Renato Tomioka is a leading expert in reproductive medicine and gynecologic surgery whose unique skills allow him to diagnose and treat some of the most impactful yet frequently overlooked conditions affecting women’s health. In this episode, Renato explores endometriosis and adenomyosis. Follow Dr. Tomioka's work: Instagram: https://www.instagram.com/dr.renatotomioka/ ; Website: https://renatotomioka.com View show notes here: https://peterattiamd.com/renatotomioka/ Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ 0:00:00-Intro 0:00:11-Endometriosis: definition, prevalence, infertility risk, and theories of disease development 0:09:03-The biology of endometriosis: estrogen dependence, progesterone resistance, and tumor-like growth mechanisms 0:13:25-Adenomyosis explained: how it differs from endometriosis, why it develops, and its impact on reproductive health 0:18:51-Recognizing endometriosis and adenomyosis: the “6 Ds” of endometriosis and key differences in clinical presentation 0:22:09-Uterine fibroids: classification, symptoms, and the importance of fibroid location for bleeding and fertility 0:24:08-Understanding endometriosis pain: lesion-driven pain, nerve involvement, central sensitization, and the importance of early treatment 0:28:26-Endometriosis in young women: rising prevalence, delayed diagnosis, and barriers to care 0:33:11-Modern diagnosis of endometriosis: specialized ultrasound, MRI, and the decline of diagnostic laparoscopy 0:45:52-Clinical case example #1: Managing endometriosis in a young woman seeking pain relief while preserving future fertility 0:54:11-Clinical case example #2: Comparing treatment strategies for symptom control versus fertility 1:01:24-Endometriosis and fertility: the roles of age, embryo quality, IVF, and surgery 1:11:50-Clinical case example #3: Managing adenomyosis after failed IVF transfers to improve implantation and pregnancy outcomes 1:20:51-The funding gap in endometriosis research: disease burden, economic impact, and growing awareness 1:22:01-Clinical case example #4: Surgical decision-making in endometriosis—balancing pain relief, fertility preservation, and common treatment pitfalls 1:27:43-Common misconceptions about fertility: maternal age, embryo aneuploidy, the inefficiency of human reproduction, and the limits of IVF 1:34:23-Elective egg freezing: timing, success rates, the fertility funnel, and the tradeoffs of fertility preservation 1:45:49-Emerging fertility technologies: mitochondrial replacement, ovarian tissue preservation, stem-cell-derived eggs, and current limitations 1:55:10-The future of endometriosis treatment: new guidelines, biologic therapies, and unanswered questions about IVF 1:58:30-Why earlier diagnosis matters: reducing years of suffering from endometriosis and adenomyosis -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/