Pauline (00:41)

Hello everybody and welcome back. I'm Pauline Walfisch and I am excited today to bring you a special episode in honor of endometriosis awareness month. I am here today with my standby regular co-host, Megan Nelson. Megan, I want to introduce our guest.

Megan (01:02)

Hi

everybody!

Today we are here with Dr. Deniz Kocas She is an assistant professor of psychology at Pace University in New York City. She has training in clinical health psychology, rehabilitation psychology, and neuropsychology. Her work focuses on understanding what it's like to live with both chronic and acute health conditions, including endometriosis, infertility, and neurological disorders. She's particularly interested

and how stigma affects mental health, health behaviors, and people's experiences with healthcare. And she also develops tools to better measure and understand these experiences. So Deniz, welcome. We're so happy to have you on here today to shed a little bit more light about endometriosis and the mental health implications of that.

Deniz Kocas (01:54)

Yeah, so thank you both for having me. I'm really happy to be here today and to talk about endometriosis. So yes, I can definitely tell you a little bit more about endometriosis. So ⁓ this is a condition that affects women and it happens when the tissue that's similar to the lining of the uterus is actually found outside of the uterus. It affects...

Pauline (02:13)

Always it's outside of the

uterus.

Deniz Kocas (02:15)

Yeah, so that tissue is migrating to outside of the uterus and attaching itself to different organs within the body. That can be in female reproductive organs like the ovaries, the uterus, the fallopian tubes, or it can spread to other organs actually to the bowel, the bladder, the rectum, and in rare cases it can also go to the lungs, the kidneys, and sometimes even up to the brain in rare, really rare cases.

Pauline (02:40)

Wow.

Deniz Kocas (02:42)

And it's often thought of as a gynecological disorder, but as I just mentioned, it's not limited to that part of the body. It's really a whole body disease. It's not just a gynecological condition, not just a reproductive health condition. It's really a whole body disease that just affects the whole system. ⁓

Pauline (03:03)

Do you think it's widely recognized as

that or?

Deniz Kocas (03:06)

Yeah,

that's a great point. ⁓ No, it's not. It's often thought of as a gynecological condition or a reproductive health condition because some individuals ⁓ also have infertility who have endometriosis. Not everyone will, but some will. And so that's the misconception that it's only a gynecological disorder, that it's only a reproductive health condition.

Pauline (03:29)

and that it's only

a problem if you're trying to get pregnant.

Deniz Kocas (03:32)

Yeah, so, ⁓ and it's not only a problem when you're trying to get pregnant.

The other thing, and I can talk a lot about what endometriosis is, ⁓ the other thing that's really important to mention is a hallmark symptom of endometriosis that not everyone will experience, but if you do experience it, that's really important to investigate further, is severe pain during the period, during the menstruation. So, like I said, not everybody's going to experience

Pauline (03:59)

Yeah.

Deniz Kocas (04:02)

that everyone's symptoms will be different, but really that should be explored further if severe menstrual pain is experienced.

Pauline (04:11)

I think so many people

think that menstrual pain is normal. like how, how, how do, what's severe pain? Like what does that look like?

Deniz Kocas (04:18)

Yeah, so again,

a common misconception, think as women we're often told pain during your period is normal, just get on with your day, just push through it. Yeah, just like.

Megan (04:28)

take some more time. Yeah.

Deniz Kocas (04:32)

it's fine, you know, we all have it. But no, really severe menstrual pain is you're not able to get out of bed. It's affecting your daily life where maybe you can't go to work. Maybe you can't go to school. Maybe you can't take care of your family. You might isolate yourself because of that pain. So and there might be other symptoms associated with it as well. So really, that's what severe menstrual pain is when it's

your daily functioning to the point that you're missing out on things and you're not able to do normal activities that you would do on a daily basis.

Pauline (05:07)

We're so,

so hard, right? In monthly patterns.

Deniz Kocas (05:10)

Yes.

Definitely, yes.

Megan (05:14)

So if one of the early warning signs, let's say, is severe menstrual pain, are there other warning signs that, you know, can say, ⁓ maybe I should have this checked out?

Deniz Kocas (05:25)

Yes, definitely. like I said, the symptoms are going to vary. ⁓ I just want to make that clear because that's really important that the symptoms vary based on the individual case. Some individuals will have severe menstrual pain, will have chronic pelvic pain that they develop and others just won't. Some might find out when they're trying to have children and they seek help through an infertility doctor and then they realize they have endometriosis. So symptoms really vary. ⁓

But

in addition to that severe menstrual pain, what can happen is ⁓ individuals might have heavy periods, very heavy periods. They might have gastrointestinal symptoms and actually be misdiagnosed with conditions like inflammatory bowel syndrome. So those gastrointestinal symptoms might look like painful bowel movements or constipation, diarrhea, vomiting, bloating and gassiness. I already mentioned infertility as

one of the symptoms and chronic fatigue is another one where individuals might experience just chronic fatigue in their daily life. So those are some of the symptoms of endometriosis.

Pauline (06:34)

is

painful intercourse.

Deniz Kocas (06:37)

Yes, yes, thank you for mentioning that.

that's one of the ⁓ symptoms as well as painful intercourse.

Pauline (06:45)

Yeah,

I know some of my clients have mentioned it and like so confusing, like why, why all of a sudden it's really uncomfortable or painful.

Megan (06:55)

So your work is really in looking at the mental health implications of endometriosis. What are some of the challenges that, you know, in your research that you've noticed are common in women that experience?

Deniz Kocas (07:11)

Before

that, you don't mind, just want to mention a few things about undementiosis too that I just want to add to a few things. I'm not sure if I said it, but it does affect one in ten women. ⁓ It is quite a common disorder. That's around 200 million women worldwide. Also, unfortunately, there is no cure for the condition, but there are treatments available.

will be personalized for every person depending on that individual case and it might look like lifestyle, just management, maybe changing your diet or it might be taking medication or it might be surgery as well. And another key component of endometriosis is that it can definitely be diagnosed only with confirmation through surgery. So that tissue goes to a pathologist

and the pathologist looks into what that tissue is and then they say this is endometriosis. And that's the definitive diagnosis. Some people who may not want surgery might be diagnosed as well, but that would be a suspected endometriosis and not a definitive diagnosis. maybe those people are being managed through medication, for example, and that's fine with them.

Mm-hmm.

Pauline (08:28)

So, so for some people, they're

told like, we think you have endometriosis, but really the only way to confirm it is to like, do an exploratory surgery. And so they have to decide whether they're willing to have surgery just to find out.

Deniz Kocas (08:47)

Yes, yes, exactly. that's a major limitation because surgery is, I mean, the surgery is termed minimally invasive, but it's still invasive because it's surgery. So that's often what's very difficult is that, you know, to get that diagnosis, women need to go through that surgery. Thankfully, there are new methods that are being developed for diagnosis, but you know, still surgery

remains the main way to find out if what's indeed there is endometriosis. ⁓

Megan (09:17)

Both Pauline and I lead

infertility groups, different ones, but that's one of the real struggles is like deciding, am I gonna go have the surgery that we're not sure if this is what's the cause of that. And it's that decision can be really difficult, yeah.

Deniz Kocas (09:30)

It's a big decision. Yeah,

Pauline (09:32)

And

Deniz Kocas (09:33)

a really, really big decision.

Pauline (09:35)

I think a lot of people try the other things that might confirm a diagnosis, but those are not always accurate, right?

Deniz Kocas (09:46)

Yeah,

they can be misleading. might not show, imaging, like MRI imaging might not show endometriosis. So it's, yeah, there are limitations to these other methods. They can be very helpful, but we need to acknowledge the limitations as well.

Pauline (09:59)

Yeah. Like I know sometimes people

will say like they do a biops and endometrial biopsy and it shows they have enduro, end, endometri, tritus. who wants to just jump right to surgery? Like every you're trying all these other things and it just, there's like this cumulative stress of

Deniz Kocas (10:11)

That's right.

Yes.

Pauline (10:21)

doing

another thing and maybe it worked. Maybe I know the answer. ⁓

Deniz Kocas (10:26)

And Megan,

you asked me about the mental health consequences and that really brings me to that is this is something that contributes to the difficulties that some people might have related to mental health. This is a journey to diagnosis. The time to diagnosis for endometriosis patients is on average 10 years, which is a really long, long time. a lot is contributing to that.

Pauline (10:47)

my gosh.

Deniz Kocas (10:51)

But that diagnostic delay and trying these treatments and maybe not having the answers really contribute to the mental health consequences of endometriosis, which as Pauline mentioned can look like stress. It can be depression, can be anxiety, it can be body image related concerns as well. 10 years.

Pauline (11:11)

10 years of pain

and medical appointments and I imagine you see a lot of different doctors in 10 years.

Deniz Kocas (11:21)

Exactly. So

⁓ That's a great point because so related to endometriosis, ⁓ the education really for medical professionals as well as just education and the general public is not very good. We don't know, we don't go around hearing about endometriosis. Only in the last few years have we started to maybe see it and you know, I've been seeing it more and I get excited every time but I see it in TV shows or movies and I'm like,

finally there's, you know, this is how awareness happens. This is how we know.

Pauline (11:53)

10 years of lots of different

doctors and trying to get a diagnosis, seeing doctors who tell you that there's nothing wrong, that it's normal to have painful periods, that you should cut out dairy and go back to work.

Deniz Kocas (12:05)

Yes.

Yeah,

so because education around endometriosis, ⁓ we don't have sufficient education around it among physicians, other medical professionals, mental health professionals, and the public, it's hard for individuals who have endometriosis to know what's going on, and it's hard for physicians to know. So physicians, because they're not aware, certain physicians, because they're not aware, might just say to patients, and this has been reported in many, many

many studies that just documented over and over and over that you know individuals go in to see a physician and they're there as we discussed at the beginning of the podcast they're told you know that it's these are periods it's normal pain that you're experiencing and then you know when people go to other doctors they might keep hearing the same thing and again a lot of evidence to support this individuals are told

It's all in your head. You know, this is this is you. And even to the point where, you know, either physicians or loved ones too might be saying you're just an excessive complainer. You just like are one. Yes, you're trying to get out of things, you know. Yeah.

Pauline (13:15)

So dramatic.

Megan (13:19)

It's your anxiety, right? It's like, and the thing

is, when you're not believed over and over again, your anxiety is going to be heightened, And so it becomes like, no, I have anxiety and also I have all of this pain,

Deniz Kocas (13:27)

Yes.

exactly.

When you're dismissed for so long, of course that has an effect on your mental well-being, whatever that looks like, whether it's depression or anxiety or whatever it is. It has such an effect on your mistressed as well. and really I say that, Pauline you were talking about this earlier, when you know that something is wrong in your body, when you feel that something is wrong, pursue that. You know, it's something, if you're not feeling right, like get, get

Pauline (13:44)

or mistrust.

Deniz Kocas (14:00)

your answers because you know your body best, ⁓ But these are all things that contribute to the mental health concerns that we see, along with what I already discussed was the pain. So the pain that people are experiencing if they are an endometriosis, an individual with endometriosis who has pelvic pain or menstrual pain, that pain, you know, might

Pauline (14:06)

Yeah.

Deniz Kocas (14:26)

lead

you to isolate yourself from your loved ones. You might not be able to pursue your hobbies, your work the way you want to, your schooling the way you want to. I mean, that just is such a huge impact on your life. So of course this is gonna affect your mental health. But in addition to that, I will say that we also know that there are some genetic reasons

also too for people with endometriosis having depression and anxiety. There is some genetic component to it too that we're learning more about but you know there is a bi-directional relationship of course too like sure there's a genetic component but then because the quality of life is affected so much then that can also affect our mental health.

Megan (15:10)

You may not want to go into the full detail, but is it related? Is the genetic link related to inflammation? Do you know?

Deniz Kocas (15:17)

I'm not actually sure if it's related to the inflammation but just my hypothesis would be yes that inflammation would definitely have a role in that because inflammation is such a big component of endometriosis overall something that I didn't go into earlier but like just immune dysfunction and hormonal dysregulation is such a big component of the condition as well which we know that those things affect again our whole body and our whole system.

Pauline (15:44)

I think this might be the first time that you use the H word, the hormone word, right? Because so many times like people are like, it's just your hormones or, but more and more and endometriosis is, is recognized as having a hormonal component.

Deniz Kocas (15:50)

Wow, what a word.

Pauline (16:06)

as well as mood and anxiety disorders. So is that also part of the bi-directional consequences?

Deniz Kocas (16:14)

Thanks.

That's a really

good question. I would hypothesize that definitely there's a connection. But, you know, we do know that endometriosis is a condition where estrogen plays a big role in endometriosis. And so, like, the reason the pain is occurring is because of the

Pauline (16:19)

Yeah.

Deniz Kocas (16:32)

monthly fluctuations in hormonal levels, especially estrogen. And we know that, for example, in pregnancy, some individuals experience symptom relief because of shifts in hormones. like progesterone kicks in more during pregnancy, so symptom relief might happen. Or for example, during menopause, know, there are changes in our hormones, in

oestrogen, so that change in oestrogen can lead to ⁓ symptom relief as well. Interestingly, like for example, hormone replacement therapy during menopause or hormonal treatments during infertility treatments can sometimes affect symptoms and might lead to worsening of symptoms. But again, these are discussions that need to be had with a physician. It's on a case-by-case basis that this would need to

Pauline (17:16)

Mmm.

Deniz Kocas (17:23)

be addressed.

Megan (17:24)

Thinking about

the mental health, we talk a lot about compounding factors, right? And we see a lot of new moms and people who have gone through infertility. And I can only imagine.

going through years of endometriosis, possibly infertility, all of the mental health implications of that, plus pregnancy, hormone shift, new parenthood, possibly perinatal mood or anxiety disorders that we call PMADS. Wow, that's a lot. And how that can be layered on and it just becomes very, very intense.

Deniz Kocas (17:59)

And like I said, it affects your whole life, really. It really does.

Megan (18:06)

I imagine it affects couples too. If it's affecting pelvic pain, you know, any intimacy or, you know, caregiving roles are shifted. You know, even like what jobs and income can be impacted by this.

Deniz Kocas (18:23)

Yeah, definitely. there's a lot of, again, a lot of evidence there to support that endometriosis really affects intimate relationships. And with us seeing that, you know, it can lead to a lot of challenges and not just intimacy, but the whole relationship as a whole.

And unfortunately, you know, there are also reports of

relationships falling apart because of endometriosis. again, know that the effects that it can have on someone and their pain and

partner might not believe the pain. So, and as you mentioned, it can affect a lot of your responsibilities in the home, not just I touched on work, I touched on school, ⁓ on hobbies, but it can affect just your ability to care for your home or care for your pets or

care for your spouse or your children. ⁓ And your sense of self, of course. And it really is something that can, you know, really gets to the core of being a person and a human and it really lead to just these... it affects your identity. Or it can affect your identity.

Pauline (19:13)

and your sense of self.

I was going to say I would imagine, but I don't have to imagine, right? I know I've seen it, especially when doctors or medical professionals are telling you that there's nothing wrong.

Deniz Kocas (19:45)

Exactly. That dismissal is just really, really awful and it happens way too much and I wish we didn't see it, but unfortunately it continues to happen. And, you know, I'm hoping that there's a shift in it, but we know that change is slow. But through podcasts like this and through other initiatives, hopefully that will change going forward.

Pauline (20:09)

So if you're somebody who thinks like, I wonder if that's what's happening to me. Like where should you start? Like what kind of doctor should you say? What questions should you ask?

Deniz Kocas (20:21)

Yeah.

It's really important to see somebody that is specialized in endometriosis. So there are endometriosis specialists around and they will be able to do the workup that's needed, the diagnostics that are needed to determine if somebody has ⁓ endometriosis. Those, again, thanks to more initiatives, we know that those specialists are increasing, but

an OBGYN might have some training in endometriosis, but they're not going to have all the training. They need to have had also the specialty training in endometriosis. And I would also say that because surgery can be an important part of endometriosis, diagnosing endometriosis and treating endometriosis, what's really important is that individuals seek out

Pauline (20:55)

Mm-hmm.

Deniz Kocas (21:08)

who are trained in minimally invasive laparoscopic surgery. So, and in excision, in excision surgery, because that is the best practice. It's the gold standard in terms of surgery to treat endometriosis.

Pauline (21:24)

with a

surgeon who specializes in endometriosis, not just an ordinary OB-GYN or...

Deniz Kocas (21:32)

Yeah,

so OBGYNs will have additional training where they'll be specialized in endometriosis, but those individuals who are specialized, those physicians that specialize in endometriosis, we also want to make sure that they have...

a surgical training that's appropriate to treat endometriosis. And that surgical training is excision surgery, minimally invasive laparoscopic surgery, but that they're specialized in excision surgery. Because there are other types of surgery that can be done that ⁓ will not be effective. So it's really important to go to the right type of doctor.

Pauline (22:05)

Yeah, I've had, I've had

clients who have had surgery and the surgeon said like, no, you don't have endometriosis. And then they pursued it, pursued it, pursued it. So I saw a different specialist and had like severe and endometriosis is staged almost like can't, you know, have with cancer diagnosis, can be stage one, stage two, but with her endometriosis, it has that same categorization.

Deniz Kocas (22:32)

Yes,

exactly. So it's from stage, I believe it's stage one to stage four. I believe it's based on the number of endometrial lesions and also the depth of the lesions as well. What's important to note though is that the stages of endometriosis don't correlate with the severity of symptoms that somebody might have. So somebody might be in agonizing pain but have mild lesions, I

lesions, when I say lesions what I mean is that tissue that migrates to other parts of the body, those are classified as lesions. So somebody might have really terrible pain but have mild lesions and someone might have mild discomfort but have really severe endometriosis. So that staging doesn't really correlate with the severity of the symptoms that people experience.

Pauline (23:24)

important,

important to know.

Deniz Kocas (23:27)

Yes.

Megan (23:27)

talking about maybe the whole experience, the whole person and getting the care that they need. Obviously, ⁓ trained OBGYN and surgeon. What else is really helpful?

Deniz Kocas (23:40)

a whole care team that would need to be involved. in addition to having the right physician that's taking care of you, again, depending on the individual case, you might want to have a physical therapist that's involved in just rehabilitation. You might want to have an acupuncturist involved if that is something that you feel you would benefit from. Given the mental health consequences,

you know, you might want to have a mental health professional involved. Yeah, exactly. Who can help you with coping strategies and support throughout this process. And obviously, I, you know, I'm trained as a clinical psychologist, so I feel very strongly about that, that this also requires mental health support.

some individuals do report that they benefit from an anti-inflammatory diet really that might look like no dairy, no gluten, so a nutritionist might be involved in someone's care. again it's really like a full approach to care with different health care providers.

Pauline (24:43)

complicated.

So it is complicated. There's a lot of different things that impact getting diagnosed, getting treated, living with endometriosis. Where do, should people go for reliable education about endometriosis? Many of us get our education from Tik Tok and Instagram, but if we want like,

educational content that's science-backed? Where do people go?

Deniz Kocas (25:11)

Yeah, so I mean one resource that I always point people to is the Endometriosis Foundation of America, which is a ⁓ nonprofit focused on advocacy and research and education. They have a lot of content on their website. The organization was found by an endometriosis surgeon, Dr. Tamar Sechkin, and also Padma Lakshmi. They founded the organization together.

And so they have a lot of content on their website where the focus is on ⁓ endometriosis and all about endometriosis. A lot of what I've talked about you can definitely find on there. ⁓ So that's really a key resource that I think I would look at.

Pauline (25:48)

great.

And are there

support groups for people with endometriosis?

Deniz Kocas (25:58)

There are support groups, definitely.

know through the Endometriosis Foundation, patients can be connected to a group through there because there are a lot of patients who are members of that organization and ⁓ you know, they're trusted patients who might have a group

I think what's also important to note is just for individuals that think that they might have endometriosis, I think it's really important to attend some events where they're patient-focused events. So I mentioned the Endometriosis Foundation of America. Every year they have ⁓ a patient-focused meeting where different professionals come. It might be physicians, mental health professionals.

professionals,

patients who share their stories, acupuncturists, physical therapists, you name it. ⁓ Yes. Yeah. yes. really we just actually I was just there two weeks ago and it was really, really a wonderful event. But not only do people get information about the condition there, but you get connected to such a lovely group of other people who are going through what you're going through. And I think that is

Pauline (26:43)

must be so validating.

Deniz Kocas (27:04)

validating in itself. Not just meeting professionals who are working in this or researchers who are working in this, but meeting people who've gone through what you're going through is just like a really validating experience. I will also say that the Endometriosis Foundation has ⁓ an annual medical conference and

Pauline (27:17)

Yeah.

Deniz Kocas (27:25)

⁓ People who have endometriosis are welcome to attend the medical conference. It's very scientific You know surgeons are showing surgical videos and sometimes and you know if you're somebody who has endometriosis some of that can be triggering So I do just want to give that trigger warning But it can also be very informative if you're interested in the science of this condition Two weeks ago when we had the conference it was focused on

aspect of endometriosis that is rarely discussed but it was on how ⁓ endometriosis can affect ⁓ nerves and it was so many different physicians just talking about their work on how endometriosis can affect the nerves but also like the immune system as well. They also discussed the immune system so that's just a great opportunity for people who have or think they have endometriosis to learn more about the science behind it.

And usually the Endometriosis Foundation of America puts those two events together. So if you're here for one, you can attend the other one too.

Megan (28:28)

We say this a lot sometimes

when you're dealing with navigating infertility, endometriosis, anything like that, that you have to become your own scientist and science project almost. So I can absolutely imagine that there are patients with it that would enjoy going to that for more knowledge,

Where do you hope that education awareness support research is going in this field?

Deniz Kocas (28:52)

Where I hope it would go is that we'd be able to get some answers about endometriosis where we would know what causes it and where we could develop non-invasive tools for the condition so that we can diagnose it in a more non-invasive way. so those things I think are extremely important and also having a cure.

We need a cure for the condition, you know, we're going to get that answer by knowing, you know, how it's caused. So those are a few things that I think are just really, really important so that, you know, we can hopefully in the future eliminate the suffering that so many ⁓ people are experiencing. I think those are my top three. Yeah, I'll leave it there.

Pauline (29:36)

So, you know, we always kind of come back to...

takes people a long time to get answers and a diagnosis and 10 years is a long time, right? What would you say is that thing that people would say over and over like nobody told me, right? What's the...

Deniz Kocas (29:54)

I think I mentioned it already, but I am glad to have an opportunity to highlight it again is that severe mental pain is not normal. Severe mental cramps are not normal. I think we hear that a lot. So I think that's the main thing that I would highlight. Yeah.

Pauline (30:11)

So don't

just suck it up.

Deniz Kocas (30:13)

exactly.

If you feel something is wrong with your body and you're not getting the answers that you want and you need, I know it's tiring, I know it affects your mental health, but keep listening to your body and to yourself and pursue those answers. And don't let go of the people that are supporting you because those are the people that are really helping you get through what you're going through. So seek their support and ask their help for their help.

And I think we already talked about it, but part of the reason that we're also not diagnosing endometriosis as fast enough is what my research is about, which is the stigma around menstruation and talking about menstruation. And I want everyone to be aware that there is a stigma around that. It is a real thing that is changing. But from a young age, implicitly, or explicitly,

we

are taught, you know, don't talk about your period, hush hush, or don't show your menstrual products when you're at work or when you're at school, when you're walking to the bathroom, like that's private. So these messages are constantly being implanted in our brains. It might also look like, you know, until I think again, like a few years ago in ads, you know, we didn't see red blood, you know, it was always past ads we would have

blue blood being put onto the pad and we and I think

Pauline (31:40)

The pad with the little happy face on it.

Deniz Kocas (31:42)

Yes. we, you know, what's wrong with blood? What's wrong with menstrual blood? There's so much stigma around that. And there's a term in the literature and the work I do, it's called menstrual etiquette. We as women and girls were taught how to navigate conversations about endometriosis. And, you know, that might look like giving a warning before you talk about your period with your friends, you might say, TMI, TMI, too much information, but I'm going to share about

Megan (32:09)

you

Deniz Kocas (32:11)

my period or we might use terms like it's that time of the month not like I'm on my period things like this and that's all flow is visiting.

Pauline (32:20)

Aunt Flo is visiting.

Megan (32:22)

Having a nickname. Yeah.

Deniz Kocas (32:25)

So this all contributes to the stigma and to why endometriosis isn't diagnosed quickly enough because as much as physicians might not be trained well enough, other medical professionals might be trained enough, as patients we might also not want to talk about this stuff because we're taught that it's not necessary to talk about it. So one of your questions was, what do you wish to see? And I hope that we, through again, lots of advocacy and initiatives,

Pauline (32:45)

Cough cough

Deniz Kocas (32:54)

I hope we can see us talking about menstruation more, us being comfortable with discussing anything that comes up related to menstruation. And I think that's the way that we can address stigma. It's already changing. I'm really happy to see, you know, change just even real blood being shown or like red liquid being shown on ads or something.

Pauline (33:13)

Or what there was one

of the Olympic athletes just recently talked about how she did her whole performance while she had her period

Deniz Kocas (33:20)

Yes, yeah exactly.

So these things might seem small but like they all make such a such a huge difference to how we interpret our periods and our body. So I hope that we become more comfortable because it's through that that we also create change and we're all responsible for that too.

Megan (33:40)

It just reminded me.

Pauline (33:40)

⁓ So maybe this is

the what no mom told you, right? No mom told you, like talk about your period.

Deniz Kocas (33:44)

Bye bye.

Megan (33:47)

Yeah,

Deniz Kocas (33:49)

Yes.

Megan (33:49)

you know, this just made me think and I know we're at the end, but I have an eighth grade boy in health class and I said, did they talk about periods? And because he said they divided it to girls and boys. I was like, well, do they talk about periods in the boy side? And he said, not really. And I was like, all right, well, that's something to advocate against.

Deniz Kocas (34:07)

Yeah.

Pauline (34:09)

I will say it

is getting better. I teenagers who have, I boys and they have...

friends who are girls. And I'm always every time I hear it, I like giggle a little bit inside because the girls will be like, I have really bad cramps. I have my period. And they just say it in front of the boys. They're not hiding. They're not like sneaking their, you know, tampon in their, in their little pocket. Like they're just like, I have to go to bathroom, change my tampon. I'll be right back. Like

Deniz Kocas (34:26)

Yes.

Yeah. ⁓

Definitely

it's changing. I completely agree, but I think we have more work to do as well. But I'm so happy to see that change and people just talking about that period, their period more. ⁓ So we're going in the right direction, but we need to do more for sure. Period talk is okay, exactly. And just one more thing I wanted to mention is Megan, you talked about education.

Pauline (34:54)

Yeah.

Period talk is okay.

Deniz Kocas (35:07)

girls versus boys. So one thing that the Endometriosis Foundation of America does is they actually go into schools and they educate. They have like an education program that can be delivered to students and it's all about endometriosis and it's given to both boys and girls in high schools. So that's one initiative that's also taking place to address some of the stigma and the lack of education about endometriosis as a condition.

Megan (35:34)

So cool. Yeah.

Pauline (35:34)

We're getting there.

Thank you so much for joining us today. I really appreciate you being able to come and share your research and knowledge about endometriosis and clearly passion. I'm glad that we could bring this information to people. Thank you.

Deniz Kocas (35:48)

Thank you for having me. It was lovely to talk to both of you and I hope your listeners

Megan (35:51)

So nice to meet you.

Deniz Kocas (35:53)

⁓ learn something new from this podcast.

Pauline (35:57)

sure.

Megan (35:57)

Thank so

much.