Shownotes
If you've had the surgeries, taken the hormones, followed every instruction, and the pain still comes back, this conversation is for you. Heather Yoshimura joins Shreya to question the model itself: find the lesion, remove the lesion, repeat.
Heather explains why chronic pelvic pain is generated by the nervous system, not just by tissue, and what shifts when you treat the whole system: inflammation, sleep, stress, unprocessed trauma, and the thoughts that quietly turn pain up. Educational conversation, not medical advice.
About the Guest:
Heather Yoshimura is a UCSF-trained nurse practitioner, founder of a telehealth practice focused on endometriosis and chronic pelvic pain, and author of The Endo Dilemma. After two surgeries and years of treatment left her still in pain, she started asking a different question.
Key Takeaways:
- Pain severity doesn't track disease stage: stage four endometriosis can be painless, stage one excruciating.
- Inflammation sensitises the nervous system, so sleep, movement, and food are levers, not afterthoughts.
- Catastrophising thoughts strengthen pain pathways; pain reprocessing work helps decouple sensation from fear.
- Unprocessed trauma and chronic stress live in the body and show up as pain.
- Track small wins, not just pain scores. That's how you can see healing while it's still slow.
Connect With the Guest:
Website: https://luteal.health
Instagram: @the.endo.np
Episode Chapters: (approx.)
[00:00] What the Old Model Keeps Missing: find the lesion, remove it, repeat
[04:10] Pain Is Made in the Brain: phantom limbs and stage four without pain
[09:20] Inflammation as the Driver: sleep, food, stress, movement
[14:05] The Part Nobody Checks: nervous system, trauma, and the mind-body split
[19:15] Pain as a Signal: what Heather's own pain was asking her to change
[24:00] Advocating in a System Still Running the Old Playbook
[27:30] For the Woman Who's Lost Faith: recovery is possible
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Transcripts
00:00:08 Shreya: welcome to Wellness Reimagined. I'm your host, Shreya, and this is the space where we question the old assumptions about health and explore the approaches that actually help people feel whole. Today, we are reimagining how we think about chronic pain and endometriosis from the ground up. This is an educational conversation, not medical advice. and we are so fortunate to have an expert who has lived this from both the sides. And by the end, I hope you walk away with a genuinely new picture of what is possible. My guests didn't come from this work from the outside.
00:00:42 Shreya: Heather Yoshimura is a UCSF trained nurse practitioner, founder of the Telehealth practice Neutral Health and author of The Endo Dilemma. After two surgeries, multiple providers, years of birth control and more than one hundred and twenty five thousand dollars spent, she was still in debilitating pain. The question she asked that changed everything is at the heart of tonight's conversation. So welcome, Heather. I'm honored to have you on my show.
00:01:12 Heather Yoshimura: Thank you so much. I'm so honored to be here as well.
00:01:15 Shreya: Thank you so much for joining, Heather. And just before we begin, a quick disclaimer for my listeners. Some statements and reflect personal beliefs and experiences and are presented as individual views, not medical advice. Listeners should consult qualified professionals for medical conditions.
00:01:32 Shreya: And Heather, I want to start with the paradigm itself, because I think that's where the reimagining has to begin. So the conventional approach to endometriosis and chronic pelvic pain, uh, has been like by, by and large, find the, uh, remove the lesion, manage the hormones. And yet for so many women, the cycle repeats indefinite times. So what is fundamentally wrong with that model and what does it keep missing?
00:02:03 Heather Yoshimura: Yeah. So our understanding of pain has changed a lot in the past ten years. And the actual definition of what pain is, is, is the experience of what the brain creates, right? And so the conventional model in the Western medicine view has been that you have damage to the body, and then that damage is equal to the amount of pain that you feel. And we find that that's actually not true at all, because all pain is created and generated in the brain. And you can see that for like a very big common example of this is phantom limb pain, where you can have your arm cut off, but you can still feel as if you still had an arm. You can have pain even though the limb isn't there. And for women with endometriosis, a woman can have stage four disease, which is the most aggressive form of the disease and have no pain and just can incidentally find it on like a surgery for fertility, for example, while a woman with stage one, which is very minimal disease, can have excruciating pain. And so what we've found is that there's lots of things that turn up your sensitivity and your experience of pain, and there's lots of things that turn it down as well, which is really great because that gives people hope. People who are in chronic pain because there's so many things that you can do to change your experience of pain.
00:03:35 Shreya: And also, when a woman steps outside that model and starts asking different questions but becomes suddenly visible, that was invisible before.
00:03:45 Heather Yoshimura: In the current model, a woman is really at the at the mercy of the medical system, if that makes sense, because she feels like, okay, I have hormones or I have surgery. And that's those are my two only options, which for a lot of women aren't really what they want to, to use, right? Especially if you have surgery and then the surgery doesn't work, which is what ended up happening to me. But when you start realizing that pain is generated by the brain, it gives you a lot of hope and control because there's other things that you can do to lessen your pain, uh, which before you know, you feel really out of control.
00:04:28 Shreya: I think I think there is something both frustrating and hopeful in what you just said, like the model keeps producing the same output, uh, because, uh, it keeps asking the same question and you work into the same loop from the inside as a patient before you became the practitioner who asked differently. Uh, that's not just a clinical insight. I think it's a hard lived one. And, uh, you, you look at the nervous system hormones, the gut immune function, and more all together. So for someone who has only ever been told their pain is about one thing, can you walk us through what it means to look at the whole system and why treating all of it changes the outcome?
00:05:12 Heather Yoshimura: Yeah. So when what we see in medicine is that inflammation really is driving Disease and inflammation sensitizes the nervous system. It causes progression of different diseases, endometriosis being one of those diseases. But there are so many things that you can do to lessen inflammation in the body. Uh, first starting out with suppressing hormones or balancing hormones. Um, a lot of times women have hormones that are imbalanced because of things like stress or nutritional deficiencies, which are really, really common now with our modern lifestyles. Um, but other things you can do to lower inflammation and therefore lower your pain burden, just getting extra movement if you can, um, really eating an anti-inflammatory diet, controlling stress, sleep is really big and important as well. Um, so much of what drives inflammation and therefore pain and disease progression is really down to to lifestyle and even things like your thoughts to also really change and increase your levels of pain. Because if you're having thoughts that are catastrophizing or like, for example, something like, oh, I can't do this or that because it's going to cause pain or, or I'm never going to get out of pain. Those thoughts actually increase the sensations as well. So there's just so many different ways that you can really attack the problem. Um, which should yeah, give more hope and more answers.
00:06:59 Shreya: And can I say more about that? Like when you begin treating the whole system rather than just the visible one, what do you find that had been missed?
00:07:11 Heather Yoshimura: I believe that most women, uh, and this is what I've seen too, is that most women don't Have their nervous system looked at, but also, you know, in the in the current model of medicine, there's a belief that the body and the mind are are separate, which they, which they really, really aren't. And a lot of times patients in the beginning, um, it's difficult for them to believe that that stress is actually impacting and worsening their disease. Most women that I, that I work with have levels of stress that are above a seven out of ten at all times, or they have history of pretty significant trauma as well and not handling the things that have occurred in your life, um, dealing with past trauma, dealing with current stress that really drives disease. And that's the thing that most providers in the field miss because, because they do think that, you know, lesions drive disease and that's it. So what we see very commonly is these women who suppress their hormones or they have surgery, but then the pain comes back or it never goes away. And that's because their nervous system is sensitized from so many different things.
00:08:36 Shreya: Yeah. I think that image of treating the soil, not just the weed, is one I think people will carry from this conversation. And I think it reframes the whole question from how we do get rid of this, to what conditions allowed this to persist. Um, I think that's a completely different relationship with the body and the, with the healing. And, uh, let's bring this into real and everyday experience of a woman living with chronic pain. So for someone who has been through the conventional route, who has had the surgeries and the medications and still lives with the pain, what does the journey of reimagining her care actually look like in practice? Like what is different about the experience?
00:09:22 Heather Yoshimura: What's different about the experience is really taking control of of her life and her symptoms a lot of time. Pain, you know, pain is just a, a danger signal. And in a very basic sense, pain exists to get your attention. And so at least for me personally, in my in my own experience, the pain was a signal for me to, to pay attention to things that I needed to change in my life. And it took me many, many, many years to actually listen. And looking back now, you know, I'm actually a little bit glad of, of the pain experience that I had because it forced me to change my life. And because of it, I am much better now in a much better place. I'm much more authentic person. I have more boundaries, um, and just happier overall. And if I didn't have the pain, I wouldn't have been forced to, to shift my, my life. And of course, I don't want to say that everyone has this experience and that doesn't diminish pain. Pain is absolutely terrible. Um, it really, I had many, many years of, of chronic pain that, um, really took me down and it was very debilitating. And it was a very dark time in my life. But after coming out of it, um, I can see the silver lining in it. And so I hope that anybody going through pain right now is able to sit down and really think about, um, their life and what the pain might also trying to be telling them, um, even if that's simply, you know, hey, I need to reduce my stress and get out of this fight or flight state that I find myself in at all times. Um, yeah.
00:11:21 Shreya: And for the woman who feels that, uh, she has been dismissed or told she has run out of options. What is the most important thing to understand before she takes her next step?
00:11:33 Heather Yoshimura: To understand that there's actually a very long list of different things that that you can do. I would really, I would really encourage a woman to, um, to take lifestyle changes seriously and really work on reducing sources of inflammation. So like changing your diet to like a whole food diet that's anti-inflammatory, making sure she's getting enough nutrients, really, really working on sleep. Because if you, if your sleep is messed up, you're not getting enough hours and you're waking up in the middle of the night, your body can't heal. And, and that in itself is one of the biggest inflammatory drivers that I see. So really working with fixing the basic things first is very important before, you know, throwing in the towel or thinking that there's no more options left. Um, because most people are not, uh, where they want to be in regards to like sleep and stress and how much movement they're getting and, and the food they're eating. So even just changing those simple things can make such a big impact. And I've seen that so much day in and day out.
00:12:41 Speaker 3: I think that really.
00:12:41 Shreya: Lands because you were describing something that so many women in chronic pain have been denied, like the experience of being taken seriously and of having, uh, someone look at the whole picture. And you were just saying that the experience itself is a part of the healing that's feeling seen is not a luxury, but a clinical necessity. And I think that reframes what good care actually looks like in a profound way.
00:13:09 Heather Yoshimura: Yeah, being believed and understood is, is so important. And, you know, I had this personal experience myself. And then with so many women that I, that I work with, that they're just not taken seriously and not believed. And having chronic pain can be such an invisible illness because, you know, it's difficult to get diagnosed with endometriosis until you actually have surgery. Um, the diagnostic criteria has changed now as of this year in the United States. But before you'd have to get surgery to even get a diagnosis. And so there were so many women suffering with, you know, alone with this, this, this invisible disease.
00:13:53 Speaker 3: Yeah.
00:13:54 Shreya: And also, you built luteal health and your six system approach on the question, like, what if the problem isn't just the lesions, but everything around that nobody is treating? So for a woman who wants to take this whole system approach to her own care. What does that actually look like? As a starting point?
00:14:15 Heather Yoshimura: Yeah. As I had mentioned, um, starting out with a lot of lifestyle changes is really, really the, the fundamental route. So as I say, getting enough sleep and movement and nutrition and stress reduction and all of that, but also addressing the things in your life that, um, that you need to take care of that maybe you're, you're not. I really found for myself and for other patients that when they, when they deal with the things that they've been procrastinating against, um, that really helps to ease up symptoms and pain because it does reduce stress, um, making sure that you're having really good relationships and you're, you're taking care of your, of your mental health. A lot of times what I've seen is that people have had stressful childhoods, or they've had traumatic experiences. And instead of working through those. Experiences, they just decide to not think about it. But when you have traumatic things happen to you, or have neglect or or emotional pain, it lives in your body. And a lot of times it can come out as pain. Um, for women also who want a more holistic approach, I really recommend things like somatic experiencing therapy or pain reprocessing therapy. Um, pain reprocessing therapy was one of the things that helped me the most. And what that does is it allows you to change your relationship to sensations in your body. Because when you've had chronic pain for so many years, any sensation that you feel in your body, you think, oh no, something's happening. Or, oh, this is pain. And you, you label it. And over time, those neural pathways become strengthened. So much so that even if you have surgery and they remove all the lesions, you can still have pain because those neural pathways are so embedded in your nervous system. And so being able to be with sensations and decouple them from from fear is one of the, the easiest ways to start changing and reducing pain.
00:16:29 Shreya: And for the woman who doesn't have access to a specialist like you, who is navigating this in a healthcare system that's still largely in the old model, what can she do to advocate for a more whole system approach to her care?
00:16:49 Heather Yoshimura: I think being as educated as possible is the most important step. And even if that means, um, you know, reading about things online or joining support groups. And the reason why I say this is because most providers aren't really trained in endometriosis. So it's not that doctors are trying to not be helpful. It's just they just don't get the training. And so unfortunately, that's just the reality of the situation. And so being, being as educated as possible about, about the disease, um, can be really empowering and really understanding the, the reality that they might have to know more than, than their doctors, um, just because of the, the limitations of, of the medical system.
00:17:46 Speaker 3: I think, I think that reframes the.
00:17:47 Shreya: Patient role in a really empowering way. Like you're not asking women to accept the narrow frame they're being offered, you're giving them language and specific question to push for a wider one. And, uh, here is the hardest part of this reimagining. Like the whole system approach takes longer, cost more for attention, and requires a different kind of patience than the surgical fix. So for women who are exhausted and in pain and just want relief now, how do you hold the tension between the urgency of their suffering and the longer arc of what genuine healing requires?
00:18:32 Heather Yoshimura: Yeah, I mean, that's that's really the difficult part, right? Because when you're, when you're in such terrible chronic pain, all you want to be is to be out of it. And unfortunately, a lot of times it is a process. And for many of these women, they've been in pain for, for years, if not decades. And the main thing that I do for women in, in that regard is is give them hope and tell them to really celebrate small wins. Because a lot of times as you're on this journey of healing, you're going to have pain flares and, and you're going to have thoughts like things aren't getting better. And instead, I would really encourage women to focus on the small wins and how things are changing. Like, for example, if, um, one of the things that you can't do because of your pain is, is you can't go on runs anymore. And you used to be, uh, like a long distance runner, for example, but even getting outside and taking a walk or increasing that walk, and even a slow jogger or whatever, even for five minutes is still a win. And tracking those changes over time, instead of just really focusing on the pain and how it's ruining your life. Um, look at the things that you can do and how things are getting better over time. Uh, one of the things that I did when I was in my worst pain was I would listen to Nicole Sachs Real Time Heal podcast episodes, which she interviewed people who used to be in terrible chronic pain but had gotten better through nervous system changes and emotional journaling about about rage and sadness and just being able to hear that other people with my same diagnosis were able to get out of pain was so powerful for me. Um, and so I think really focusing on hope is, um, it can, can help with softening the, the reality that the journey can be long.
00:20:43 Speaker 3: Yes. And lastly.
00:20:45 Shreya: Like, what would you say to a woman who has lost faith that anything will ever actually work for her?
00:20:53 Heather Yoshimura: I would tell her that I used to be her. And there's so many women who used to be her. But pain recovery is completely and totally possible. I mean, for so many years I had absolutely debilitating pain. I would have bloating every night. I had Sibo for many years. I had bladder symptoms where it felt like I had a UTI, and I couldn't sleep because I was so itchy all the time. And, um, I thought that there was no way that I would ever feel okay again, that I would ever enjoy sex again, that I would ever have a good relationship with my body. But it is completely possible, um, with, with the work. And, and as I mentioned, the work is changing your relationship with things like stress and improving your lifestyle and reducing inflammation and, and taking, removing things from your life that are, are making your pain worse and really sitting down with the reality of of. Of the situation. So.
00:22:05 Shreya: That's beautiful. And I think that is one thing people will carry home today. The reminder that losing fit in the old model is not the same as losing hope for the healing, and that there are still questions nobody has asked yet, um, and answers that nobody has looked for. And that door is not closed. It is just needs a different key. And if there is one thing to take from this conversation, that would be chronic pain was never just about the one thing being treated. The body is a whole interconnected system and healing. It requires a big model to hold that truth. And the old model isn't the only model, and your story isn't over just because the conventional path ran out. and hither. This is such a wonderful conversation. So thank you for joining us and sharing all this information with us. And if after this, my listeners want to connect with you and want to learn more about you or about your work, then what's the best place to find you?
00:23:09 Heather Yoshimura: Yeah, they can find me on luteal dot health, or you can follow me on Instagram. And my handle is the dot endo dot np.
00:23:20 Speaker 3: Yes. And I'll make sure to attach.
00:23:21 Shreya: All these details and links below in the show notes so that the listeners can find them easily and get in touch with you. And thank you again, Heather. Reimagining something as entrenched as the model for chronic pain care takes courage, and doing it as both a patient and a practitioner makes your voice, uh, that women in this situation can truly trust. I think that's exactly what wellness Reimagined is for. And to all my listeners, if you have been told you have run out of options. Here is what I want you to hold on to. The options that haven't been explored yet are the ones nobody thought to look for. Keep asking different questions. Keep advocating for a wider picture, and find the practitioners who are willing to look at the whole of you. I'm Shreya and this was the wellness reimagined. Until next time, keep questioning and keep exploring. And do not forget to hit the follow button. Subscribe and feel free to share your thoughts because your ears deserve premium content. Thank you.
