169 Living With and Managing Endometriosis

In this conversation, Sally interviews Cindy Dabrowska, a registered dietician and endometriosis specialist, to discuss the debilitating disease of endometriosis.  Here’s what we cover:

• What endometriosis is and why it causes so much pain.
• Why there are challenges getting a diagnosis.
• Management strategies for endometriosis include pharmaceutical options as well as naturopathic.
• What progesterone resistance is and how we can address it.
• What a holistic approach to managing endometriosis might look like.
• Why endometriosis is so challenging. 
• Side effects of prescription hormone therapies. 
• Dietary and lifestyle modifications to help endometriosis. 
• What supplements may help to alleviate symptoms.

Cindy’s Links:

Instagram: https://www.instagram.com/endo.fertility.dietitian

Website: https://www.endometriosisdietitian.ca/

TikTok: https://www.tiktok.com/@endo.fertility.dietitian

YouTube: https://www.youtube.com/@theendofertilityspace

Sally's Links:

How to Heal The Trauma Underlying Your Menopause Symptom Severity [Online Workshop] www.sallygarozzo.com/healingtrauma 

[Free] Relaxation Hypnosis Recording:  https://bit.ly/relaxationwithsally

How to Create Phenomenal Self Esteem [£47]:  https://www.sallygarozzo.com/selfesteem

Menopause Wellbeing Practitioner [£127] https://www.sallygarozzo.com/meno

Cold Water Therapy Practitioner [£127] https://www.sallygarozzo.com/cold

Transformational 30 Day Rewire (Includes RTT) [£447]: https://www.sallygarozzo.com/rapid-transformational-therapist

Transformational Trauma Informed Coaching [From £197]:  https://www.sallygarozzo.com/transformational-coaching 

Instagram:  https://www.instagram.com/sallygarozzomindmentor

Linkedin: https://www.linkedin.com/in/sallygarozzo/

Send me a voice clip via What’s App - https://wa.me/message/FTARBMO7CRLEL1

Transcript

Sally (00:02.028)
So my guest today is Cindy Dobrowska. Cindy specialises in helping people with the debilitating disease endometriosis. She's a registered dietician, a master of applied nutrition and is someone who is dealing with endometriosis herself too. And she's here today to help us understand endometriosis on a much deeper level and to discuss what help there is if any of you or someone you know is struggling.

So Cindy, welcome to the podcast today. How are you doing this morning?

Cindy Dabrowska (00:36.286)
Thanks so much, Sally. Appreciate the invitation. Happy to be here and I'm good. I'm excited this morning. How are you?

Sally (00:44.034)
Good, I'm well, thank you. I know there's a bit of a time difference for us. So it's 12 o 'clock for me, it's 7 a for you. So we're supporting you here in this time with your coffee and your, you know, a gentle wake up for you. Yeah, yeah, okay. So I approached you on Instagram because I kind of recognized that we haven't talked much about this subject on the pod and.

Cindy Dabrowska (00:58.105)
Exactly. My duds will start to the day.

Sally (01:12.758)
I really wanted to introduce my listeners to an expert like yourself, because I know that it's something that can get worse for many women during perimenopause and can also leave women as well with an instant menopause situation for those who have to undergo hysterectomy and oophorectomy as a result. So think it's really important that we highlight this conversation, especially around what we can do to support ourselves. So thank you so much for being here today. So

Cindy Dabrowska (01:42.697)
Thanks

Sally (01:42.847)
Endometriosis, can you tell us what it is for those that don't really know?

Cindy Dabrowska (01:46.281)
Of course. Yeah, of course. So endometriosis, like you alluded to in your intro, it is very debilitating. It's a condition where tissue that is similar, but it's important to acknowledge that there are many differences between the endometrium, the lining of the uterus, as well as the endometriosis lesions. So it's a condition where tissue that is similar to the endometrial lining, also very different grows outside of the uterus.

everywhere at this point it's been found on every organ of the body. It's of course a little bit rarer to find it on places like the heart or the thoracic cavity, although it's being found there as well. And this tissue does respond to the cyclical hormonal changes of the cycle. I mean, again, assuming that somebody is cycling regularly. And so these lesions do bleed when the progesterone and estrogen drop that,

essentially trigger the shedding of the uterine lining. And so they do bleed, but because they are outside of the uterus and they don't have anywhere to go, this tissue essentially forms lesions and it can advance into scar tissue that makes organs very immobile. They don't move around very well. It can lead to extremely debilitating pain. It could lead to leg pain very often, upwards of 90 % of sufferers.

experience some kind of IBS or bowel symptoms. Infertility is a huge unfortunate consequence for many who live with endometriosis and I always make a point to to mention that one of the the big symptoms with endometriosis kind of goes outside of the physical like there's a lot of literature around

mental health being negatively affected by the disease. There's a lot of anxiety reported in this population. So that's kind of endometriosis in a nutshell.

Sally (03:50.484)
Mm -hmm. Yeah, okay. That's really fascinating. How, why does it grow outside of the uterus? Do we know?

Cindy Dabrowska (04:00.265)
There are a lot of theories as to why endometriosis occurs. There's this idea of retrograde menstruation, that the blood flows backwards essentially from the uterus through the fallopian tubes. There's a well -established genetic link. So you are six times more likely to have endometriosis if some...

a female in your immediate family also has endometriosis. That's probably where I got it from because my mom had endometriosis. But we don't know for sure. We don't have a definitive cause for endometriosis. There's a lot of fascinating literature, new research coming out about the gut endometriosis link, how certain bacteria in the large intestine microbiome are

Sally (04:32.428)
Hmm.

Cindy Dabrowska (04:52.401)
more likely to contribute to the growing and establishing of this disease. And then that some have a protective benefit against development of endometriosis. There's a lot of literature around diet having protective effects as well as the opposite rate that it can contribute to the development of endometriosis. But we don't know for sure. mean, one thing we do know.

without going off on a tangent here, is that it is a condition of immune dysfunction. So the way that I like to describe this to people is that in somebody like me who has endometriosis, when my immune cells rush to respond to an endometriosis lesion attempting to establish in my body somewhere, it's defective. So, you know, it'll rush to that spot.

it'll attempt to remove that endometriosis lesion. It may be somewhat successful at removing that endometriosis lesion, but not fully successful. So let's say for the sake of this conversation, maybe 10 % of it is left behind. Well, that 10 % is still sufficient to be able to establish, know, develop a blood supply and then grow and proliferate to other parts of my body, right? So, and then conversely, in somebody who does not have endometriosis, the immune system is...

strong enough, it's functioning well enough to be able to fully remove that endometriosis lesion. And then from there, the things that can feed that endometriosis to grow are, it's a long list of things. It could be nervous system dysfunction, it could be estrogen, it could be prolactin, it could be low levels of progesterone, it could be aspects of diet that contribute to inflammation, right? And the list goes on. So that was sort of a long answer. don't have a concrete answer, but that's...

of somewhat some of what we understand about you know how endometriosis develops and grows.

Sally (06:39.83)
Yeah, so what I'm hearing is it's like a whole body condition rather than just a local condition that exists in the uterus.

Cindy Dabrowska (06:48.901)
I love that you say that because a lot of, I guess what you can say, well -meaning surgeons and doctors and specialists do refer to it as a gynecological condition only where in fact you're absolutely right. It is a whole body condition. Like I said, it is rare, but it's been found in the brain. It's been found to affect nerve function and...

And yes, of course, fertility and bowels, and then of course it extends into mood and your ability to have a social life and be a productive employee, right? So absolutely, I would agree with that, that it is a whole body condition, definitely.

Sally (07:30.828)
Yeah.

Yeah, and I guess that plays into how we treat it as well, but we'll get on to treating it in a moment. I'd love to know from you, Cindy, what's your story yourself around Endo? Like, how did you realise you had it and what were your symptoms?

Cindy Dabrowska (07:39.977)
Thank

Cindy Dabrowska (07:48.617)
Yeah, so my story is sadly not very unique. Like I think so many women can relate to my story because this is just kind of how the women's healthcare spaces, they just kind of are. So I am somebody who's had extremely debilitating periods from the very first one I ever had when I was about 12 years old.

It's really funny, I sometimes tell this story when I'm asked this question but I don't need to get into the details of how I knew what a period was before I got my period. I I think many women do, you kind of mentally prepare yourself. But my aunt, my mom's sister, my mom would tell me stories when she was younger that she would do anything she wanted on her period. She was so active, she had so much energy, she played sports and I was like, I want my periods to be exactly like my aunt's.

But unfortunately, that wasn't the case for me. They were significantly more like my mom's, which were very painful, debilitating, know, taking you out for a couple of days. So anyway, back to the story. I should have warned you, Sally. I tend to go on tangents when I'm on podcasts, but hopefully they're, know, conducive to what we're trying to get at. Okay. So yeah, very debilitating from the first one ever.

Sally (08:57.926)
That's so right.

Sally (09:02.889)
we love a tangent, don't worry.

Cindy Dabrowska (09:11.335)
I remember that day I was calling my the office at school was calling my mom to come pick me up because it was just so terrible. You know to the point where I would simultaneously be passing you know very loose bowels on one end but then on the other end I was vomiting because the pain was just so extreme that you know it was causing me to vomit to faint just like completely immobile. I can't even tell you how many

how many memories I have of me just like laying immobile either on like my shower floor or my bathtub or on my bedroom floor because it was just so debilitating that I even just like like a slight movement of a body part you just you feel like you're You know, you're just like disintegrating. It's like so Anyway, it's very extreme So those are my symptoms. I did have some Bowel symptoms like

My bowels would change depending on where I was in my cycle. A lot of fatigue, especially when you're kind of coming out of an endometriosis flare, there's a lot of fatigue. really just, your whole body, you you just kind of feel like you've gone through something very traumatic. And I had a lot of ovulation pain as well. So like one -sided pain. Those were my symptoms.

Sally (10:35.873)
Yeah.

Cindy Dabrowska (10:36.881)
And then, basically, it was all my own doing that I was able to get a diagnosis because, again, the healthcare industry, I suppose you can say, where I live in Canada is just not very helpful. So I was back and forth when I was younger.

you know, I was being prescribed a lot of birth control pills, other medications, which a lot of women, that's probably the first thing you're going to encounter if you suspect you have endo, the doctor's going to want to give you birth control or some kind of hormone therapy. So it on and off those for a while. It got to a point where I was breakthrough bleeding. So was on a birth control pill, but I was still bleeding and I was like, what,

is going on, right? And my doctor's solution was to put me on a stronger pill and something about that didn't sit right with me. It just kind of seemed like I was putting a band -aid over, you know, over this issue that I was having. And so at that point, I was probably in my early 20s. I was already kind of moving into studying nutrition and dietetics. And so I thought to myself, you know what, there are so many other chronic inflammatory

non -communicable diseases that can be managed successfully with diet and lifestyle. So I'm gonna try, I'm gonna try, gonna research, I'm gonna figure out a way to manage this without relying on medications. It took me a very, very long time. I was like up and down for several years trying all these different diets and all these different supplements and all these things. And it was most certainly not a linear journey at all.

And so now I'm happy like in my programs to be able to simplify that for people. So I'm happy that people don't have to go through the same sort of up and down journey that I went through with diet and lifestyle, but it was very effective for me. So that helped. And even before I had my surgery in 2018 to like formally diagnose my endometriosis, I was already seeing significant improvements in my level of pain, the extremities of my flares.

Sally (12:33.121)
Yeah.

Cindy Dabrowska (12:47.465)
my bowel symptoms, like all of those things started to normalize. So going into surgery, I was kind of like, do I want to do this because surgery is scary? was the first surgery I ever had in my life. was newly married. So was like, know, I don't know, do I want to do this? But anyway, I went through with it because more than anything, a diagnosis was really important to me. I wanted to know that I had this, like this, this, I had something that explained this extreme pain. And so in 2018,

Sally (12:57.77)
Hmm.

Cindy Dabrowska (13:15.451)
I had my laparoscopy, my excision surgery in a hospital in Toronto. yeah, endometriosis was found on my left abdominal wall, on my appendix, on my bladder, on my cervix. There was some on my bowels, but the surgeon did not remove that because I wasn't having bowel symptoms at the time. And he didn't want to risk puncturing my bowel. There's a whole other side of that story. Now, you know, fast forward.

you know, to 2024 and anyway, I can talk about that after but now all the symptoms have creeped up. So moral of the story there is try and have it fully removed the first time around so you don't have to have a second surgery. But yeah, those spots, none on my my ovaries or my uterus so I'm thankful for that. But yeah, so it was excised, know, appendix was removed at that time, surgery recovery was interesting.

Sally (13:50.486)
Yeah.

Sally (13:55.7)
I see, yeah.

Cindy Dabrowska (14:12.265)
I am somebody who did not have any symptom resolution post -excision surgery. So it's a mixed bag with surgery. Some women have it's night and day. They feel so much better. Their cycles normalize, abnormal bleeding stops for me, which just wasn't the case. So I had to, I was basically forced to continue to try and manage with diet and lifestyle because I didn't want to go back on birth control. At that point, I was already married. My husband and I, you know, we're talking about starting a family. So birth control wasn't going to be an option for me anyway. So...

Sally (14:37.335)
Yeah.

Cindy Dabrowska (14:42.313)
That's sort of my story. And since 2018, I've been managing, you know, with diet, with lifestyle. There are a couple of like holistic prescription. I guess you can't really say holistic, but my management strategy now is a combination of holistic approaches, diet, lifestyle, and then some prescription medications, but not hormone therapies, which I'm certainly happy to get into.

Sally (14:43.734)
Mmm.

Cindy Dabrowska (15:09.469)
but and not pain relieving medications. There are things that I think most women should be aware of, so I'm happy to talk about those, but that's my long story of my experience with endometriosis. I still live with pain, unfortunately, but it's much, much, much better than it was. Way more manageable. I'm not having those extreme flares where I'm nearly fainting or vomiting from pain. I live a mostly normal quality of life, which is great. I'm so, so grateful for that.

Sally (15:09.591)
Yeah.

Sally (15:18.122)
Sally (15:36.706)
And that's really hopeful to hear. if anyone's listening and who is struggling with endo or thinks they might have it, is going through, you know, the process of trying to get a diagnosis. There is light at the end of the tunnel. And it just, I know it's the same in the UK. It just takes so long to get a diagnosis of endometriosis. Why do you think that is by the way? Do you have any idea of why it just takes? I don't know if it's the same in Canada or the USA. Why on earth? I mean, it shouldn't really take this long, but why does it?

Cindy Dabrowska (16:01.577)
Hmm.

Cindy Dabrowska (16:06.377)
think it's a combination of things. think the first is that women's health concerns are still very much brushed under the table. I think there were studies done comparing reports of certain symptoms and how reactive healthcare providers were when it was a woman over a male making the complaints.

So think there have been studies about that. So I think it's just, yeah, again, women's health concerns, period pain, these types of things I think are still very much, you know, brushed aside. So I think that's one reason. I think a second reason is that there just aren't enough surgeons and specialists in this space who actually do the surgeries and who are very well versed in endometriosis and adenoidosis.

Sally (16:43.586)
Hmm.

Sally (16:56.588)
Mm.

Cindy Dabrowska (17:00.037)
And so, you know, like the statistic now I think is like one in nine women, I would argue that it's significantly more than that. I think it's significantly more than that. If I just think about my friend group and those that have, you know, gone through surgery to get a diagnosis to either improve fertility outcomes or reduce pain or whatever it is, it's more than one in nine for sure. I think it's just, you know,

whether it's silent endometriosis or you know these symptoms are being brushed off but that's a big part of it as well. think it's just access to a surgeon who can help is very very limited worldwide.

Sally (17:39.754)
Right. Is it hard to diagnose because of all of the different types of symptoms? I was just wondering that actually, because there's so, because it's a whole body issue and you you can have pain anywhere in the body and vomiting and nausea and you know, all of this. Do you think that contributes to it being difficult to diagnose?

Cindy Dabrowska (17:58.377)
Yeah.

Cindy Dabrowska (18:03.401)
100%. So again, I wish I had a statistic I could share with you, but there's a massive overlap between endometriosis in several conditions. So a lot of women will be diagnosed with IBS, for example, before they ever get an endometriosis diagnosis. You might be diagnosed with inflammatory bowel disease before you get a diagnosis of endometriosis. So there is a massive overlap between other...

chronic inflammatory diseases and endometriosis. The timing right now for a diagnosis is estimated at about eight years. It took me 15 years to get my diagnosis. And that's pretty typical. Like I've connected with so many women, 20, 25 years they waited. But yeah, so that's kind of one thing I wanted to mention in response to your question. Yes, there's a major overlap between endo and a lot of these other conditions.

Sally (18:44.851)
my gosh.

Cindy Dabrowska (18:59.911)
you're very, very likely to get diagnosed with something like IBS or IBD or fibromyalgia or something like that before you get your endometriosis diagnosis. And in terms of like the difficulty of diagnosis, so it is difficult because until very recently, the only way to get a diagnosis was through a laparoscopy with excision, so an actual keyhole surgery.

where the tissue was excised and biopsied, right? And an example I like to give people here because there are now specialists who are diagnosing using advanced ultrasound and there is literature to show that the advanced ultrasound is accurate and can diagnose you with endo and I think we should celebrate that. I know that there's a bit of a division in the endometriosis space about this but it's a significantly less invasive way to get a diagnosis.

And if it's accurate, why not, right? Nor women can get this diagnosis and then can get the support that they need. But yeah, when it was limited to just having a surgery, of course, it's gonna limit how many women are getting a diagnosis, right? And the reason, so one question I still have and I have connected with surgeons who do the advanced ultrasound, who are specialized in diagnosing via advanced ultrasound, my one question has always been, you know, with the...

keyhole surgery they're actually excising the lesion so they're able to biopsy it and tell you definitively is this endometriosis. An example I like to give is part of what was found on my left abdominal wall was scar tissue but they wouldn't have been able to tell the difference between that and what was found let's say on my appendix or on my cervix if they didn't do a biopsy. So that's still removal of the lesions and doing that biopsy but the surgeon that I connected with who does the advanced ultrasound he told me that

Yeah, they're able to tell the difference. They're trained to be able to tell even just looking through ultrasound, whether it could be scar tissue or endometriosis lesions, just based on the way that they're trained, right, and their expertise. The one limitation with advanced ultrasound is they cannot diagnose superficial endometriosis that way. It has to be a pretty deep infiltrating advanced stage of the disease.

Cindy Dabrowska (21:14.653)
because of the way that it presents, right? It could be microscopic in nature, so you might not be able to see it through an ultrasound. You may actually need to go in and really look around in a lot of detail through surgery. So yes and no, it is hard to diagnose. Yeah, and then there's like a lot of chat online, whether you can diagnose it through an MRI or a CT scan. My understanding is it's laparoscopy with excision.

Sally (21:30.474)
Hmm, okay.

Cindy Dabrowska (21:41.065)
for a biopsy or the advanced ultrasound, are the two recognized ways to get a diagnosis these days.

Sally (21:46.774)
Hmm, okay. And do bloods look different? So anyone that's got endometriosis, would their blood tests look different to someone without endo?

Cindy Dabrowska (21:58.951)
really, really, really interesting question. So you cannot diagnose endometriosis through blood work. So I just wanted to put that out first and foremost, like you cannot look at a certain lab and go, this person has endo. However, there are a couple of things that could look a little bit different in blood work. So somebody who has very advanced, a very advanced stage of endo or somebody who has large endometriomas, so endometriomas are...

basically a more advanced stage of the disease. It's a fluid -filled or blood -filled cyst on the ovary. It's not like other types of cysts, like a follicular cyst or a dermoid cyst or something like that. They're there always, they tend to continue to grow as the disease progresses, thank you. So if you have endometriomas,

Sally (22:49.206)
progresses.

Cindy Dabrowska (22:55.649)
then I just completely forgot your question, Sally, I just escaped my brain. the blood, yes. So yeah, so if you have that more advanced stage, if you have these large endometriomas, then you might see an elevated CA125 in blood work, you may see an elevated CRP, see reactive protein. So these CRPs are very, it's a marker that elevates with inflammation. So, you know, it is a chronic inflammatory condition, you're gonna see a lot of inflammation.

Sally (23:00.194)
blood blood that's okay the blood yeah does the blood look different yeah

Cindy Dabrowska (23:24.965)
Sometimes you'll see that in somebody with endo. The CA125, it's a marker used to diagnose various types of gynecological cancers or varian cancer. But in people who have endometriosis, it is common to see that CA125 elevate either just due to inflammation or because of the large endometriomas. So again, it's not diagnostic for endo, but you might see this overlap. Some other things that I look for, again,

Sally (23:49.281)
Yeah.

Cindy Dabrowska (23:52.225)
I really wanna highlight, it's not diagnostic, it's not gonna tell you you have endo, but bloods are really, really valuable in somebody who has endo because it can really narrow down where you should really pay attention, right? And what you should work on to really improve your quality of life with endo. You may see consistent low white blood cell, or conversely, you may see very elevated white blood cells.

but it's only really valuable if you're seeing a trend, right? So if you're seeing a trend over two, three, four years of data where your blood cells, your white blood cells are consistently low or consistently high, because that's telling us about your immune system, right? Is there something beneath the surface that's either stimulating your immune system or suppressing your immune system? Hormones are another helpful thing to look at, right? Progesterone resistance is very common in the endometriosis population.

So you'll see a lot of suboptimal progesterone levels in the luteal phase, prolactin is a hormone that tends to be very high in somebody with endometriosis. You might see low testosterone. We know that low testosterone is associated with the development of endometriomas. So you can kind of see, I'm giving you a couple of examples. So they're not diagnostic, but there are some interesting things that we can look at.

Sally (25:07.521)
Yeah.

Cindy Dabrowska (25:07.783)
In the blood, hypothyroidism is also associated with more severe forms of endometriosis, more aggressive disease progression, more severe symptoms. So looking at your free T4, your free T3, your TSH, your antibodies, those types of things can be really helpful just to help you understand, you know, how do you approach the disease, right? Do you take some generic advice online or do you start taking hormonal birth control or do you dig deeper into all of these?

areas that we know overlap with the endo and can make the symptoms better or worse. those are just some examples. So yeah, you cannot diagnose through blood, but it can be very helpful at understanding where do I even start when it comes to my management strategy, right?

Sally (25:55.072)
Yeah, I think that's so helpful for people to understand and you're really helping me to understand it a lot deeper as well. So I think it's so useful to just be armed with all of this knowledge, even if it's not affecting you personally, you might know someone that is affected by it. So let's get to symptom management then. I know you've got a wealth of information around diet, nutrition and lifestyle. What can we do from a naturopathic

point of view and also in terms of like drugs, are there drugs, pharmaceuticals that we can take? So I'd love to get your point of view on both of those areas if that's all right.

Cindy Dabrowska (26:33.907)
Of course, yeah. So in terms of pharmaceuticals, the main management options shy of surgery would be your hormone therapies. So there's combo birth control pills which have progestin and estradiol or some form of synthetic estrogen. There are progestin only pills like Vizan or

the mini pill which is just progestin. There's Mirena IUD is a very common option. There are get atotropin releasing hormone agonist and antagonist like Lupron or Alyssa and those are the drugs that will put you into like a chemical menopause basically. They bring your estrogen levels to post menopausal ranges. So.

Sally (27:26.338)
So are we looking for, sorry to interrupt, are we looking to reduce the estrogen and increase the progesterone basically? Or is it not as simple as that?

Cindy Dabrowska (27:34.985)
That's a good question. So if you're taking a hormone therapy that will block ovulation, you will not be producing progesterone. So this is something to know, right? You will not be producing progesterone, which I love that you brought that up because this is something I want people to consider before they make the decision to take a hormone therapy because progesterone is anti -proliferative. It literally can slow the progression of endometriosis. It's anti -inflammatory.

Progesterone is also anti -anxiety, it's mood boosting and sleep promoting. So there are lots of beautiful benefits to progesterone and in somebody who's already resistant, if you're already experiencing low mood depression, if you're already experiencing, you know, spotting and...

you're you're you already have a more advanced stages stage of the disease just consider the benefits of that progesterone if you can find a receptive doctor who might prescribe you bioidentical progesterone which is different from a progestin you probably know a lot about this as somebody who's like a little bit more is your is your podcast more like menopause perimenopause yeah

Sally (28:47.37)
Yeah, we talk a lot about the bioidentical HRT. So the eutrogestam, which is the stuff that you can get in the UK, is the body identical micronized progesterone derived from Yam. And I take it. It's brilliant. It's really, really good. And it really helps to reduce stress. And I really want, I would love it. I would love it to be prescribed for estrogen dominant type symptoms, which I think

Cindy Dabrowska (28:50.395)
Yes. Yes.

Cindy Dabrowska (28:58.343)
rights.

Right.

Yeah.

Cindy Dabrowska (29:12.327)
Yeah.

Cindy Dabrowska (29:16.467)
Mm -hmm.

Sally (29:16.906)
endometriosis is, you know, this idea of progesterone resistance as well as a new one on me, but I think that probably is a factor in it as well. So yeah, I'm sorry I've interrupted you there.

Cindy Dabrowska (29:30.705)
No, no, no, I asked, but yeah, it's funny. I mean, you look very, very young to me still, but I would imagine we're probably in slightly different stages of life. And I also take bioidentical progesterone HRT, right, in my luteal phase because it does really help me. It's reduced the heaviness of my bleed. It's helped with my pain. This is one of the prescription medications I was telling you that I take. So...

Sally (29:37.494)
Yeah.

Cindy Dabrowska (29:56.871)
And I really, really wish, I agree with you, like I would love it to be prescribed to perimenopausal and menopausal women, but I'd also love it to be prescribed to women with endometriosis who really struggle with that progesterone resistance because it's night and day, it's fantastic, it really helps return quality of life, it helps to sleep, it helps with mood, it helps with pain, and it's just so simple, it's just so simple, a bioidentical progesterone prescription. I think it's so much better than a lot of these synthetic

options that we have but anyway let me get into let me get into why I say that. So those are some of the options and the whole idea with these hormone therapies I believe it's it's two things. One is that if you're taking something like this continuous and it blocks you from menstruating

When we menstruate, is an uptick in these inflammatory prostaglandins that are needed to shed the uterine lining. And so if you're not menstruating, you're not getting this uptick in these inflammatory prostaglandins. And I think that that's kind of one method of action. It helps reduce inflammation because again, you're not getting that uptick in these inflammatory prostaglandins. The second reason is the hormone length, right? So, and this is something that's kind of, I guess,

can be helpful, but it's also a little bit frustrating because as you alluded to before, endo is a whole body condition. It's not just a hormonal condition. So when you're targeting just lowering estrogen levels, it's a completely incomplete management strategy for endometriosis, right? You're just addressing the fact that endo is an estrogen dependent condition, but you're neglecting the fact that there is a huge immune system dysfunction component or that there's nervous system involvement or that it's an inflammatory condition also.

So with these medications, with these prescription hormone therapies, a thought that I have had, and there is some literature to suggest that I'm kind of on the right track with this kind of out of the box thought is if you are suppressing testosterone and estrogen with something like, let's say, excuse me, Lupron or Elissa, are you perhaps doing a little bit more harm than good? Because...

Cindy Dabrowska (32:06.277)
Yes, you are suppressing the estrogen to postmenopausal ranges, you're not menstruating, you're reducing inflammation there. However, are you then negatively affecting your immune function? Are you suppressing your immune system's ability to respond to those endometriosis lesions, let's say while you're on the medication or when you transition off the medication? There isn't a large body of literature to support this, but there is some research that shows long -term use of hormonal birth control.

has been associated with more advanced stages of the disease. So am I onto something with this, right? Just something to consider. I do wanna preface by saying like, I am not anti any of these medications if they return some quality of life to my fellow endo sufferers because I live with the disease. I know it can be extremely debilitating. I just want people to be well informed because these medications also have physiological side effects, right?

Almost all of them will affect your blood sugars. They'll make you slightly insulin resistant and there's a huge connection between blood sugar dysregulation and hormonal imbalances as well as inflammation. If you have dysregulated blood sugars, you're gonna produce more of what's called advanced glycation end products, which are these unstable inflammatory DNA damaging molecules essentially. So just be informed. So almost all of them will affect blood sugar stability

Almost all of them will affect your thyroid function. And remember when I said earlier that hypothyroidism is associated with more advanced stages of the disease, more severe symptoms of endometriosis. Consider these things, right? Almost all of them will have a negative effect on your liver function. So we'll see a slight increase in liver enzymes. I mean, I think it's pretty...

I think it's pretty obvious the effects of elevated liver enzymes on endometriosis, like this is your dominant detox organ. If you're burdening the organ with these synthetic hormones, then yes, you're gonna get a buildup of estrogen, you're gonna get a buildup of toxins that may then contribute to worsening of the disease also. Almost all of them will have a negative effect on some digestive health markers in the blood, like globulin, alkaline phosphatase.

Sally (34:03.969)
Yeah.

Cindy Dabrowska (34:25.525)
I just really want because it's sad to admit but you're very unlikely to get a thorough explanation of the possible side effects long term on these medications from your doctor, your prescribing physician. So I just really want people to be aware of this. I have a lot of really great content on all of these topics and you can mitigate these risks, okay? So I don't want people being like, she's, you know, saying this and that about these medications. They've transformed my life.

I just want people to be informed. I'm not suggesting that you shouldn't take these things, but just be informed the effect that they're gonna have on your body so that you're setting yourself up for success, so that when you do transition off, you're in a better spot than you were when you started taking these medications. So that's sort of the prescription. Two other things, so I already alluded to the bioidentical progesterone. And then the other prescription medication that I take that is...

Sally (35:06.934)
Hmm.

Cindy Dabrowska (35:16.553)
think more more physicians are realizing that there is a place for this medication in the endometriosis space is low dose naltrexone. So in high doses, LDN for short is typically used for addictions. So they use high dose LDN for addictions, treating addictions. However, in low doses up to 4 .5 milligrams, it can be used for these chronic inflammatory conditions.

I don't know if there's literature now because the last time I checked there wasn't about LDN and endometriosis, but there is literature around LDN and other chronic inflammatory and autoimmune conditions, fibromyalgia and things like that. LDN works by boosting endorphins to reduce pain. And it's a low dose. You creep up from about one milligram to the 4 .5 milligrams over about two, three weeks.

Sally (36:01.996)
Yum.

Cindy Dabrowska (36:12.805)
And I will say I took it on two separate occasions. The first time I took it for about two years, I didn't notice any difference. And then I took a break and then I got a little older and I tried it again. And it's had a huge effect on my pain levels. So this is something that for any of your listeners, if you're in, you know, if you have endometriosis and you want to try something maybe a little bit out of the box, you can consider talking to your doctor about low dose naltrexone. And then...

From a holistic perspective, mean, there's a ton that we know can help with endometriosis, right? So I just finished recording a podcast, not podcast, a YouTube video for my YouTube channel that I just started. It's very new. But I just finished recording one about all the various diets and the literature we have about whether they can help. you know, a plant -centric diet,

Sally (36:45.259)
Mmm.

Sally (36:58.018)
Hehehe.

Cindy Dabrowska (37:09.255)
I'm not suggesting a vegan or vegetarian diet. I did break that down in the video too. Not that I'm suggesting that pattern of eating is negative, but just watch the video for more of an explanation. But a plant -centric diet, one that's very heavy on the fiber, the fruits, the vegetables, the plant protein seems to be very protective, right? It has a lot of benefits for the large intestine microbiome. And like I said before, there's a big link between certain bacteria and...

Sally (37:19.702)
Yeah.

Cindy Dabrowska (37:39.305)
Excuse me. And endometriosis disease progression. So diet is huge. You we've long known that diet is very protective against so many inflammatory non -communicable conditions. It applies to endometriosis as well. But I always tell people that, you know, there is an anti -inflammatory eating pattern. You can absolutely adopt a Mediterranean style diet. However,

Sally (37:40.94)
Bless you!

Cindy Dabrowska (38:08.277)
depending on what's going on for you there may be some slight tweaks that are needed right like if you're somebody who in your labs you're showing signs of depletion maybe you've done a some kind of functional tests that are showing signs of depletion yes maybe you should adopt a Mediterranean style diet but maybe we should also do a little bit of like a pro metabolic eating pattern so that we're giving your body

nutrient dense foods, bioavailable nutrient dense foods so that we can get your body feeling safe faster, right? Safe faster to make healthy levels of hormones, to normalize your digestion. So there's a lot of nuance to diet for sure.

Sally (38:45.73)
What, explain a little bit about pro metabolic foods. I've never come across that word before. And then you associated it with feeling safe. I'm interested in that. That piqued my curiosity being a trauma -informed coach.

Cindy Dabrowska (38:54.318)
Mm -hmm, yeah.

Cindy Dabrowska (38:59.975)
Yeah, so it's a pattern of eating that prioritizes organic, grass -fed animal proteins, lean meats, in -season produce. And the whole idea behind it is that you're giving your body foods that are a little bit easier to access the nutrition. If you compare how easily your body's gonna be able to

like B vitamins, zinc, magnesium out of like a steak or a piece of salmon over a big bowl of like beans and rice or something like that. It's going to be quite a bit easier to pull it out from the animal protein. It's just a fact. It's easier to pull it out. It's more bioavailable. And so, and the whole idea behind it is we're trying to increase the metabolism. We're trying to kind of normalize the metabolic function.

And when you've normalized your metabolic function, your body, you're generating a lot of energy, your basal body temperatures increase. And the reason I kind of made the comment about feeling safe is because when your metabolism is working well, like it should be, your BBTs are jumping up, you're starting to produce healthy cervical mucus, you're gonna get this positive spillover effect into...

all the things your body should be doing when it feels safe because you're giving it enough energy, you're giving it foods that have a lot of bioavailable nutrition and does that make sense? Does that answer your question?

Sally (40:35.53)
Yeah, that makes sense. Yeah, yeah, because I definitely think the way that we eat can either increase anxiety or decrease anxiety for sure. I know for me, if I eat a lot of sugar, I will get palpitations. I'll feel a bit jittery. I'll just feel like I'm looking for danger a little bit more. And I do believe that, you know, when we tune into the way that we feel and really expose of sorry, build a relationship with that mind body connection, it helps us to

Cindy Dabrowska (40:43.037)
Mm -hmm.

Yeah.

Cindy Dabrowska (40:53.427)
Mmm.

Sally (41:05.248)
really just make sense of where we're going, you know, and what to do for ourselves. So, yeah.

Cindy Dabrowska (41:09.148)
you

Yeah, I'm like that with gluten. find like gluten is very stimulating for me. I find it's very interesting actually. I find that I stutter more. I find that I get more forgetful when I eat gluten. But yeah, I totally hear what you're saying.

Sally (41:25.996)
Yeah. It's funny how certain components of food can affect our mental health and our behaviors as well. It's just, it's bonkers. It really is. So yeah, thank you for that. Yeah. So, so what else can someone do along a naturopathic route? So nutrition, obviously really important, like get your blood work done for sure. Have a look at the results of that blood work and see where you perhaps need to tweak.

Cindy Dabrowska (41:35.869)
Yeah.

Sally (41:54.978)
your diet from an inflammation point of view, from an immune system point of view, from a nervous system point of view, all of those different things that are going to help the symptoms. What else can we do naturopathically to support endometriosis?

Cindy Dabrowska (42:14.237)
I will say I'm not a naturopath. So don't know if they have some other strategies that they're using that I'm not using. I know a lot of naturopaths are very well -versed in like herbs and traditional Chinese medicine. So I know that there's a lot of value to that. I can just speak to acupuncture. There's a lot of literature about acupuncture and helping improve endometriosis symptoms, promoting blood flow. And that's actually science -based, right? We have literature to show it can help.

Sally (42:31.574)
Mmm.

Sally (42:40.652)
Yeah.

Cindy Dabrowska (42:41.481)
A lot of people in the endo community get frustrated and annoyed when you say do yoga, but there is actually a lot of research around yoga as well. It's very helpful. It has been shown to improve symptoms. I'm not saying it's going to heal your endo or, you know, completely return your quality of life, but there is some literature to show that it does help. And then the other thing I was going to say is like herbs and supplements, right? So we do know that there is a lot of...

Sally (42:58.935)
Yeah.

Sally (43:04.599)
Yeah.

Cindy Dabrowska (43:08.241)
a lot of uses for certain herbs and supplements. have literature around things like ginger and bromelain, alpha lipoic acid, NAC, zinc, magnesium, omega -3s, vitamin D. We have a ton of literature around those. Vitamin D in particular for endometriomas, right? In the literature, people who had the largest endometriomas were the most vitamin D deficient. And then like ginger, bromelain, alpha lipoic acid, zinc.

These are all vitamin C, pine bark extract, and acetylcysteine. These all have literature to show that they have helped in some capacity to reduce either inflammatory markers in the blood or pain or pain symptoms in individuals with endometriosis specifically. NAC also very helpful for endometriomas. omega -3s obviously we know that there's a big like

inflammatory load when it comes to endometriosis omega -3s can be very helpful for kind of just balancing out that omega -6 to omega -3 ratio in the body to help reduce pain and inflammation. So that would be the other thing, the other thing that I would consider as well is supplements. I'm trying to think if there's anything else from the holistic side. movement, so physical activity of course because

very good for immune function and blood flow. There is some research around high intensity movement, specifically being protective against endometrioma development. Although we do need to approach high intensity movement with a bit of caution, just depending on how you're feeling. If you're very depleted, if you have a lot of fatigue with endo, I think even just doing some like low intensity movement, you whenever you feel up to it can be beneficial. Sleep is...

incredibly important, right? Like for everything. There's a great book. It is kind of a boring read, I'm not gonna lie, but it's called Why We Sleep. And it's all about the science of sleep and all the physiological changes that happen on the body when we're sleep deprived, right? From hormonal dysregulation to immune dysfunction, mood. So that's really important, especially for somebody who has a chronic inflammatory condition where it's common to have extreme fatigue and already...

Cindy Dabrowska (45:29.378)
be prone to estrogen excess or progesterone deficiency or higher low testosterone. Is that kind of what you had in mind Sally for that question?

Sally (45:38.048)
Yeah, yeah, absolutely. So I'm just thinking about all the supplements that you mentioned there and there's quite a lot and I'm wondering if it might be quite overwhelming for someone to think, my God, there's all of these different things that you can take. What would you say would be like three of your go -to supplements for someone with endo that could start taking to maybe they might see a diminishment in symptoms through taking those?

Cindy Dabrowska (46:03.283)
So I have, yeah, I have actually a supplement line, the Endometriocure that I developed specifically with somebody who has endometriosis in mind. And the reason I'm bringing this up is because even though I have a supplement line that's supported by what I know about the disease, I still cannot, like I get people DMing me all the time being like, which of your supplements do I take?

Sally (46:08.178)
Do you? Wow, that's amazing.

Cindy Dabrowska (46:32.687)
sure I want you to try my supplements, but at the same time, like I'm realistic, it's hard. It has to be personalized, right? So, but let me see if I can give you the most simple answer. Probably the ones we have the most research for would be NAC. So, N -acetylcysteine. There's two separate studies that have been done on NAC and the results have been pretty profound in both, right? So, in the first one,

the results were so significant that a large chunk of the participants canceled their surgeries because they felt well enough that they didn't need to pursue surgery. Or there's literature around NAC shrinking endometrioma size. So N -acetylcysteine in very, very severe cases, I would say 1 ,800 milligrams a day could be helpful. And then in somebody who

has maybe slightly less severe endometriosis, I would say 1800 milligrams for three consecutive days and then none for the rest of the week. Could be a good place. Zinc is probably another one that would be very powerful. Zinc is very immune supporting and we do have research around zinc.

deficiency exacerbating pain symptoms in somebody with endo. So it's just a deficiency that if we satisfy that gap, could be, you know, it make a world of difference in your pain symptoms. Zinc is also extremely important for thyroid hormone conversion, right? So you can, you your body requires zinc in order to convert T4 to T3 thyroid hormone. So the amount varies maybe 10, maybe 25, maybe 50 milligrams depending on the individual, but

Sally (48:02.923)
Yeah.

Cindy Dabrowska (48:22.331)
One thing to note about zinc is you do want to supplement with copper, excuse me. So they're antagonistic. If you supplement too much zinc, you can drive your copper down and then you could inadvertently create an iron deficiency in your body. So that's just something to keep in mind. Maybe if you're supplementing zinc, maybe find yourself like a zinc copper blend. And then the third.

Sally (48:40.844)
Mm

Cindy Dabrowska (48:47.409)
The third, would say.

Cindy Dabrowska (48:52.807)
I think, so I think I would say either like a quality multi or prenatal and or ginger might be a good option here. I just say the quality multi or prenatal just because it's very hard to satisfy all of your nutrient needs with diet, especially with like depleted soils. And then when you tack on that.

chronic inflammation component as somebody with endo like it does slightly increase your nutrient needs and so I do find like most people can benefit from a multi so that you're hitting your B vitamin needs that you're you know you're hitting your zinc your retinol that those types of things vitamin C because we do again have literature around vitamin C vitamin E helping with pain with intercourse and

pain with urination and defecation and things like that in endometriosis patients specifically. So just satisfying those nutrient needs I very often find makes a huge difference in pain symptoms and energy and your ability to eliminate waste and things like that. And ginger because we do have research around ginger helping with elimination with nausea, which is a common symptom of endo. It also helps feed good gut bacteria in the large intestine microbiome. We've kind of.

explored that connection a little bit in our conversation. It has been shown to help with heavy bleeding too, so ginger can help with just kind of calming the heaviness of somebody's bleeding. I think there's lots of, there's a large applicability for ginger in somebody with endometriosis. So.

Sally (50:32.631)
Yeah.

Cindy Dabrowska (50:33.393)
I don't know, maybe if you ask me again in a few weeks, I might change that answer, but let's go with those for this conversation.

Sally (50:37.346)
Let's go with those. Yeah, no, that's lovely. I mean, it definitely gives people food for thought, you know, and do check out Cindy's website because you've got a really good blog. You've got, you know, your shop. I'm not sure if you ship to the UK. Do you ship to the UK?

Cindy Dabrowska (50:54.899)
So it will, you will be able to place an order if you're in the UK. It's just a little bit of a pain with the shipping. I'm trying, I'm working on trying to get it to be a little bit more accessible worldwide. But yes, it will ship to the UK. Just you might not like the duties you're dinged with and things like that. So yeah, I'm working on it. I'm working on it.

Sally (51:10.828)
just might be a expensive.

Sally (51:15.542)
Yeah, okay. Okay. That's great. That's great. And just finally, just backtracking slight, I know we're gonna wrap things up, but endometriosis has a very diverse range of symptoms, which we touched on a little bit, but what are some of the more unusual symptoms that you have seen that might be good to discuss just before we wrap things up?

Cindy Dabrowska (51:34.825)
Yeah.

That's a great question. I don't know if it's unusual, but abnormal bleeding, I would say is a little bit more unusual than something like extreme pain or digestive type symptoms. So bleeding around ovulation or spotting into the luteal phase, so if you're spotting three or more days before your period or you're getting tail and brown bleeding for three or more days.

Nerve pain, a pain down the legs. So if you're getting kind of like jelly feeling legs or if you're getting like sharp kind of like stabbing sensations down the legs. Recurring or seemingly recurring BV or yeast infections. I cannot even tell you how many people I've connected with who, you know, they seem to be getting these symptoms. Maybe it's burning with urination or itchiness.

because it seems like the same symptom picture the doctor won't actually test and they're being prescribed these antibiotics for something that they don't even have and in the process you're destroying your large intestine microbiome that's contributing to more aggressive proliferation of the disease and symptoms or severe symptoms and this whole time these antibiotics weren't even needed so if you're if you suspect you have especially like UTIs

or yeast symptoms like yeast infections always always test always test especially the UTIs because you're going to get prescribed an antibiotic for that because endometriosis on the ureters or on the bladder can cause these type of symptoms but it's not actually an infection okay and so you don't actually need to be treated for this

Sally (53:07.606)
Mm.

Sally (53:22.583)
Yeah.

Cindy Dabrowska (53:27.081)
I mean you do need to be treated for it. You need to have endometriosis removed from your bladder and your ureters, but not with an antibiotic. So that's a kind of common yet lesser known symptom I suppose you can say when it comes to endo.

Sally (53:45.847)
Hmm.

Cindy Dabrowska (53:46.115)
cyclical changes in your bowel. So if you're normal and then you hit your luteal phase, which is the phase after ovulation to the start of your period and all of a sudden you're feeling constipated or your stools are getting looser. So these fluctuations in the stools are not normal. I'm trying to think what else is unusual. You might get a left or right sided pain.

Sally (54:16.14)
sort of like, are there kind of like general yuckiness feeling as well that associated with it? I think you did say that, didn't you? Like the sort of general tiredness, the lethargy, brain fog perhaps.

Cindy Dabrowska (54:26.45)
and

Cindy Dabrowska (54:30.117)
Yeah, absolutely. would say fatigue is a very common symptom though, like very debilitating fatigue. Yeah, it's a common one with endo. I'm just trying to think of those like truly kind of unusual symptoms.

Cindy Dabrowska (54:49.737)
So there is something called silent endometriosis where you're not somebody who presents with those characteristic pain symptoms. Usually the number one symptom of endometriosis in that case would be infertility. So it's very interesting because you know can have very extensive endo and not have symptoms and then you go to try and conceive and you don't have any luck and then eventually

Sally (55:10.946)
Really?

Cindy Dabrowska (55:15.645)
you if you're lucky enough you have surgery and the endometriosis is everywhere and it's just so bizarre how you can have extreme widespread endometriosis no pain and just the only symptom is an inability to conceive. one other interesting symptom maybe to look out for is unusual patterns in your cervical mucus especially if you're somebody who's not on hormone therapy or trying to conceive.

If you have long stretches of like wet cervical mucus, that could be a sign of infertility potentially overlapping with endometriosis or very minimal cervical mucus scores as well, like very little, either of those could potentially point to endo. Yeah, I'm sure Sally, I have some other things I'm gonna wanna add in tonight when I'm falling asleep. I should have said that. But yeah, those are just some unusual ones.

Sally (56:12.896)
Yeah, thank you. Thank you for sharing those. I think it's really important to highlight, you know, the broader picture of it, because sometimes people will worry that they might have got it, but when you highlight some of these other symptoms, they're like, no, that's definitely not what I've got. But just to be really transparent about what some of the symptoms are is so useful, really useful. So I've really enjoyed this conversation with you. I really feel like I've had a bit of a masterclass in endometriosis. I hope that

Cindy Dabrowska (56:13.651)
Yeah.

Cindy Dabrowska (56:33.277)
Hmm.

Sally (56:42.036)
our listeners have as well. Clearly you're a real expert, you know, know your stuff based on the research that you've done, the experience that you have had with ENDO. And I would love for you to tell us what are your services? Like how do you actually support people if someone's listening to this thinking, I really need to get into your world? How do you work with people?

Cindy Dabrowska (57:05.865)
So I have a couple of high level coaching support programs and then I have some like slightly like lower level support where we just do like some functional testing and you get an interpretation or you can book in for like a 90 minute intensive. But in terms of like the high level coaching support for somebody who feels like they really need a lot of support, I just want to kind of, I don't necessarily want to go through like the inclusions of the program, but the approach. So.

Like obviously as a dietician, I'm not doing surgery, I'm not prescribing hormone therapies. So my approach is to identify what hallmarks of endometriosis affect you most. So I'm asking you questions about your digestion, about your bloating, when you're bloating, you know, your stools, symptoms of hormone, excess or deficiency. I'm looking at your diet, right? We're deep diving into your diet. Is there signs of inflammation in your lab work? So my job is to really like dig in.

Is it a gut or immune deficiency hallmark? Is it estrogen excess? Is it progesterone deficiency? Do you have high testosterone? Do you have DHEA, elevated DHEA? What's going on with your cortisol? What's going on with your diet? Let's compare your diet against some of your blood work. What kind of dietary pattern should we be adopting? I look at sodium, potassium levels to understand your adrenal function. So it's basically a deep dive and then I'm like laying everything out and I'm trying to understand

What is the best approach to help improve your symptoms of endometriosis or your fertility, depending on what your objectives are? And so my programs do include some functional testing so we can dig a little bit deeper to understand what that hallmark may be and how to best address it, how to best target your diet. So.

That's the important thing I wanted to highlight is that's the approach, right? So it is very unique to you and it is based on your body, what your body is telling us, your physiology, right? Because we are doing functional testing to gather that information. So no two people ever really have the same approach or intervention that we're applying to help improve the symptoms.

Cindy Dabrowska (59:13.73)
So yeah, it's based on that. mean, if you're fertility focused, we might be doing some vaginal microbiome swab testing to make sure, you know, if the environment there is dysbiotic, is it imbalanced? That's gonna create to the uterine microbiome, there's inflammation here. So we work on normalizing that. So I don't know how clear that was, but that's kind of my approach. like my main coaching support options are on the website.

Sally (59:31.297)
Yeah.

Cindy Dabrowska (59:38.185)
So if anybody wants to take a look at those, the inclusions, the investment, and then I do have those, like I said, those lower support coaching options where, you you could just do a functional test with me and I do your interpretation, or you can schedule in for a 90 minute if you just want to go over like your fertility protocol with me, or if you feel like you don't need a full coaching support program, but you just want to kind of follow up with me on certain things. There is also like a three session option.

Yeah, so those are some options there.

Sally (01:00:06.976)
Yeah. Perfect. That's brilliant. And your Instagram account is really useful as well. There's so much knowledge on your Instagram. Is that where you are most active on social media?

Cindy Dabrowska (01:00:13.117)
Thank you.

Cindy Dabrowska (01:00:18.769)
Yeah, so my major platform is Instagram, but I did recently also start posting on TikTok. So I'm on TikTok now as well, same handle. And then like I mentioned, I did just start a YouTube channel. So I'm going into week four of posting on YouTube. Longer form content, there are great videos there on like the most recent research on endo, what to do if you've been newly diagnosed to somebody with endo. I break down all the diets.

Sally (01:00:34.486)
Wow.

Cindy Dabrowska (01:00:47.517)
all the diets we have literature for when it comes to endometriosis and I can't remember what my fourth video was about now. Anyway, there's four videos up there and a bunch of shorts that I share kind of between my Instagram and my TikTok and I have a Pinterest as well. So, and the Pinterest typically it will link to the blog. So yeah, on all those platforms.

Sally (01:00:56.982)
Yeah

Sally (01:01:12.47)
Yeah, great. So there's so many free resources if you want to get into Cindy's world and also if you feel like you want to work with her on a deeper level, definitely go and check out her website. Obviously, Cindy is so knowledgeable about endometriosis and sounds like the go -to person really to ask a question to. So do go and interact with her. Pass this

this podcast onto anyone that you know who might be struggling, maybe some younger people in your life, maybe some teenagers or some young adults who are struggling, not just in perimenopause, because this is a debilitating disease that affects so many women and we really need all the help that we can get. So thank you so much for sharing this time with us. I know that you're going on your holidays now, so we wish you a lovely time and just thank you.

Cindy Dabrowska (01:02:03.165)
Yeah, my pleasure. Thanks so much for having me.

Sally (01:02:07.49)
cool.