Category "Dr. Cook"

Introducing :

The Endometriosis Health & Diet Program, co-authored by Dr. Andrew Cook and Danielle Cook.

This comprehensive, integrative program for treating endometriosis, and serves as a starting point for building an individualized program. It explains the medical side of endometriosis and how lifestyle factors may impact the disease — it answers the “why” of this condition, including ways to strengthen your body to optimize your health through detoxification and stress reduction. This program includes 100 delicious inflammation reducing recipes and useful tips to manage symptoms and potentially slow or halt endometriosis disease.

Now available for order on Amazon: The Endometriosis Health & Diet Program


Ready to start your healing journey? Request a free virtual consultation today.

Please tune into your local CBS station to see Dr Cook on Monday, 12-5-16, on The Doctors TV Program. It will air in California at various times, depending on location.  For those unable to watch the program at the airing time, there will be a post airing video available on our website, our Facebook page, and on The Doctors CBS website.  San Francisco Bay Area residents can view on KRON-TV at 2pm, Los Angeles Area can view on KCAL-TV at 11am.

Director and Producer Shannon Cohn announces the premier screening of her documentary film Endo What? this April 13th at the Delaney Street Theatre in San Francisco.  Please join Dr. Andrew Cook and Libby Hopton, Director of Research & Evidence Based Medicine, as we gather with a group of esteemed panelists to answer questions on Endometriosis, and discuss issues relating to public awareness of this disease. Don’t miss your chance to view this important film which includes heartfelt stories from patients and insightful commentary by world renowned Endometriosis experts and leaders in the field.  Tickets are available on the Endo What? website at

Announcing ~  Special 25% discount on tickets when you enter VitalHealth on the tickets page !  Special thanks to Shannon Cohn for this discount offer for all of our patients and Facebook fans ! 

Congratulations to Director and Producer Shannon Cohn, along with her production team : Patricio Cohn, Producer and Cinematographer, and Arix Zalace, Producer / Editor for this fine production.  We would like to extend a special thank you to the women in this film who so bravely and generously shared their stories and personal experiences. These testimonies have contributed greatly to the core content and are truly instrumental in depicting the impact of Endometriosis on women worldwide.  




Are you sometimes so bloated that you feel like you are pregnant? Or even had people ask you if you are pregnant? Do you have an extra set of clothes set aside for those times when you are so bloated that it’s time for a wardrobe switch? Maybe you are like Samantha, a woman just trying to deal with this painfully inconvenient, embarrassing physical disruption, along with all of the other frustrating and painful effects of Endometriosis.

We met Samantha in a forum recently, and she agreed to share her story and photo. She says: “I now only go out to doctors/hospitals or dentist as I cannot cope with people thinking and staring at me thinking I am pregnant. Every doctor blames the bloating on something else, but no one has investigated or tried to do anything about it. I would be so grateful for any help, as I feel totally alone.”

The severe bloating that goes hand-in-hand with endometriosis is too often dismissed by doctors as a minor symptom. For the patient, however, this symptom can be emotionally and physically devastating.

Endo Belly is also an example of the wide array of symptoms endometriosis patients experience and one of the very common misunderstandings about this disease. Physicians, patients, and even endometriosis specialists often misunderstand the root cause of many “endo symptoms”. Are they always a result of endo, or could there be other causes?

Good progress has been made on increasing awareness of endometriosis and optimal treatment. Proper surgical treatment of endometriosis requires wide excision of the endometriotic implants rather than just burning or cautery. Surgery that simply burns the surface of the implants leaving underlying disease behind is often associated with either continued symptoms or recurrence of symptoms soon after surgery.

This is not the full story, however, and to truly understand this condition, we need to raise awareness of the missing pieces in the puzzle. In my 25 years of practice specializing in endometriosis, I have come to appreciate the complexity of the pattern of symptoms many of my patients deal with. While approximately half of my patients are primarily affected by endometriosis, which is effectively resolved by excision surgery, the other half have other conditions or health problems that co-exist with their endometriosis. In this latter group of patients, while excision surgery provides the foundation of their treatment, complete resolution of their symptoms requires that we address additional health problems, including multi-systemic dysfunction. In these patients, it is a mistake to automatically assume that continued symptoms after surgery are due to persistent or recurrent endometriosis. The real problem may well extend beyond this diagnosis and often encapsulates other often-related health conditions that may masquerade or be overshadowed by the initial diagnosis of endometriosis.

“Endo Belly” can be the result of endometriosis implants and may get better after surgical removal of the disease. Endometriosis implants, however, are not the only cause of “Endo Belly”.

One such example is the infamous “Endo Belly”. While “Endo Belly” can be the result of endometriotic implants, and may resolve after complete excision of all endometriosis, this is certainly not always the case and other health problems can also cause or contribute to those all-too-familiar flares of extreme bloating and distention. At our center, we therefore approach endometriosis and its associated health problems from a multi-disciplinary paradigm including traditional medicine (e.g., excision surgery), as well as a variety of integrative and holistic modalities.

Our approach is based upon the most recent scientific information. We treat the whole patient, not simply surgical removal of the endometriosis implants. One example of this is the role of the bowel, including the human microbiome (the bacteria that live in our bowel), in causing pelvic pain and other health problems. We will discuss below the importance of gut bacteria as a contributing causal factor in bloating and “Endo Belly”. This is a very brief overview and covers just a few of the important facts about the critical impact of our intestinal health on our overall health.

Best wishes,

Dr. Andrew Cook

Gut Bacteria & Endo Belly – Why You Look & Feel So Bloated

What does your gut bacteria have to do with that annoying bloating and gastrointestinal discomfort? A lot!

We have more bacteria living in our guts than we do human cells in our body. We have a balance of beneficial (commensal) bacteria and potentially pathogenic bacteria (disease-causing unfriendly bacteria). This is actually one of the most complex ecosystems in nature. It is important to maintain a healthy balance of bacteria in the gut.

These beneficial bacteria are not simply along for the ride, but rather, they play a critical role in our health. For example, they are involved in digesting food that we eat, producing vitamins such as vitamin K2 and biotin, converting thyroid hormone into its active form, detoxification, reducing inflammation, reducing pathogenic forms of bacteria, and energy production. These are only a few of their important jobs! We also have yeasts and viruses in our guts. It’s important to keep a healthy balance of these microorganisms in our guts too.

Gastrointestinal problems can be a result of bacterial problems in the small and/or large bowel. Most of the bacteria are in the large bowel. A little is in the small bowel, but not nearly as much as in the large bowel. Dysbiosis is a condition where an imbalance in beneficial and potentially disease producing pathogenic bacteria occur in the bowel. SIBO (Small Bowel Intestinal Overgrowth) is a condition where the bacteria from the large bowel migrate up into the small bowel. With SIBO, the disease-producing of bacteria in the wrong location is exposed to undigested food, which it eats and turns into a large amount of gas (bloating, pain, indigestion).

Factors that may negatively alter the sensitive bacterial balance lead to dysbiosis or SIBO and include:

  • Antibiotics (with certain antibiotics it can take up to 2 years to regain a healthy microbial balance in your gut)
  • Chronic stress
  • Non-steroidal anti-inflammatories (NSAIDS)
  • Constipation
  • Standard American Diet (SAD diet – high in unhealthy fats, processed carbohydrates, and sugar and low in fiber and vegetables)
  • Food allergies and Sensitivities
  • A weakened immune system
  • Intestinal infections (such as yeast overgrowth) and parasites
  • Inflammation
  • Poor function or removal of the ileocecal valve (valve between the small and large intestine)

There are several common symptoms of dysbiosis and SIBO. You may be experiencing several of them. They include :

  • Bloating, belching, burning, flatulence after eating
  • A sense of fullness after eating
  • Indigestion, diarrhea, constipation
  • Systemic reactions after eating (such as headaches and joint pain)
  • Nausea or diarrhea after taking supplements (especially multivitamins and B vitamins)
  • Weak or cracked finger nails
  • Dilated capillaries in the cheeks and nose (in a non-alcoholic)
  • Iron deficiency
  • Chronic intestinal infections, parasites, yeast, unfriendly bacteria
  • Undigested food in stools
  • Greasy stools
  • Skin that bruises easily
  • Fatigue
  • Amenorrhea (absence of menstruation)
  • Chronic vaginitis (vaginal irritation)
  • Pelvic pain

Dysbiosis is not uncommon in women with endo. Endometriosis-associated intestinal inflammation may alter the balance of gut microflora.[i] Balley and Coe investigated the intestinal microflora in female rhesu monkeys and found an increased amount of intestinal inflammation and fewer aerobic lactobacilli and gram negative bacteria in monkeys with endometriosis compared to those without the disease. A disruption in the gut microflora (dysbiosis) can have negative health consequences including poor digestion, malabsorption of nutrients, increased inflammation, and increased gastrointestinal infections.[ii] Intestinal microflora act as a barrier to gut pathogens by blocking attachment to the gut-binding site and produce antibacterial substances.

Problems with an overgrowth of bacteria in the small bowel can also result in the common gastrointestinal complaints among women with endometriosis. Recent studies have demonstrated the presence of Small Intestinal Bacterial Overgrowth (SIBO) in women with endometriosis.

In one study, 40 out of 50 women with laparoscopic confirmed endometriosis were found to have SIBO. [iii] SIBO needs to be considered as a contributing factor anytime a woman has severe bloating.

The gut also plays an important role in estrogen elimination. Phase II detoxification in the liver (medical term for the process of eliminating many hormones including estrogen) utilizes conjugation of estrogen to other compounds so they can be excreted in bile.[iv] If the gut flora is unbalanced, certain bacteria secrete an enzyme called beta-glucuronidase, which cleaves the glucuronide molecule from estrogen, allowing estrogen to be reabsorbed into circulation vs excreted in the stool. Lactobacillus, a healthy bacteria, decreases the activity of B-glucoronidase.[v] If the activity of B-glucoronidase is increased, more estrogen will be reabsorbed and potentially worsen the endometriosis.

Do you have any of these symptoms? If you do, they may be caused by more than your endo inflammation. If you have these symptoms after good quality endometriosis excisional surgery, your endometriosis is gone, but your symptoms may be a result of other conditions such as the ones discussed above. Some tests that may be performed include a hydrogen/methane breath test, a comprehensive stool study through a lab such as Genova Diagnostics, organic acid testing, and food sensitivity testing. There may also be therapeutic diets that can be helpful for symptom management such as the Specific Carbohydrate diet, the FODMAP diet, the Microbiome Diet, and the Autoimmune Paleo Diet. There is no one size fits all treatment for dysbiosis. Some diets that help with dysbiosis can make SIBO worse. A qualified practitioner can help to determine what studies and treatment may be helpful.  Some of the lab tests which may be relevant are included in our Specialized Lab Testing at Vital Health Endometriosis Center.

You may be interested in this video : Enterome: the gut microbiome and it’s impact on our health:

Wishing you a happy and healthy day,

The Vital Health Team

Vital Health Endometriosis Center continues to provide the most comprehensive approach to the diagnosis and treatment of endometriosis.

Ready to start your healing journey? Request a free virtual consultation today.

Visit Our Resource Center to Learn More About Endometriosis

Read & Share What it Really Means to Have Endometriosis


[i]. Balley M, Coe C. Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction. 2002;17(7):1704-1708.

[ii]. Miniello V, et al. Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta. 2015. Web. Accessed February 25, 2015.

[iii]. Mathias JR, Franklin R, Quast DC, et al. Relation of endometriosis and neuromuscular disease of gastrointestinal tract: new insights. Fertil Steril. 1998; 70:81-88.

[iv]. Evans, J. An integrative approach to fibroids, endometriosis, and breast cancer prevention. Integrative Medicine. 2008; 7(5):28-31.

[v]. Goldin BR, Gorbach SL. The effect of milk and lactobacillus feeding on human intestinal bacterial enzyme activity. Amer J Clin Nutr. 1984;39(5):756-61.


The Endo Patient’s Survival Guide, co-authored by Dr. Andrew Cook, Libby Hopton and Danielle Cook, is the essential patient’s companion to living with and overcoming endometriosis and pelvic pain: from seeking help and getting an initial diagnosis to navigating treatment options and achieving optimal relief and wellness.

The guide is now printed and available for order on

Endo Guide cover FINAL1


Endometriosis tortures people. It doesn’t kill them but there are times when you may wish it would kill you.

CBS news LA covers the story of Leslie Valladares, a former patient of Dr. Cook who had her life transformed following his specialized endometriosis excision surgery. Leslie had suffered for years with the crippling symptoms of endometriosis and had been unable to find relief, despite enduring surgeries and rounds of hormone therapy with several doctors. After exhausting all her options locally, she decided to travel to Los Gatos to undergo surgery with Dr. Cook, world-renowned specialist in endometriosis, and went on to make a full recovery.

We hope that Leslie’s courage in sharing her story will bring hope to other women who are struggling to live with the same debilitating symptoms.

Have Dr. Cook review your case
Find out about the unique endometriosis treatment program at Vital Health Endometriosis Center


I just love bowel preps! ~ Said nobody ever

The purpose of the pre-operative bowel preparation is to cleanse your intestinal tract so that it can be safely operated on. While this process is unpleasant to endure it is absolutely necessary in minimizing the risk of complications during bowel surgery.

There are several bowel preparations on the market. Some involve drinking large volumes of laxative drink while others combine a single laxative drink with an enema solution or oral tablets. The prep may be combined with a low fiber diet during the days that precede it, and on the day of the prep (the day before surgery), you will be required to follow a strict diet of clear liquids only. Whichever method you are given, be sure to follow all instructions carefully.

Tips on getting through the bowel prep

  • Eat lightly the days prior to the prep. This should make cleansing your intestines a little easier.
  • Some patients find the prep drink difficult to palate because of the unpleasant taste. Allowing it to cool in the fridge or packing it in ice in the sink may make the drink that little bit more palatable.
  • To get the unpleasant taste out of your mouth, follow-up the prep drink with something pleasant tasting such as broth, a hard boiled sweet, or chewing gum (but be sure to keep to the dietary instructions provided by your physician).
  • Drinking the prep through a straw can help reduce contact with your taste buds as the liquid passes through your mouth.
  • If you feel nauseous try alternating between a pleasant tasting liquid, such as broth, clear fruit juice, and ginger ale, and the prep. Ginger is good against nausea. Either sipping ginger ale or sucking on boiled ginger candy may help. Another trick is to compensate and counteract the unpleasant taste with something pleasant smelling, such as scented candles or a handkerchief sprayed with your favorite perfume. Lavender scents are good against nausea and can help boost pain tolerance (such as intestinal cramps).
  • Be sure to remain hydrated during the prep. Drink plenty of clear fluids throughout.
  • Once the cleansing process begins, use wet wipes instead of regular toilet paper and apply topical non-prescription hemorrhoid cream, which contains a local anesthetic and will numb the area. This will help prevent soreness and discomfort.
  • Once the prep begins to take effect you may start to experience intestinal cramping. Applying a heat pad or ice pack may help sooth this pain.
  • Provide yourself with pleasant distractions – reading materials, puzzles etc. to tide you over during the prep.
  • Lastly, remind yourself that many have gone before you and that this is the last hurdle before a surgery that will hopefully provide you with ongoing relief from your pain. You can do it!

Remember, this is the last hurdle before a surgery that will hopefully provide you with ongoing relief from your pain. You can do it!

The typical medical treatment for endometriosis provided by most OBGYNs consists of manipulating a woman’s hormones, primarily her estrogen and/or progesterone levels. The rationale behind this treatment is that estrogen tends to stimulate the growth of endometriosis and progesterone is believed to balance or stabilize the effect of estrogen. In a very simple example, one can think of estrogen as fertilizer for the lawn and progesterone as the lawn mower. The goal of medical treatment of endometriosis is to increase the ratio of progesterone to estrogen (progesterone-only treatment), decrease the amount of both estrogen and progesterone (combinational birth control pills) or to eliminate estrogen from the body (GnRH agonist treatments such as Lupron and Zoladex).

Unfortunately, all hormone therapies commonly employed to treat endometriosis are fairly crude and are frequently associated with unacceptable side effects, making these medications difficult to tolerate. Some patients find the side effects even more debilitating than the symptoms of the disease itself. Hormone therapies do not provide a cure for the disease, are only effective in a portion of endometriosis patients, and even when this treatment option provides relief the results are typically short-lived and symptoms return. Furthermore, hormone therapies are not appropriate in patients presenting with infertility or who are trying to conceive. Even use of a GnRH agonist such as Lupron that causes a temporary medical menopause is frequently ineffective in managing endometriosis as endometriotic tissue itself can produce its own source of estrogen, allowing it to remain active and symptomatic despite the treatment.

When should hormone therapies be considered?

If hormone therapies are only temporarily effective in some patients and do not make the endometriosis go away nor necessarily stop the disease in its tracks (treating the symptoms but not the disease), why are they so commonly prescribed?

When a patient first presents with pelvic pain, and in particular period pain, the doctor and patient face a dilemma: How long should her symptoms be managed symptomatically (via medical therapy) and at what point should more invasive treatment options be considered (such as laparoscopic surgery) to actually diagnose and treat any underlying disease? On the one hand the patient wants to avoid unnecessarily invasive treatments and the risks associated with surgery (albeit minimal,) yet on the other hand she also wants to get to the root of her problem so that it can be effectively treated and she can get on with her life. This is obviously a very personal decision that needs to be made based on the severity of symptoms and the individual needs and priorities of the patient. Importantly, however, the patient needs to be informed of her options so that she can play an active role in the decision-making process.

Prescribing hormone therapies requires limited expertise and is a treatment option that is readily available to all. Surgery, in contrast, may require a level of expertise that most OBGYNs do not have. Moreover, if a patient is presenting with erratic and painful menstrual periods, a prescription of birth control pills may lighten, regulate and shorten her periods, easing her pain. It is when a patient keeps returning to her doctor complaining of the same symptoms despite trying different hormone therapies or cannot tolerate the side effects, that it is time to consider other treatment options.


A condition that is common among women with endometriosis is adenomyosis. Adenomyosis is when endometriotic tissue is found within the muscular walls of the uterus. Typically these areas of rogue tissue are scattered diffusely throughout the muscular uterine walls and so are not amenable to surgical removal. Endometriosis patients who also have suspected adenomyosis may find that some of their pelvic pain persists despite endometriosis excision surgery. While surgery to destroy or sever the nerves that innervate the uterus may help reduce this residual uterine pain, in most cases the only curative surgery for adenomyosis is hysterectomy (removal of the uterus). Obviously, many women will not be a position to undergo hysterectomy because they wish to retain their fertility. In these patients, conservative management of the chief symptoms of adenomyosis (pain and abnormal uterine bleeding) with hormone therapy provides an important alternative.

Pre-operative ovarian suppression

Another example where hormone therapy may be appropriate is in managing pain in patients who are waiting for surgery. For example, a teenage patient who plans her surgery during her school vacation so as not to disrupt her studies may benefit from hormone therapy to manage her symptoms and help her function in the mean time. Importantly, however, it is best that the patient is not on ovarian suppressive therapy shortly before or at the time of her surgery as this can hamper the surgeon’s ability to visualize all areas of disease. Ideally, all ovarian suppressive therapy should have be discontinued 6-8 weeks prior to surgery.

Should hormone therapies be prescribed following surgery to prevent recurrence?

If a patient has undergone the complete surgical removal of her endometriosis and her pain has been resolved there is no clinical indication for continued use of hormone therapies (other than for contraceptive purposes). Post-operative hormone therapy has not been found to reduce the rate of symptom nor disease recurrence. Recurrence of endometriosis rarely occurs following the complete excision of the disease regardless of whether the patient follows up surgery with hormone therapy.

Post-operative ovarian suppression following cystectomy

Some surgeons recommend post-operative hormone therapy following endometrioma (cystic ovarian endometriosis) removal (cystectomy) with the hope that ovarian suppression will reduce the risk of recurrence of the endometrioma(s). Research into this, however, has been inconclusive. Another reason for post-operative ovarian suppression following endometrioma removal is to give time for the ovary to heal before ovulation recommences, which might otherwise cause additional pain during post-operative healing.

Further reading

For more information on different types of hormone therapy, common side effects and their efficacy in treating endometriosis and adenomyosis,, check out Dr. Cook’s in-depth patient guide to hormone therapy treatments.


Copyright © 1996-2018 Vital Health Endometriosis Center. All rights reserved. Web Design by WorldLight Media