#397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.

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View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter View our full terms of use 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, explaining what these conditions are, why they often go undiagnosed for years despite affecting millions of women worldwide, and how advances in MRI and specialized ultrasound are transforming diagnosis beyond traditional surgical laparoscopy. He discusses the decision-making process behind hormonal therapy versus surgery, how treatment strategies change when fertility preservation is a priority, and where IVF fits into the care pathway for women with endometriosis, adenomyosis, or age-related fertility decline. Renato also examines the profound effects of female age on egg quality and quantity, including the accelerating rise in chromosomal abnormalities after age 35, highlights common mistakes in both surgical and fertility management, and shares promising developments on the horizon for treating these conditions and preserving fertility. Follow Dr. Tomioka's work: Instagram: @dr.renatotomioka; Website: Renato Tomioka, M.D., Ph.D. We discuss: 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 0:18:52 - 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 0:24:09 - Understanding endometri