It's all in your head, You're being over dramatic.

這都是你的想法，你太誇張了。

That's just a normal period.

這只是一個正常的時期。

Yeah, periods can hurt cramping and bloating and back pain are kind of to be expected when your body is literally expelling the inside of one of its organs.

是的，當你的身體真的在排出一個器官的內部時，經期可能會出現痙攣、腹脹和背痛，這是可以預期的。

But at what point is a certain level of pain, not norm.

但在什麼時候，一定程度的痛苦，不是規範。

The whole idea that periods are supposed to hurt often means that folks may not get the help.

月經應該是痛苦的，這種想法往往意味著人們可能得不到幫助。

They need to manage certain conditions, conditions like endometriosis.

他們需要管理某些條件，像子宮內膜異位症這樣的條件。

What endometriosis is is when you have cells that are similar to the lining of the uterus.

什麼是子宮內膜異位症，就是當你有類似於子宮內膜的細胞。

But those similar cells are found external or outside of the uterus.

但那些類似的細胞是在子宮外部或外面發現的。

Let's put that in the context of a period.

讓我們把它放在一個時期的背景下。

So each cycle, endometrial cells inside the uterus are reacting to changing hormone levels by breaking down and then being released through the vagina as a period.

是以，每個週期，子宮內的子宮內膜細胞都在對不斷變化的激素水平做出反應，它們會分解，然後通過陰道釋放，成為一個週期。

But with endometriosis, the endometrial like tissue growing outside of the uterus is doing the same thing.

但是對於子宮內膜異位症，生長在子宮外的類似子宮內膜的組織也在做同樣的事情。

Except these cells have no way to get out of the body, symptoms of endo will vary, especially based on where the endometrial like tissue is growing in the body.

除了這些細胞沒有辦法離開身體外，內膜的症狀會有所不同，特別是根據子宮內膜樣組織在體內的生長位置。

And often these symptoms aren't taken that seriously.

而這些症狀往往沒有那麼認真對待。

They're brushed off as just a bad period.

他們被刷掉了，只是一個糟糕的時期。

But for Jenna.

但對珍娜來說。

Her endo was found on her diaphragm, I was having nausea.

在她的橫膈膜上發現了她的內臟，我當時有噁心的感覺。

I was starting to have difficulty with running.

我開始在跑步方面遇到困難。

I was having crazy constipation bloating pain with sex and this gynecologist asked me if I had ever heard of endometriosis and I told her no, I'd never heard of it before.

我在性生活中出現了瘋狂的便祕腹脹疼痛，這位婦科醫生問我是否聽說過子宮內膜異位症，我告訴她沒有，我以前從來沒有聽說過它。

Endometriosis.

子宮內膜異位症。

Is this invisible disease and the way that so many patients describe the diseases like barbed wire being wrapped around their admin and those found anywhere in their body.

這種看不見的疾病，以及那麼多病人描述疾病的方式，就像有刺的鐵絲被纏繞在他們的行政部門和那些在他們身體的任何地方發現的。

So the patient looks okay, they look healthy but they feel miserable.

是以，病人看起來還好，他們看起來很健康，但他們感覺很痛苦。

The clumps of tissue that grow outside the uterus are called implants and they can literally pull on and distort internal organs and muscles.

長在子宮外的組織團塊被稱為植入物，它們可以實實在在地拉扯並扭曲內部器官和肌肉。

Those degrading cells can also cause inflammation that spreads to surrounding areas and in severe cases, implants may eventually scar and basically act like glue, causing organs to stick together and they shouldn't.

這些退化的細胞還可能導致發炎擴散到周圍地區，在嚴重的情況下，植入物可能最終結疤，基本上像膠水一樣，導致器官粘在一起，而它們不應該這樣。

All of this contributes to the increased risk that we see of issues like ectopic pregnancy and infertility in those with endometriosis because when it's found around the reproductive organs, rogue and demetrius like tissue can wreak havoc and prevent normal ovulation.

所有這些都有助於我們看到子宮內膜異位症患者出現宮外孕和不孕症等問題的風險增加，因為當它在生殖器官周圍被發現時，流氓和類似Demetrius的組織會造成破壞並阻止正常排卵。

But the lack of awareness around this disease means that many who struggle with it may not get diagnosed for a long time.

但是，對這種疾病缺乏認識意味著許多與之鬥爭的人可能在很長一段時間內沒有得到診斷。

On average.

平均而言。

It takes about 7 to 10 years.

這大約需要7到10年。

You can't imagine what it's like in the office to see patient after patient tell their journey and tell their story This debilitating awful pain.

你無法想象，在辦公室裡看到一個又一個病人講述他們的旅程，講述他們的故事，這種衰弱的可怕疼痛是什麼樣子。

They're just not living their lives to the fullest.

他們只是沒有把自己的生活過到極致。

So we just really need to do a better job at making sure that that doesn't continue and the weight to get diagnosed can seriously impact someone's life.

是以，我們真的需要做一個更好的工作，確保這種情況不會繼續下去，得到診斷的重量會嚴重影響某人的生活。

In the meantime, like Jenna whose diagnosis took four years, I lost my career.

在此期間，像詹娜一樣，她的診斷花了四年時間，我失去了我的職業生涯。

I'm still not back in grad school, I have friends that I've lost, I thankfully have a really supportive family, but I know that it can fracture family relationships and marriages.

我仍然沒有回到研究生院，我有失去的朋友，我感謝有一個真正支持我的家庭，但我知道它可以使家庭關係和婚姻斷裂。

So why does it take so long to get a diagnosis and to get treatment?

那麼，為什麼需要這麼長時間才能得到診斷和治療？

And no, wasn't even discovered until the 1920s and it took decades for the condition to be regularly included in medical training in France.

不，甚至直到20世紀20年代才被發現，而且過了幾十年後，這種情況才被定期納入法國的醫學培訓。

For example, endometriosis was just added to the medical training curriculum and in many countries, education on effective treatment options is still not regularly included in training even for gynecologists and as if to add insult to injury, there's only one way to definitively diagnose endo and it's surgery, a doctor will go in through a tiny incision and take a biopsy to make sure that there really is un demetrius like tissue growing outside the uterus.

例如，子宮內膜異位症剛剛被列入醫學培訓課程，而在許多國家，即使是婦科醫生的培訓中也仍然沒有經常包括有效的治療方案的教育，而且似乎是雪上加霜，只有一種方法可以明確診斷子宮內膜，那就是手術，醫生會通過一個小切口進入，進行活檢，以確保真的有類似子宮外的組織生長。

If we, as gynecologists were simply armed with the knowledge that the symptoms of endometriosis can cross all organ systems with the symptoms that I had mentioned before, we would be picking up so many more patients and we'd be really shortening the suffering and stopping that 10 year diagnostic delay.

如果我們，作為婦科醫生，只是簡單地掌握了子宮內膜異位症的症狀可以跨越所有器官系統的知識，也就是我之前提到的症狀，我們就會接診更多的病人，我們就會真正縮短痛苦，阻止10年的診斷延誤。

But other factors play a role too.

但其他因素也發揮了作用。

A recent study found that black and hispanic women are typically diagnosed with endo at later ages than their white counterparts and this reflects the larger societal biases and inequalities related to race and ethnicity, I think that if I want a nurse and specifically a nurse at the hospital that I was working at.

最近的一項研究發現，黑人和西班牙裔婦女通常比白人婦女更晚被診斷出患有內科疾病，這反映了與種族和族裔有關的更大的社會偏見和不平等，我認為，如果我想要一個護士，特別是我在工作的醫院的護士。

I think that my experience would have been a lot different.

我想，我的經歷會有很大的不同。

And that's not saying much because it still took me going from doctor to doctor to doctor, feeling like no one was listening to me.

這並不意味著什麼，因為我仍然要從一個醫生到另一個醫生，感覺沒有人聽我說話。

So I can't even imagine how much more for someone who was not me.

所以我甚至無法想象，對於一個不是我的人來說，還有多少。

So what's the good news?

那麼，有什麼好消息呢？

There are ways to manage this condition.

有一些方法可以控制這種情況。

Hormonal medications like the birth control pill can often ease symptoms.

像避孕藥這樣的荷爾蒙藥物通常可以緩解症狀。

Pain medication can also help, but it just masks the pain.

止痛藥也可以幫助，但它只是掩蓋了疼痛。

And it's really important to remember that none of these options actually make the endometrial like tissue go away.

而真正重要的是要記住，這些選擇都不能真正使子宮內膜類組織消失。

Now, surgery is another treatment for endo.

現在，手術是另一種治療內膜炎的方法。

There are two kinds of surgery.

有兩種類型的手術。

Ablation and excision ablation is where the tissue is basically burned away and excision is where the implants are cut out.

消融和切除 消融是指基本上燒掉組織，切除是指切出植入物。

Excision is the preferred treatment for most cases of endo, especially where that endometriosis has deeply infiltrated other areas of the body.

切除術是大多數內異症病例的首選治療方法，特別是在子宮內膜異位症已經深深浸潤到身體其他部位的情況下。

More research could help us better understand which treatments work best for different stages, locations and types of endometriosis.

更多的研究可以幫助我們更好地瞭解哪些治療方法對不同階段、位置和類型的子宮內膜異位症效果最好。

And surgery isn't a perfect cure either.

而且手術也不是一個完美的治療方法。

Because while that endometrial like tissue won't grow back in an area where it's been cut out.

因為雖然那種類似子宮內膜的組織不會在被切掉的地方再長出來。

The tissue could develop in new areas of the body and pain can persist after treatment.

該組織可能在身體的新區域發展，治療後疼痛可能持續存在。

So, with all this going on, you can see why it's so important to speak with a specialist and make sure that your care plan for endometriosis makes sense for your specific situation.

是以，在所有這些情況下，你可以看到為什麼與專家交談是如此重要，並確保你的子宮內膜異位症護理計劃對你的具體情況有意義。

Now, a glimmer of hope here in the last few years, more and more of the underlying cellular mechanisms have been explored for why this tissue is growing, where it's not supposed to.

現在，在過去的幾年裡，這裡出現了一絲希望，越來越多的潛在細胞機制被探索出來，以瞭解為什麼這種組織在不應該生長的地方生長。

But this research has yet to be translated into better treatment options.

但是這項研究還沒有轉化為更好的治療方案。

And this comes down to what we talked about in our very first episode of this series.

這就涉及到我們在這個系列的第一集所談到的問題。

Issues like Endo have only been acknowledged and thoroughly investigated by the medical community relatively recently.

像Endo這樣的問題只是在最近才被醫學界承認並進行了徹底調查。

So the more we talk about it, the more we advocate for more research and better solutions.

是以，我們越是談論它，就越是主張進行更多的研究和更好的解決方案。

Hopefully, the faster we're going to get better outcomes for real everyday people, I know that the symptoms that come with endometriosis can kind of be a constellation and all over the place and you're seeing all these different specialists and no one's putting the pieces together.

我知道子宮內膜異位症帶來的症狀可能是一個星座，而且到處都是，你看到所有這些不同的專家，沒有人把這些碎片放在一起。

Ultimately, though it's not in your head, your pain is real.

歸根結底，雖然它不在你的腦子裡，但你的痛苦是真實的。

Your symptoms are real.

你的症狀是真實的。

And to keep fighting until you find someone who believes that if you or someone you know, is struggling with pain or getting a diagnosis, we've left some resources for you in the description.

並繼續戰鬥，直到你找到相信的人，如果你或你認識的人，正在與疼痛作鬥爭或得到診斷，我們在描述中為你留下了一些資源。

Thank you all so much for watching seekers.

非常感謝大家的觀看尋求者。

Body language and we hope you learned something new in this episode.

肢體語言，我們希望你在這一集裡學到一些新東西。