Understanding Chronic Pelvic Pain: Tanya Borowski on Endometriosis

Leigh Brandon (00:01.208)
Tanya, welcome to the Radical Health Rubber Podcast. It’s great to have you here.

Tanya Borowski (00:04.899)
You’re welcome. It’s fantastic to be here. We had a little bit of an issue with microphones to start with, but the listener doesn’t need to worry about that. So yeah, great to be here.

Leigh Brandon (00:14.018)
Yeah, I wasn’t going to mention that bit, don’t worry. It’s all good. It’s all good. So I’m really looking forward to diving in and talking to you today, specifically about your work around women’s health and particularly, persistent pelvic pain, which I know is a topic that so many struggle with, often silently. So to kick things off, could you share a little bit?

Tanya Borowski (00:17.851)
It’s a bit to make it real.

Leigh Brandon (00:42.03)
a little bit about your background, what led you to work in women’s health, and what sparked your interest in helping those with persistent pelvic pain.

Tanya Borowski (00:51.131)
Amazing, yes, I’d be delighted to. So my first modality was in this world, was nutritional therapy. So I trained in nutritional therapy, actually started in Australia, I was living in Australia for a decade. so trained as a naturopath in Australia, and then moved back to the UK.

and started to work in clinical practice and probably like most individuals, realised that that first modality really just touched the surface, if you like, and that very quickly recognised that A, I had an absolute passion for wanting to connect with dots and to know more, and also recognising this was going to be a lifelong learning. And that…

coincided with the same time that the Institute of Functional Medicine came to, was starting to become more well known and more recognized, or the term functional medicine was becoming more recognized in the UK. And they brought over to London their inaugural sort of initial training module. And it was a five day foundational course

in functional medicine and I was on the edge of my seat. I was five days, I had to scrape together the money to afford the course itself. But I was on the edge of my seat and just knew from that, really within that first lecture, that one day, A, I wanted to be that person that was up on the stage.

Leigh Brandon (02:44.003)
you

Tanya Borowski (02:44.855)
and I did cover sales background and B, just that this was absolutely that I found my calling. And that wasn’t specifically about women’s health or hormones or endocrinology, but it was just the thought process of interconnected medicine, of knowing that there is always a cause and effect and that so many conditions and syndromes are multifaceted.

So that then sort of, I then embarked on training and going through their qualification, which was took another two years. And at that point that involved traveling back and forth to the States because you couldn’t do remote training at that point. But for me, that was ideal because I always find that learning in a room and being surrounded by your tribe is, you just absorb more.

Leigh Brandon (03:28.174)
Mm.

Leigh Brandon (03:41.389)
Hmm.

Tanya Borowski (03:42.011)
And that then really, so that really developed my interest in working more specifically in women’s health because I began to recognize and see that women’s health was so under served, both in the areas of research. And it just seems that

there was such a linear approach to conditions that are associated with women’s health and everything seemed to be put at the door of it’s a hormone imbalance. And then really the solution was pretty much always, well, let’s stop those hormones and let’s put women on the pill until they reach the age of menopause.

And then the solution is, well, OK, now we’ll replace them. And it just seemed to me just so illogical that this was just such it was going at it was approaching so many such conditions with such a blunt instrument. And that’s sort of a very simplistic way of explaining of explaining it. But within that, I fell in love with.

Leigh Brandon (04:54.764)
Hmm.

Tanya Borowski (05:07.585)
understanding biochemistry and the connections of that biochemistry and how we always talk about or the term hormone imbalance is used so flippantly actually and it’s so much more than that it’s about the ebb and flow that our hormones

that interact with our immune system and our nervous system. So we now talk about the neuro-endocrine immuno system and that really far better encompasses so many different conditions that I work with in women’s health, be that endometriosis, be that PCOS, PMS, PMDD, all of these types of…

Leigh Brandon (05:40.43)
Hmm.

Tanya Borowski (05:58.203)
conditions involve multi systems and it just continues to fascinate me and it is now becoming much more, there is much more awareness but it is, we are still, we still have such a long way to go and bridging that gap between the medical system and complementary or integrative medicine and

I really, my hope and my dream is that increasingly that that bridge becomes much easier to walk across and what to facilitate that there is a far better working understanding, a relationship between medical doctors and this communication with other types of healthcare practitioners that can be incredibly supportive because it takes a village.

Leigh Brandon (06:56.13)
Hmm.

Tanya Borowski (06:56.699)
And so many of these conditions that we’re focusing in on talking really about chronic pelvic pain and endo today, but they require such a intricate group of people to be able to support that one woman because there’s so much that’s involved. And that’s really sort of what I continue to do and love doing and never stop.

Leigh Brandon (07:19.469)
you

Tanya Borowski (07:26.137)
wanting to go to a conference or flying off somewhere to learn about something that’s around women’s health. So that’s sort of where I am. So I’ve been in practice for coming up to 20 years and yeah, I love what I do.

Leigh Brandon (07:33.058)
Mmm.

Leigh Brandon (07:42.414)
It comes across like you know your passion is is clear you know from just hearing you speak today obviously I’ve heard you speak several times before but what What it really feels like to me is I’m speaking to a fellow nerd You know you love you love to learn you know you can’t get enough of more information Which is exactly what I’m like as well You know I just can’t stop learning new stuff and wanting to use that information to help people you know not not necessarily

you know, female pelvic pain, although, you there are times when I have helped women with those kind of problems, but, you know, for me, any kind of pain. But, I guess it’s great to be talking to a fellow nerd and someone that shares a similar passion for learning and helping people with that knowledge. Yeah, something that…

Tanya Borowski (08:18.661)
Yes.

Tanya Borowski (08:28.965)
And I take that as a compliment. I think that this can occur in any walk of life and modality. when we become, and I will use this way, when we become arrogant enough to think that we know everything, and this can, as I said, this can be applied to anything, then really then we may as well put, then we may as well.

then we may as well walk away because I believe that we’ve always got to be open to relearn what we think we know because science moves and science changes and well, the life and also the environment in which we immerse ourselves in is infinitely and that environment is key to

Leigh Brandon (09:04.654)
you

Tanya Borowski (09:22.501)
how that interacts with all of the systems that we want to learn in a textbook fashion. But unless we actually respect how that environment changes, we’re never going to be able to really truly support our clients. So, yeah, I think always be open and to… I use the word lens a lot and this is very true with endometriosis and chronic pelvic pain and I sort of…

you can bear with me, I just always have this image in my head of a kaleidoscope. One of those old, those kids kaleidoscope, you and I are a similar age that you sort of look down and you just move the end of that kaleidoscope just slightly and the picture changes and the colors change and the depths of the colors change. And that presents to me in women’s health, that slight change.

Leigh Brandon (09:57.166)
Mm-hmm. Mm-hmm.

Tanya Borowski (10:18.331)
creates an opportunity to heal because you’re changing the environment or you’re seeing a touch point that we have the power to be able to work with and that is truly remarkable. And that’s very different from taking this run a set of blunts and don’t get me wrong, there is absolutely a place to do that and to be able to rule out serious pathology when you’re looking for key markers.

Leigh Brandon (10:20.942)
Hmm.

Leigh Brandon (10:32.845)
Hmm.

Tanya Borowski (10:47.397)
But for so much of what forms into the realm of what you and I work with is that we can use gold standard markers from a blood test to be able to help to rule in and rule out certain situations. For example, is there anemia present? And we can support that. But we are the…

The depth of knowledge that we can gain from really spending time with our clients and our patients and hearing their story to actually map their case is invariably that is where the gold is to be able to make those interventions, to be able to apply those interventions.

Leigh Brandon (11:34.018)
Yeah, when you were speaking a little bit earlier, the thing that came to my mind is that there’s complexity, but there’s also simplicity. And what I mean by that is the human form is so complex. We’ve got so many different systems. As you were saying, they all interact. So in the situation that you stated, if a woman has…

hormonal imbalance in inverted commas. Okay, let’s take birth control and then when you get to menopause just take some more pharmaceutical to supposedly balance them without looking at all the potential causes that could have caused the imbalance in the first place. But then when it comes to the solution actually oftentimes it is relatively simple. You know if you look at you know as you were alluding to you’ve got to look at someone’s environment. know God knows what they’re spraying in the sky.

We know, we kind of got an idea of what’s in our water supply. We’ve got an idea of what’s in the food supply. We’ve got an idea of what’s in all the, you know, clean stuff that we clean ourselves with, clean our houses with, the stuff that out gases in our cars and our sofas and all that kind of stuff. But yet, you know, the solution is, just take a pill. That’s going to solve all of those other issues that have caused your problem in the first place. Right. But actually cleaning up your lifestyle.

is actually relatively simple. are obviously, where the complexity of that comes in is behaviour. That’s the challenge because people don’t like changing their behaviours, they like their habits, they like their comfort zone. And for most people, to change means going outside their comfort zone. And that’s quite scary for lot of people and it’s not a comfortable thing for them to do. And something I always try and remind people of is that you generally don’t achieve anything amazing unless you go outside that comfort zone.

Tanya Borowski (13:12.719)
Yep.

Leigh Brandon (13:27.084)
Right? But, you know, and to put it another way, the closer we live in alignment with nature, the more likely our bodily systems are going to be in balance. And the more we move away from nature, the more likely our bodily systems are going to be so-called out of balance, because it’s trying to compensate.

Tanya Borowski (13:27.685)
Yeah.

Tanya Borowski (13:46.627)
Yeah, and that the beauty of that is the simplicity of it. But, but actually doing that is for a lot of people is is very difficult. And I think that what is nobody is not anybody is nobody is not anybody’s fault. And Lara Brydon actually talks about this in her most in her recent book, Metabolic Reset is that we as

We are in a complete evolutionary mismatch and that it’s not anybody’s fault, but we have, and I think COVID really woke everybody up to that because suddenly we were overnight, we were having to step off the proverbial treadmill. actually, and I think then it began to question, people then really began to question, well, hang on a minute.

Why am I getting up at 5am and getting on it and spending £500 on a season ticket to go into London and never see my kids? And okay, yeah, I’ve got a nice car in the drive and I’ve got a nice house, but actually does this really truly make me happy? And actually, what is the point? And I really do, yeah, certainly within my circle, I really noticed that there was

a definite step change in actually in what people really recognize that actually they really could how they want to truly live. And I think that that’s quite interesting. And certainly women’s endocrine system, so their hormonal system, it is more complex. It is more complex than the male.

Leigh Brandon (15:39.374)
Mm-hmm.

Leigh Brandon (15:42.658)
Yep.

Tanya Borowski (15:43.335)
And so therefore that interaction with the when there is more there is more there is more of a state of flux throughout the what is called their reproductive years because there is a natural ebb and flow of the key ovarian hormones is estrogen and progesterone and

Those actually interplay very much with how we make our neurotransmitters. So it’s no surprise that there is a natural change in the way that we feel across the menstrual cycle. Because for example, estrogen is a cofactor, is needed as a cofactor to make serotonin, to make dopamine as an example. But also those hormones are involved in the removal

Leigh Brandon (16:26.254)
I

Tanya Borowski (16:42.903)
of those neurotransmitters. So whereas just the natural ebb and flow of those hormones across that woman’s menstrual cycle will change how driven she is, how or whether she feels more insular and she wants to hibernate or whether she’s got more va-va-voom and more drive, dependent on where she is in her menstrual cycle. And so to your point, we’ve become very

Leigh Brandon (17:08.462)
Hmm.

Tanya Borowski (17:13.551)
There is a really important point and I really feel passionate about this about we need to go back to the way that we educate our children about our hormones and this. Well, male, young men and young women around because the way that it’s pitched on our education is about sex education, which of course there is a place, but that’s basically all it is. It’s about

Leigh Brandon (17:23.416)
I was just thinking that. I was just thinking that. But particularly the males.

Tanya Borowski (17:42.477)
sex education and contraception. There is a place for that. But actually, there’s no engagement or excitement or thrill or wow factor around, look at all of the reasons why we produce these hormones for three or four decades of our life. It’s not just about reproduction.

It’s about bone health, it’s about helping to make your neurotransmitters, it’s about cardiovascular health, it’s about modulating your immune system. I would love to be involved in any way of being able to help, because the more that we can engage our young people about the power of and truly understanding our body,

then of course there is an, then there becomes an understanding of why, to your point, we want to be as more aligned with our circadian rhythm and nature as possible. But if that information comes in, in our forties, by which point we’ve just spent two decades just completely taking that for granted, it’s very difficult to change those habits. So yeah.

Leigh Brandon (19:02.382)
Hmm, yeah. Yeah, it’s interesting. mean, this isn’t something that we were gonna talk about, but again, just thinking about education, and you think if you were teaching teenage boys about the effects of the fluctuations in hormones in females, would that not make a massive difference to their ability to have a good relationship later in life? Right?

Tanya Borowski (19:29.498)
Yeah.

Leigh Brandon (19:30.062)
because most people think that women are aliens, right? But if they understood the ebb and flow of estrogen and progesterone and what effects that has on a woman, they’d probably be a lot more empathetic rather than complaining about, they’re in this mood or that mood or whatever. Well, if your hormones were going up and down like that, you’d probably be in a mood as well, right?

Tanya Borowski (19:32.953)
Yeah, yeah, I mean I’m, yeah.

Leigh Brandon (19:57.046)
So I think it would just allow for lot more empathy.

Tanya Borowski (20:00.919)
I I’d like to think so. And also just it’s true, it’s about understanding what is going on in this amazing body that we all inhabit. And we’re so used to…

Actually palming that off, there isn’t a responsibility and I’m not for a minute suggesting that it’s someone’s, when they’re in chronic pain, I’m not saying in any way that’s their fault, but actually understanding, having a more in-depth understanding of human physiology is incredibly powerful in of itself because

with understanding becomes, maybe the way the desire to change and to try something. also, if you, if we don’t understand something, then yeah, we hand everything over combined with the fact that our healthcare model is, know, GPs, they don’t have the time to, they don’t train in all of these different systems.

to that amount of depth. So a GP can’t be expected to know the intricacies of all of these components. So it is from any, a, again, from a woman’s perspective. I mean, I just hear so many horror stories where maybe the wrong type of pill was prescribed with the wrong type of progestin in it or…

and when it comes to menopause hormone therapy, whether again, it’s the wrong type of formulation or dose, and it just comes from not having the time to really actually understand the intricacies of it. And there’s so much information. it is, yeah. And again, it’s about bridging that gap.

Leigh Brandon (22:03.554)
Yeah, and that’s again, that’s the complexity, right? But you know, I always see my role was understand the complexity, but delivering it in a way that’s simple. And that’s really what in an ideal world, what GPs would do. But as you say, they haven’t had that level of training, sadly. So moving on. So one of the things that or the main thing we’re going to talk about today is endometriosis. For the audience, can you…

Tanya Borowski (22:12.219)
Yes.

Leigh Brandon (22:31.278)
give an overview of actually what it is, what are the typical signs and symptoms that someone might experience with endometriosis.

Tanya Borowski (22:41.711)
Yes, absolutely. So endometriosis is a complex condition. I’m going to try and not use the word disease because there is a movement within both the medical community and within the more sort of the supporting communities.

to reframe this as a syndrome because it is a multifaceted, what we call in medicine, heterogeneous condition, which means that there are multiple different components involved. But it’s characterized by the presence of endometrial glands, the endometrial, so the lining of the uterus, that actually

take up residency outside the uterus. And this tissue can be found in the pelvis, in the ovaries, in the fallopian tubes, in peritoneal surfaces, in the bowel and bladder, and sometimes even very distant organs like the sinuses, amazingly. And these lesions…

respond to estrogen, there is this sort of misnomer that it’s an estrogen dominant condition. So they respond to estrogen. So every time a woman goes through a menstrual cycle where estrogen builds and builds, then that will sort of drive, if you like, those lesions to proliferate.

and to bleed alongside of the menstrual cycle. So with that over time, then there can be fibrotic tissue that builds up and that’s what causes basically the pain. it is, and we’ll kind of come onto what other there are. So that’s basically what endometriosis is. And it is very, sadly, it is,

Tanya Borowski (25:00.699)
very poorly diagnosed. The route to diagnosis can be in this country in the UK, it can be up to 10 years, which is woeful. so many, in fact, Endometriosis UK have published last year a really fantastic document, which is very easy to read. And I encourage anyone to read.

just about and they interviewed thousands and thousands of women across sort of reproductive age and the story is a tragic of the dismissal of it’s just period pain, know, well basically put up and shut up and pretty, it makes for some pretty sad reading. So…

Symptoms, so basically, symptoms are quite broad, but it is the symptoms to be aware of are severe, severe period pain, period pain, I mean, I just want to caution the word, I’m gonna use the word normal, but please listen, please just bear with me to the end of the sentence, is that,

Leigh Brandon (26:17.769)
Mm.

Tanya Borowski (26:20.891)
So a level of cramping and releasing that endometrial lining because of how much it is thickened across the menstrual cycle and the process of doing that activates part of the immune system and the release of what are called cytokines and prostaglandins and mast cells that can and does cause a level of cramping.

and so therefore can cause and does cause a level of pain, but it should be, and that is normal, but that, what is normal is that pain that can maybe begin to occur 24 hours before the first day of the bleed and continues maybe for two to three, maybe two days of the bleed that is relieved by standard, by taking ibuprofen.

or other maybe more natural alternatives of pain medication and applying heat, et cetera. So that is basically what we call primary dysmenorrhea. So pain, that is sort of, when it moves into what is called secondary dysmenorrhea, so dysmenorrhea is the medical term for painful periods, then that endometriosis is the most common cause or syndrome.

that causes that. And what happens is that that pain will invariably happen pretty much constantly across the menstrual cycle. It may become more exacerbated when she’s menstruating, but it doesn’t relieve. And over each decade and year, it gets increasingly worse. Whereas with what we call primary dysmenorrhea, then

generally that will dissipate. And the reason that with endometriosis it gets gradually, it gets worse is because they’ve, as going back to what I said in beginning, we’ve got these endometriosis, we’ve got these lesions that are in, that have taken up residency if you like, in tissue where it shouldn’t be. And every time

Tanya Borowski (28:45.935)
that woman is going through a menstrual cycle and the building of that oestrogen, those lesions are becoming more and more prolonged and inflamed and agitated. So it becomes a vicious cycle. And then you have sort of very heavy periods. There is fatigue. That can be because they’re

because they’re having heavy appearance, may be anemic. I see that quite commonly. But it might not, it might just, it might be for other reasons. Of course, low mood and depression, because if you’re in that much pain, three weeks out of four, then yeah, that is going to be, that is going to…

impact your nervous system and of course is going to because it is becomes very debilitating and these women because of the heavy bleeding I mean they’re going through a sanitary pad in half an hour and so it becomes you can it doesn’t matter what age the woman but that becomes incredibly debilitating in terms of being able to socialize being able let alone the pain it just means it’s very limiting

Leigh Brandon (29:53.421)
Wow.

Leigh Brandon (30:08.366)
Mm.

Tanya Borowski (30:08.927)
or how they can interact with the world because they’re just fearful of having, of bleeding through their clothes and it’s very debilitating. those are the main, and then of course there is infertility. but it is not a light, is not the quite often the delivery of

Leigh Brandon (30:19.246)
Mmm.

Tanya Borowski (30:35.373)
a diagnosis of endometriosis has historically been very brutally delivered as well. And actually when I was in Australia, I was fortunate enough to be in Australia and do some presentations at the back end of last year and we were talking about this and a young girl came up to me afterwards and said, so I’ve actually, she was 22. And she said, I’ve just been diagnosed with endometriosis and I’ve been told I’ll…

I’m infertile, I’ll never be able to have children. that is just, well, A, that’s incorrect. And it’s just a brutal diagnosis and delivery to give a young woman because there are so many avenues to be able to pursue. But that’s a very long-winded way of me hopefully answering your question of what it is and what are the signs and symptoms.

Leigh Brandon (31:12.078)
Mmm.

Leigh Brandon (31:21.966)
Mmm.

Leigh Brandon (31:26.028)
Yeah, no, that was great. One of the questions I’ve got in my mind, and I don’t know if there is an answer to this, but I know there have been lots of studies done on, let’s call them native tribal people, and quite often they don’t have, like for instance, it’s something that I’ve looked into in detail, they don’t suffer from acne at all, right? As one example, I know those studies have been done.

Tanya Borowski (31:39.525)
Hmm.

Leigh Brandon (31:52.686)
Do you know if there’s been any studies done with native people living in their natural environment? I mean, first of all, do you know if there’s been that study? But also, if there is those studies, do they also experience pain when they’re menstruating?

Tanya Borowski (32:11.835)
It’s a really great question. The short answer is I don’t know if there is a study, but I do know that, but I will definitely, I’m definitely going to look into that now. But the correlation that I would draw is that I know that there are studies that are done on the Hasda tribe and other indigenous societies around the

Leigh Brandon (32:23.949)
I’m

Tanya Borowski (32:42.133)
experience that these women have around in perimenopause and menopause. And they do not experience feelings of loss or brain fog or fatigue. And it is a transition in life that is part of their, a step change. And therefore, and I think that this, so this comes back to

with, if we’re talking about endometriosis and pain there and heavy heavy bleeding as an example and part as part of that, we know that a significant component to this is a dysregulated immune system. And we know that therefore, okay, so what then, what then dysregulates an immune system are

environmental triggers that overwhelm the immune system to tip into a feed-forward aberrant response. the more inflammatory side, so by that I mean, that can be, there are definitely studies done that the consistent pollutants, dioxins, all of these,

environmental chemicals, these chemicals that are far more abundant in our, that are ubiquitous in our water supply and in our environment, absolutely upregulates the immune system. And when we upregulate the immune system, and then there is an, then that actually has a feed forward cycle to many different connections. But one is it upregulates something called VEGF.

And VEGF then actually causes more angiogenesis. So there are, and that actually creates more vessels to feed these endometriotic lesions. So you can very easily plot and map how this can actually take place. So I could definitely see a route in either way of that, but this dysregulated immune system is a central piece.

Tanya Borowski (35:06.927)
to endometriosis and that the immune system has in women that we’ve studied that they are not able to clear. There are certain particular subset of cells called macrophages and they kind of belong to two different families. there is, they’ve shown that actually these macrophages have a less ability to be able to clear the natural

the natural retrograde menstruation that occurs and the fibrotic tissue that happens each month because the immune system is dysregulated and that is one component that we know to be the case.

Leigh Brandon (35:50.008)
Hmm.

Leigh Brandon (35:54.862)
Yeah, it would be great to see if there was a study, wouldn’t there? Because that would kind of underline how much of a role, I guess, our current environment plays in that condition, as we know it does in lots of other conditions. So, yeah, that would be interesting. So that’s what it is, or at least that’s what the symptomology is.

Tanya Borowski (35:59.099)
and we’ll get back to you on that.

Leigh Brandon (36:21.558)
What do medical doctors and researchers currently believe cause endometriosis? Do they have a clear explanation of why or how it develops?

Tanya Borowski (36:33.206)
No, so in terms of the…

The multifactorial components to it are there is a genetic, there are certain genes that are play and there is a hormonally driven component, i.e. it is estrogen driven and in many women

There is a progesterone resistance component as well. There is a significant inflammatory process. it’s very, there is a sort of an inflammatory milieu of cytokines that then drives angiogenesis, which feeds the lesions. There is a dysregulated immune component where there are

There’s a degree of subset of, if you like, defunct natural killer cells. And then there is also a dysbiotic component, which is both from the gut, but also more interestingly, and this is very, very recent, around endometrial microbiome component to that as well.

it is in all the most recent papers is that it involves all of those components and actually

Tanya Borowski (38:17.691)
The integrative world has a far broader toolkit of intervention to be able to support that than the medical because the medical approach in my experience is either surgery, which removal of the lesions, which has its place for some women.

but not all by any stretch of the imagination or hormone therapy. So turning off and generally that is using, so to prevent the heavy bleeding, so prescribing either an IUD or in some severe cases, even switching the whole system off completely. But

their treatment, that’s really that is the focus of gynaecology in my experience of the treatment. Whereas through our lens, we have a much broader kit bag to be able to support still the hormonal component because we can also support the clearance of estrogen and the biotransformation of estrogen.

And in short, can run nutrigenomic panels to look at how predisposed an individual is to, they might actually be in a, they might be pre genetically predisposed to actually synthesize more estrogen or they don’t produce, they don’t produce, they don’t have an ability to produce progesterone as robustly, for example.

And of course we have a far broader toolkit to be able to modulate the immune system and provide support with reducing inflammatory processes. And of course the environmental factors. So that is a big piece. So counselling and working with clients around how to remove certain environmental components from their environment.

Tanya Borowski (40:46.381)
In your world, hypoxia is also a really big issue with endometriosis and chronic pelvic pain that becomes this sort of stagnation, if you like. So there is this fear around movement and breathing. And of course, the more in pain we are, the more fearful we are.

Leigh Brandon (40:54.894)
Hmm.

Leigh Brandon (41:11.01)
Hmm.

Tanya Borowski (41:11.237)
We do, what do we do? We stop breathing. We don’t breathe properly. We shallow breathe, because that’s what we do when we’re panicked. So the working, very often, and that is the beauty of a multidisciplined approach and sort of working with a very in tune and qualified body worker that can actually show a woman how to move appropriately through her menstrual cycle.

and be able to oxygenate and be able to move blood is very, very important and to learn how to breathe properly.

Leigh Brandon (41:54.926)
Hmm. Yeah, I mean, again, if you think about breathing properly, you know, if you inhale and you use your diaphragm, which is how you should inhale, what does it do? Expands the abdomen. Right. So can imagine most women, probably they’re in pain. They want to tighten that area, right? Because they, you know, so there’s almost a double-edged sword there really. But, you know,

not only would that improve oxygen intake, but it would also make them more parasympathetic as well, which is going to help with pain. The other thing you were talking about there as well, what I was thinking was, okay, so doctors are prescribing hormone medications or surgery or whatever else, IUDs, et cetera.

Tanya Borowski (42:33.573)
Definitely. Yeah.

Leigh Brandon (42:53.196)
What about a discussion on endocrine disruptors from their food supply or from their environment? no, forget all that. Forget all that. We’ve got the solution. Let’s just take a pill. know? It’s… I’m sure…

Tanya Borowski (43:06.072)
This is why, yeah, I mean, I’m not, this is not about, and I’m sure it’s not about slamming GPs. mean, it’s just like, but they are not, they, that’s kind of, I’m sure that’s, that’s what’s in the nice guidelines is that that’s what’s prescribed. So it is, but it is just one component. And absolutely there is a place for, for being able to support that woman to add their

Leigh Brandon (43:12.28)
Hmm.

Tanya Borowski (43:34.393)
to stem the heavy bleeding while you can work on all of the other components. But it is just one component. So, yeah.

Leigh Brandon (43:48.846)
Yeah, sorry, I smiled when you said nice guidelines. I’ve got a bit of an issue with nice guidelines, but that’s a whole nother episode. I don’t want to go into it, but if anyone wants to understand what I’m talking about, just research NG163. But I don’t want to go into that now because that’s a whole nother topic. I’ve already discussed many times anyway. So you’ve mentioned a little bit about

Tanya Borowski (43:53.659)
I bet you have. Yeah.

Tanya Borowski (44:10.103)
Okay, I’m done with it.

Leigh Brandon (44:16.896)
you know, how endometriosis can be treated in the medical system. So generally, you’re saying, hormone treatment, surgery, et cetera, et cetera. But how is it diagnosed? And I guess in your opinion, what have you seen in terms of the effectiveness of, let’s call it medical treatments for endometriosis?

Tanya Borowski (44:41.723)
I mean I have seen, yeah, I’ve got family members who have been purely down the medical route and

There is a level of success, but the bottom line is there have been multiple interventions and laparoscopies, but really the only true resolution came once they graduated into menopause. So, you know, how successful is that? it’s quite interesting because there are…

So these lesions, so you can have a vaginal ultrasound, which is less invasive, but that doesn’t, it doesn’t pick up, it doesn’t pick up all the lesions at all. So there is, you can have a laparoscopy, which actually, which is also used as surgery as well. So that can be used to diagnose.

And then there is a grading of the lesions. So there is from grades one to four. So four is the most severe, so very deep lesions, deep infiltrating lesions. But what’s incredibly interesting is so unlike where cancer, where we talk about grade four is the top and that is very serious, having in endometriosis with the lesions,

having a more advanced stage of endometriosis does not always, in fact, it does not always, and in my experience, actually very frequently, mean that you have more severe symptoms or pain. And I have had clients who have had interventions and have had, have been sort of told, did you know that you’ve got endometriosis?

Tanya Borowski (46:49.603)
And actually, don’t experience any symptoms whatsoever. And then, so once you’ve got this diagnosis, there is definite element that then one can become the diagnosis, which is there is a fear factor on that. But coming back to the point of, if you’ve found to have a grade four deep infiltrating lesions, some women with stage four endo…

have very few symptoms. So really it is about supporting the symptoms of that woman, supporting their heavy flow, supporting their pain, supporting and looking at how we can ensure that they’re across their menstrual cycle, that they are clearing their estrogen effectively as an example, that we’re modulating their immune system.

And we’re absolutely looking at all of the environmental components as well. But that’s how it’s, in the medical model, that’s how it’s diagnosed. So we would like, we feel, and in fact it was in the BMJ, that we would be, that we are far more consistently like to characterize

the symptoms and support or treat the symptoms and refer to this as a syndrome rather than a disease.

Leigh Brandon (48:30.441)
You mentioned laparoscopy. For the audience could you just explain what that is in case anyone doesn’t know what that is?

Tanya Borowski (48:37.785)
Yes, sure. So a laparoscopy is an intervention by where there is…

Leigh Brandon (48:42.222)
you

Tanya Borowski (48:50.017)
this a second. We just need to explain that properly or just in a… I just need to… you can edit this. Yeah. Let me just…

Leigh Brandon (48:58.734)
Yeah, yeah, yeah, no problem.

Tanya Borowski (49:19.835)
So it is a surgical procedure where they use just a small sort of fibre optic instrument that’s inserted through the abdominal wall and it facilitates allowing to be able to view sort of organs in the abdomen, so be able to view the lesions, but also…

This is actually used for surgery as well. So for eradication of the lesions. that’s why it can be used as either an operation to make small incisions and or it’s a diagnostic instrument as well. But the waiting time for this commonly is quite long and less women go privately. And of course not every woman can

Leigh Brandon (50:01.592)
Hmm.

Tanya Borowski (50:14.341)
can afford to do that privately.

Leigh Brandon (50:17.07)
Do you know what the success rate is for surgery?

Tanya Borowski (50:24.251)
Yeah, it’s, well, I think probably the proof in the pudding is that once you get on that train, women very, very, very rarely, if not at all, just have one intervention. They have to go back for multiple surgeries and removal. So the old age adage, if you have to keep going back to do something four or five times,

something ain’t working or we’re not addressing we’re not addressing the pathophysiology of like the angiogenesis etc etc that’s that’s driving that or the hormone dysregulation etc just by removing them it’s not it’s not actually preventing the development of of the lesions so yes there is a success rate for a year 18 months

But it’s not uncommon for women to have repeated interventions from five up to, I mean, I’ve had, in fact, Dr. Peta Wright, I’ve heard say she had, who’s a leading gynaecologist in Australia, who’s sort of had 15 interventions. It’s like, again, if you’re having to do that, that many times, is that successful?

Leigh Brandon (51:52.782)
Yeah, because what I’ve heard and certainly reading Dr Wright’s book, it seems like, yes, the endometriosis has been removed, but it doesn’t necessarily equal the pain going away.

Tanya Borowski (52:09.709)
No. And this we see the same in…

So in women who have, very sadly, women who have hysterectomies, and they resort to that in conditions like PMDD, which is for those of you who are not, PMDD is a far more intense neurological relation to PMS.

So it’s, and it is a very, another incredibly debilitating condition where these women experience devastating mood changes across their menstrual cycle with only sort of four or five days’ relief. And the same is true with this, with women who have chronic pelvic pain when they sometimes revert to having a total hysterectomy thinking, okay.

just going to switch everything off. There is this sort of, there is this memory pattern and there is this of the communication between the brain and the ovaries to produce estradiol that we still see happening even when, either when women enter menopause and that mechanism.

no longer operates in such an ingrat, or they’ve had a hysterectomy. But yes, to your point, that is not a given because the body kind of has set down learning patterns is the way that we view it. And this is where the central point of Dr. Peta Wright’s work is the central piece to this is in an essence is retraining the nervous system.

Tanya Borowski (54:07.929)
because those pathways become so embedded of fear and fear and that sort of that sympathetic drive which then fuels pain. It becomes so embedded that it is a, it’s a retraining that actually forms part of the treatment plan. And that is why, again, it’s another beautiful part of our.

integrative kit bag that is so powerful.

Leigh Brandon (54:40.686)
Yeah, I guess I get frustrated when I hear, you know, people, they go for help and the solution is well, let’s just cut it out the body, right? You know, I mean, we know there’s something called phantom pain. You know, someone can have an arm amputated and they can still feel pain in the hand. The hand’s not even there, right? And, you know, the amount of times I’ve had someone come to me with lower back issues,

Tanya Borowski (54:58.265)
Yes, yeah, they lose a limb, yeah.

Tanya Borowski (55:04.345)
Yep. Yep.

Leigh Brandon (55:10.19)
and they’ve had a discectomy and they say the pain’s actually worse or it hasn’t changed at all. Right? And it’s because they haven’t changed anything else. They haven’t looked at, okay, what caused that in the first place? And yeah, I just get really frustrated when, oh yeah, you’ve got this problem, let’s just cut it out of the body. You know, I kind of believe the body doesn’t make mistakes. The body’s responding to its environment to…

Tanya Borowski (55:37.687)
it is responding to its environment. And we have these sort of tiny nerve endings and nerve fibers and afferent and efferent nerves that absolutely respond, mean, just respond to the tiniest change in tissue chemistry and the milieu that just being a human being and existing, we don’t live in a bubble. And so therefore there is this continual stimuli.

both externally and endogenously, so within the body, that these nerve endings are responding to. And in the area of the pelvis, we have this in menstruating and cycling women, to write back to the theory of where endometriosis originated from back in, I think it was the 1920s, of this theory of retrograde menstruation was that sort of this sort of

meant that this menstrual blood that contains these endometrial cells was flowing backwards through the fallopian tubes and into the pelvic cavity. Now we now know that that’s actually is a very normal and commonplace situation that happens in pretty much all women. We all encounter that, but it is this sort of dysregulation of the immune system that has this inability to be able to

that should be able to clear that debris and all of the communication molecules that that then activates because we have a change in tissue chemistry. So immediately there’s a change in tissue chemistry. The immune system pops its head up and says, I, I, what’s this? And we want that to happen. That’s what its job is to do is to become awoke, is to become awoken and create a

small inflammatory response to be able to have the resolution phase. But the answer is not just to say, is not just to have one theory and then say, okay, this is the issue. we just, we just, okay, if we stop the menstrual flow, then that is, that will source the problem. Or we cut out, we cut out the tissue that we’re not dealing with cancer here. We’re talking about

Tanya Borowski (58:02.253)
natural physiology that has become dysregulated and a number of systems have become dysregulated in the presence of a genetically prone individual. Now we all have genes and variants that are unique to us. Nobody has a complete clean bill set of health. That’s the beauty of being human. But it’s what actually the

what actually overwhelms those, that genetic predisposition to flip that switch to kind of just set that the scene of an ongoing aberrant inflammatory response that becomes unrelenting. And I think again, it comes back to this, the way that this lack of sort of being in tune with our bodies,

through again, no fault of our own, but that’s what, if you don’t feel well, you go to the doctor, you have a 10 minute appointment, you’re given a pill. Well, we chase a diagnosis, great. Okay, we have a diagnosis. We’ve got what’s the pill for that, off you go. Now in acute care, that’s great. But the majority of conditions that is causing our healthcare system to be on its knees is the

overwhelming amount of conditions that are as far as the medical can the medical conciplature concerned are idiopathic. Okay, there’s no I can’t give you a diagnosis. This is where fibromyalgia ME chronic fatigue. They all fall into this this net of there isn’t a sole cause. So, okay.

Leigh Brandon (59:52.75)
Mm.

Tanya Borowski (59:57.147)
I’ll give you this for the pain, I’ll give you that for the constipation, I’ll give you that for the diarrhoea. And endo is the same, is that when you’ve got that level of inflammation, it’s going to impact bowel habits, giving something for constipation isn’t going to sort the problem.

Leigh Brandon (01:00:18.358)
Yeah, so from your perspective, obviously you use an integrative approach and then obviously you’ve got the medical approach. What would you say are the main differences in the way that you work with someone with pelvic pain and the way that someone’s likely to be treated by the medical system?

Tanya Borowski (01:00:41.819)
Okay. So I do work with a number of amazing doctors. really, yeah, yeah. mean, there are, yeah, there are, and I really, really truly believe that everybody goes into healthcare to want to do good and to make a difference. I think where the reason that

Leigh Brandon (01:00:50.626)
Good to hear.

Tanya Borowski (01:01:11.727)
working collaboratively and an integrative approach is so successful is A, starting off by giving that woman the actual time to be able to be heard. And as we started off this conversation with, sadly, there are too many women that, well, first of all, let’s just back up.

It takes a lot of courage, especially for a young woman, to go and visit a GP to say, I’m having really heavy bleeding and I’m in pain. That takes a lot of courage, even just to talk about her anatomy in that way. And there can be a whole array of course of cultural issues and barriers around that as well. So being able to create an environment

where that woman feels safe and can actually be heard without judgment and without clock watching is a really powerful first intervention because where the beauty of this approach really takes hold is trust and building a therapeutic relationship. so within that, and then within that therapeutic relationship,

is explaining in a way that doesn’t instill fear that this is going to be a journey that we’re going to do together, that this is a partnership of I really want to educate and teach you about the different components that are happening within the body so that you understand why I’m asking you to do, make certain changes.

because the accumulation of these changes is what actually shifts the dial and moves the landscape. Or going back to one of my very original analogies is its accumulation of those that change this, the kaleidoscope to be able to change the colors. And that actually is what makes the difference is that it’s pulling these, it’s drawing these different threads

Tanya Borowski (01:03:33.645)
at certain points and that can be, going to, it’s, we, what can we, what can we do? What interventions can we do to help you settle your nervous system? And that’s, talk around sleep, around the importance of being in touch with your circadian rhythm, around the importance of breathing, moving, oxygenating.

And of course nutrition from a whole array of different components. But as an example, when somebody is insulin resistant or they’ve got dysregulated blood sugar issues, that’s going to cause that in of itself exacerbates the immune system. Because wherever there is dysregulated blood sugar,

and a heightened stress response, you’re gonna get an uptick of inflammatory cytokines that basically messes with blood sugar disposal and regulation. So very quickly then it’s about unraveling all of these different threads. And that is different to a linear approach of, okay, well really all that’s in my kit bag is

We’re going to turn off the hormones and I’m going to give you some pain relief. That is the beauty in the difference. It’s a longer, but it’s also explaining that this is a longer process. There are going to be peaks and troughs along the road and you’re just going to have to trust me in the process, but all with a view to relieving your pain. And this is possible.

fertility is possible. It is not a sentence of infertility but it is yeah and it is definitely and but the nervous system if you like is probably the most pivotal intervention that is central to to all of this because with a dysregulated nervous system

Tanya Borowski (01:05:54.747)
the core, the center is off balance and that kaleidoscope is never going to be able to show the depth of what it needs to.

Leigh Brandon (01:06:04.11)
Yeah that’s an interesting point, just reminded me of something you know someone told me many years ago he’d seen a lot of women with endometriosis and he said in every case they were like a high-flying executive trying to succeed in a so-called man’s world.

And it’s, know, I thought that was quite an interesting comment that they were all very, very similar. But that does fit into, you know, a dysregulated nervous system. Whether it’s going more esoteric, they’re becoming too masculine, they need more feminine energy in their life, I don’t know.

Tanya Borowski (01:06:44.671)
Yeah, it’s very, it’s a very interesting, I mean, that’s probably a whole two hour conversation there. But on a fundamental level, if the immune system is, if there’s just heightened levels of adrenaline and cortisol, then that is going to negatively impact so many

components to this web. it’s also, I mean, a big link is that inflammatory response of cortisol and adrenaline is going to stimulate VEGF, which is another communication molecule. VEGF is a mass, is a proliferative communication molecule, for the want of a better word, that upregulates angiogenesis. So you’re feeding

more blood vessels into those lesions. you know, any type of inflammation is just going to keep feeding, it’s going to keep feeding that angiogenesis. So it’s continuing about breaking these vicious loops. And the beauty of, let’s just use one nutraceutical as an example. And I’m not for a minute saying Omega-3 is going to cure endometriosis, but just the beauty of

thinking about selecting specific either nutrients or herbs, I’m always thinking about, okay, something that is going to have multiple impacts across the map and the web that I’m working on. And this is how I sort of, and how I teach. as an Omega-3, as an example, is anti-inflammatory. It will reduce the…

has impacts on those cox and lox pathways and reduce those inflammatory mediators. The high amounts of DHA will have neurological and cognitive benefits. It is also going to tame, has a Marcell stabilizing.

Tanya Borowski (01:09:05.051)
component so it’s preventing the liberation of all of the components and histamine that is inside the mast cells and therefore reducing the, helping to reduce the contractions. So there are most of the beauty of nature when it’s thought through but that is very different than what we’re not doing is

talking about polygreen pharmacy. It is not just replacing a pill or a medication for a supplement. That is not what this is about.

Leigh Brandon (01:09:40.642)
Hmm.

Leigh Brandon (01:09:44.802)
Yeah. Do you have you seen or do you know all the numbers of women suffering from endometriosis or you could say pelvic pain? Do you know if that’s increasing?

Tanya Borowski (01:09:59.011)
Yes, it is increasing because the route to diagnosis is taking so long. So yes, it is increasing. but well, that’s one component. But also because we know that the again, coming back to the environmental pollutants plays such a big component to

up regulating the immune system or dysregulating the immune system and switching on that genetic predisposition.

Leigh Brandon (01:10:35.598)
Yeah, yeah, I mean, the reason I asked that question was because there has been, as I think you might have been alluding to, an increase in environmental toxins. You know, there was a big one in 2021 that we all know about that’s been spoken about a lot and I’ve been cancelled for talking about many times. But also, you know, the 5G network, we don’t know what effect that’s having on us. How many people use…

mobile devices near their abdomen, laptops on their lap, mobile phones, tablets on their lap, how much of an effect could that potentially be having? I would suggest it could be a huge effect.

Tanya Borowski (01:11:17.659)
Definitely. And in fact, I’ve just found that the survey that I spoke about, which was done by Endometriosis UK, and in the UK, so this was done in the end of 23, and there were 1.5 million women in the UK and 200 million globally. That’s a lot. Yeah.

Leigh Brandon (01:11:44.354)
Yeah, that is a lot. Awesome. Tanya, thank you so much for today. I can’t think of anyone, so this is, I can’t remember what number episode this is gonna be, maybe 176, somewhere around there. And I can’t remember someone answering questions so thoroughly, so.

Tanya Borowski (01:11:50.907)
You’re welcome.

Tanya Borowski (01:12:04.731)
Oh wow, that’s really, that’s a praise indeed, thank you.

Leigh Brandon (01:12:08.428)
Yeah, it’s just really, really great. But what’s next for you? What have you got in the pipeline?

Tanya Borowski (01:12:13.861)
thank you. Well, if you don’t mind, hopefully this will end before that, but I am running a practitioner masterclass in East Sussex on the 15th of October, all on mapping endometriosis. So it is, tend to do, I do one of these a year and

I haven’t covered endometriosis for two years and there is a lot of new learning that I am on the edge of my seat to deliver. So for anybody that this has sparked your interest, please do look on my website under events and you can book your ticket. And hopefully you will enjoy the way that I run my master classes. I practice what I preach.

I run these in a beautiful spot in East Sussex in a field. And it is a day of immense learning, but also connecting with colleagues and clinical pearls, but also looking after yourself. So we do yoga and we do breath work and you’re fed beautifully and watered beautifully.

that’s kind of, that’s a hopefully that will spark some interest, but I’m always I’m head of education from Rita. So I’m always on a webinar somewhere. And I also run a mentorship group annually as well, all around women’s health. So that will start again next January. So if you’d like to work with me, then there’s always a way to work with me, but I’m not currently seeing

clients sadly but if you can contact me and I can refer to people who’ve gone through my mentoring program and point you in the right direction of some amazing practitioners.

Leigh Brandon (01:14:21.024)
awesome and what’s the best way for people to get in contact with you.

Tanya Borowski (01:14:24.303)
So if you go onto my website tanyaborowski.com, www.tanyaborowski.com, you can see all the contact details of how to work with me or come to any of my teaching there.

Leigh Brandon (01:14:36.77)
Awesome, and I’ll make sure those details are in the show notes.

Tanya Borowski (01:14:39.567)
That would be great. Thank you.

Leigh Brandon (01:14:42.028)
Tanya, thank you so much again for today and sharing your knowledge.

Tanya Borowski (01:14:44.571)
You’re welcome. It’s been fantastic. I’d definitely love to talk to you more. So thank you so much.

Leigh Brandon (01:14:49.951)
My pleasure and I’m sure the audience are going to love this episode as well. So that’s it from Tanya and me for this week but be sure to tune in same time same place next week on Beyond The Pain.

Tanya Borowski (01:14:54.021)
Great! See you soon.