QC:Rethinking Endometriosis: Healing The System, Not Just The Lesions

What if the fastest path to endometriosis relief starts before the operating room? We sit down with Dr. Iris Kerin Orbuch, a board-certified OBGYN, fellowship-trained excision surgeon, and co-author of Beating Endo, to map a smarter plan: prehabilitating the body so surgery becomes safer, recovery gets easier, and daily pain loosens its grip. In a tight, five-minute Quick Connect, we unpack the exact levers that move the needle—without fluff.

Dr. Kerin Orbuch explains how overlapping conditions like pelvic floor dysfunction, painful bladder syndrome, SIBO, POTS, MCAS, hypermobility, anxiety, and trauma can upregulate the central nervous system and amplify pain. By addressing these drivers before surgery with pelvic floor therapy, gut work, integrative nutrition, mental health support, and nervous system regulation, patients often see 20–80% improvement before the first incision. The payoff is real: clearer surgical fields, fewer post-op complications, and a dramatic reduction in narcotic use, often down to zero to two pills.

We also talk through the practical barriers—costs, access, triggering diet changes, the emotional weight of trauma care—and how to tailor a plan that fits real life. Short, frequent check-ins build understanding and momentum, turning patients into true partners in their own outcomes. Excision remains essential for removing disease, but it isn’t a panacea; it won’t lengthen tight muscles or correct gut dysbiosis. Pairing high-quality surgery with targeted prehab shifts the entire healing trajectory and restores confidence in the process.

If you’re ready to rethink endo care with clear steps and compassionate science, this conversation offers a grounded starting point. Subscribe for more Quick Connects, share this with someone who needs practical hope, and leave a review to help others find these expert insights. Got a question you want answered next? Send it our way and we’ll bring you the expert voice you need.

Transcript

Fast Answers, Expert Ground Rules

Speaker 0:00

Life moves fast, and so should the answers to your biggest questions. Welcome to Endo Batteries Quick Connect, your direct line to expert insights. Short, powerful, and right to the point. You send in the questions, I bring in the experts, and in just five minutes, you get the knowledge you need. No long episodes, no extra time needed. And just remember, expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, Alana, and it's time to connect.

Meet Dr. Iris Karen Orbuch

Speaker 0:41

Today I am honored to welcome someone who has truly shaped the landscape of endometriosis care, Dr. Iris Kerin Orbuck. Dr. Kerin Orbuck is the founder of Iris Wing Sanctuary for Endometriosis Surgery and Wellness in Los Angeles, where she provides compassionate individualized care rooted in both advanced surgical expertise and whole body healing. She is a board-certified OBGYN and fellowship-trained endometriosis excision surgeon, having trained under pioneers like Dr. C.Y. Lu and Dr. Harry Rich, names synonymous with the evolution of minimally invasive surgery. Beyond the operating room, Dr. Kerin Orbuck is known for her integrative approach, blending Western medicine and functional healing by collaborating with nutritionists, pelvic floor therapists, psychologists, and acupuncturists to help her patients truly heal, not just manage symptoms. She's also a co-author of the widely acclaimed book Beating Endo, How to Reclaim Your Life from Endometriosis, and her advocacy work extends beyond the clinic. She has served on the AAGL Foundation Board, helped lead the Endometriosis Special Interest Group, and contributed her voice to the groundbreaking documentaries like Endo What and Below the Belt, which have helped bring this disease into the public conversation and policy spaces. Please help me in welcoming the brilliant Dr. Iris Kerin Orbeck to the table.

What Prehab Means And Why It Matters

Speaker 2:06

What is the benefit to addressing some of that inflammation and changing these habits prior to even having surgery?

Speaker 1 2:11

So that's all I've been doing for the last 15 years. That's been my approach. So is the prehab. And like I will take a patient who is severely symptomatic. They're coming in for a consultation. Of course, they're like, I want your soonest surgery. I then explain to them the multitude of coexisting conditions that I think are happening in their body, right? Really, I individualize care. Consults are an hour and a half at least. And I have read every medical record before I enter into that consult. So I could have read for four hours before I stepped into that consult. So I know every bit of their record. So then I explained to them how all of these coexisting conditions like pelvic floor type muscles or painful bladder syndrome or SIBO or anxiety or trauma or POTS if they've already been diagnosed or MCAS mascellactivation syndrome if they've been diagnosed, EDS,

Treating Overlap Conditions Together

Speaker 1 3:09

whatever they're like these overlapping pain conditions, right? And then I explained to them how they're all together come to upregulate the central nervous system, which is kind of our central processing unit of the body. And that's where we experience pain, is in our nerve. Like, and so I explained to them, well, we're gonna lift up as many hands off of this hot stove that is flaring our central nervous system. The more prehib we do, the quicker you're gonna recover after surgery. And then the patients are like, A, overwhelmed, B, they're crying, tears A, both of joy and of like, thank goodness, I finally feel like there's a path towards healing. And then just other, utter overwhelm, right? As they're getting ready to walk out the door. And then I see them at short-term intervals. Like I see them at six weeks. And then I'm like, we can go ahead and schedule surgery. You know, I for each one of them, it's a little different. I'm like, okay, I think in three months you'd be ready, or four months, or six months. It just depends on the history where people are at. I'm like, you can go ahead and schedule surgery. And then I keep seeing them roughly about every six weeks to keep explaining what's happening. So they are partners and they're understanding things.

Results, Barriers, And Realistic Recovery

Speaker 1 4:21

I typically, not for all patients, but I'd say for the bulk of the patients, at minimum they're 20% better. And many of them are 60 to 80% better before I step foot into the OR. The ones who in the pre-surgery appointment and then the pre the day of surgery appointment who are like, I'm not better, it's usually they haven't done the PT and they're for valid reasons. It's financial reasons, like they just like they can't do it. Um, they haven't gone to like the the gut specialist, like they haven't been tested for SIBO or worked with the integrative nutritionist. And often it's because there's like restrictive eating, it's activating those things. So they don't want to delve down that I fully understand, or they have a history of some type of abuse or trauma. And so they haven't delved into like re-establishing care with a therapist who can help them with the brain, brain-mind connection to help them get out of sympathetic overdrive, or they just don't want to believe that endoexcision is not the panacea to get them better. I'm always like endoxision is not gonna fix your tight muscles. Endoxision is not gonna fix your seabout. Moving forward, it won't activate those things, but your muscles are tight from curling up in a ball for the last 20 years of your life. We need to undo that or at least make a dent in undoing it. And since I changed how I'm doing things, so like the last 15 years, I remember prior to that, I'd give a prescription for a narcotic for like 40 narcotics or something like that. Now my patients take between like zero and two after surgery. There's some who need more, and I there's no judgment here. None at all. But most of the people don't need that, right? Assuming that they've really partnered and they have the ability

Closing And How To Send Questions

Speaker 1 6:13

to partner.

Speaker 6:13

That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming. Send them in, and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at indobattery.com or visiting the Indobattery.com contact page. Until next time, keep feeling empowered through knowledge.