Tahnee's back on the Women's Series today, with returning guest Dr. Amanda Waaldyk talking female reproductive health, with the spotlight on endometriosis (endo). Recent figures on the Endometriosis Australia page show approximately 1 in 9 women worldwide suffer from this at times debilitating disease, that's around 200 million. These are pretty alarming statistics, considering it takes (on average) 7-10 years for endo diagnosis. Dr. Amanda has so much knowledge in this space; she is the founder/director of Angea Women's Health Clinic (Melbourne), doctor of Chinese medicine, acupuncturist, yoga teacher, and energy healer. Being diagnosed and living with endo herself, Dr. Amanda's personal experience has deepened her holistic approach to treating this disease and is helping so many women on their journey of healing. This episode is a must for all women; the ladies get into pertinent aspects of the menstrual cycle, pregnancy, the contraceptive pill, and how they're affected by endometriosis.
Tahnee and Dr. Amanda discuss:
- What is endometriosis, why is it so painful?
- Endometriosis and the vital role of the liver.
- Chinese herbs for treating gynecological issues.
- Treating endometriosis holistically.
- Adenomyosis vs endometriosis, what's the difference?
- Dyspareunia (painful intercourse) and dysmenorrhea (painful menstruation), as common symptoms of endometriosis.
- Why painful menstruation is not normal.
- The genetic link with endometriosis; looking at paternal and maternal family history.
- Why endometriosis is often misdiagnosed as IBS.
- The DUTCH test (advanced hormone testing) and why it's essential when diagnosing endometriosis.
- The benefits of abdominal, Mayan, and womb massage for the female reproductive system.
- Understanding endometriosis as an inflammatory condition and foods to avoid.
- Yoni steaming.
Who is Dr. Amanda Waaldyk?
Amanda is the founder and director of Angea Women’s Health Clinic, an integrative Chinese medicine practice that focuses on fertility, female endocrinology, and supporting women through every phase of life. With extensive experience in reproductive/hormonal conditions, menopausal concerns, endometriosis, and PCOS, Angea clinic is truly a haven for women. Amanda’s practice is soul meets science, guiding her patients to ultimate health by providing a whole-body approach. Amanda is a Doctor of Chinese medicine, yoga and meditation teacher, acupuncturist, hormone expert, and energy healer. Amanda empowers and educates her clients to reconnect with their inherent body wisdom, navigate their way back to balance (naturally), and live the happiest and most thriving version of their lives.
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Check Out The Transcript Here:
Okay. Hi everyone, and welcome to the SuperFeast podcast. Today I am here with Dr. Amanda Waaldyk from Angea, which is this incredible space down in Melbourne, and I can't wait to go there as soon as I'm allowed. She's the founder and director of Angea Women's Health Clinic and she has an integrative Chinese medicine practise that also weaves in traditions like yoga and abdominal massage, which I hope we get to touch on a little bit today. And she works a lot with fertility and female reproductive health.
So, we're here to talk about endometriosis today, which I'm really excited about, but I wanted to welcome Amanda back, because we have had her on the podcast before and she was very, very popular amongst our community. So thank you for coming back again, Amanda.
Dr. Amanda: (00:48)
Oh, thank you for having me. I've been so excited to chat about this today.
Yeah. Such a great topic, and I mean, such a relevant one right now. Something we're hearing a lot through our communication channels at SuperFeast. It's one that women are really enduring. So I wonder, could you tell us a little bit about how you got to be working in women's fertility, and your journey toward becoming this expert on endometriosis?
Dr. Amanda: (01:14)
Well interestingly, I am an adenomyosis and endo as well myself. So it's something that I've been really interested in back in my university days. I did an assignment on liver function and looking at endometriosis and the role of the liver and endo together. So that sparked a little bit of an interest. And then also, to just with the magnificence of Chinese herbs, how well herbs can actually treat gynaecological issues for women. And I did study four years of Chinese medicine, specifically herbs, and then did two years after with an acupuncture degree.
Dr. Amanda: (01:55)
So, I was always into sports, I think, and when I finished university I went over to China and lived in China and studied in China for a year. Did a lot of gynaecological training over there. And was going to come back and set up a sports clinic, but of course, the universe had other things in store. And women just kept appearing at my door. So from there it's just organically grown, and I think because I've had so much trauma in my life, how much that actually I can support on a holistic perspective, not only physically, but also through the use of acupuncture, but also emotionally as well.
Yeah, because we were first connected by Farley who's one of our staff, and that was her experience, being treated by you was not just about receiving Chinese medicine treatment, it was on this multi-dimensional level that you were really supporting her. And she still raves about that experience, and I think she's still looking for someone like you up here.
But yeah, I think it's like you were saying before we jumped on, a huge amount of women coming through your clinic are suffering from endometriosis. So do you know anything around the statistics of how many people are suffering from the condition in general? Or is that hard to gauge?
Dr. Amanda: (03:17)
Yeah, it's an epidemic. Statistically worldwide there's 176 million women been diagnosed with endometriosis. So if we think about those numbers, there's probably a higher amount as well, considering the ones that go undiagnosed. Because unfortunately it takes around seven to 10 years for women to be diagnosed. A lot of women often go misdiagnosed as irritable bowel or just heavy periods.
Dr. Amanda: (03:43)
It's just part of the female normal existence, and that's part of, I think, where this podcast is so important, because it's creating an education piece for women to really understand their bodies more, but also their menstrual cycles. I think in Australia it's about 600,000 women have been diagnosed with endometriosis, and one in 10 women have endo.
Dr. Amanda: (04:10)
And also too, the statistics now are that 42% of women that have been diagnosed with adenomyosis are also diagnosed with endometriosis. So it's huge, and for some women it can be a very debilitating condition that they're living with, not only daily but monthly. And having those constant reminders of being in excruciating pain and then being told that, sorry, there's nothing that we can do for your pain, I think is extremely frustrating. Because women are so intuitive, and we know when there's something wrong in our bodies, don't we?
Dr. Amanda: (04:45)
So when we notice that something's wrong, we seek out answers. And then we'll go and see our GP or our healthcare provider. And if those symptoms are dismissed, then the dialogue starts to create of, "What's actually wrong with me? What's wrong with myself and my body?"
Dr. Amanda: (05:06)
A lot of common symptoms that we see with women with endometriosis is dyspareunia. Dyspareunia is painful intercourse. Dysmenorrhea which is painful periods. And we have a rating at work, we often have a scale of one to ten. So if any women are experiencing pain up around the eight, nine, ten mark, that requires an investigative process. Because if you're having to take days off school or having to take time off work when you're having your period, we just want to assure you that that's actually not normal, and painful periods are not normal.
Dr. Amanda: (05:42)
Then also, too, menorrhagia which is heavy bleeding. And also too pelvic pain is part of that presentation. Abdominal bloating. Nausea, vomiting, clotting. So you can see it's quite an extensive list, and if I've missed something all, I think I've managed to catch it all.
Well, it's something that when you say that, that sounds like what a lot of people endure just with periods. And one of your big topics is always around painful periods aren't normal. I appreciate your social media so much for flying that flag all the time. It's your right to have a healthy menstrual cycle.
So if you're saying it takes seven to ten years to be diagnosed, are you saying that women are suffering for seven to ten years waiting to find someone who can diagnose them? Is that basically the problem? It's common?
Dr. Amanda: (06:34)
Dr. Amanda: (06:37)
I guess what happens is, I mean, it is an invisible condition in the sense that if you were to go and see your GP, you were complaining of painful periods, and they sent you off for a pelvic ultrasound, and that pelvic ultrasound showed that there was no endometriomas or no endometriotic tissue then that would come back and they'd say, "Well, you're fine. There's nothing there."
Dr. Amanda: (07:02)
Also, too, it's genetically linked, so it's really important, and I think this is what's great about the Chinese medicine, is that when we go back to the history of what was your mother's menstrual cycle like? What was your grandmother's menstrual cycle like? Because it can come from both the genetic link of paternal and maternal sides.
Dr. Amanda: (07:20)
For young women that are going through puberty, it's that if their mothers had a hysterectomy or if they had endo, because a lot of it went misdiagnosed back in our parents' generation, because they were all having children younger, and that's why it's called the career women's disease because now we're forging on our careers and having children later, is that painful periods will often start for those pubescent girls when they have their first menstrual cycle.
Dr. Amanda: (07:47)
So, for all our young listeners out there, if you're having painful periods and heavy periods and you're needing to take time off school, and your mother's had a history of heavy periods, then please find someone that you can actually work with. A GP or a healthcare provider, that can offer you some support. Because sometimes women have to have laparoscopic surgery in their teenage years because their periods are so debilitating.
Yep. Just if people don't know exactly what we're talking about, one of the main things that occurs with endometriosis is that the lining of the uterus, the endometrium, actually exists outside of its normal habitat, right? Is that the diagnosis?
Dr. Amanda: (08:34)
Yeah. You're exactly right, but it's so interesting, because there's a lot of women out there now, I guess, that are celebrities, that are actually creating a greater awareness for endometriosis. But the actual definition is, it's not actually the endometrium that lines our uterus that we shed each month. It's a different type of tissue. It's called epithelial glands, and the endometrial stroma, that basically it migrates to areas within our uterus, to essentially the pelvic organs, the pelvic reproductive organs.
Dr. Amanda: (09:16)
So the tissue will migrate, it'll implant around the ovaries, it could implant into the fallopian tubes. It can also go into the muscle layer of the bowels. It can be found in our pouch of Douglas, our uterine ligaments, and then also, too, in extreme cases, lungs and liver, and it can also migrate to our bladder. So you can just get that constant irritation when you're having your period of feeling like your bladder's full all the time and that you need to go.
Dr. Amanda: (09:48)
The issue is, is that the tissue still responds to the same hormonal fluctuations that our menstrual cycle relates to, so your oestrogen and progesterone. So the tissue still responds in that way, so every time you're about to get your bleed, is that tissue will start to respond because it's got prostaglandins. Prostaglandins line endometrium, and so if we've got endometriosis, we know that it's an inflammatory condition, and the research also shows that prostaglandins are actually elevated for endometriosis.
Dr. Amanda: (10:26)
I've done so much study into the endometrium. I love it, because it's its own endocrine gland, and it forms in spirals. I always like to say you imagine a DNA helix. Endometrium forms in spirals. It has prostaglandins. The prostaglandins' role is to essentially create a gentle uterine cramp, so as the oestrogen and the progesterone drop, it signals the endometrium to start to shed, to start to bleed. So it creates this gentle, mild cramping so the lining can start to shed.
Dr. Amanda: (10:57)
Can you imagine, if we've got endometriosis, we've got high amounts of inflammation, is that that tissue has a wringing. Imagine a towel wringing out, right? And that's going to cause extreme amounts of pain, because I'll go on a divergent here. In Chinese medicine we know that the liver meridian comes up through the medial aspect, it circulates around our reproductive organs, finishes at our breast tissue. You know the liver, the liver's role is to ensure the smooth flow of chi and blood.
Dr. Amanda: (11:25)
So the heart being the empress at the time of the period says to the liver, "Okay, General," which it should be a woman, "It's time to release the blood. So let that blood flow." And so when the liver is impacted, which we know that it is, because endometriosis is an oestrogen-dominant condition, and the liver's role within Western medicine is to be able to metabolise our estrogens through the right pathways. So that chi and blood then becomes impeded, and starts to form pockets of blood stagnation, because the blood can't empty properly.
Dr. Amanda: (12:17)
Because the first thing that we're taught in Chinese medicine in our gynaecological classes is that the period has to empty completely so you can start afresh with a new cycle, new, fresh blood flows, and endometriosis is called [foreign language 00:12:33] in Chinese medicine which essentially means big stagnation.
So there's pain as well, when you have stagnation.
Dr. Amanda: (12:43)
Yeah. All that pathology.
Yep. Because one of the things blood stagnation causes is pain, because it's a bruise or something, right? You touch it and it hurts. Is it throughout the cycle that there's that stagnation feeling as well?
Dr. Amanda: (13:00)
Dr. Amanda: (13:02)
Yeah. Because the liver attacks the spleen, so you've got an inflammatory response condition happening the whole time. And some women experience, throughout their entire cycle, that pain and stagnation. Because also, too, if their bowels involved, most of the time it gets diagnosed as irritable bowel, is that when they're trying to have a bowel movement is that they're getting a lot of constipation. So that whole peristalsis action becomes impeded as well, so you get blocked bowels. You're alternating from constipation sometimes to diarrhoea.
Dr. Amanda: (13:42)
So when you've got that pressure... Because if we think anatomically, girls, if you imagine that you've got your bladder and then you have your vagina next to your bladder, and then at the back you've got your rectum. And then in between the rectum and your vagina you have the pouch of Douglas. And the pouch of Douglas is where a lot of endo tends to hide, goes into this... It's like a deep, dark crevice, right? And so that then pushes onto the bowel. So that's where you get even more stagnation. So you just think, because [foreign language 00:14:20] as we know, what's the role of the [foreign language 00:14:23] 00:14:24] it's that water element.
Dr. Amanda: (14:26)
To keep everything in flow. So nothing's in flow. The liver's not in flow. Everything's becoming stagnant, tight, and so blocked, and then you just start to get all this pathology.
So I'm thinking immediately we've got spleen and liver involved and then kidney, because you're sounding like there's this genetic link as well. Is that where you're looking mostly when you're treating women? It's a combination of those organs that you tend to see dysfunctional? Or is there more going on? Because I've also heard it's positive as an autoimmune kind of thing, but is that more the inflammatory response, that the tissue's in the wrong place and the body's attacking it? Would that be more what that would be pointing to?
Dr. Amanda: (15:13)
No. You're absolutely right. There is an immune condition as well, from the research they've found that there is an immune response which is also linked to that inflammatory response. So you have multiple organs involved. But it's also too, so much of that is the liver.
Dr. Amanda: (15:34)
That's why I always recommend my endo patients to have the Dutch test, and the reason being, because if they have to go and have a surgery, because once they've had excision surgery, and we'll come back to that, is that you want to make sure that the endometriosis is being completely removed with the scissors and cut out. Because that way, it reduces the chances of that endometriotic tissue growing back. And so, by doing the Dutch test, we can see which pathway is our liver metabolising the estradiol properly. Because then we know we've got the 2-OH pathway, and that's the way that we can metabolise that oestrogen out properly, and then with endometriosis sometimes we can have high amounts of estrone, which is the 16-OH pathway, and then estriol, which does the 4-OH.
Dr. Amanda: (16:23)
They're the ones that are more prone to breast cancers, to ovarian cancers, so this is where it's really important to find out that whole history of your family. So when I did my Dutch test, I found out mum's got breast cancer, ovarian cancer, so I was very high on that estrone. So my liver wasn't metabolising my oestrogen properly. So by finding that out, then you can support it, supplement foods, to make sure that you're able to metabolise it. And of course your gut health as well, to metabolise your excess estrogens and make sure you're getting the conversion into estradiol that can then be metabolised out through your liver correctly.
Dr. Amanda: (17:06)
I think there's actually, if anyone's out there, just putting it out there if anyone's up for doing a study on that, I actually think it would be great research.
For sure. Well, because I think that's the thing, like we were talking before we turned on the recording, but about how people are prescribed the Pill. I'm thinking if you've already got a liver that's not functioning well and then you're putting a synthetic oestrogen or a progesterone or something in there, that's going to make the liver suffer more. It seems like you're just building up for more problems later on down the track, right? Is that what you see?
Dr. Amanda: (17:47)
Babe, yes, you're so right there. Because I would actually love the medical community to go, "Okay, we've got a young girl who's Stage Four endometriosis, and if she's had surgery I need to make sure this grows back quite quickly." There sometimes these women are candidates for the contraceptive pill in terms of just management, because sometimes these are the options that are available, particularly for those really difficult cases.
Dr. Amanda: (18:22)
But then, to see if they did go on the contraceptive pill, to perhaps go back and do a surgery in two years to actually see if the endometriosis had grown back. Or had the pill actually stopped the growth of endometriosis? Because we know that women that go on the Pill that come off the Pill then have to have laparoscopic surgery. The endo's still there. And then like you said, because if your whole liver pathway's this synthetic oestrogen, I see it as synthetic oestrogen liver can't metabolise, you're therefore then increasing that estradiol which is then going to amplify the endo anyway.
Which sounds like maybe a band-aid solution for short-term results. So, I mean, I've heard of people having improvements with pregnancy. Is that something you see clinically as well, or is that more of an anecdotal thing?
Dr. Amanda: (19:22)
What was that? Say that again. It cut out a bit.
I've heard of people having improvements with pregnancy. Is that something you see clinically?
Dr. Amanda: (19:34)
Doctors will be like... I had a patient the other did, she said, "The doctor said to me after my surgery that I should get pregnant, because pregnancy essentially cures endometriosis."
Yeah, but then you have a child.
Dr. Amanda: (19:45)
I thought that was...
Oh, my dear.
Dr. Amanda: (19:52)
No. So in terms of, absolutely, it's like a Band-Aid, isn't it? It solves a problem for a short period of time. But I think that's where we absolutely have control of being able to support our health by doing all the right things to minimise that endometriosis from growing back, which is diet, nutrition, all your lifestyle factors, and then your supplements, acupuncture, exercise, pelvic floor, physiotherapist. So having a real holistic approach to it.
Because you offer abdominal massage in the clinic, and is that something? Because I often think with these inflammatory things, is it beneficial to manipulate that tissue, or do you have any experience with that in terms of women doing self-massage and those kinds of things? Because I mean, I'm always an advocate for it just in terms of connecting to your body. It's such a great way, I think, to get in touch with learning where all the bits are and all that kind of thing. But yeah, I'm just wondering as a clinical treatment, I imagine it would help relieve some of the stagnation and pain.
Dr. Amanda: (21:06)
Yeah. Absolutely. Like you said, it's the best way to be able to reconnect into your body and develop a loving relationship. Because for a lot of women that have endo, you hate your body. You hate it, because you're experiencing so much pain. Because tissues have issues, as we know. Tissues have imprints of everything. They hold our whole life story. It's a web. So by doing abdominal massage, absolutely. Because then, you're starting to create healthy blood flow through your reproductive organs and through your abdomen. So then you start to break out some of that tissue as well.
Dr. Amanda: (21:51)
We know that for women that have had laparoscopic surgery, or haven't, is scar tissue. So what does scar tissue look like? When tissue meshes, it meshes in together like there's a synergy, where it just folds in together. But with scar tissue, it's all just hacky. Hacky tissue, that's formed together in these weird, web-like structures. So by doing gentle abdominal massage, we're starting to create a beautiful flow. And we know that when tissue's in flow that it brings in chi, it brings in energy, allows the blood to flow.
Dr. Amanda: (22:26)
So absolutely, abdominal massage, Mayan massage, womb massage. Because you're going deeply into the layers of that connected tissue and the reproductive organs are part of the fascial planes, as we know, embryonically that form when we're embryos. And there's a body of research that says that endometriosis is formed actually when we're in utero.
Wow. Okay. Is that pointing to then something genetic? Or is it pointing to something going on in an epigenetic sense? Do you have any sense of what that might be?
Dr. Amanda: (23:04)
I would say genetic, absolutely. And then also too epigenetic, isn't it? Because when we're an egg in our grandmother's womb, forming in our mothers, so you think about that.
Dr. Amanda: (23:19)
And trauma. Trauma. So much trauma. I mean, I got only diagnosed with endo at 41. I'd never had painful periods. I've had multiple traumas. I was raped a couple of times, and I think that that definitely... It's our sacred chakra. It's our pleasure centre. So if someone has entered without permission, that causes a stagnation and a trauma, and that then develops into a pathology. So I think there's so much stuff around trauma, and I see a lot of women in clinic with a link between sexual abuse experiences. First-time sexual experience trauma, whether that's physical abuse, emotional abuse, even women working in male-dominated industries where they've not been able to be their expressive selves.
Well, that ties into what you're saying about that idea of being a career woman, too, and almost in a more masculine setting. It could be some suppression of that feminine, creative expression. Because you really think about that lower area as that Shakti, it's that feminine, creative space, and so if it's not fully expressed then yeah, you're going to see stagnation of that energy. And over time, that's one of the things Chinese medicine teaches us, is over time that energetic stagnation causes a physical transformation or changes a tissue in some way. That's how we end up with the disease process.
I mean, it's sounding like if someone's got endo, it's a bit more complicated, I guess, than just focus on one thing. So you're normally getting people to do Dutch tests and I guess, working with herbs, and acupuncture, and emotionally. Are there other areas people should look at if they've been diagnosed and they're not sure how to go forward? Is healing possible? Is it something you see where women can really transform this?
Dr. Amanda: (25:23)
Yeah, absolutely. And I think it's also, to put a point in there, is it's really important to know as a provider ourselves, is that we're limited to what we can do. I always say, if women come in and they have no relief from Chinese medicine, acupuncture, womb healing, Moksa, and being on the correct diet, Dutch test, is that that's when we know that they actually need to have surgery.
Dr. Amanda: (25:51)
Then it's being able to work with a surgeon, and I would say, ladies, do your research here. Really important to find an endometriosis specialist surgeon. Not just a gynaecologist, gynaecology, fertility specialist, an endo surgeon, because they've dedicated their life to mastering how to be able to excise the tissue. Because that will therefore then, it extends your anatomy, your fertility as well, and then you're not having to go back for repeated surgeries. And I think I'm a good test case.
Of course you are.
Dr. Amanda: (26:33)
Look, I'm hoping. I've got adenomyosis, which is even... You know, they're just as bad as each other. Adenomyosis is endo's mean stepsister. Mean sister, mean cousin.
She's a bitch, that's what she is.
Dr. Amanda: (26:50)
She is a bitch.
Would you want to touch a little bit on that? Because if you're saying 40% of people have both of these conditions, what's going on there? What's the causality, do you think? Or what's the relationship between them?
Dr. Amanda: (27:08)
They say it's retrograde menstruation where the blood goes outside the reproductive organs. So the tissue essentially migrates into your myometrium. So I always use the analogy in clinic is that our uterus is a beautiful garden. Underneath we have our irrigation, which is all the uterine arteries and veins. We need to have a beautiful, healthy vascular blood flow through there as well to help create a nice soil, a fertile soil, an endometrium. And then we have the myometrium, which is the muscle layer. That's the terrain that supports our garden.
Dr. Amanda: (27:42)
So when we've got endometriosis, it's a weed. The endometriosis grows in and around, so essentially it's disease tissue. If we've got fibroids, fibroids move into the myometrium. They're like a boulder. So endometriotic tissue migrates into the myometrium, which is the muscle layer of our uterus. So then you've got tissue migrating into this muscle layer, and you imagine that's a smooth muscle.
Dr. Amanda: (28:09)
So when we have our babies, that muscle grows and grows and grows, and we have an expansion of our uterus. It also releases oxytocin at the time of birth. So the myometrium, you've got this endometriotic tissue migrating, and it starts to change the shape of the uterus because you've got this heavy cramping into smooth muscle each month when you're bleeding. So over time, this starts to change the shape of your uterus. So when you go for a pelvic ultrasound, it can be seen on a pelvic ultrasound, and it's normally described as a bulky uterus.
Dr. Amanda: (28:42)
With that, you get lots of diaphragmatic pain up in your upper rib cage. Heavy bloating, feeling like you're distended, feeling like you're six months pregnant. Really heavy periods or just periods that just don't bleed properly, like really lots of stagnation, clots. And then issues with your bowels as well. So that one's hysterectomy. You need to have a hysterectomy. So there's no way I'm having a hysterectomy. I'm not on the Mirena. I'm just dealing by doing Chinese herbs and all the things that I know to best support the health of my liver, and my uterus, and my menstrual cycle.
Well, coming back to the Chinese medicine question, because if you think about the spleen too, it's keeping the blood in the right place, right? That's one of the functions of the spleen. And if you're thinking of soil as well, that soil function is what the spleen provides for the blood. That nutritive function. So I mean, there's got to be a spleen component too. So, diet you were saying before is super effective. What do you see as... Are there dietary themes? Or is it really individualised? Or is there anything you can speak to there?
Dr. Amanda: (29:57)
Absolutely. I think looking at the earth, what is the earth element? The earth is our centre. It's ability to be able to digest, transform and separate the turbid from the pure. So in order to make sure that the body and the spleen function and the stomach's able to separate the pure from the turbid, then you're actually able to absorb all your nutrients through your gut. And interestingly enough, there's been a link between estrobolome and estrobolome is... Okay, I'm just going to read.
Dr. Amanda: (30:32)
Basically, of course, gut health being the spleen is really important, so we know how much a healthy microbiome influences our digestive function. So with endometriosis, there's been research that shows we are lacking in lactobacillus. We're lactobacillus deficient. And also, our vagina has its own ecosystem as well. And women who have endo have lactobacillus deficiency. Particularly women over 40 as well. So really important that we have a healthy microbiome.
Dr. Amanda: (31:04)
So new research has emerged indicating that the gut microbiome, of course, plays an integral role in the regulation of our oestrogen levels. So metabolism is really important when it comes to endo so we can metabolise (as you were saying), those estrogens out.
Dr. Amanda: (31:20)
So essentially, when there's too much inflammation in our gut it causes a gut dyssymbiosis, and that starts to wreak havoc, creating more of an inflammatory response in through our gut. So when we have that, the body can't metabolise the oestrogen out properly. So we just have more oestrogen circulating through our bloodstream. So, what it does is the estrobolome comes in. Estrobolome is a term used to describe the collection of enteric gut bacterial microbes. Their job is to essentially metabolise the oestrogen. And these microbes, the estrobolome, produce beta-glucuronidase, sorry about the pronunciation there. This enzyme alters oestrogen into its active form which binds to oestrogen receptors and influences oestrogen-dependent physiological processes.
Dr. Amanda: (32:12)
Essentially, basically, the more your gut is out of balance, the more beta-glucanase is produced and the less oestrogen is excreted out of your body. So the research has shown that women that have high amounts of beta-glutinase bacteria leads to higher amounts of oestrogen circulating, in a roundabout way. Sorry about that.
No, yeah. So basically, gut dysbiosis is leading to higher circulating estrogens in the body, and that's effectively on account of, for whatever reason, from a TCM perspective, the spleen function isn't there. From a Western perspective, it's going to be maybe intolerances and things like that, or an inappropriate diet.
Dr. Amanda: (32:54)
Your sugars, blood sugar. And interestingly enough, what's the flavour of the spleen? The spleen loves sweet.
Yeah. Not too much.
Dr. Amanda: (33:05)
Yeah. Don't kill it with sweet. So you've got that whole gut thing going on. And some research that I found out was, the body's essentially designed to procreate, right? So when we don't conceive, is the endometrial changes into glucose secretions. So that's why we also, too, as we're losing our blood, the chi and blood come out, we're losing energy. You know when we get into that second half of our cycle and we're like, "Just give me the sugars, give me the carbs." That's because there's actually a physiological function that's taking place with the change in the spiral arteries of the endometrium.
Dr. Amanda: (33:44)
Then, that's the spleen, isn't it? The spleen function comes in. We just want those things that are nurturing, like the earth, to support us. Give us all those sweet foods. But it's a perpetuating washing machine, isn't it?
Yep. And I mean, I guess our culture's definition of sweet versus a traditional Chinese definition of sweet, which was more your grains and your root vegetables and starchy kind of things, whereas we're talking-
Dr. Amanda: (34:11)
Yeah. We're talking Mars bars, and that's not really going to be particularly helpful.
Dr. Amanda: (34:19)
Sure. And then you think about the liver. What's the emotion of the liver? The liver's anger, frustration, stress. So women that have endo and adeno, how stressed are we? How angry do we become because we're frustrated that no one's listening to us? Our symptoms are being dismissed? That then causes tightness through the actual liver meridian. And what's the pathology? The fascia becomes tight. The fascia becomes restricted.
Dr. Amanda: (34:48)
And then you've got the kidneys. If you're losing a lot of amount of blood as well, you become anaemic. So that then therefore affects the spleen, which is production of iron. The kidney function, as women, us being in that male dominant Yang type, living our life out in the Yang, the adrenals then become deficient, don't they? Which then affects the kidneys. And we know how much the kidneys support the reproductive function in Chinese medicine. So it's just this whole cycle. So it's really looking at so much of that holistic approach to supporting endo, through all the organ bodies, through your supplements, to make sure you're getting all your nutrients. Through your nutrition as well, because our nutrition doesn't deliver everything that we need, that our body needs.
Dr. Amanda: (35:41)
And then of course, wanting to teach our tissue to love our tissue again. And having a pelvic floor specialist physio to be able to teach you how to switch off your pelvic floor. Because of course, Yang women, hypertonic pelvic floor.
Yeah. That is a good visual for people.
Dr. Amanda: (36:03)
Sounds [crosstalk 00:36:04]
Well, people have been taught, again having done some Taoist study, we're taught to relax as much as we're taught to strengthen. But you go and talk to a Western-trained physio and it's Kegels and all these squeezy-squeezy-squeezies. And it's like, well, no, we need that to be like a diaphragm. It needs to be able to be soft, and it needs to be able to be supple, and it needs to be able to spread, and also to contract when required. So yeah, I think it's that tonus, that ability to be flexibility that we lose.
But again, you're looking at the liver, that makes so much sense if there's that rigidity in the tissue, there's going to be that rigidity and that stress in the mind as well. Right?
Dr. Amanda: (36:41)
You're so right. It is. It's teaching women how to come back into the essence of being women, isn't it? It's slowing down and really honouring that Yin aspect, which is nurturing and nourishing, because we're very good at having the opposite of that, of constantly doing or overachieving in our careers. Which is a great thing as well, but where's that other half? Where's the duality of bringing the Yin and Yang back in and finding that balance?
Dr. Amanda: (37:10)
So self-care, babe, like you were saying. Self-care is so important. Your little rituals, when you're bleeding you might want to bleed into a menstrual cup and then look at your blood when you bleed and honour her. Honour your bleed. And then maybe find a tree and put your blood into that tree, so you're nourishing back into Mother Earth as well with your bleed, rather than looking at your bleed like it's the worst thing possible, as starting to cultivate a really healthy relationship with parts of our body that we don't like. Because when we can start to disassociate from the pain, like in yoga. A witness. We can start to change the neuroplasticity of our brain to our pain. That's so important, too.
I can even imagine that fear of the cycle coming would impact the kidney as well, and then you get these perpetual cycles of fear of the pain, the pain itself, and then this... Yeah, must be an ordeal, I can imagine.
Dr. Amanda: (38:16)
Yes, yes. She's like, "Yes, it is an ordeal." So yeah, I mean, if someone's wanting to avoid... Is it the worst-case scenario, hysterectomy is where it goes? Is that the last resort for these kinds of things?
Dr. Amanda: (38:38)
Yeah. It is, yes. For some women, one of our patients, she's had a hysterectomy and she said it was the most liberating thing that she ever did. She also had ovarian cancer as well. So for her she said, actually, having not to go through that every month, the pain, to have that liberation, and then to be able to feel like she can function as a woman every month. So she didn't have her ovaries removed, just her uterus removed. So she's still got her reproductive-
Dr. Amanda: (39:15)
Yeah, because that's something I'm curious about, even, because I know that the uterus itself is an endocrine organ and I think you just mentioned that before, with the endometrium having that function as well. And even, I was talking to another integrative doctor the other day and we were talking about how the menstrual blood is actually different to the blood in our veins. Do you know much about that?
Dr. Amanda: (39:44)
Yeah. I do.
It's cool. I was like, "This is cool. These are cool."
Dr. Amanda: (39:53)
Yes. It's so amazing. You're so right. It's just phenomenal how our bodies operate. That whole evolution, isn't it? I still think about when babies formed in utero, how incredibly, highly intelligent that is. There's no science-
It's wild. Yeah. It's just like, "Make a human, go." And you're just eating your, I was eating my tamari almonds like, "I'm making a baby right now."
Dr. Amanda: (40:22)
Dr. Amanda: (40:30)
It's wild. "I'm growing a heart today. I'm growing the skeletal system." There's 386 different proteins. The endometrial lining is made up of vaginal secretions, the endometrial stroma, the epithelial cells, and then 356 different proteins that help to form that endometrial lining. So it's totally different to the blood that circulates through our veins. So essentially, when we are bleeding each month, and this is what I love, is that it's that whole thing of releasing. They say it's, when we're having a period, that we're releasing the debris. So medical, isn't it? Just releasing the debris.
Dr. Amanda: (41:19)
Well, we're releasing cytokines, so if we don't conceive it releases inflammation. We're releasing cytokines, the vaginal fluid. And so that's the process women, of honouring that letting go, we're releasing the old, essentially. The old blood, to make way for the new. So that is that process of releasing, letting go, and then bringing in the new. So when we go into our menstrual cycle, we're going into winter. We're going into that time to slow down, to honour ourselves as women, honour the letting go, looking at those psychological things of potentially what we wanted to let go of through that last cycle so then that way we can bring in the evolution of the new.
We were talking about trauma before, and about this stagnation that occurs. Is there a sense of holding on? Is that one of the themes that you see with people? I mean, I guess that's something you need to work through with a therapist, but is there a sense of resisting life in some way? Or I don't want to be rude or anything, but I'm just feeling into that, and it's like, yeah, I could feel like if there was a trauma or something you couldn't handle and you couldn't share, then you would store that in the body and that would manifest.
Dr. Amanda: (42:43)
Yes. So every month that's coming up, and it's a reminder as well. So even just deep, cleansing breaths. Using all your tonal sounds when you are bleeding, to soften through all that connective tissue. And then it's also an opportunity to practise the physicality of letting go. I always like to use... And go deep to then where you're softening through your diaphragm, that whole jellyfish analogy, soft through your diaphragm, and allow the blood to release and let it go. So when you're sitting on the toilet, if you're at home and you've got a really heavy cramp, instead of bending over and holding your stomach, you could take a nice deep breath in. And then as you feel the blood pass, and you go... It's no different to giving birth.
Like birth. Yeah. It makes a roar.
Dr. Amanda: (43:46)
Get your lion out. Women that have, we've got a lot of tight jaws, that connection of tight jaws. So you can soften through. And then when you do that, you can actually feel the blood passing, and the whole pelvis starts to soften, and the whole connected tissue starts to release. And you're like, "Ah." And you can feel the physical body releasing that stress in that moment. So breath, major part of treatments.
Yeah. Yeah. And I mean I am curious about things like steams and things. Do you have any experience with those? Because I personally haven't had endo but I've used them for things like, a little bit later than just having given birth, but in my postpartum stage I used them. And yeah, I'm just curious as to whether you've got any evidence of whether they're useful for helping... Because I imagine warmth would really help, something I can imagine.
Dr. Amanda: (44:45)
Yeah. Well, no, you know, because in that post-partum period, our uterus is vacious and in Chinese medicine, everything's prone to exogenous, external factors. So when we're losing our blood, the period, the whole menstrual bleed is emptying our uterus, and it's the same after we've given birth. So by doing steams, you've got medicinal herbs that are helping to promote healthy blood flow, warming the uterus, protecting the uterus as well from any external factors from coming in. Because if cold comes in, that's why you should never swim on your period, particularly in Melbourne, because it's so bloody freezing, the uterus contracts.
Dr. Amanda: (45:25)
You don't want anything to be causing a contraction, because more contraction leads to more blood stagnation, which leads to more pain, more inflammation. So yeah. And I think as women, we want to explore all the different options that we can. And yoni steaming is one of those. I actually haven't personally tried it myself. Can you share to me, how does it feel? Yeah.
I love it. I mean, I don't do it much at the moment really, but I used to do it a lot for self-care before my daughter. I just think it's this really... I usually do it when I'm not bleeding, so just the week before. For me, I guess I'm quite a livery type of person anyway, so it's that pause. It's an intentional pause. You're sitting there for a period of time with all the yummy herbs. I will often use rose and quite beautiful herbs, because I don't have any medicinal problems. Medical problems, I mean. But yeah, and for me that warmth in my lower abdomen is just a really nourishing feeling. It's something that I just find very comforting.
And my experience has been, post-partum, that it helps to clear blood. I had some dark, stringy blood at the first bleed, after I finished breastfeeding, so about 18 months. So did steams for the next two or three months after that, and it just seemed to clear it out. The blood became fresh and bright again. It just seemed to clear out any of that lingering stuff that maybe hadn't moved through well after birth, or was remaining from after birth.
And I mean, I've had my teacher, she said she passed a mass, a big... She said it was almost a placenta, a big alien clump. I've heard some wild stories. But I think yeah, just as a general thing to try, it's definitely worth it. You've got to be careful not to burn yourself. But it's beautiful. It's a really beautiful therapeutic practise. I love saunas, I love heat anyway.
Dr. Amanda: (47:28)
Yes. It's so nourishing.
Dr. Amanda: (47:31)
It is so nourishing.
Yeah, yeah. So I just imagine that would be beneficial. And I mean, from an internal perspective, obviously great to see a clinician and work on that level, and I know you've got some things pending which is exciting. So yeah, in general, if people were looking for supplements or herbs or things, are there things that you see working, or again should they just seek individual care? Is there any general things we can talk about? I'm imagining DIM, an estro-block kind of a product? Do you know that product?
Dr. Amanda: (48:03)
Yes. I think that's where it's good to do the Dutch test, because sometimes DIM can actually have the opposing effect and it can cause more oestrogen dominance. So I guess, if you are experiencing all that breast tenderness, yeah, all your cruciferous vegetables as we know, because they help to block the oestrogen receptors and to be able to metabolise oestrogen through your stools. And psyllium husks also are a great one to use. Curcumin, there's been some great research there to help reduce inflammation. And also evening primrose oil, evening primrose helps with the elevation of prostaglandins. It also helps with reducing inflammation. So all our essential fatty acids. Basically, no sugar. Definitely no gluten and wheat, are huge proponents for increasing more inflammation, particularly noting if you've got any celiac in your family, because then you'll definitely have a gluten sensitivity.
Dr. Amanda: (49:01)
Dairy as well. If you think about what's happening when cows are constantly being milked, in terms of they have to be milked regularly otherwise they get mastitis, they've just given birth. They've got oestrogen circulating, producing hormones, that's going into the milk. So it's just no dairy. Also, too, because dairy creates an inflammatory response through your gut. So if you notice that you're sensitive to dairy, cut dairy out. Farm to plate. Your blend, I love your women's blend. The Gaia.
Dr. Amanda: (49:38)
She is beautiful because she's got the [foreign language 00:49:39] and the [foreign language 00:49:41] helps to warm. It also nourishes blood. So after you've had your bleed take your Mother Gaia, because that helps, then you've got your goji berries, so the goji berries are really good because we know that they go to the liver meridian. They also help to support the spleen function as well, and they're red in colour. And they're delicious.
Something that's tasty [crosstalk 00:50:06] thank you so much for your time, Amanda. I will create a list of show notes for everybody to access your site, your book, all of your resources, your training, opportunities to work with you, and yeah, I really appreciate everything you've shared. It's been really enlightening and nourishing conversation. So thank you.
Dr. Amanda: (50:24)
Thanks, beautiful. Thank you so much.