
Episode #57
When Hormones Backfire: Managing Endometriosis Through Midlife with Dr. Karina Hoan
If you've been told that your endometriosis, adenomyosis, or fibroids will magically improve as you approach menopause—think again. In this paradigm-shifting episode of The Dusty Muffins, our expert trio—Dr. Aoife O'Sullivan (MD, MSCP), Dr. Christine Hart Kress (DNP, MSCP), and Dr. Rebbecca Hertel (DO, MSCP)—sit down with board-certified OB-GYN and minimally invasive gynecologic surgeon Dr. Karina Hoan to debunk the myths and reveal the truth about pelvic pain and hormonal transitions. Dr. Hoan has spent nearly a decade specializing in endometriosis and complex pelvic pain at The Portland Clinic, and she brings both surgical precision and a hormone optimization perspective to this conversation. In this episode, you'll discover: The Perimenopause Paradox: Why endometriosis and adenomyosis often worsen during perimenopause—just when many assume symptoms should be calming down—and how fluctuating hormones drive inflammation and pain. Beyond the Ultrasound: Why these conditions can't always be seen on imaging, and how to identify them through clinical history, symptoms, and specialist evaluation. ⚖️ The Estrogen-Progesterone Balance: The critical importance of hormonal balance for women with a history of endometriosis—and why progesterone matters as much as estrogen. Cutting-Edge Diagnosis: The exciting potential of blood-based diagnosis for endometriosis—and what this could mean for the future of managing these conditions. ️ Surgical & Medical Options: A clear-eyed look at the range of treatment options—from hormone therapy to minimally invasive surgery—and how to build a personalized plan that works for you. The Hysterectomy Hormone Question: Why women who undergo hysterectomy still need hormone support, and how ovarian function impacts menopause timing. Mast Cell Activation & More: The emerging science of inflammation in pelvic pain—and why understanding the underlying biology can change your approach to treatment. Tune in for an episode that replaces fear with knowledge and empowers you to take control of your gynecological health—whether you're managing endometriosis, navigating fibroids, or simply tired of being told to "just live with it." Social Media Links: The Dusty Muffins: Instagram → https://www.instagram.com/thedustymuffins Linktree → https://linktr.ee/thedustymuffins Hosts: ⚕️ Dr. Aoife O'Sullivan → https://www.instagram.com/portlandmenopausedoc ⚕️ Dr. Rebbecca Hertel → https://www.instagram.com/drrebbeccaherteldo ⚕️ Dr. Christine Hart Kress → https://www.instagram.com/christinehartkress_dnp Guest – Dr. Karina Hoan: Website → https://www.theportlandclinic.com/doctor/karina-hoan Disclaimer: The Dusty Muffins are doctors, but they're not YOUR doctors. This is for entertainment and informational purposes only. Always consult your own healthcare provider for personalized medical advice.






