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

June 21, 2026

AI Summary

5 min read

Endometriosis affects roughly 10% of reproductive-age women globally—about 200 million people—and contributes to infertility in 30 to 50% of cases. Yet the average woman waits five to twelve years for a diagnosis, often because her pain has been dismissed as normal. Dr. Renato Tomioka, a reproductive medicine specialist and gynecologic surgeon, argues that this delay is the single biggest modifiable problem in the field. The earlier the diagnosis, the better the prognosis for both pain and fertility.

What endometriosis and adenomyosis actually are

The uterus has three layers: the outer serosa, the middle muscular myometrium, and the inner endometrium, which thickens and sheds each month. Endometriosis occurs when tissue resembling the endometrium grows outside the uterus—on the ovaries, fallopian tubes, bowel, bladder, and sometimes the diaphragm. Adenomyosis, its often-overlooked counterpart, is the presence of similar tissue inside the myometrium. Up to 70% of women with endometriosis also have some degree of adenomyosis, but the two are molecularly distinct diseases.

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What you'll learn

1 (03:04) **Defining Endometriosis and Its Prevalence** - Dr. Tomioka explains the uterine layers and defines endometriosis as endometrial-like tissue growing outside the uterus, affecting ~10% of reproductive-age women and 30-50% of infertile women.
2 (06:15) **Causes and Risk Factors: Genetics, Retrograde Menstruation, and Modern Life** - Dr. Tomioka discusses the 50% heritability and the theory of retrograde menstruation, linking the rise in endometriosis to modern reproductive patterns.
3 (11:11) **The Mechanisms: Estrogen Dominance and Progesterone Resistance** - The lesions produce their own estrogen via aromatase and become resistant to progesterone, creating a self-sustaining cycle.
4 (15:35) **Adenomyosis: The Often-Missed Cousin** - Dr. Tomioka differentiates adenomyosis (endometrial tissue inside the uterine muscle) from endometriosis, noting it is more prevalent and a distinct disease.
5 (20:36) **The Six D's of Endometriosis: A Framework for Symptoms** - Dr. Tomioka presents the "six D's" to describe the classic and often debilitating symptoms of endometriosis and adenomyosis.
6 (26:52) **The Three Layers of Pain in Endometriosis** - Dr. Tomioka explains the three distinct types of pain—nociceptive, neuropathic, and nociplastic—which dictate different treatment strategies.
7 (31:49) **The Diagnostic Revolution: Moving Beyond Surgery** - Diagnosis is shifting from invasive diagnostic laparoscopy to specialized MRI and ultrasound, drastically reducing the 5-12 year diagnostic delay.

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Show Notes

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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 im