122. Endometriosis in Perimenopause and Menopause: Diagnosis, Treatment, and Excision Surgery with Lillian Medhus, NP

Endometriosis affects roughly one in ten women and girls of reproductive age worldwide, yet many women spend close to a decade, and sometimes ten or more doctor visits, before anyone names it. It is also a condition we tend to assume quietly disappears at menopause, which isn’t always the case, and a history of endometriosis can change how you and your clinician approach hormone therapy during the transition. In this episode, I talk with Lillian Medhus, a women’s health nurse practitioner, certified menopause practitioner, and founder of Aspire Women’s Wellness, where she cares for women with endometriosis, pelvic pain, and hormone changes across the lifespan. Lillian lived with symptoms from her very first period and spent years treating endometriosis patients while telling herself her own pain wasn’t as bad as theirs, until a collapse on a New York City street led to a diagnosis of stage four deep infiltrating endometriosis. That experience shapes how she listens to the women in her practice today. We talk about what endometriosis actually is (and why it behaves so differently from ordinary tissue), the many conditions it overlaps with, and why perimenopause is often the point where long-standing coping strategies stop working. Lillian also explains why a hysterectomy is not a cure for endometriosis, what separates excision surgery from ablation, and why finding the right surgeon can be one of the biggest hurdles women face. In this episode, we discuss Lillian’s own path to an endometriosis diagnosis while working as a pelvic pain clinician What endometriosis is, how it differs from adenomyosis, and the symptoms that are often mislabeled as IBS, interstitial cystitis, or sciatica Conditions that commonly overlap with endo, including autoimmune disease, chronic migraine, hypermobility, POTS, and MCAS How endometriosis is diagnosed in the US today, clinically and surgically, and where imaging is improving Her measured take on the saliva test being studied in the UK and why external validation still matters Why there is no cure, and how she layers hormonal treatment, pelvic floor therapy, nutrition, and other tools to lower the overall burden of disease How perimenopause can intensify endometriosis, and why scar tissue and adhesions can still cause symptoms after menopause Excision versus ablation, and the insurance and access barriers that keep many women from specialized surgery How to find a vetted endometriosis excision surgeon Lifestyle supports, including sleep, an anti-inflammatory eating pattern, reducing alcohol, gentle movement, and pelvic floor therapy Why the threshold for seeking care is simpler than many women think: if your cycle or pelvic symptoms are affecting your daily life, it is worth getting checked Episode timestamps 00:01 Introduction: endometriosis by the numbers and why it matters in midlife 02:01 Lillian’s personal health journey 06:27 What endometriosis is and how it presents 08:34 How endometriosis is diagnosed in the US 09:22 The saliva test and other emerging diagnostics 11:09 Is there a cure? 12:10 Managing endometriosis day to day 14:13 Endometriosis in perimenopause 15:11 Endometriosis after menopause and after hysterectomy 17:16 What’s encouraging in endometriosis care 19:36 Barriers to excision surgery 22:43 How to find a vetted excision surgeon 23:50 MCAS, POTS, and looking at the whole person 26:35 Inside Aspire Women’s Wellness 28:43 What’s next in women’s health 30:25 When to make an appointment 31:52 Lifestyle and over-the-counter supports 35:13 Where to find Lillian A note on treatment Several of the therapies Lillian mentions, including