Exercise it and ask questions if you need to. And you can ask more questions here. We'll answer them for you. But just remember, above all, not all doctors do all things. So our producer Marielle went halfway around the world to find our next guest. This is one segment that you'll want to listen to more than one time. We are excited to introduce you to one of the top occasion surgeons in the world right after this quick break. There's no easier way to make sure that your beauty and personal care products are what they should be safe and good for you. Then finding a source you trust that does all the homework for you. That source is Beauty Heroes, a healthy beauty retailer that carries over 120 brands from around the world featuring truly all good for you skin, body, sun and hair care. They screen for harmful ingredients, sneaky, fragrance, petroleum based ingredients, and other estrogenic ingredients for you so you don't have to decipher ingredient list. They have a well stocked online store and a really unique beauty subscription service that is a huge value delivering founder Jeannie Jarnow's Hero products in a well curated box that is all about quality, not quantity. Take a look at their selection and save 15% on your first purchase from their beauty store or on your first subscription with the code uterine kind at checkout. Visit beauty Heroes.com. That's Beauty Heroes.com. Thank you. Now let's get back to the show. A few weeks ago, we had Aria Vias on the show to discuss her experience with Endo. I was surprised to learn that after trying to get a diagnosis in the United States for years while she was in India, she had a flare and she was quickly diagnosed. That led us to discover today's guest, dr. Vimee Bindra. Welcome to hello. Uterus. We are so grateful that you are taking time out of your weekend to come spend it with us.
Dr. Bindra: Thank you, Carol, and thank you, Uterinekind for having me on your podcast. It's always a pleasure when I talk about endometriosis, and if it helps even one person to help them diagnose their endo or reach to the correct doctor, it will be a pleasure to help them, actually.
Carol: Yeah, that's how we feel having this podcast, that if it's just a few people that have a better experience as they address uterine conditions, then our job is done. We're very happy. So would you tell us how you came to specialize in endometriosis?
Dr. Bindra: When I started my practice after completing my post graduation in Gynecology, I felt there was a need for a specialist who can look into endometriosis treatment. I saw many women suffering undergoing multiple surgeries. That's how I developed an interest in endometriosis. And that day I decided that I'll dedicate my life towards endometriosis treatment because I have seen these women and patients with endometriosis suffering struggling to get the right treatment, get the right surgery, get the right experts. So that's how my interest towards endometriosis started, and that led to my specialization in endometriosis and I started doing excision surgeries.
Carol:How long have you been doing excision surgeries?
Dr. Bindra: It's more than eight years. I have been doing excision surgeries, and in my Gynecological practice, it's more than 13 years. So it's not that I have not been doing it for last 13 years, but I was doing everything initially in my practice, but now I have restricted my practice to only aiming assets so that we can excel in this treatment.
Carol: Are you finding that since you made that shift, that you've seen that acceleration in terms of awareness and being able to treat more people who are experiencing endometriosis, has this specialization positively affected your practice?
Dr. Bindra: Yes, definitely. It's so satisfying to see my patients free from pain. They can expand their families, those who are suffering from infertility, and it gives us immense satisfaction. When I see my patients walking free from pain and they can take care of their children, they can take care of their family, they can do justification to their jobs, it's really so satisfying. I agree. It takes a lot of time on our part, spending hours together for consultation, spending hours together in the operation theater. But once these patients are free from pain, it gives us immense satisfaction and job satisfaction that has never given to me even after any kind of surgery.
Carol:I can understand that. The more that I learn about excision surgery, it's like a sculptor. You are science and art, and I don't think that the artistry has ever been more important than with excision surgery. It is such a delicate surgery and it requires a specialist to be able to do it. So can you tell us a little bit about excision surgery? What is going on when you are operating on someone and you are removing by excision endometriosis?
Dr. Bindra: Before we go into excision surgery I would just like to brief about the endometriotic lesions. Now, endometriotic lesions, as all of us know, are like iceberg phenomena. So what we see it is much more than that, be it in terms of symptoms or be it in terms of lesions. So the lesions which we can see on the peritonial surface or anywhere else, it is much more deeper than that. That is the reason we advocate excession surgeries that we have to scoop out the complete lesion with clear free margins. And also it explains that ablation does not work. So if we ablate or burn the endometriotic tissue it only burns the surface of the endometriotic tissue, the deep down, the lesions, the deep infiltrating lesions are not destroyed and that keeps on causing inflammation and the pain persists for patients. So excision means completely removing the disease with the free margins. Now, excision can be anywhere. In most of the enumetrosis advanced cases where there is a SRM, stage three or stage four disease, the pelvis is completely frozen, the uterus, the rectum, the uterusacral ligaments and the rector vaginal area, there is no space to go in. We call it as a frozen pelvis. Now, as an exit specialist we unfreeze the pelvis, we try to get the anatomy in normal shape and we try to do an organ preserving approach. We have to be very radical against the disease but the organ preservation is a priority. Now, when I say organ preservation, what does it mean? So suppose I do rectal nodule excess. We have to be very careful about the nerve supply to the rectum and the nerve supply to the bladder because if we damage those nerves while doing the exception, patient may have a long term post operative morbidity in terms of bladder emptying and bowel empty. So these are the things where we have to be radical against the disease but always try to preserve the organs. When we remove the ovarian cyst we have to avoid damage to the healthy ovarian tissue so that if patient is trying for conception later she gets a good number and quality of eggs. So excess means completely removing the disease wherever it is. Now, a gynecologist who is trained in endometriosis surgeries, who can identify the endometriosis should lead the team and we should have a team of a colorectal surgeon, a neurosurgeon and if required, a cardiothoracic surgeon as well if it is a thoracic endometriosis cases also. So it's a multidisciplinary team management. Now, this team is the surgical team. Now, endometriosis goes beyond that. So we should have a counselor, we should have a nutritionist, a pelvic physiotherapy. So all these things are very important when we are managing a patient with endometriosis.
Carol: And is it normal for all of those physicians to be there? Here, it's hard enough to just get an excision surgeon, but then to know that you're going to have all of those other surgeons that are required because they specialize in those organs. Right. A colorectal surgeon is the one who would assist in the removal of endometriosis that was on the rectum, for example, is that correct? Yes. So is it easy to make that happen? Because it doesn't seem like it is here.
Dr. Bindra:It does happen when we work as a team, because as I work in multi specialty hospital, so the colorectal surgeon is around, the neurosurgeon is around. So when I need them, I call them. It's not that they are there throughout the surgery. So we start the surgery, we do our part, we do the endometrium exhibition, other nodule, excision, even rectal nodules, we can exercise, but they are there most of the time. When their role is involved, they are called into the theater because they have their own routine work as well. So they cannot be with us all the time. So we lead the team, we do the surgery almost completely and they are there when required because in endometriosis bowel surgeries, we need stapler firing, so we need staplers for display exception or segmental resection and an Astrosis. So I make sure that my cholera surgeon is with me when the Stephen is being fired. The rest of the time he's not required in the theater.
Carol: Understood. So when you're diagnosing and what is the method that you rely upon to diagnose it?
Dr. Bindra: The first thing for diagnosis endo is I always tell is listen to your patient properly. So if you listen to your patient properly, her complaint itself can lead you to diagnosis. So once I suspect endometriosis, then we take the proper history and we do the examination. If advanced disease in examination only, we can make out a lot of findings. We can make out utilize Anthonyardios, we can make out endometrios, we can make out the pelvis is frozen or not. Where are the tender points where she gets the pain? So a proper history and examination is the first step. Then comes the imaging. Now, a good imaging can help us pick up most of the lesions and help us plan our surgery in properly. With the blessing of all my patients, I have a good team where I have a good sonalist as well. So in 90% of our patients, we do only ultrasound. Only. In 10% of our patients, we need MRI. So in those patients, she can pick up everything on ultrasound and we give her NZ scoring, the revised engine, the hashtag NZ classification. She classifies all the lesions, whether the endometriums are there or not, tube involvement is there or not. Rector vaginal septum is involved utrosacrals and the rectal module, and if any other lesions like adenomyoma, ureter involvement or bladder involvement. So she writes it in the ancient form and then the role comes, the role of my counseling to the patient what surgery I'm going to plan. Now, suppose a patient has a bladder endometriosis. She has an endometriuma and she has recycle endometriosis as well. So then we can't tell them that it is going to be a surgery which will involve me, a cholerical surgeon and a Euro surgeon. Now, what are the complications, how many days she will stay in the hospital, how many days she will be discharged, what a patient can expect in the first two weeks of the surgery, what are the early complications, what are the late complications? So all this counseling comes there and then we schedule them for surgery. And I do robotic surgery and laparoscopic both. So very complex cases. I prefer robotic surgery, but as an India robotic and laparoscopic, there is a huge cost difference in the surgery. So if patient can afford robotic, fine. If they can't afford robotic, we can do a very good surgery laproscopically as well. So there is no difference in surgical outcomes. But given the choice for complex cases, I choose robotic.
Carol: When you're doing the imaging and using the ultrasound, are you able to see the lesions that are on the backside of these organs?
Dr. Bindra: Yes. So we can see the lesions on the ovaries, the taurus uteriners, the uterusacrals, and she even tells us about the bowel nodules, the depth of involvement and the circumference of the bubble it involves. So suppose it is a very big nodule. We do talk about segmental restrictions. And if it is a smaller nodule with less circumference involved, we discuss about disqualified excision or shaving. So depending on the lesion and its involvement of the layers of bowel and the circumference of the bowel, the bowel is a tubular structure, so it involves a circumference. If it is more than 40% to 50%, definitely she needs a sigma rejection rather than destroyed. So this helps us in guiding the type of treatment which we offer to our patients.
Carol: And you've mentioned before a frozen pelvis. Is that from the stickiness of the endometriosis tissue that's growing between the organs?
Dr. Bindra: Yes. So endometriotic tissue actually produces its own hormones and it causes a lot of fibrosis and inflammation. So that fibrosis and inflammation leads to sticking off all the organs together. That is the reason these dissection are very difficult, because the normal planes are lost and all the vital structures come and stick together like ureters. They may be very close to the uterusacle. And this is also a reason that many of the gynecologists or the general gynecologists who do lacrosse copies, but they do not touch these cases or they go in and they abandon the surgeries because these vital structures are involved and there can be an injury or damage to these structures.
Carol:In a situation like that, how many hours on average are you in the operating room? Exciting. This is it exciting. The endometriosis.
Dr. Bindra: Carol it depends on the type of case. Some cases may take six to 8 hours. In some cases we do two to 3 hours. It really takes a lot of time, but at the end of the day, we feel very satisfied after removing the complete disease.
Carol: That's something that I want to just point out to our listeners when you hear that it's a surgery that can take hours and hours. And as we said, it's art and science and it's like being a sculptor, except you're not dealing with marble, you're dealing with a human being. So you have to be extremely careful about your work that you're doing. So this is not your typical gynecologist, right? Your typical gynecologist isn't signing up for this. What is it when you go to do something that's really, really difficult and other people decide they're like, no way, that's too much for me. I'm not going to do that. It's like you're making a choice to go down a road that is fraught with complications. And so just in the middle of this interview, I just have to thank you again because I can see why doctors would be like, no, that's okay. I'm not going to be an endometriosis specialist. It's far too difficult.
Dr. Bindra:I agree with you that many people don't want to do, but in India, what problem we face is that every gynecology treat syndrometrosis. So there is a lot of usage of hormones, and when they take the patient for surgery, those are mostly incomplete surgeries. So it does not help them. They do not refer the patient to the specialist doctor, rather than that everybody is treating an amateur oris so that is the problem we are facing.
Carol: Yeah, and same here. I wonder if it's part of sort of the life cycle of how we're looking at this disease. And the more that we learn about it and we understand and I guess also the more that we respect the experience of people living with endo that we recognize that their quality of life is significantly impacted. This will, I hope, emerge as a specialty, and as a specialty that almost sure, it can sit within gynecology. But this is a full body, inflammation oriented disease. And the way that you describe the excision surgery, I kept imagining an oncology surgeon, someone who needs to go in and remove the cancer. And if it's a melanoma, they need to get the mole out. They need clean edges, and they need to go deep enough or it's not going to work. So now you brought up hormones. I wanted to talk about that. I've heard a variety of things about using hormones specific to endometriosis. One is that it helps to diagnose that by suppressing the symptoms. The suggestion is that endometriosis might be the cause of the person's symptoms. If they take Hormonal medication and those symptoms are suppressed. But I always think that that's just delaying a diagnosis. And my concern is that the disease is progressing during that time. And some physicians give the Hormonal, let's say, birth control pills or a depot shot, and the patient's symptoms are suppressed. And so then they stop going to the doctor because they're like, okay, I feel better, everything is good to go. And then meanwhile, the disease is progressing. So how do you work with Hormonal treatments in this capacity? And what is your opinion about using them to diagnose endometriosis?
Dr. Bindra: So I absolutely agree with you. The problem with medical or Hormonal treatment is it does suppresses the symptoms and the disease keeps on progressing silently. As you said, the patient sits back and relaxes and they say that nothing will happen. We have seen patients losing their kidneys because of the urethra obstruction, because of the progressive disease. So as a matter of fact, as an excuse surgeon, I do not believe in medical therapy, but we have a set of patients who do not have very severe symptoms, but they have been diagnosed with endometriosis and they want to wait for surgery. So in those cases, I prefer to put them on progesterone only pill and tell them to come for interval monitoring at three to four months. So I have a baseline imaging for them. I know she has these lesions and if her symptoms are better. Even then we strictly tell them that you have to come back for the interval growth of the lesions or any denoval lesions are coming back or not a patient with denominators comes back to us and then we do a repeat imaging and if any growth of lesions is there or any denovations are there. She is definitely a candidate for surgery. But if the growth of lesions is the same or it has regressed minimally, the patient can be under follow up. This is for a set of patients where they do not want immediate surgery or they do not have any debilitating symptoms, right?
Carol: Maybe the time is not right. They need a little bit of time. That is music to my ears because I feel like we can't keep treating everything with birth control pills. This is what I want to say.
Dr. Bindra: Yes, for diagnosing endometriosis, I do not agree that hormones should be used to diagnose endometriosis. Endometriosis can be diagnosed clinically by imaging and with the slightest suspicion I can diagnose endometriosis. So to diagnose only endometriosis hormones should not be given. And definitely we do not use much of GNR analogs in our practice because they have a lot of long term side effects. Also, for some patients who have adenomyosis or their reproductive endocrine, logistics wants GNR challenge, that's a different case scenario.
Carol: Okay, that is really important information to tuck in your head and take with you to your doctor, because you don't have to go down this long path of medical intervention and delaying any kind of imaging and we know what works right and we're hearing it from a worldwide expert. So make sure that when you walk into your appointments, when you walk into a consultation, that you speak your needs. Another question about using birth control pills or hormones in the diagnosis or treatment process of chronic uterine conditions. Do we know what the mechanism of action is of endometriosis? Do we know how it's hormonally triggered?
Dr. Bindra: No. Endometriotic tissue, as we all know that it is lining of the uterus, like the similar tissue to the lining of uterus is implanted outside. Now, basically it happens during the development that these cells are laid down. That is according to the theory of malariosis I'm describing it that these are kind of stem cells which are triggered or there is an insult during the growing years and it starts forming that endometriotic tissue and this tissue produces its own hormones. Now, the birth control pills, what they do is they suppress our ovaries. Now, that's the reason we say that endometriotic tissue produces its own hormones. So these hormones, the external hormones which we give it may not always work for it. So what it does is it produces a state of annivelation and it suppresses your ovary. So patients who get pain before periods or during periods or ovulation time, their pain is suppressed to some extent but exactly it does not have any impact on the endometriotic tissue. So it produces a state of like GnRH analog, they produce a state of pseudomenopause. Like a patient has deficiency of FSH and LH, like the deficiency of estrogen and registered because FSH and LH is high. Now, birth control pills effect locally on the reproductive organ, the ovaries, the GNRs work centrally so it produces a state of pseudo menopause and pseudo pregnancy. So that is how it suppresses your symptoms but there is no direct impact on the endometriotic tissue.
Carol: So is there a concern that by giving birth control pills that you're going to accelerate? Could you accelerate the progression of the disease or is that not a potential?
Dr. Bindra: There are some theories which say that as it is estrogen dependent disorder there may be acceleration and growth but none of the studies have proven it. So there is no evidence that it increases the growth because many patients who do not tolerate progesterone only pills, they are given birth control pills. I don't think there is a direct correlation between this estrogen and direct progression of the disease. So this disease has different characteristics in different patients. What we have observed, for some the growth is very rapid, for some the recurrence is very rapid and for some it never comes back. So there is a lot of interplay of genetics and epigenetics which plays a role in the causation of the disease and recurrence of symptoms or recurrence of lesions. So direct Hormonal correlation has not been proven yet
Carol: and what are you seeing in under research that you are excited about or that has you thinking that we might have some breakthroughs coming soon? Is there anything on the horizon?
Dr. Bindra:All of us know that endo research is always underfunded. But yes, many institutions and organizations are doing a lot of work in India. Also there is an organization which is working towards endometriosis. I may get involved with them soon, but then there is a lot to be done for such breakthrough. Or I would say yesterday only one patient was asking that I need what permanent cure can be. Something like gene therapy or a vaccine for endometriosis. Till then, exceedure is the only answer, right?
Carol: That would be just the best day ever, wouldn't it? Yes. You understand so clearly because you're not seeing one or two patients a month. Every patient that you see is an endopatient. So you have a very clear understanding of the impact to quality of life and also the difficult nature of treating the condition. And so while a vaccine would mean that you would need to change your specialty, I may become jobless, right? You would retire. But is that even feasible? Is it something that we could accomplish until
Dr. Bindra: unless we know the specific reason for it, it is very difficult to develop something like that. Right?
Carol: So we have to understand a specific map.
Dr. Bindra: Yes, more biomarkers and more studies towards the pathophysiology involved, then only maybe we can reach at that point.
Carol: So, you had mentioned earlier when we were talking about having all of your colleagues around to help you, you mentioned having a nutritionist and I believe you mentioned pelvic physical therapy and things like that. What are some of the things that you think are absolutely essential for someone who has already invested in the excision surgery?
Dr. Bindra: They've committed to do that and in order to make their recovery from that as best as it can be. And then also to ensure that the endometriosis doesn't return or it doesn't have a hospitable environment to grow in, what do you recommend to the patients that they do there? So costoperatively our patients, we routinely put them on anti inflammatory diet and pelvic physiotherapy. And then also many patients have pain post surgery as well. So the role of pain specialist comes in. So, as I always say, that endometriosis exception is just one step. There are many things which patients should do post operatively. So regular exercise, proper nutrition and anti inflammatory diet. And if pain persists, they may need a help of pain, especially because there are multiple pain generators which can lead to such kind of pain. And also the role of a counselor. It is very, very important because these patients go through a lot. They go through multiple surgeries. Some people may have lost their job or they may have family issues. So role of psychological counseling is very important, preoperatively as well as postoperatively to bring back these patients to the normal life. When these patients experience that their pain has reduced, definitely it helps them to bring back to normal. But there is an emotional wellbeing which is also involved with these kind of surgeries, because when we counsel them for surgery, we do counsel them for a lot of complications. So it gives them a lot of mental stress when they go for surgery. Will I get that complication? What will happen post operatively? Will I end up with another surgery if a bowel leak happens? Will I get a Stoma if the leak happens? So these are the things these patients go through a lot even if we do the surgery. So postoperatively psychological counseling, diet, pelvic, physiotherapy, role of pain specialist, these are very important.
Carol: Yeah. As you're describing that, I'm thinking about the type of care that I can only speak specific to the United States that we offer cancer patients and we offer that type of care to cancer patients. They have access to multiple specialists and therapists and pre and post operative coaches. It is such a beautiful pathway for a very terrible disease. Right. We need the same here because this disease, in some cases, it may lead to someone dying. But generally speaking, this is not a terminal situation here. But it requires the same kind of delicate and supportive handling.
Dr. Bindra: I think that benign terminology. It is not getting the attention which endometrosis should get. And being a predominantly women disease, I will not say that I'm not getting gender specific, but majority of women who are assigned female at birth have more endometerosis. Am I correct? Yes. So these are the two reasons where it comes to benign and a disease where majority of women are affected. It is not getting the proper attention which it should get, but otherwise I always say that it invades it is not cancer, but it invades the surrounding structure. It invades the relationships, it invades your emotions, it invades all your social life, emotional life. So it is similar to cancer if pathologically it is not. And these surgeries are as complex as ongoing surgery and neurosurgery. So it should get a proper attention so that patients suffering with rendomatosis get a proper care.
Carol: So in the United States, I believe this is an accurate number. We have approximately 150 excision specialists in the United States, but one in ten people are living with endometriosis. So that's not sustainable. There's no way 150 people can treat one in ten. How do we change that?
Dr. Bindra: This actually needs a change from the medical school teaching. The change in medical school teaching can only bring about a change because endometriosis should be sub specialized. Like you do your medical training, then you do a specific gynecology training and there should be a sub specialty training in endometriosis like they have for neurosurgery or onco surgery. There is no service to facility training for endometriosis'it should be a separate branch altogether where people can opt for after doing their gynamic residency, they can opt for Endometriosis as their sub specialty. Then we may produce more number of specialist every year and even gynecologists will understand that this is not my domain, so I'll not deal with it and I'll refer to the right specialist. So if those restrictions come that only people who are specialized in endometer surgery can operate on these patients will definitely increase the number of doctors, also increase the awareness among patients, and patients will not line up with multiple incomplete surgeries.
Carol: Yeah, so we need that change. I think that a subspecialty. Is that what a fellowship would be? If we had a fellowship in Endometriosis, then they would cycle into that after they completed their residency?
Dr. Bindra: No, we do have fellowship, but the problem is how many of them are recognized fellowships? More than Chelsea. We have fellowship in minimally invasive gynecology like in laproscopy and robotics now. But these gynecologists can do all surgeries. So Endometriosis should be a sub specialty, like physician can treat diabetes and physician can treat other diseases as well. But now diabetes has emerged as a sub specialist. Like there are diabetologists, so there should be Endometriosis specialist. So then maybe we can bring the change we are looking at.
Carol: Yeah, it's essential because I guess this has been going on for a long time. Right. Endometriosis didn't just start showing up in 1970. This has been going on and ignored for a long time.
Dr. Bindra: So you won't believe in India, in India we have some courses where they do a three days course or a five day course and they become indomitable as a specialist. So these things, because they are already doing a transportation, so they will go somewhere, they'll do a three day training or one week, they'll observe and they'll come back with the Endometriosis specialist. So there has to be a regulation or there should be a regulatory body which controls these training programs. Then maybe we can emerge as a service specialty.
Carol:Yeah, so we need to continue to bring awareness to this condition and we need to support the physicians that are battling on our behalf and are changing the way endo is diagnosed and treated. And also something that Dr. Bindra pointed out, we need to get gynecologists to refer their patients out. That if those gynecologists because remember, not all doctors treat all things. So if those kind of collages are not, for instance, trained and minimally invasive gynecologic surgery, then you need to find a doctor who is and get referred to someone who is a specialist. So last but definitely not least, you've mentioned quality of life. And I know that in research there is a lot of research focused on quality of life. But it seems like when a patient goes into a doctor's office, quality of life is not a central part of the conversation. It's more about how much can you tolerate and oh, this is normal. Everybody has bad periods, everyone has pain with their periods, et cetera, et cetera. So there's this gas lighting component that happens, and we leave thinking that our quality of life is not as important as being on our best behavior, let's say, when we're at the doctor's office. So can you talk to me about your feeling around a person's right to the best quality of life that they can access?
Dr. Bindra: Carol, what you mentioned, I can't agree more with you because many patients who come to me, their main complaint is that they were dismissed. They were told that this is normal, and everybody goes through that. You are overreacting. All these things are not uncommon to hear of. So many patients are told this, and this also needs improvement. That also, again, should come from the medical school. Now, when my patients or our clinic patients come to us for endometriosis, we look them as a whole like how many years she has been suffering, her reproductive life, her emotional wellbeing, her social life, how this disease is impacting her. So this is our main concern. It's not only the surgery which we aim at, like, I'll do surgery and everything will settle out. It's not so first, talking to the patient is very important. Validating her symptoms. If she's saying she has pain, we have to believe. Nobody can fake pain throughout the year, nobody can fake pain throughout the month, nobody can fake pain every day until unless they have some psychological issue. And all end of patients cannot have a psychological issue. So it is the reverse psychology, which we are playing, where if we don't validate their symptoms like, I'll give you an example of a dollar girl. Suppose her mother keeps telling her that this is normal and everybody goes through this. After insisting, she takes her to a Gynecologist and the Gynecologist says this is normal, every girl goes through it, it's fine. So what happens to that girl? So when she goes to school and she has pain or she has periods, she sees her classmates, they are not having any issues during periods or any problem during periods. She feels there is a problem with herself. So she starts doubting herself and she starts undermining herself that I cannot handle myself. Everybody is handling so well during periods. They do not have pain, they do not have any issue. They can play, they can do their exams, they can do everything. It is me who has the problem. So this has a huge psychological impact on her development. She starts thinking that she cannot do it as others can do it, and it will impact every aspect of her life. So not validating someone's symptoms or telling them that this is normalization of symptoms, we do not advocate at all. And we have patients who have been told this multiple times, and they were frustrated. They went to seven, to ten gynecologists, then they came to us and then I have seen patients started to cry because I validated them. I agreed with their symptoms, and I could find an endometriotic nodule or I could find a diagnosis for them so they knew that there is a reason for their pain and they stop self doubting themselves. So diagnosis is therapeutic in most of the cases, right?
Carol: I want to say that again, getting a diagnosis is therapy. It's therapeutic. That is so beautiful that you said that, because we experience here like, this sort of aversion to getting a diagnosis, not on the patient's side, but on the physician side. They diagnose. Without diagnosing, the patient comes in and expresses some symptoms and perhaps doesn't express the symptoms in a detailed enough fashion that gives enough evidence if there's a real problem. And we always want to be on our best behavior in front of doctors anyway, so we minimize our symptoms, and then the physician is like, oh, I see this all the time. This is normal without actually diagnosing anyone, right? And it leaves us in a limbo. I'm also so glad that you raised that example. Using an adolescent, using a young girl. It really hit home for me when you said her mom tells her it's normal, which is a completely normal response from a mom. Because the first time that a child expresses pain with their menstrual cycle as the mom or dad, you might be thinking, they haven't felt these cramps before. So it's a new kind of pain for them, and we just want to kind of calm them down and make them realize it's okay, this is normal. And yes, that is so damaging. Not that the parents are trying to be damaging. I'm not placing blame. It's just the realization of how damaging that is. I immediately envisioned in my mind's eye that girl thinking, oh, it's me. I'm the one who's the problem here. And then that carries on until someone unwinds. It just so powerful. That is such a powerful example.
Dr. Bindra: So that's what I said. Diagnosis is therapeutic. I'll give you another example. Like, two weeks back, one patient from Netherlands came to me, to India. She self diagnosed her symptoms and then went to the doctor, and she said that I have endometriosis. And how she did pause going through our social media posts. She was having all those symptoms, and for last two years, she was visiting multiple doctors in Netherlands, and everybody was saying, nothing is there, it's fine. And ultrasound imaging, nothing is there. Then she insisted, no, I have these symptoms. Please get an MRI done for me. Then the doctor did MRI, and in MRI they could pick up endometry OMAS. And then she was diagnosed and she came and told us that, doctor, we followed your post, and I have self diagnosed myself, but I have suffered for the last two to three years. And we did her surgery recently. She came from newer lands, so for her also like getting a diagnosis itself was so therapeutic that there was a reason for her pain. She's not just saying that she has a pain. There is something which was validating her symptoms. So diagnosis is therapeutic and it's really satisfying to see patients getting the diagnosis. First exception is the later part, right?
CarolL The diagnosis is an important first step. And if someone doesn't take you through that process to get you to a diagnosis so that you can make choices based on real facts rather than just someone's assumption, then you need to go see a different doctor. Dr. Bindra, you make me so grateful for social media because I love knowing that people are finding you on social media much like we did. And connection is leading to them getting relief. That changes their life. It changes the trajectory of their life. I can't imagine how busy you are actually. Before we let you go, would you please tell us what it is like during a work day for you when you are at your practice? Is it chaos? There must be so many people who want to be your patient. So how do you manage that?
Dr. Bindra: Yes, because of so much of time involved in our operation, theaters, it becomes a fight for us also to help all our patients. So we get a lot of inquiries. We get a lot of requests for online appointments from abroad and other cities in India. So I practice in Hyderabad. It is in South India. And I practice in tertiary care center. It's Apollo hospitals. So most of the patients who are coming from outside, they write a mail or contact our secretaries. And first what we tell them is we schedule an online consultation. I have a team of doctors with me who helped me with these consultations as well. And then we talk to them. We try to figure out what these patients are going through and whether they really need a surgery or not. Then, if they are for surgery, we give them a tentative date for surgery. There is definitely a waiting of around four to six weeks in our practice as well. But then for patients who are coming from abroad, they need that much time anyways and from other cities. So we give them a tentative date. We call them one or two days prior to the surgery. We get their imaging done with our Sonils, and then there is a detailed discussion about the surgery. And then we take them for surgery. Now. Yes. As you clearly said that with so much of demand, sometimes it becomes very difficult for us to balance the professional and personal life. That's the reason I agreed for a Sunday recording rather than a weekday recording. Because Monday to Saturday we are really very busy. The first consultation, I have two more consultants. Granny calls with me. So when they schedule an online consultation, one of the Garlic colleges talks to them. Take all their details, all their previous imaging, previous surgery notes and everything. We clearly write it down on our software. And then second consultation, as per my schedule, is scheduled with me. It's a part of first consultation only, but first they have to go through this process so that the time with me can be saved, because I have their charts ready and then we can talk more about her symptoms and all this is how we manage our patients. And, yes, I have a lot of physical appointments on a daily basis. When I'm not operating, we are somehow managing and we are trying to help as many as possible.
Carol: I see a future where there's bindra endometriosis centers that are all around the world. That's what I'm going to wish for, which is you're probably like, I'm busy enough. But it would be amazing. It has been just such a gift to talk to you, and I'm so appreciative of this time. And I also want to just congratulate you and thank you for making this choice. The people that you're helping in your practice, you're helping them, but you're also helping everyone around the world by making sure that you're putting content out there that helps them, no matter where they're located, have a better experience getting diagnosed and treated with endometriosis or treated for endometriosis. So. Thank you, Dr. Bindra. I'm so grateful.
Dr. Bindra: Thank you so much, Carol, for having me, for your podcast. It was really a pleasure to talk to you. And as I said, that if it helps even one person, my job will be done. And really, it gives the immense satisfaction when I completely excise the disease. And to let you know that I'm also coming up with Endometriosis Foundation of India to create more awareness and more work towards educating doctors and people both so that I can reach more people.
Carol: Oh, that is fantastic, because you're only one person. But the more structure you have beneath you and the more support you have, we can extend your experience around the globe. So that is really exciting to hear. And it's a small world. That's why I definitely look outside of the United States often for research and for experts, because it doesn't matter where you're located, we're all human, right? If you're in Los Angeles, you're human. And if you're in India, you're human. And if you have Endometriosis, you're human. And you deserve to have excellent quality of life. And so wherever we need to go to get that, we're going to help people make that happen. So thank you. Enjoy the rest of your Sunday evening, and we hope you have a great week, healing and patience, and we hope to see this foundation get off the ground, and we'd love to have you back on when it does.
Dr. Bindra: Thank you so much, Carol. Thank you.
Carol: That was a consultation with Dr. Vimee Bindra. Amazingly helpful. I know that some of you are going to be relieved. To know that there are doctors out there who are specializing in endo and that we're at the beginning of a wave of that. We're going to continue to apply pressure to medical schools and to the American Congress of Obstetrics and Gynecology and to anyone that we can apply pressure to, to encourage surgeons to become specialists in endometriosis and be able to provide more assistance because it's a super common condition and it's obviously ridiculously debilitating. So it's time. It's absolutely time. And then the other thing that Dr. Benjamin brought up was the idea of subspecialists and or sub specialties. We talked earlier about fellowships, these little bits and pieces of information about sort of the behind the scenes of how gynecology works and surgery works and how the industry works. These are really important things for you to know, because then you can more confidently navigate it. And when you're talking to a doctor, you can ask questions like, should you be referring me to someone else? Are you a specialist in excision surgery? Have you performed excision surgery before? What is your method of diagnosing endo? All of those types of questions, you're allowed to ask them. You are encouraged to ask them. And you need to ask them because you have to be the one that is in control of this process. If you give over control to a physician, unless it's someone like Dr. Bindra, you're taking a chance. You really need to be the one that is at the helm. You need to be the one that is leading your team so that you have the best chance of a successful surgery and a swift recovery and it's possible. Yay. Dr. Bindra, we are so glad that you made that choice eight years ago to leave behind a general gynecology practice and devotee yourself to eradicating endometriosis. And we're so glad that she was able to come on our show. So we will take a quick break and we will be right back with ending on a high note.
Carol: Ziggy came home after eleven years on the run. All I can hear in my head is Bowie. David Bowie. I won't sing it for you. That'd be like the worst thing that I could possibly do. Instead, I'm going to tell you about a missing cat that was reunited with its owner eleven years after it disappeared. I cannot imagine. I can't imagine. I would have definitely never expected that cat to show up. But Ziggy did. Ziggy's owner, Ruth Worm in the UK lost her cat eleven years ago. She put up some posters and the cat was chipped. She put up posters, but nobody found Ziggy. And then over a decade goes by. She said after a couple of years, she had given up hope. I think after one year I live in California. If my cat disappeared, I'm assuming it's in the stomach of a coyote. But where she lives, probably no coyotes. So it took her a couple of years. But then she did give up hope and she got a new cat, freddie. Freddie didn't know about Ziggy. Freddie probably thought that Freddie was like the only cat in her eye. The only one who occupied a space in her heart. Freddy the be all, end all cat. And then one day, Ziggy stardust, yes, she did name the cat after David Bowie's alter ego showed up. Not really on our doorstep, actually. Ziggy showed up in somebody else's backyard and they gave him a little bit of food and water and then he got a little bit more friendly and started coming around to get pet and stuff. They then posted on Facebook pictures of Ziggy. This would make me so mad. Ziggy was found a 20 minutes walk away from his original home. He was only 20 minutes away for eleven years. That would haunt me. It would haunt me. And I would also have a really stern conversation with Ziki, like, yo, you know where you live, what? Don't run away. And they make me have to come get you. So they brought Ziggy back and the woman who owns Ziggy said, you know, he looks the same and he acts the same, but we can't tell if he recognizes us because he was always a friendly cat. And I just find it remarkable that one, that she recognized him, that the whole thing came together, right? First of all, that he never in eleven years, he never strolled, made a left and ended up back at his house. Instead he's 20 minutes away at somebody else's house for eleven years. And then she happens to see it on Facebook and yay, one tiny little mark in the positive Facebook column and is able to bring her kitty home. It's the most exciting thing ever. The only thing that probably is a little bit of a sticking point is, you know, Freddy. I mean, Freddy probably thought he had it all and now all of a sudden there's this new cat around and the new cat is getting all the oohs and AHS and pictures in the newspaper and people are calling for interviews and what about Freddy? Freddie didn't run away. Let's give Freddy some love. Actually, I'm just really happy that Ziggy came home and I'm really happy for Ziggy's parents. It's just super exciting. So pets return. They do. Unless you lose your cat in Northern California, in which case it's probably not going to return. Oh my gosh, what an amazing conversation that we had. Today is just an incredible opportunity for us to be able to talk to Dr. Bindra and learn about excision surgery from her perspective and the things that you need to do. And I really love that she kept coming back to the need for therapy. This is a really brutal condition to deal with. That's why we talk about it so often on this show. And so if you don't have endometriosis, chances are there's someone in your circle of friends that may. And so, even if you don't have it, definitely stay up on what's going on and be a good support to that person because this condition is brutal. I want to thank angel for producing this podcast. We had some issues with audio. I hope she's able to polish those out. I'm sure she can. And I also want to thank the team at Uterine Kind, thank Marielle, who is another producer on the show, who's helping to bring the best guests that we can invite on so that you can have these free consultations and learn more about chronic uterine and uterine adjacent conditions. And thank the rest of the Uterine Kind team who's building an app that's going to make it a lot easier for you to get diagnosed. We have some amazing interviews coming up in the next few weeks, including patient stories, so please do come back and listen. And also, we're going to be announcing next week our four winners for August for our Beauty Heroes Giveaway, and those boxes will be landing on your doorstep. Inside are going to be some great, clean beauty products that really help you spoil yourself and pamper yourself and take good care of your skin and body so that you can be your healthiest. Because your quality of life matters. It really does. You do not have to suffer. We'll help bring those resources to you and you can always reach out to us. Send us your questions at hello at hello. Uterus.com. And also please do visit uterinekind.com. And if you'd like, you can share your email address with us and be entered into our Beauty Heroes Giveaway, and also receive an email when we launch our app this fall. And you can get 30% off an annual subscription and have a much better experience with your physician consultations and with any conditions that you're dealing with. So definitely take advantage of that. Visit uterinkind.com and send us your questions at hello at hello. Uterus.com and have a great week. And we'll be back next week with another episode of Hello Uterus. Till then, stay cool, be well, and thanks for listening.
Angel: The Hello Uterus podcast is for informational use only. The content shared here is to not be used to diagnose or treat any medical condition. Please speak with a physician about your health condition and call 911 one if it's an emergency. And thank you, Uterine kind for listening.