Hello everyone and welcome back. All right, I am so excited. I have to do my hand motions because I have an amazing surgeon here who I’ve been wanting to talk to for a while. And we’re gonna cover a range of topics today. So first of all, I just want to welcome Mallory Stuparich Dr. Mallory Stuparich. Welcome to the podcast.

Mallory Stuparich, MD (00:27)

So excited to be here and so excited to connect with you. I’ve been watching your podcast. You’ve so many interesting people, so many interesting topics, so I’m happy to finally be a part of it.

Ginger Garner PT, DPT (00:37)

Yeah, thanks for being here. I know you’re so flippin’ busy, my gosh. So I’m gonna brag a little bit, on you like I usually do with all of our fantastic guests. Just world-class, fantastic human beings. Not just fantastic surgeons and healthcare providers, but like fantastic human beings. And I think that’s a driver for why they’re doing what they’re doing. So let me tell you just a little bit about Dr. Stuparich She specializes in the surgical management.

of endometriosis and complex benign gynecologic conditions. She believes patients deserve expert high quality surgical care, employing a multidisciplinary team, hands in the air, when necessary. Dr. Stuparich views the physician-patient relationship as a team dynamic, which I think is so essential.

⁓ offering her medical and surgical expertise and recognizing that also patients are the experts in their own values, goals, and lived experiences. And I just couldn’t underscore that enough. This team-based approach is crucial to optimizing patient outcomes. She prioritizes patient education, advocacy, shared decision-making to ensure individualized care. ⁓ She also has received

numerous awards for teaching surgical innovation and she’s co-authored, get my head around this, more than 75 peer-reviewed publications and scientific abstracts. That’s like incredible. After completing her residency in obstetrics and gynecology at University of Texas Southwestern Medical Center, she pursued fellowship training in MIGS or what we know as minimally invasive gynecologic surgery.

at the prestigious McGee Women’s Hospital of the University of Pittsburgh Medical Center. She is board certified by the American Board of Obstetrics and Gynecology and she is a fellow of ACOG and American College of Surgeons. Welcome, Dr. Stuparich

Mallory Stuparich, MD (02:36)

Thanks for having me. Yeah, yeah.

Ginger Garner PT, DPT (02:38)

Yeah, I’m glad you’re here. All right, so

don’t let me forget at the end to ⁓ go over where everyone can find you because they can find you in several places and I don’t want to ignore that at all. But I kind of want to set the scene for you, your expertise, your background. Can you tell our listeners a little bit about your journey into medicine and what drew you to focus on endo, particularly the bowel involvement, which is what we’re going to talk about this evening.

Mallory Stuparich, MD (03:06)

Sure. Yeah, happy to address that. So I knew when I was really little, like elementary school, that I wanted to be a physician. There was a ⁓ dad of a childhood friend that was a physician. And I feel like I gained exposure to being a physician through interactions with him. And I really just never considered anything else. And so…

As I grew and you take the tests in high school that sort of align you to what would work with your interests and career and science of course popped up, medicine popped up. it just honestly never, nothing else really came up to compete with that in a way. And so medicine was always at the forefront. I studied chemistry and biology in ⁓ undergrad and then applied to medical school.

In medical school, I actually went in thinking I was going to do orthopedic surgery. So something surgical was kind of always on my radar. I didn’t really put together the whole like breadth and scope of what obstetrics and gynecology meant until I really started speaking to physicians that actually work in that field. Like I didn’t quite put it together that OB-GYNs were surgeons until I realized, well, who would be doing hysterectomy? Okay. And so finally put that together and

I knew on paper that OB-GYN would be a good fit. And I had really excellent mentors in OB-GYN. And then when I did my rotation in the third year, that just really sealed the deal for me. Fast forward a little bit into residency. I was probably in my second year of residency and I had a mentor, her name is Dr. Kimberly Ko, sort of take me under her wing and really mentor me in what minimally invasive gynecologic surgery was. And so she brought me in on

Ginger Garner PT, DPT (04:42)

Hmm.

Mallory Stuparich, MD (05:00)

a research project and helped me understand what scientific research is like and how to go about that process. I applied for fellowship and I was fortunate enough to match at McGee Women’s where I had excellent mentors in my minimally invasive GYN surgical fellowship. Ever since graduating, my focus has really been on

A lot of endometriosis, I would say that a lot of us that graduate from a minimally invasive GYN surgery fellowship, ⁓ sometimes the focus could be more fibroid oriented, sometimes it’s more endometriosis oriented. For some people, it’s a blend of both. ⁓ But for me, I think we saw a lot of patients that would travel from states away to come and see my mentors at ⁓ McGee Women’s ⁓ for their endometriosis care.

Ginger Garner PT, DPT (05:50)

Yeah, it’s incredible that you knew so early what you wanted to do, you know? ⁓

Mallory Stuparich, MD (05:57)

I know I sit there and I think about that and I think

that’s like definitely not how a lot of people come about the decision.

Ginger Garner PT, DPT (06:05)

Yeah, it just peaks volumes to, know, I think probably having, you know, support system and other things in place that allow you the freedom to think about those things and really focus on it. So that’s amazing. ⁓ All right. So your Instagram presence, I want to ask a little bit about that because I love that. It is unapologetically bold. It’s incredibly educational, like.

Mallory Stuparich, MD (06:17)

Right.

Ginger Garner PT, DPT (06:30)

What inspired you? What was the catalyst to bring this level of like just honesty and advocacy to social media?

Mallory Stuparich, MD (06:39)

I think it’s very much needed. think that, and I’ve said this before, I think the medical establishment has not done a good job of really, I think, educating patients about these disease processes and particularly disease processes that affect women or people who ⁓ are assigned female at birth. ⁓ And so a lot of it, that passion is really education because

If people don’t know that these processes exist out there, then it’s very hard for them to even try to seek care for something that they may not even know is a problem or that they’ve been told by other people is normal. So I think the education piece for patients is very, very important. That’s something that I really strive to maintain on my platform. ⁓ I think also the opportunity to collaborate with colleagues.

Ginger Garner PT, DPT (07:22)

Mm-hmm.

Mallory Stuparich, MD (07:37)

⁓ create posts that are multidisciplinary in nature. I’ve collaborated with pelvic floor physical therapists, ⁓ other physicians. I’ve done lives with other physicians again, really to bring about that education piece because I think that education of colleagues is also very important. We all have the things that we’re very good at and to be able to share that knowledge to elevate somebody else’s care, think is helpful for patients and things that might

Ginger Garner PT, DPT (07:56)

Yeah.

Mallory Stuparich, MD (08:07)

colleagues are interested in. And then the advocacy. And I think bringing together all of those three items are really what my platform is about. And I would say I really started investing the consistent time in this maybe about like two years ago. I had created a professional Instagram, you know, several years ago and just kind of let it be and I wasn’t really doing much to make it grow but

Two years ago, I was like, you know what? I feel like I can really build this into something that could be a resource for patients, resource for colleagues, ⁓ platform for just shouting those things from the rooftop that we all wanna shout. And that was when I really started putting in the more consistent work to grow it.

Ginger Garner PT, DPT (08:56)

Yeah, yeah. Tell us what your Instagram handle is. We’ll put it in the show notes, so don’t worry about that, but tell us what it is.

Mallory Stuparich, MD (09:01)

Of course.

Yeah, it’s at Mallory Stuparich MD. All one word no dots underscores or spaces so Mallory Stuparich MD.

Ginger Garner PT, DPT (09:09)

All right.

There was

one post that you did, I absolutely love it. You gotta do more of these. was, Storytime with Dr. Stuparich. I love that. Yes. Yeah, you have to do that. And it was on something that is like, it’s so obvious, but also people aren’t talking about it. It was the lack of pain management for office procedures.

Mallory Stuparich, MD (09:20)

Oh, yes. I know. I think I should make that a recurring series. I think that that would be really fun to do. You know, yes.

Mm.

Mm-hmm.

Ginger Garner PT, DPT (09:40)

And I was like, okay, we have to revisit this and y’all go to her Instagram account. Okay, so just go do that when you’re done listening, but then also listen to this, which is, can you go through options for pain management, biopsy, IUD insertion, and advocating for pain management? it’s just like you said in your story, some offices will flat out say, we don’t offer that as if.

Mallory Stuparich, MD (09:43)

Yes.

Right.

Ginger Garner PT, DPT (10:07)

you have no say in whether or not you get pain management. So what say you?

Mallory Stuparich, MD (10:10)

Right.

I mean, I think that when it comes to having a successful physician or practitioner, clinician, patient relationship, I think that it’s so important that you find somebody who it’s almost like you have to be looking in the same direction together. And it’s like, we’re going to go together. OK, that’s the team based approach that I really think is so, important.

just as a patient has to be comfortable with their clinician, clinician has to be comfortable and feel like they can be able to help the patient. And I think one of the circumstances specifically where this is really exemplified is discussing these pain management options for office procedures. mean, historically, there hasn’t really been a lot of options offered. And I think that people in my generation and younger are just, we’re not gonna stand for that anymore.

We’re not gonna stand to just have people in pain because, well, it’s better than having a baby. Like, yes, I could think of many things that are more pleasant from a pain standpoint than having a baby. But is that really the barometer that we wanna use? No, it’s not. And so I think that, I mean, specifically for those procedures, we can talk about how to prepare your body even starting the day before or in the days leading up to.

Ginger Garner PT, DPT (11:14)

my gosh.

Yeah. Yeah.

Mallory Stuparich, MD (11:34)

taking over-the-counter medications that are available to you, discussing whether or not an anti-anxiety medication would be appropriate for your specific case, discussing whether or not a prescription strength pain medication is something that’s appropriate for your case. ⁓ Then one of my mainstays is a local anesthetic agent. I offer patients parasorbic blocks. There’s topical lidocaine that can be applied. ⁓

there was, ⁓ you know, you can employ meditation or even aromatherapy has been shown in office hysteroscopy to reduce the perceived pain score. ⁓ And I got an interesting tip from a colleague of mine that said somebody could even bring like a little mini ⁓ vibrator to put it in their umbilicus because there’s some ⁓ sort of overlap or even it’s if it’s a distraction.

Ginger Garner PT, DPT (12:08)

Mm-hmm.

Mm-hmm.

Yeah.

Yeah,

Mallory Stuparich, MD (12:30)

Hey, you know what? I’m all for it.

Ginger Garner PT, DPT (12:31)

mm-hmm. In the birth literature, there is plenty of evidence to show that actually using music not only improves the empathy of the caregivers, but also decreases the perceived pain. So like, put those headphones in, yeah.

Mallory Stuparich, MD (12:43)

Correct. Exactly.

Put the headphones in. And then also understanding that even despite all of these interventions, some patients may still not choose to do that. And that’s totally fine. And we should have the ability to be able to place these things under some sort of regional or even general anesthesia, if that’s what’s needed. We need to meet patients where they’re at. And that’s really where the discussion of all these options.

Ginger Garner PT, DPT (13:06)

Mm-hmm.

Mallory Stuparich, MD (13:12)

I think leads us to.

Ginger Garner PT, DPT (13:14)

Yeah, for sure. And then also, I think, acknowledging to patients that they can actually decline to move forward with that procedure or find another provider that’s willing to actually meet them where they are. I think a lot of people are afraid to say no. Yeah.

Mallory Stuparich, MD (13:25)

Correct.

Yeah, there is

nothing wrong with you saying, thank you for your time. I don’t think this is a good fit for me. And I understand like it sucks to start over. It sucks to start over and to go through the whole process again, but your comfort with your clinician and physician that you’re seeing is really gonna serve, it’s an investment in you to have the best healthcare outcomes.

Ginger Garner PT, DPT (13:43)

Yeah.

Mallory Stuparich, MD (14:00)

And I think it’s worth it to spend that time and diligence to find that optimal relationship.

Ginger Garner PT, DPT (14:07)

Yeah, yeah, for sure. The other thing, then, as we shift into kind of the Endo conversation, not that that’s unrelated, it’s very much related, because there’s a lot of office procedures that can happen when you’re trying to manage endometriosis. ⁓ But one of the things I also saw also on your Instagram account, which is maybe surprising to listeners, is the impact, the percentage or the statistics.

of endo that impacts adolescents with pelvic pain, like 64%. And of course, I would agree with that because actually of the last cases that I have, if I’m like holding them in my hands of all the women and young girls adolescents that I love very much and serve as a clinician, I would say, yeah, that statistic holds.

Mallory Stuparich, MD (14:41)

Correct.

All right.

Ginger Garner PT, DPT (14:59)

of the number

Mallory Stuparich, MD (14:59)

Yeah.

Ginger Garner PT, DPT (15:00)

of referrals that I have made in the past six months of teenagers with pelvic pain that have not been screened for endo at all. And who pretty much would almost be guaranteed to have it because their mothers had it, but yet nobody asked. Yeah, so what do you recommend parents do? Because I know they feel overwhelmed, you know, when they see their daughters throwing up, passing out, like the pain is so intense, that must feel, I don’t have daughters, I have all sons.

Mallory Stuparich, MD (15:03)

Yes.

Yes.

Correct. Yeah.

Ginger Garner PT, DPT (15:28)

So that just must feel overwhelming. What do you recommend that parents do to try and advocate for their daughters?

Mallory Stuparich, MD (15:36)

Yeah, I think that that’s a really important question. I think first step is, is again, education, recognizing what is truly normal and what is truly not normal. We get told a lot of the time of what I think people want to be normal or or these symptoms that sound so horrific, throwing up, passing out on the bathroom floor.

not able to participate in normal extracurricular activities or even school. And in fact, actually, that’s one of the biggest signs that an adolescent may have endometriosis is they can’t participate in their schoolwork. They can’t participate in their extracurricular activities. if, you know, anyone who’s listening, if that’s your daughter that’s calling you every single month to be picked up from school because they are in so much pain that they can’t tolerate sitting there for their schoolwork.

that’s a huge red flag that endometriosis is potentially at play. So I think the first thing is understanding what is truly normal and what is truly not normal. It’s okay to have a little bit of mild cramping that usually is able to be overcome by over-the-counter medications. It should not significantly debilitate a person though. So again, recognizing those symptoms. And I think that

We’re trying to do a better job of educating colleagues about what those normal and non-normal symptoms are. There are some very excellent pediatricians out there who are aware of these things. ⁓ I know some parents even end up taking their daughters maybe even into their gynecologist. And it doesn’t have to be, I know thinking taking a teenager into a gynecologist can be scary.

thinking, my gosh, is my daughter going to have to have a pelvic exam or something invasive? Usually in most cases in an adolescent, it’s not typically the case. Of course, nobody has to give their consent to do anything that they’re not comfortable with. Again, retaining that autonomy. But I think it boils down to understanding what the symptoms are and then finding a physician or clinician who will listen and sit there and listen and take

both the patient and their parents’ concerns seriously.

Ginger Garner PT, DPT (18:02)

Yeah, yeah. There’s too many cases of, ⁓ I think I probably see a lot of this being on what you’d think of as kind of the back end, you know, of like rehab post excision or something like that. But I end up with a lot of cases where teenagers, adolescents, young adults in their 20s will come in with a slew of symptoms that have been dismissed or invalidated. So anything related to pelvic pain, back pain, know, GI pain.

Mallory Stuparich, MD (18:15)

Mm-hmm.

Right.

Correct.

Ginger Garner PT, DPT (18:33)

Disprunia, like a painful intercourse, all of the things that can’t, you know, can’t wear a tampon, you know, those types of things. And they’ll have considered all that normal. And then they’ll, you know, they’ll end up coming to pelvic PT because somebody was like, I don’t know, just go to pelvic PT. I don’t know. Yeah. Yeah.

Mallory Stuparich, MD (18:39)

Right.

Mm-hmm.

Right, I don’t know what to do with them. And I will say, I mean,

in so many circumstances, it is the very excellent pelvic PTs that recognize this. And they say, okay, this sounds a lot like endometriosis. You need to go see somebody. And a lot of times, you know, I think probably the physician’s going to the pelvic floor PTs as well as.

Ginger Garner PT, DPT (19:10)

Yeah.

Mallory Stuparich, MD (19:16)

pelvic floor PT’s like coming to the physicians, we’ve been able to forge those networks because there’s so much overlap in our worlds. And so that can be a lifeline, I think, for a lot of people too, is that that may be how they get connected to an endometriosis expert.

Ginger Garner PT, DPT (19:24)

Yeah.

It is.

Yeah, and then they’ll sit down and on a first visit for me is 90 minutes. I get to hear everything, the whole history top to bottom. And I think in our hurried system, ⁓ as much as practitioners that aren’t endo-focused don’t realize it, I think some that do don’t even have the time to fully go through the history in order to be able to identify it.

Mallory Stuparich, MD (19:39)

Yeah. Yes.

Right. It’s very

broken. Yeah. It’s very broken in that way. It’s very broken. Yeah.

Ginger Garner PT, DPT (19:58)

Yeah, yeah.

Well, if you think about things that are broken, when we talk about endometriosis, I think that there is still a big misconception. And I think those of us in the endo world think maybe it’s conquered because we always talk about it in the endo world, but outside the endo world, people really do misunderstand and think that endometriosis is only a reproductive organ disease. And so,

many, many, many patients still, even after they’ve been through the endo-excision experience, may discount or gaslight themselves over their own GI symptoms that they have ⁓ because of potential bowel endometriosis or the fact that they had that. So if we kind of break the silence on that and say, okay, yes, it’s often misunderstood, it’s misdiagnosed, I can’t tell you how many times I’ve had GYNs tell patients,

Your GI symptoms have nothing to do with your pelvic pain. They’re not related. What do you wish more providers and patients knew about so that they could better advocate for themselves and their patients?

Mallory Stuparich, MD (21:10)

Yeah, I think that there’s so much overlap in endometriosis. I mean, it’s because of just the geographic location of the organ systems with the rectum and the sigmoid colon sitting right behind the vagina, cervix and uterus. There physically is just not a lot of distance that the disease has to travel in order to involve that. And then, you know, even expanding that even further, when we start to affect the nerves in that area, there’s a lot of

crosstalk between the nervous systems that go to both of those organs. so somebody can have endometriosis, it may not be physically on the bowel, but they can still have bowel symptoms and vice versa. They may have endometriosis on the bowel that may not be causing a lot of bowel symptoms, but could be causing a lot of like gynecologic symptoms and uterus pain and things like that. I think understanding those, how the nervous system crosstalks in those.

Ginger Garner PT, DPT (22:00)

Yeah.

Mallory Stuparich, MD (22:08)

ways and I mean that can get pretty in-depth and complicated, but just understanding that I would say probably secondary to a lot of the classic GYN things that you hear about, painful periods or pain with intercourse, I would say gastrointestinal type symptoms, bloating, issues with bowel movements, not able to empty completely, alternating constipation, diarrhea, which a lot of times is diagnosed as IBS. That’s probably like the secondary set of symptoms that I hear about the most common.

Ginger Garner PT, DPT (22:31)

Yep, I guess.

Yeah, definitely.

Mallory Stuparich, MD (22:38)

when it comes to endometriosis.

And then you get the patient who’s had the million dollar GI workup. They’ve had the colonoscopy, they’ve had the upper endoscopy, they’ve done the SIBO testing, they’ve done all of these things. And when you’re left with IBS, it’s almost like being diagnosed with unexplained infertility. It’s like, no, I think that we still need to look for endometriosis. And it’s like, can’t.

Ginger Garner PT, DPT (22:46)

Mm-hmm.

Mallory Stuparich, MD (23:07)

IBS truly is a diagnosis of exclusion, and we can’t really call it IBS until we’ve done our due diligence to rule in or rule out the presence of endometriosis.

Ginger Garner PT, DPT (23:09)

Mm-hmm.

that’s such an important point, that IBS is a diagnosis of exclusion and I think too many women come in and sit down and say, I just have IBS, it’s just a thing. I’m like, okay, let’s reframe this a little bit. So I think that actually moves perfectly into my next question because there’s a lot of common myths, there’s a lot of misdiagnoses that you see around bowel endo or endo that’s close enough to create bowel symptoms.

In addition to IBS, as one of those diagnoses that, you know, endopatients get saddled with, what else do you see in terms of misdiagnoses?

Mallory Stuparich, MD (23:57)

I think.

patients can also present, know, bowel endo can present with pain with as pain with intercourse, just because of geographically during intercourse, you know, genitals might be touching that area. And so that can be a symptom ⁓ or that can be one way that bowel endometriosis may present. ⁓ Rectal bleeding.

You know, we have to keep on the differential. Anybody who’s having some sort of rectal bleeding is there a possibility of cancer? And I mean, there’s, you know, I’m sure it’s no secret to a lot of folks that may be listening to this podcast, know, colorectal cancer is affecting people younger and younger. Used to be that our screening colonoscopy would be at 50. Now they’ve lowered the age to 45, you know, if there’s no other risk factors. And so I think, you know, rectal bleeding.

Ginger Garner PT, DPT (24:42)

Yeah.

Mallory Stuparich, MD (24:53)

pain with intercourse can sometimes, you know, masquerade and that might actually be bowel endometriosis. Sometimes the bowel endometriosis can start to, from sort of the outside in type of a situation, start to get into the uterus. It can eat through the surface of the uterus and get into the myometrium. So then we’re sort of getting this, ⁓ like almost like this from the outside in adenomyosis type of picture. Okay, because that endometriosis now is infiltrating into the myometrium, which is

essentially the definition of adenomyosis. It can happen in the reverse.

Ginger Garner PT, DPT (25:26)

Mm-hmm.

I think that’s pretty important to point out because I do get a lot of patients that ask me, ⁓ what’s the harm in not doing anything about endo, right? I really don’t want to have surgery, what’s the harm in that? And it is almost like we need a proper classification of what endometriosis is because I think a lot of people think or feel, if we just suppress estrogen, then that’s going to be enough and it’s not going to continue.

Mallory Stuparich, MD (25:39)

Mm-hmm. Yeah. Yeah.

Ginger Garner PT, DPT (25:58)

Can you shed a little bit of light on that and then ⁓ how that works into what bowel endometriosis care should look like from like diagnosis to treatment? Because you’ve touched a little bit on the differential diagnosis points of what else we should be looking for, like cancer, obviously. But in many ways, endo can act like that and continue to grow. You can lose organs from it.

Mallory Stuparich, MD (26:21)

Right.

Correct.

Ginger Garner PT, DPT (26:23)

So yeah,

shed a little bit of light on that, because I think we get, I get a lot of patients thinking they can just suppress estrogen and roll on with it.

Mallory Stuparich, MD (26:30)

Yeah.

Yeah. I mean, when you look at some of the natural history studies of endometriosis, ⁓ in general, if you just kind of watch people, a third of people will have just extremely progressive aggressive disease, okay, left alone not doing anything, they’ll have very progressive disease, a third of people, it’s gonna say stay kind of static. And then a third of people, there might be some sort of spontaneous regression.

of some type or sort of some dialing down or like lower level of disease. The problem is we don’t have testing or any way aside from following patients at different time points to know which group they fall into. ⁓ So, you know, if a 33 % chance that it’s either gonna, well, I mean, if you put it together, if a 67 % chance that it’s either gonna stay exactly the way that it is or get worse is acceptable. I mean, sure, only I suppose a patient.

can make that determination, but that’s sort what we’re looking at. Getting into, a lot of times if we’re thinking, okay, maybe they fall in the static group or something like that, then they’re gonna continue in the same state of health that they’re in. They’re gonna continue to have the symptoms that they’ve come to see you for. And again, only the patient can decide if that’s something that’s tolerable.

if the benefits of staying in that state outweigh the risks of staying in that state. And so that would be up to a patient, of course, with the guidance of their personal physician to determine that. And so there’s a lot of discussion that I think needs to be had around that. Yeah.

Ginger Garner PT, DPT (28:09)

Yeah, how do you approach

shared decision making with your patients who are terrified of surgery, but they also have these GI symptoms and yet they’ve been gaslit for years to go, well, you know, it’s kind of normal to have some indigestion, if you will.

Mallory Stuparich, MD (28:18)

Mm-hmm. Yeah. Right.

Sure. Yeah. Yeah,

I know. I’m just laughing because I just see I’m like, indigestion. that’s it seems like such a it’s such a little word for what goes on with a lot of these patients. But but I know what you’re saying. I mean, that’s part of the minimizing and the normalization of it. Yes. Yes. Yes. I know you get an icky feeling saying it exactly. I know exactly. Well, I think

Ginger Garner PT, DPT (28:34)

Yeah.

Yeah, exactly. Exactly. It is, it totally is. I chose that word deliberately. It was hard to even say it because I was like, ooh, let’s call this what it is. Yeah, it makes my skin crawl.

Mallory Stuparich, MD (28:55)

Part of that goes back to the education of a patient of what should be normal and what’s not. Okay, explaining to them that, okay, you’re in bed for two to three days of the month, or you can’t go to work. You can’t be earning money during that time. Or if they’re in high school, college, grad school, you’re having to interrupt your studies for like two or three days every single month. So I think there’s a lot of education that I tend to.

give to patients surrounding what’s truly normal and what’s not. And then my approach is I do a full presentation of the options for the patients because ultimately the patient has to be comfortable with what they choose because that’s going to significantly increase the chance that they’re going to stick with that treatment plan. Okay. And so it’s very important that they be

be talked about what options are, even if I’m like, you know, I don’t know that this is the best option for you, but I would have, I would never want you to go down the path that we’re going down and come across this in your own research and say, well, gee, why didn’t Dr. Stuparich bring this up? So I’m, can certainly bring it up. And if I give my professional recommendation that it’s either something I do or don’t recommend, then we can continue to have a discussion. So I just, think that the discussion piece is a very important.

is a very important part. And I would say the majority of my patients ⁓ appreciate that approach. Occasionally I do get the patient that’s like, doctor, what would you do? Like if it was your body, like what would you do? ⁓ Which I mean, you I’m very humbled that they would place their trust in me to ask me that. But I think that it just sets everybody up for success, both surgeon and patient and therefore the team when everybody has all their questions answered.

Ginger Garner PT, DPT (30:25)

Yeah.

Mallory Stuparich, MD (30:43)

and when all of the options have been presented and then the patient can take the information that you are giving and make the best decision for them because again, they’re the expert in their values and their goals of treatment and their body.

Ginger Garner PT, DPT (30:57)

Yeah.

How do you navigate, because that must be a difficult part of the process. Again, because many people think that endo is a reproductive disease only and it’s not. And then they learn about what they’re learning about today and they’re listening to the realities about endometriosis. And it obviously can be in other areas too, but how do you navigate the kind of heavy surgical decisions when endometriosis is in the bowel?

especially in a system that often delays intervention and people are just scared of bowel resection and things like that. How do you navigate those surgical decisions?

Mallory Stuparich, MD (31:36)

Well, I would say from my standpoint now, it’s very helpful for me to have a colorectal surgeon on my team that has experience treating patients with endometriosis. And so I’m very thankful that I have that resource. And I would say, you know, he is more than willing to step in if a patient were to ever need, ⁓ you know, more specific colorectal, ⁓ you know, surgical questions answered. And so that just, you know, to take a step back,

Ginger Garner PT, DPT (31:57)

Yeah.

Mallory Stuparich, MD (32:04)

that just underscores the importance of the multidisciplinary team, both within surgery, but also during the preparation and the recovery period. Okay, it really does take a village to treat the patients. And so we tend to approach it from that multidisciplinary approach.

Ginger Garner PT, DPT (32:08)

Yeah.

Right.

Yeah, yeah. So let’s switch gears just a little bit. ⁓ Because there’s this obvious thing that is kind of the elephant in the room that I think people don’t want to talk about. Maybe they think it’s a distraction from their work, but it’s actually an essential part of what they’ve overcome to get to the place where you are, where you’re a female in the OR and functioning at such a high level. ⁓

Mallory Stuparich, MD (32:47)

Mm-hmm.

Ginger Garner PT, DPT (32:51)

So let’s talk about the obvious, medical gas lighting and gender bias. So, okay, as a surgeon, how do you see misogyny? Or we can internalize misogyny and just turn it on ourselves, right? How do you see that play out in the operating room, like towards patients ⁓ and female surgeons?

Mallory Stuparich, MD (32:53)

Sure. Sure. Sure.

Yes.

Yeah, I…

I think it is an existing component. I think that there are differences in the ways that some surgeons who are women are properly treated. ⁓ Now, I’m not in any sort of like executive or leadership role to like, you know, be getting the complaints of like, you know, staff that might have an issue and

Ginger Garner PT, DPT (33:45)

Mm-hmm.

Mallory Stuparich, MD (33:46)

Have I heard anecdotally about both surgeons who are men and surgeons who are women be brought up ⁓ to governing bodies and OR boards and things like that? Sure, it happens. But I think that there is a little extra care that sometimes surgeons who are women need to take, sometimes with the tone of their voice, how they address some of the OR staff that

maybe surgeons who are men don’t even really think about. And so it is a reality and I think it plays into how OR dynamics work. Do I think it’s the only variable at play? No, it’s not the only variable at play, but it does color how things sometimes get carried out in the operating room and some extra things that I think surgeons who are women need to worry about that maybe surgeons who are men.

don’t have to worry about.

Ginger Garner PT, DPT (34:45)

It is one of the many less burdens that they have to worry about. It’s kind of like when you look at the evidence base on, ⁓ like take the Supreme Court, for example, when they looked at how many times ⁓ the female justices were interrupted, the frequency and the duration of that, and it was clear they were interrupted far more often. But then at the same time, ⁓ if you look at then women being assertive, then they’re also knocked for that.

Mallory Stuparich, MD (34:59)

Mm-hmm

Yes. ⁓

Ginger Garner PT, DPT (35:15)

of being either too aggressive or their tone wasn’t quite right. But yet, statistically looking at that, men are doing that all the time and talking over the women. And so in this particular example, ⁓ Supreme Court Justice ⁓ Sonia Sotomayor said, after they instituted sensitivity training.

Mallory Stuparich, MD (35:15)

Right.

Correct.

Right.

Mm-hmm.

Ginger Garner PT, DPT (35:38)

Okay, we can appreciate that. After they instituted sensitivity training of like basic manners, like golden rule, like don’t interrupt the female justices when they’re talking, that things got better. But at the same time, they also instituted training that actually masculine, like created a more masculine environment for the female justices in the court where they actually became more assertive and the balance was better. But

Mallory Stuparich, MD (35:43)

Mm-hmm.

Correct.

Okay.

Mmm.

Ginger Garner PT, DPT (36:07)

I don’t know if we’re that far evolved in an OR where you could just be more assertive because it seems like that’s the time where then women are knocked for being assertive, but yet it’s just assumed that men can do that and not get into any trouble.

Mallory Stuparich, MD (36:22)

Right. And, and I think going back to your point, some of the things that that I’ve experienced, mean, one example that popped into my head as you were mentioning what you’re mentioning was the number of times I have to repeat myself ⁓ to maybe get something, you know, it’ll be like, can I can I get the, you know, this instrument? Okay, they didn’t hear me. Can I get this instrument? they didn’t hear me.

Ginger Garner PT, DPT (36:38)

Yeah.

Mallory Stuparich, MD (36:48)

And it’s like, can I get this instrumented by that? By that time, it’s like I’m screaming and it’s like I don’t not did not mean to scream or somebody might have interpreted it as screaming. Whereas it’s just like, OK, you didn’t hear me the first two times that I said this. ⁓ I’ve even you know, sometimes the staff will maybe start to play music and, you know, I think.

Ginger Garner PT, DPT (36:54)

Yeah.

Yeah.

Mallory Stuparich, MD (37:13)

given the right vibe, know, music can be appropriate in the OR, but sometimes it’s too loud. And so I have to be like, can we make the music lower because I can’t communicate with my team effectively. And so, you know, it’s just, ⁓ yeah, I mean, there’s all sorts of stories and experiences that have happened. So.

Ginger Garner PT, DPT (37:32)

I think

that we have as a society failed to normalize women in leadership positions. I think that’s really, it’s a global failure everywhere, particularly in the United States when you think of the UK having a prime minister in what, the 70s? know, Margaret Thatcher in the 70s. And we still really have failed to have, know, women have broken the glass ceiling. So I think it is a failure of normalizing women in leadership positions.

Mallory Stuparich, MD (37:39)

rates.

Yes.

Mm-hmm. Right.

Ginger Garner PT, DPT (38:02)

and that women having a voice when you think of women’s rights in general, if women couldn’t even get a credit card without their husband’s permission until like 1973.

Mallory Stuparich, MD (38:05)

Mm-hmm.

Right, right, exactly.

Ginger Garner PT, DPT (38:13)

Women leading

in any capacity is ⁓ pretty much brand new.

Mallory Stuparich, MD (38:18)

Yes, it is a brave new world out there.

Ginger Garner PT, DPT (38:21)

It is. It’s like we’ve had those rights for like five seconds, you know, in all of time and space.

Mallory Stuparich, MD (38:24)

Right. And I,

right. And I was going to say to even expand upon that more, especially in the world of OBGYN, where overwhelmingly the residency, if you looked at the gender identification of like the current residents, it’s like 80 % people who identify as female. Yet when you look at

you know, especially in academics, because it’s easier to kind of track these things. But when you look at academics and the percentage of people who identify as women who are assistant clinical professors, who are associate clinical professors, and who are full clinical professors, that number shrinks dramatically to where it skews very, you know, towards towards people who identify as men. And and so it’s it’s like, well, we have to ask ourselves, like, what’s going on? And it’s very multifactorial, you get into

Ginger Garner PT, DPT (39:09)

Absolutely.

Mallory Stuparich, MD (39:18)

know, paid family leave, you know, the mental load of tasks that disproportionately gets placed upon people who identify as women. And unfortunately, the sad reality is just so many women are either going part-time in medicine or they’re leaving medicine altogether.

Ginger Garner PT, DPT (39:36)

Or they never enter because they go,

they’re in college and they’re in undergrad and saying, I better not choose that because I want a family one day, which boys don’t ask that question. They’re like, what do I want to do? This is what I want to do. I’m going to go do it. But the number of friends that I have as a Gen Xer, the number of friends that I have as a Gen Xer who chose their career based on becoming a mother is the majority of women that I know in the Gen X field.

Mallory Stuparich, MD (39:43)

correct.

Yes, yes, yes.

Mm.

Yeah.

Ginger Garner PT, DPT (40:01)

that they actually turned down careers which they were perfectly suited for in medicine or engineering because they wanted to be flexible. Well, I’ll just be a teacher then. Not that just being a teacher is just being a teacher. That’s a massive undertaking. like exactly, bowing down to all the teachers of doing it like right now, it’s amazing and we should pay you more, but we undervalue caring professions. That’s also part of the inherent misogyny that we’re not valuing caregiving professions.

Mallory Stuparich, MD (40:13)

No. Correct. Yeah, bow down to the teachers. Exactly. Absolutely. Right. Right.

Yes.

Ginger Garner PT, DPT (40:31)

We’re not valuing female surgeons in the OR. We’re not valuing female surgeons in leadership and in academics. If you look at APTA, it was founded by women in 1921. Look at the leadership.

Mallory Stuparich, MD (40:34)

correct.

correct.

Mm.

Ginger Garner PT, DPT (40:45)

It’s not women. The highest tiers of paid PTs, okay, in the United States, not women. But, so I think the next question is, we’ve established this a problem, like the Supreme Court has a misogyny problem, like if the Supreme Court has a misogyny problem, okay, it’s a given, right? And there’s all these stats to support it. So it’s inarguable, it just is what it is. But what do you think institutions can do to reduce, you know, and…

Mallory Stuparich, MD (40:47)

Yes, I know, I know, yes.

not women. Yeah.

Right.

Ginger Garner PT, DPT (41:15)

stop normalizing the gaslighting that happens, not just from a of a women’s rights and acknowledgement and leadership standpoint, but overall, if you stand back from a 40,000 foot view, women are being gaslit and are victims of medical misogyny, but when they have endo, they’re not getting the care they need and it’s delayed. So what do you see as kind of a shift and change in that? How do we do that?

Mallory Stuparich, MD (41:18)

Mm-hmm.

Right. Right.

How do we address it with patients in endometriosis? No, it’s like the $64,000 question. ⁓ I think, I mean, some of the mantle that I’ve taken up is really educating colleagues. ⁓ You know, even people outside of just the world of obstetrics and gynecology. So ⁓ a colorectal surgeon that I previously worked with, ⁓ he would…

Ginger Garner PT, DPT (41:44)

Yeah, like small question, no pressure. Yeah, it is.

Mallory Stuparich, MD (42:12)

he mentioned to me, was like, he’s like, I am happy to help you. I want to let you know, I did not do a lot of endometriosis cases in my fellowship. And I was like, well, come on into your unofficial fellowship, and I will teach you about endometriosis. And, and so that was like a very nice, I think, ⁓ really ⁓ collaborative ⁓ relationship that we that we had. And so, and it actually ended up ⁓

that the fellows I was working with at the time, now they would rotate with him. And so they would get colorectal surgical experience. And I think that was because of some of the nice collaborative relationship that we had fostered as far as caring for patients. So I think colleague education is really paramount. ⁓ Anytime I’m in the operating room, and especially if I have other observers or students or residents or fellows, I think that is a

key and crucial opportunity to educate them about the disease process. And sometimes I’ll even start off by telling, by saying, hey, you Joe or whoever, whatever your name is. I don’t say whatever your name is. I ask them their name, but I’ll say like, hey, medical students, ⁓ tell me what you know about endometriosis because I just want to know where are we starting from? Like what, what is our baseline understanding?

And a lot of times they’ll say, ⁓ you know, yeah, it’s endometrium outside of the uterus. And I’m like, we’re going to take a pause right there because we’re going to talk about how ⁓ I was like, you’re on the right track, but I’m going to tell you that it’s not what we consider to be utopic or true endometrium located outside of the uterus. Because if it was that and it behaved in the exact same way that endometrium behaves,

then birth control would work so much more than it does. So this is tissue that’s similar to or endometrial-like tissue. And I know that sounds like such a semantic difference, but it really underscores why a lot of the treatments that we tout as working don’t work well all the time. So I think understanding where your learners are coming from and knowing their foundation.

Ginger Garner PT, DPT (44:12)

huge.

Mallory Stuparich, MD (44:25)

Sometimes they’ll throw out, yeah, I heard that’s formed by retrograde menstruation and the blood coming out of the fallopian tubes. And I’m like, well, there are a lot more theories actually than just that because that theory doesn’t explain many of the other instances that we find endometriosis, diaphragmatic, chest or thoracic cavity endometriosis. And so…

Ginger Garner PT, DPT (44:46)

Yeah.

Mallory Stuparich, MD (44:48)

you know, I think there’s a lot more of a big picture and clearly a lot more research that’s needed for both disease mechanism as well as therapies. So I like to open up that conversation with learners ⁓ and then extrapolate that. mean, I’m not sitting there quizzing the colorectal surgeon, like, what do you know about endometriosis? You know, it’s a much more, you know, ⁓ collaborative relationship and it’s approached from a different way. But I think

education all around for patients, for learners, like for medical learners, as well as colleagues is just it’s so crucial to spreading awareness because the first thing we have to know to fix a problem is that there’s a problem. Exactly.

Ginger Garner PT, DPT (45:31)

that it exists

and it’s such a systemic whole body disease. Yeah. So that speaks volumes to how you’re teaching clinicians to reframe their approach to the red flags. Like ⁓ if someone says, I have pain with painful bowel movements, right? That they just don’t pass it off as constipation. That they just tell them to go take Miralax or eat some more fiber and drink water and have a nice day.

Mallory Stuparich, MD (45:37)

Right.

Mm-hmm.

Right.

Ginger Garner PT, DPT (46:01)

Or they say sex hurts, that they’re investigating that just a little bit more. Okay, so recap. We have spoken openly about systemic failures in gynecology, how we can be better, ⁓ how we can as women in the field ⁓ have pushback from colleagues or institutions or whatever for speaking out, how…

Mallory Stuparich, MD (46:01)

Great. Yep.

Yes.

Mm-hmm.

Ginger Garner PT, DPT (46:29)

You can take social media and use it in an ethical way as a platform for medical truth telling, for patient empowerment. ⁓ You have spoken about what you wish more medical students knew and how you are educating them, residents in the OR about endo and getting them to come in. And I think that also applies to across the board, with that multidisciplinary team of

realizing that people will need, probably most women, I think, will need access to quality mental health where people understand what the struggle is. Not because they have inherently, know, inability to handle the stress. It’s because usually they’ve been gaslit for so long and their diagnosis has been delayed. That’s traumatic. And now they have some kind of form of, you know, PTSD or even complex PTSD as a result. All right, so.

Mallory Stuparich, MD (47:12)

Mm-hmm.

Right. correct.

And

I was going to say, and to go through that journey, perfectly reasonable to have somebody there for support, for mental health support, because it’s no secret that the patients have been on this road for a long time. And to have a ⁓ neutral party to be there to be able to provide support in going through something as

Ginger Garner PT, DPT (47:36)

Yeah.

Mm-hmm.

Mallory Stuparich, MD (47:55)

that’s as much of a discovery, going through the consultation, getting the ultrasound, getting the MRI, and then ultimately having, in many cases, what can be very major surgery. I think we really need to normalize that this is a perfect opportunity for somebody to have a mental health professional and somebody to support them through that.

Ginger Garner PT, DPT (48:07)

Yeah.

Yeah, it really is kind of the perfect storm. I think something you touched on too about support is important because a lot of patients that I see ⁓ with endo come in sometimes with support, but sometimes their biggest pain point, other than the obvious pain of endo, is that their own family is gaslighting them. Like you were fine last week, why are you not fine this week, right? ⁓ but you’re…

Mallory Stuparich, MD (48:42)

Mm-hmm.

Ginger Garner PT, DPT (48:48)

you’re healthy person, so how could you possibly be sick because you work out and you have a full-time job? it’s almost like they’re faking it, know? Like they insinuate that somehow they’re faking it because they’re fine one week and flat on their face the next week. And I think that can’t be talked about enough ⁓ because that’s heartbreaking when you don’t even get support from your own family and they misunderstand because they don’t even know, they don’t understand the disease process.

Mallory Stuparich, MD (49:15)

Right. Yeah, I would agree with that. I mean, I think that the family members and I welcome family members into the consultation because I’m like, listen, the more education and understanding you have about this disease process, the better. And I mean, the disease very much for an invested partner or friend or relative, it affects them so much because

they see their family member or their friend suffering and they’re like, what can I do? You know, I can imagine they have like very much a feeling of helplessness. And so I really think that bringing the partners, the friends, the relatives, the family into the fold is so crucial to be able to give that support to the patient who’s bearing all of the testing and the treatment. So such a crucial piece.

Ginger Garner PT, DPT (50:12)

Yeah, so that kind of is perfect segue into talking about the human side of medicine. ⁓ What gives you hope when working with complex endo patients in cases who have frankly been failed by the system?

Mallory Stuparich, MD (50:30)

Yeah. I think when what gives me hope is them telling me, you know, for example, when we’re sitting in the first consultation or the consultation together and they’re like, you know, you’re the first doctor that’s ever listened. ⁓ That gives me hope because I’m ⁓ I did a live with Dr. Hunkin and she got me a very nice I was like, you know what I need? I need like a

a little plaque to put on my desk that says the gas lighting stops here. Like the buck stops here, but the gas lighting stops here. And so she actually went and had one made for me. It was very, very thoughtful, very, very thoughtful. So it’s sitting on my desk in my office. And I really, for as many patients as I can, I want that to be what happens.

Ginger Garner PT, DPT (51:03)

Yes. I love it. I love it.

Mallory Stuparich, MD (51:21)

Like I’m not going to tell you if you are coming to me with a concern, clearly it’s something that you have thought about for a long time or been experiencing for a long time or both and all of the above. And let’s work this up together to the capacity that I can as a medical professional. And if I reach a limit to where I have exhausted my resources, then let’s come up with other options. It’s a very much a let’s go together. We’re a team in this together.

I’m happy to be, I think I was also like, feel like I’m kind of a sherpa for patients as well, like an endometriosis like sherpa to help them like lead, yeah, like lead them in this. because I’ve been there with other patients before, but obviously this is the first and first time, maybe the only time for some patients that they’re gonna be going through something like this. And so…

Ginger Garner PT, DPT (51:55)

Yeah.

I love that. That’s the first time I’ve heard that.

Mallory Stuparich, MD (52:18)

that gives me hope. Them saying that that was, you you’re the first doctor to listen to me. I’ve never had a doctor say these things. I think what also gives me hope is when I hear back from patients. You know, I see patients that have fertility struggles as a result of endometriosis. And so when they have ⁓ success in the fertility world, I tell them, I’m like, please keep me posted, because that really helps give me hope that, you know, what I’m doing is making a difference.

or just hearing back from patients that are like, was debilitated, I suffered and suffered, and now I can go on hikes and I can travel and things like that. So things like that give me hope.

Ginger Garner PT, DPT (53:02)

Yeah, that’s also very protective, I think, for you, for your well-being. Like, you’re in this emotionally and politically charged system where we need less misogyny, we need more research funding, we need more of everything, we need more resources and better access and insurance companies covering things. It’s like, ooh, that has to keep you going on a day-by-day basis. Yeah.

Mallory Stuparich, MD (53:16)

Yes. Yes.

Mm-hmm.

Mm-hmm. Yes, there’s a lot that we need.

Ginger Garner PT, DPT (53:28)

Yeah, there’s a lot of needs for women’s healthcare for sure. ⁓

Mallory Stuparich, MD (53:28)

Yes. Yes. Absolutely.

Ginger Garner PT, DPT (53:33)

Okay, so some parting, a parting question, I think, two things, this is two part. One, if you could redesign pelvic pain care from the ground up, what would it look like? And okay, we’ll stop there and then I’ll ask the second one. Because that’s kind of a big one. Yeah.

Mallory Stuparich, MD (53:36)

Yeah. Okay.

Okay, okay. You’re like very excited. ⁓

So I think some way to screen and detect early, some way to screen and detect early, ⁓ just like we have, you know, screening for cervical cancer, just like we have screening for breast cancer, is there some way that we can screen or detect endometriosis early? Because as somebody who

you know, lives and breathes and operates on endometriosis all the time, I will tell you, for the most part, it is much easier to operate on early stage disease than it is to operate on advanced stage disease. So the earlier or the more that we can collapse that diagnostic delay that happens by either like even if somebody got a blood test and it’s, you know, says like comes back positive for endo or negative for endo, then those patients would be able to be referred to

people who are experts that can do the appropriate imaging, have the teams in place and be able to counsel them about their options with the most up-to-date evidence that we have. So I think early detection and screening would be great. And I would say as a corollary to that education of patients and also other medical professionals, having a place in a curriculum for medical school. ⁓

Ginger Garner PT, DPT (55:09)

Mm-hmm.

Mallory Stuparich, MD (55:09)

and then

just education of patients and colleagues to undo that normalization that has happened and has been so detrimental to many women.

Ginger Garner PT, DPT (55:20)

Yeah, yes, yes, yes, yes. Just say that again, yes. So, ⁓ all right. Two things, one is what message do you want listeners, especially those who’ve been dismissed or misdiagnosed, what do you want them to walk away with and where can people find you?

Mallory Stuparich, MD (55:23)

Yes.

Yes. I think in addition to the gaslighting stops here, I think one of my classic ⁓ public service announcement campaigns I would have if I could have one is to just have billboards all over the place that says painful periods are not normal. I mean, it’s simple, it’s to the point, and anybody who is debilitated by their period pain, it’s not normal. I don’t care what anybody else tells you. It’s not normal.

Ginger Garner PT, DPT (55:57)

yes, yes.

Yeah.

Mallory Stuparich, MD (56:09)

and it’s not a way to live. And then I would say that the easiest places to find me are of course on my socials across all platforms. I’m at mallorystuparichmd ⁓ Also ⁓ the practice website is ⁓ internationalendo.com. And then that would be the way that patients would be able to request a consultation to come and see me.

Ginger Garner PT, DPT (56:33)

Fantastic. Everyone, the amazingness of Dr. Mallory Stuparich. Thank you so much for being here, Mallory.

Mallory Stuparich, MD (56:40)

Thank you so much for having me. It’s been a pleasure.