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

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 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
0:54:10 - 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

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

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