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Innovations in Endometriosis Diagnosis, Pelvic Pain Management, and Patient Support | Margaret Melville

Listen to Margaret Melville of Lasa Health discuss the resources and technology available for early endometriosis diagnosis, pelvic pain management, and patient support.


Episode Summary

In this first episode of Fempower Health’s four-part series on endometriosis, Margaret Melville of Lasa Health joins to discuss this underrepresented condition. Margaret transformed her decade-long struggle with endometriosis and celiac disease into a mission to improve women’s healthcare today. She talks about the alarming shortage of OB-GYNs and primary care providers who have specialized training in endometriosis and the importance of early diagnosis of endometriosis to manage this progressive disease. 


We explore common misconceptions and myths about endometriosis, the dangers of false cures, and the importance of patient advocacy and clinician education. We also cover the many applications of Lasa Health, a technology platform designed for women with chronic pelvic pain. This conversation is a must-listen for anyone looking to understand the complexities of endometriosis and pelvic pain or find endometriosis support.


Key Takeaways 

  • The importance of early diagnosis for effective management of endometriosis and prevention of chronic pain or organ loss

  • The need for clinicians to educate themselves and their patients about endometriosis, self-advocacy, and treatment options

  • Margaret’s background in global health innovation and the founding of Lasa Health, which improves diagnosis and pain management of endometriosis through technology and education

  • Real-life applications of AI in improving patient care quality

  • Systemic issues in healthcare that hinder effective diagnosis and treatment of endometriosis

  • False “cures” of endometriosis to be aware of

  • The future of endometriosis care, including further innovation and community advocacy

  • A preview of upcoming episodes, including interviews with endometriosis specialists, advocates, and surgeons


"You have bias and you have years of things being done a certain way that we're fighting against. Getting doctors and healthcare administrators who are so busy and have so many [responsibilities]... Getting them to care about pelvic pain, or changing the way things are done at their hospital or clinic to improve care for pelvic pain patients, that is a monumental hurdle." - Margaret Melville

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Guest Bio

Margaret Melville is the CEO & Cofounder of Lasa Health. She suffered from pelvic pain for over a decade and visited 25 doctors before finally being diagnosed with endometriosis and celiac disease. Margaret previously worked at USAID's Global Health Center for Innovation and co-founded a medical device startup. She has an MBA from INSEAD. She is passionate about using AI / ML to revolutionize the way we diagnose and care for women with chronic health conditions. 


Endometriosis Diagnosis

Transcript

Margaret Melville:

And I realized that this was the next problem I wanted to tackle. It was so huge and nobody was really talking about it at the time. But as I started talking to friends and family members, I just saw how many patients were being impacted. And I remember just joining all these Facebook groups and being like, wow, this is a huge, huge thing. And it's just a silent epidemic happening.


Georgie Kovacs:

Welcome to Fempower Health. This is Georgie. Today marks the beginning of an insightful four part series dedicated to unraveling the complexities of endometriosis and pelvic pain. In this opening episode, we zero in on the alarming shortage of ob gyns and the widespread lack of training in endometriosis among primary care providers. Our special guest, Margaret Melville, founder of Lasa Health, shares her personal struggle with getting diagnosed with endometriosis, a battle she largely navigated on her own. Through Margaret's story and our discussion, we highlight the critical importance of early diagnosis in managing endometriosis effectively, a condition that, if left unchecked, can escalate into chronic pain and organ loss. We also tackle common misconceptions and warn against false cures and products that prey on those seeking relief. This episode is not only a call to action for clinicians to educate themselves and their patients about endometriosis, but also a guide for patients on how to advocate for themselves by seeking out supportive healthcare professionals and exploring all treatment options.


Georgie Kovacs:

And please remember, the views expressed in this series are those of our guests and should not replace professional medical advice. We encourage our listeners to consult with their doctors to find what's best for their unique situation. Our hope is that this series will enlighten and support you on your journey with endometriosis. So let's get started. So, Margaret, why don't you talk to us first about your own journey with endometriosis, with what you're comfortable sharing about it. Because I think the personal stories are really what leads so many of us to make an impact in women's health. So tell us your own journey.


Margaret Melville:

Yeah, definitely. So I have bowel endometriosis and I also have celiac disease. And so I always had stomach issues and painful periods and so many symptoms going on that were all very confusing for the doctors to figure out because to them it seemed like the pain was jumping around all over my abdomen. So obviously they told me that was fine and to just relax and it was just stress or IBS. And ultimately it took about ten years to get diagnosed and about 25 doctors when I went back and added it all up. So I got diagnosed with celiac disease about two years ago, and then endometriosis in January, I had my first surgery.


Georgie Kovacs:

Wow. How did it go?


Margaret Melville:

It went well. I mean, I think that to me, the biggest thing is that to have that definitive diagnosis right, to actually have all those years of feeling like I was going crazy, validated to say there's a reason why you were in this pain. And then I think that there's always this hope that surgery is going to completely fix everything, and that rarely happens. And so then post surgery, it's about figuring out pelvic floor therapy and lifestyle changes and medications and figuring out long term, how you're going to manage the symptoms.


Georgie Kovacs:

So many women are struggling, generally speaking, and having a hard time getting answers. And many of these women, it turns out, do have endometriosis. And so I'm so curious, what was your life like as you were going through this journey? What were your symptoms? And why were doctors not pointing to endometriosis? And, well, you also had the complication of also celiac disease. So I'd love to just better understand that because I think everyone has similar but different journeys, and I think hearing those stories are always so helpful. So maybe you can tell a little bit more about that.


Margaret Melville:

I think you hear a lot of stories of endo, and people have such a spectrum of symptoms. So I'm by far not the most severe case of Endo I've heard. But I do think it's important to share many perspectives because Endo can present in so many different ways. For me, I think the biggest thing that held me back from a diagnosis is just a stigma about period pain and it being normalized. So having sisters and mom who also had had painful periods, that was just normal, right? Like it was normal to maybe have to miss school on your period, or it was normal having friends who had really severe periods, way worse than mine made me feel like, oh, mine aren't that bad. And so it wasn't until I was in my twenty s that I even brought it up to a doctor. And no doctor had really asked me about it, or if they did, I didn't really know what was normal and what wasn't normal. So I think that's a huge thing that holds patients back, is not knowing when to talk to their doctor.


Margaret Melville:

And then the second piece is, when I did first bring it up to a doctor, I didn't know how to bring it up to the doctor. So I remember I was really nervous. And at the end of the appointment, right when they were about to leave, I was just like, hey, by the way, my periods are pretty bad. Is that normal? Is that fine? And they're like, yeah, that's totally fine, and then left the room. And so not really dedicating an entire appointment to discuss it, minimizing it myself. And I really think that it would have been differently received if I had said, hey, I want to have an appointment discussing this topic. I am missing school. I have to take ibuprofen every day.


Margaret Melville:

I am nauseous, really outlining exactly how it's impacting my life. But I didn't really have the language or the knowledge of what was normal, what wasn't, to have that conversation with my doctor until I was much older.


Georgie Kovacs:

Endo is so interesting, right? Because we do normalize pain. So it's like, how do we talk about it? And generally with a lot of these women's health topics, we're not really taught much of anything. And it's like, how do you describe something and which do you need to describe which is normal, which is not? And like, for example, I recently posted on my social media, it was actually a repost of an OBGYN who had put into visuals what too much period blood looks like. And so many people were sharing it because people are like, I didn't know. I didn't know. I mean, it's amazing how little we know.


Margaret Melville:

Yeah, exactly. Because where would we learn that? And so many things are common, but that doesn't mean they're normal. And that doesn't mean there aren't things that can help just because it's common. So it's definitely tricky. And I want to be careful that I'm not blaming the patient. Absolutely. But what we need is better tools to help facilitate that patient provider communication. Doctors have such busy schedules and short appointment times that it's just really, if you do end up getting diagnosed at a young age, you have an amazing doctor that really took the time to listen to you and took the time out of their day to sit with you and go through all your symptoms.


Margaret Melville:

And that just isn't what normally happens. And so that's why I believe we need tools to help doctors be able to do this more effectively and facilitate that communication between patients and providers.


Georgie Kovacs:

So tell us now your professional background, because now this all ties into some things that you're trying to do to help make changes in the endometriosis space. And so now it's kind of come full circle where you're merging your knowledge and your experience. So tell us about your professional background.


Margaret Melville:

Yeah, so I work in global health innovation, so I worked with USAID during the height of COVID While managing pandemics, I worked started a medical device company where we developed a neonatal ventilator for low and middle income countries. So I've traveled all around the world looking at how we can make health more affordable, more accessible. And along this way, I was having my own health problems. And so when I was doing my masters, I was trying to figure out what I was going to do next and kind of at the accumulation of really severe symptoms and finally starting to get some insights into what could be causing it. And I realized that this was the next problem I wanted to tackle. It was so huge and nobody was really talking about it at the time, but as I started talking to friends and family members, I just saw how many patients were being impacted. And I remember just joining all these Facebook groups and being like, wow, this is a huge thing, and it's just a silent epidemic happening.


Georgie Kovacs:

Yeah, no, absolutely. How did you finally get to the diagnosis? Because you really had to do a lot of digging to finally be able to get the right information. And again, celiac and endo, like, whoo, right? Because honestly, I could see getting diagnosed with celiac and then people being like, no, okay, that's it. It's just the celiac because of the symptoms, right.


Margaret Melville:

So I ended up getting put on continuous birth control for most of my twenty s, and that was able to manage a lot of the pain. And so for a while, I wasn't actively looking for a diagnosis. The pain was manageable. But during my masters, I actually caught Covid and that really exacerbated endoceliac everything. And I was just in excruciating amount of pain every day. And I went to the emergency room, I went to primary care, I went to Ob. Just going to all these doctors trying to figure out what was the cause of it, what was going on. And this was the same time, actually, I was doing my masters, I was thinking about what I wanted to do next.


Margaret Melville:

And just having these doctors not believe me, not take my pain seriously, dismiss my pain, opened me up onto that topic initially. And so I decided I was going to do something in women's health, in how can we use AI to help patients get a diagnosis, help doctors take patient symptoms more seriously. And we were trying to decide, okay, well, we can't boil the ocean, we can't tackle every condition at once. So what condition should we start with? And we ended up picking endometriosis after doing a market analysis and seeing that it was really just a large patient population and a great place to start, so we decided we were going to focus on endometriosis. And I had a couple of friends with Endo, so I did some interviews with them, and then ultimately, that year, I did about 100 interviews with endometriosis patients. And again, at this time, I did not think I had endometriosis, but I just kept hearing these stories again and again and hearing symptoms that sounded just like mine. I was like, okay, wait. I think I might actually have endometriosis, too.


Margaret Melville:

And I told that to a couple of doctors. They said no. And then, like you mentioned, that was when I got diagnosed with celiac, which was just happenstance because my little sister got diagnosed. So I asked my gi. I'm like, could I have celiac? And he was like, no, you don't have celiac. And I was like, can we just run a blood test just to see. Ran a blood test. It was positive.


Margaret Melville:

And he was like, it's a false positive. You don't have celiac. I was like, well, can we do an endoscopy to confirm? And he was like, okay. So we did an endoscopy, and he came after, and I was like, how did it look? And he's like, it looked totally fine. You don't have celiac. And I was like, well, did you take biopsies? Can we run them to the lab just to be sure? He was like, yeah, we can, but you definitely don't have it. Everything looked fine. And then the lab biopsies came back positive, and I was like, I had it.


Margaret Melville:

And then, like you said, once I got diagnosed with celiac, it became really difficult for anyone to believe I had another condition, because so often there's this framework of, like, you're trying to find the underlying cause, and then you find a cause, and you stop looking for causes. But so often patients have multiple conditions, so I had to keep finding doctors. Fighting. Found an endometriosis specialist in my area, scheduled a surgery with them, and got diagnosed. So the only doctor to ever think I had Endo was my surgeon.


Georgie Kovacs:

What blows my mind, because I didn't know this part of your celiac story. Know, I interviewed Alice bast of beyond celiac, and I understood it's pretty simple. There's a blood test, and you have it or you don't. And the fact that you had to advocate for yourself and the fact that you knew, because I would never have known if I were in your shoes. I would have said, oh, blood test is negative. I mean, I might have pushed, but I would never have known. Get the endoscopy.


Margaret Melville:

The blood test was positive.


Georgie Kovacs:

Positive. And you still knew to continue the advocacy, and you've been in health care. And this is the other thing I'm noticing, is, if you're in healthcare, the fight. I'm in health care, too. The fight that I had to have to be able to figure out what was going on with me was crazy and why actually I started fed power. Health is, I'm like, I'm in healthcare, and this was impossible. What about people who aren't?


Margaret Melville:

I know, yeah. I always say, if it was this hard for me to get diagnosed, I don't know how anyone else ever gets diagnosed because, yeah, it was a fight. I remember the week before my endometriosis surgery, I had a GI appointment and mentioned to them, hey, I think I'm having all these symptoms still. I think I have endometriosis. I'm going to have a surgery. And they were like, no, don't do it. That's going to be a complete waste. You definitely don't have endometriosis.


Margaret Melville:

And I was like, well, how many patients with endometriosis have you treated? And they're like, no, we haven't seen any. It's super rare. There's no chance you have it. And I was like, you know what? I really don't think that my symptoms are explained by IBS. And I really think it aligns with. Endo was trying to explain why. And he was like, well, do the surgery if you want to. Let us know what happens.


Margaret Melville:

And so I came back after my surgery and brought my pictures, and I was so excited to be like, look, endometriosis is growing on my erectum and my sigmoid colon. This is what was causing the pain. And they wouldn't even look at the pictures. They were like, oh, endometriosis, that's not really in our purview. You should see Ob for that. But it was growing on my GI tract. So I brought my pictures to show you so that I want to know what this means for my GI tract. Am I going to need a bowel resection one day? What can I do? I had all these questions, and they wouldn't even look at the pictures.


Georgie Kovacs:

How did you know what to ask when you were dealing with the celiac part? Around continuous testing for them to finally believe you. What did you research? How did you know? So that others may learn from.


Margaret Melville:

I read medical journals. I read the clinical guidelines. Like, I read the publications from these associations about. For each condition, there is a clinical guideline for what are the steps for a diagnosis? What are the blood test values that mean it's positive or negative? What are the next steps? And so I really just try to read it all and educate myself. And it's not realistic for patients to have to read medical journals. They're so dense and hard to read. So that's why with Endo, we put together our twelve week endometriosis course that's free on our app that walks through all the medical journals that I read when getting my diagnosis, but putting them at an 8th grade reading level so that they're easy to understand and approachable and you can just pull out the parts that are really relevant for you when it comes to making an informed decision.


Georgie Kovacs:

Thank you very much for sharing that. Because I agree with you, we need to simplify the language. Okay, so now let's go to Lasa health. So we've now given the history, and I'm sure there'll be more things that come up as we continue to chat. But you had this professional experience, you've done this market analysis. You used your 100 plus interviews to, one, learn more about what you wanted to do, but two, diagnose yourself. Tell us what led to what you learned from those interviews that got you to build Lasa Health. Like, what was it that said, okay, this is where the gap is?


Margaret Melville:

Oh, my gosh, I think I left the interviews just more confused than I started because it is such a complex and multifaceted problem. Right. There's not one easy thing that's going to fix everything. But the two things that I really anchored on were problems with differential diagnosis and problems with informed consent. And so that's what I've really built the platform on. So differential diagnosis, that's really about distinguishing between symptoms, conditions that have really similar symptoms. And so, so often I would hear stories of a patient who goes to a doctor and the doctor says, oh, this is pelvic inflammatory disease, or, oh, this is IBS. And the doctor is not wrong per se.


Margaret Melville:

Like a patient with those same symptoms might have pelvic inflammatory disease or might have IBS. There are a lot of conditions that are really similar. So a doctor is making an informed recommendation based on the symptoms that they're seeing. But the problem was that they were not thoroughly looking at what the other things might be and eliminating those before giving a diagnosis. And then the issue of informed consent becomes about doctors were not giving patients thorough enough information about their health and their options. And patients obviously get almost no training or resources about their health. So patients were being told, like, hey, this medication is going to help you or cure you, and then ending up with devastating side effects that were never disclosed to them. Or patients would have a surgery thinking it's going to cure everything, and then they're so frustrated, like, why are my symptoms back in three months? So we want there to be an easy solution, but there isn't.


Margaret Melville:

There just isn't. Because of that, we really need to have clear, honest conversations with patients about, here are your options. Here are the pros and cons, here are the risks. Let's figure out a plan that works best for you and putting you in control of deciding which path you want to take.


Georgie Kovacs:

Tell us where you are with this. Now. What have you decided? Because it completely makes sense, by the way, I just have to say one thing about informed consent. I have heard many a story about women getting hysterectomies without knowing that that was going to be happening to them. And this is not necessarily just related just to endo. It's in many other situations. But it's like, wait, what? So I actually have a friend who is getting an IUD removed because it is, like, stuck in tissue, and her husband is a doctor. I said to her, I'm like, can I just tell you something? I'm not trying to scare you, but I have heard that doctors will go in and if they see something that they believe requires a hysterectomy, which I know ACOG, it's not published guidelines, which is frustrating.


Georgie Kovacs:

It may be now, but the last time I looked, it wasn't where they're saying, let's not automatically just do hysterectomies. Let's try everything else first. Because they also felt they were being done too often. But nonetheless, I told her, I'm like, look, I've been hearing enough of these stories where I just at least want to tell you that before you do this surgery, that you specify the answer is no. Or like, they have to go get your husband and have him have a discussion with them. And she actually was like, I'd rather just keep the IUD in there and leave it stuck because I don't want a hysterectomy. So anyways, I just wanted to add that as, like, I think one of the scariest anyhow, so I love that you're looking at both of those aspects. So now, how have you put this into life?


Margaret Melville:

Great question. So the way our platform works is we really start from the first appointment with a clinician. So we are building machine learning algorithms that screen patients medical histories for these common conditions that are overlooked. That piece is being tested, and it's not actively available to the public yet, but hopefully we'll be end of next year. It's kind of the timeline we're working towards. And so this is a really powerful tool for screening for not just endometriosis, but that full differential diagnosis. So all of the other conditions that have really similar symptoms to help a doctor understand what the most likely causes, what other things they should check are, and what the right next steps are for diagnosis. And then the second piece we have is our patient resources and patient engagement.


Margaret Melville:

So I really am of the belief that these conditions should be managed like any other chronic disease. My experience with my surgeon was I had a two week follow up and then never heard from him again. And I think that's kind of the common scenario, right? This is treated as not. No one is managing and taking on the management long term for these patients. So that's what our platform is doing, is giving a place where patients can track their symptoms, can learn about different treatment options, get reliable, trustworthy information, and then have the results reports being sent back to their doctor, so that the doctor can make updates to their treatment plan and monitor their patient for an ongoing basis. So that second piece is live, the patient app is free for patients to use, and then we work with doctors to have them offer this to their patients, and so that they can send reports and review how each of their patients are doing post surgery or post treatment.


Georgie Kovacs:

What goes into building something like this? First, I will say, when I first read about LASA Health, and my understanding was, you're trying to get patients at the point of care and through the EMR systems that doctors are already leveraging when they're working with patients and updating reports and things like that. And so I thought it was brilliant because having interviewed so many clinicians, being a consultant in healthcare, and hearing so many of the gaps, and, like, the way we're really going to make change is when the women go to the doctor and changing what happens at that appointment. And because the key theme has been, we need that appointment to go well.


Margaret Melville:

There are so many challenges to making this happen from a technology standpoint. You have HIPAA regulations and data security and encryption, patient privacy. That's so important, especially with all the data breaches happening with a lot of period tracking apps and with Roe v. Wade. And it's a really important time to have your technology be super solid. And then the other piece is that the technology that the doctors are using, these electronic health records, I don't think patients or normal public can understand how dysfunctional the software is. It is so clunky, so difficult to use, so difficult to integrate into. It's just a mess, like it's a decade or more behind the rest of the technology the world the US uses.


Margaret Melville:

And so then, as our platform is trying to integrate with these platforms, it's a beast. But that is nothing compared to the issues when it comes to actually making societal change. Right. You have bias and you have years of things being done a certain way that we're fighting against. And so getting doctors and healthcare administrators who are so busy and have so many things, paying their time to care about pelvic pain and care about changing the way things are done at their hospital or clinic to improve care for pelvic pain patients, that is a monumental hurdle. And it takes a collective effort of, from advocacy, from patients to physician champions who really care and are pushing for this to be implemented at their health system. It's moving a mountain, but I think it needs to be done. And I think bringing a community together and having a clear solution that's going to make a difference for the next generation, that's what keeps me motivated to keep pushing through.


Georgie Kovacs:

Right now, you're focused on, I am a patient, I come in with pelvic pain, and then seamlessly, your tool would be integrated into the electronic medical record and they would be asking questions of the patient. And does the patient also get to enter information in on their side as well so that there's collective okay.


Margaret Melville:

Yes, exactly. So both proactively asking questions to the patient so that we can make sure we have the right information, and then giving the patient a place to share, giving them a place to give perspective about what their goals are. That's the platform. But I think when I talk about this, I think it's really important to talk about how sometimes as patients, when we've had bad experience with clinicians, it's easy to villainize doctors and say, the doctors, they're not doing good enough, they're not doing enough. And I just don't think that's true. The doctors I've talked with are, they really got into medicine to help people. And we're met with a really broken system that is not giving them enough time to spend with patients. Like, they want to be able to make these diagnoses, they want to be able to help these patients, and they're not given the resources to and they're not giving the training to.


Margaret Melville:

And so that's what our goal is, is to be able to bridge that gap and allow doctors to be the doctors that they want to be, to be able to have patients have this really personalized experience and have a quicker diagnosis and have ongoing care and monitoring. But doing that in a way that is going to be effective and effective use of their time.


Georgie Kovacs:

No, I agree with you. And what I have learned is your incentive compensation and your organization structure drives behavior. And it's not like people wake up and say, this is what I'm going to do because this is how I'm paid. It's like a subconscious thing that just happens. It's this very subconscious behavior that happens. But I've seen examples where obviously clinicians will often be bonused based on patient satisfaction. And so as a human, it's like, well, if I try to help the patient, they're going to argue with me what might happen with how I'm perceived. Right.


Georgie Kovacs:

There's also certain appointments can be reimbursed more if there's a prescription given. So it's even just the reimbursement models of health. And this is not necessarily just specific to endo or anything, but just generally speaking of just how messed up our system is. They're almost incentivized to not help us be proactively healthy. And again, I want to be clear. It's so subconscious. It is not like they wake up and how should I treat said patient so that I can get paid. It is just a health care wide behavior that happens.


Georgie Kovacs:

Which is why you see a lot of doctors are cash paying now because they're like, I can't deal with this. I really want to help patients. So it's just a real bind.


Margaret Melville:

It's such a mess. And I think, like you're saying, so many doctors go cash pay because they want to help patients, but then you have only patients who have disposable income are getting the help. But I think that's why I see the potential for a lot of these AI tools to help reduce the cost of providing this higher quality care because we just don't have enough doctors. We don't have enough doctors and there aren't the right incentives to do it the way the system is set up right now.


Georgie Kovacs:

Yeah, absolutely. Now, you've had success in getting your tool tested with clinicians. Do you want to share it all? Like, how's that going and what you're learning?


Margaret Melville:

Sure. Yeah. So I think there's always a concern from clinicians that AI and machine learning, these are new tools for them and they don't have any training in these tools at all. And I hear a lot of doctors kind of being concerned about AI replacing doctors, because you'll see these publications about chat, GPT, performing better than a doctor, and those are just, they're all just sensationalized. And so what I like to say is that doctors who use AI are going to have better outcomes than doctors who do not use AI. AI is never going to replace doctors, but it is going to significantly improve the quality of care for patients. And that's already been happening. We've had AI tools for so long, it's just become a little bit more mainstream and talked about right now.


Margaret Melville:

So I think that's always the first conversation, is assessing what's the doctor's comfort level with technology. And if they are not comfortable with technology, they're not going to be our early adopters, right? They're not going to be the ones who are the first to try this and the first to put this into their clinic, and that's totally fine. What we're looking for is the doctors who want to be on the cutting edge of technology, who want to deliver a higher standard of care and really push the boundaries. So that's what I always look for, is that type of doctor who's really excited about what we're doing, and then once we're able to publish some studies together and validate our model, then we can work on getting it more mainstream and into a broader sample of doctors.


Georgie Kovacs:

So what I'd love to do is talk about the context of having decision making tools at the point of care, but knowing that with Endo, it's not always so easy to diagnose. And so can you talk about that path? Because, one, I'm doing an episode series on Endo because it is such an important topic that impacts so many people, and yet, because there's still so much to be understood about Endo, there's kind of this very intense world of discussion around diagnosing it and treating it. And right now in the innovation world, there's people that are tackling diagnostics for endometriosis. So I guess just given that, where do you see the value of that point of care? And I'm not asking because I literally don't know, but I think it's just important to talk about how this fits into the big picture of, oh, you can only diagnose Endo with surgery. So I'm more speaking to that debate of where does this fit and how should we look at having a tool like this early on in women's lives.


Margaret Melville:

You have tools that are designed for different things, right? Like you're going to have some tools that are really good at diagnosing one condition like the celiac blood test, right? That's really accurate, really great at testing for celiac. But if a doctor never orders that blood test, it doesn't matter how good that blood test is. Right? And so what we're tackling is, Hannah, that before place about what's stopping a doctor from ordering the right tests and making the right next steps for diagnosis in order to get to an official diagnosis or multiple diagnosis or whatever the case may be. And so really pulling in the patient information and pulling in the clinical recommendations so that they know what the next steps are. And in the endometriosis space, unfortunately, there aren't a lot of non invasive diagnostic tools. Right now you have ultrasounds and mris, which can show some types of endometriosis, but not all. But we really think our platform scales with innovation, right? Like if there is one day a blood test for endometriosis that's really accurate, then our platform can recommend that when a patient is screened as likely having endo, it will recommend that blood test. So we'll update our model and the recommendations as the clinical recommendations change and as new innovations come out.


Margaret Melville:

I've talked to a lot of entrepreneurs who are in the diagnostic space and building out these tools or these tests. And yeah, adoption is a huge problem for them. Right? Like getting doctors to actually prescribe or use their tool, even if they have really great studies showing how effective it is, is a hurdle because you have to educate all these doctors about this new tool. And so what our platform can do is really serve as this place where a new innovation can easily get in front of doctors once they've gone through the right regulatory hurdles. And then we'll be able to make sure every doctor using our platform has access to what the newest recommendations are.


Georgie Kovacs:

And obviously, I could see this as being like the women's health EMR, honestly. Right? I mean, that's really what I could see, the potential of this tool. I don't know what your reaction is to that.


Margaret Melville:

I have really mixed feelings about that for a couple of reasons. So, one, that was the vision for the company originally. But as I've dove in more into it, most of these conditions that we're doing for a differential diagnosis don't just impact women. And even endometriosis doesn't just impact women. And so it's really difficult to talk about something that impacts so many women, but also is bigger, really, than just women. And so when you have it be focused too much on women's health, then people see it as like, okay, that's something obGyns will use, but it usually takes seven visits with your primary care before you're even referred to an OB. And so our goal is to get it adopted by primary care. And so having this be a tool to screen all patients with pelvic pain, regardless of gender, and get them the right diagnosis.


Margaret Melville:

So, yes, we are helping a lot of women, but also our mission is beyond that, is focus more on that primary care and the screening of patients regardless of their gender.


Georgie Kovacs:

You make a valid point. Okay, so then I have a question about the primary care versus OB GYN. Who's seeing who? Because, for example, for me, I started getting an annual physical with my primary care as I got older and was like, oh, I should probably getting blood tests and stuff like that. I don't feel almost 50, but apparently now I have to do all these tests, but I'm a rule follower. So, yes, when I was 18, I started going to the OB GYN religiously every year because of birth control pills and I guess from a habit, being a rule follower, et cetera, I still go every single year. And so I'm so curious about this path, and I know that it's more than just women, but I guess for women specifically, who would have an OB GYN and a primary care, are you finding that a lot of women actually don't and tend to just go to the primary care? I'm so curious about that path.


Margaret Melville:

Great question. Yeah. So some people have their OB GYN be their primary care provider, right? And so they'll just go annually to their OB GYN and get their pap smears or birth control or whatever they need. But the majority of women do still go to a primary care provider, and I think this is largely because of the shortage for OB. There's usually like a six to nine month waitlist for an OB, depending on if you're not pregnant, depending on what state you're in, and if you're in a rural or suburban population. So there's a huge shortage of OB. So you see more and more being moved to primary care and as well as for advanced practice providers. Right, like nurse practitioners and physician assistants, like taking on more of this primary care role.


Margaret Melville:

And so these are people who probably don't have I mean, OB GYNs get so little training in endometriosis, but, like, primary care and pas and nps receive next to no training on these conditions. But these are the ones that are really the front lines of the healthcare system and the ones hearing the first symptoms and the first signs of these conditions.


Georgie Kovacs:

Yeah. No, it's a fair point. Tell us why it is so important to know early. I mean, obviously, for the many, many endo sufferers that have severe pelvic pain, the obvious answer is we want the pain to go away. But it's more than that. Why, from a clinical perspective, is it so important to know early on?


Margaret Melville:

Yes, that's a really good question. So these are progressive diseases. So there's multiple stages. They get worse over time, and so the earlier they're diagnosed, the better the long term treatment outcomes are for the patient. So a patient who's had undiagnosed endometriosis for an extended period of time, they don't have good outcomes, and they'll probably never have full resolution of their pain. And that's just the reality, because when your brain has been used to being in pain for more than six months, you develop, I think it's called pain centralization syndrome, and it really changes the way your body perceives pain. And that is really, really hard to treat. And it's under research, so we don't know too much about it.


Margaret Melville:

But we know is if a patient's having pain and it's not resolved within six months, the patient has really poor outcomes long term. So the sooner it is addressed, the better. And then there's also the risk of organ loss. Fertility. See so many patients who will lose part of their digestive system or lose their ovaries or lose their uterus. Those are really, really big impacts. Even if you don't want to have children, losing an organ is a huge deal and can have long term health outcomes.


Georgie Kovacs:

Are there any misconceptions that you've been hearing about endo that are still around that we need to dispel or that we can't dispel quite yet because we need more data? I'm curious if there's any interesting things you've been hearing in this journey of yours.


Margaret Melville:

That's a good question. There's so many misconceptions. It's like, where do you even begin? But I think that the thing that makes me the most sad, I guess, is just there's a lot of trend in selling certain products to patients that might be a supplement or a program or a diet, that this is going to be the cure. And as a patient, I would love for there to be a simple cure, and suddenly everything would be better. I would love that. But as a researcher, that's just not the case. And so I would really just always tell patients, like, if you hear somebody on TikTok on Instagram claiming to have the cure, the solution, they're probably trying to sell you something and they're probably not being honest with you. And so, yeah, that's the thing that makes me most sad, is you'll see patients just spend a lot of money on things that they hope will help.


Margaret Melville:

But we need to be more honest and have more nuanced conversations about the risks and the benefits. And that's just difficult to do in our current society where we have really short attention spans and you have like a 22nd TikTok, and it's hard to have a nuanced conversation. So I think podcasts like this are really great formats to actually be able to have more in depth conversations about these important topics.


Georgie Kovacs:

Yeah, no, absolutely. Thank you for sharing that. So, I mean, we've talked so much about your experience and this journey and trying to help women be diagnosed early on, yet the education is available now, but being able to have that perfect doctor appointment isn't quite yet available. So I guess what would your suggestion be for today, whether it's a clinician who is listening or it's a patient? Because I find that clinicians will say, I didn't learn this in med school, and they'll listen to the podcast. And it's also women who are like, I'm so sick of this. Help me get educated so I can be proactive with my clinician. So for either both of those, what would be your words of wisdom as you're continuing to build Lasa health?


Margaret Melville:

Yeah. So for clinicians, send me an email. We send a packet, basically, of flyers for you to hand out to patients who have chronic pelvic pain or endometriosis to tell them about our app. It's completely free for the patients, completely free for you to hand out flyers about the platform. We'd love to support you and work with you if you're interested in getting it integrated with your EHR and monitoring your patients, happy to chat that too, but that obviously takes a lot more advocacy and a lot of administrative approvals. But I think the place to start for a clinician is to get this resource out to patients. Right? And happy to send over those flyers to any clinicians interested. And then for patients, I think you can do the same thing of helping to educate your own clinicians about new tools available, about what's helping you, what research you're reading.


Georgie Kovacs:

You can do a lot to advocate, I will say. I've even been putting into practice just all that I'm learning on the podcast and how I change, how I talk to my clinician. And it doesn't always have to be an hour long appointment or even 30 minutes. It can be quick, and it can be those quick exchanges over the electronic health record systems. And I've been finding so much value in being like, this is what I heard. Tell me what you think, and it could be within that ten minute appointment. It doesn't always have to be drawn out. And so I'm really happy to see that all these things are happening, like what you're doing and others and even those listening to this podcast.


Georgie Kovacs:

That conversation is so important. But to your point, we also have to find the right person who's willing to have that dialogue. Honestly, no egos here. Anything else that you wanted to add before we close out?


Margaret Melville:

No, I think that. Thank you so much for putting this series together. I'm really excited to listen to all the other episodes. And I think the endometriosis, there's been so much happening lately, so I'm really glad we're getting the right information out to the patients and going to help educate the community.


Georgie Kovacs:

No, absolutely. And thank you. And so stay tuned, everyone, because the rest of the series, it'll be interviewing someone who is a very strong advocate for patients and who has a science background. And we're going to be talking about the diagnostics and treatments. I'll be interviewing a surgeon and then also someone who works with pelvic floor pt and yoga to help folks with dealing with pelvic pain. So thank you so much for sharing your expertise and your experience, and congrats to you. And I'm really looking forward to seeing how you're doing in the future.


Disclaimer

The information shared by Fempower Health is not medical advice but for informational purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. Additionally, the views expressed by the Fempower Health podcast guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent.

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