Podbit · The Peter Attia Drive
Two hundred years ago women had roughly 100 lifetime ovulatory cycles; today the number is closer to 400. Later menarche, earlier menarche now, fewer pregnancies, less breastfeeding — the modern reproductive pattern was never anticipated by evolution, and endometriosis prevalence is rising as a result.
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At 8:10 · chapter starts 0:11
To understand endometriosis, Tomioka begins with the architecture of the uterus: the outer serosa, the muscular myometrium, and the inner endometrium where embryos implant. Endometriosis, he explains, is a chronic disease in which tissue resembling the endometrium migrates outside the uterus — onto the ovaries, fallopian tubes, bladder, bowel, appendix, and even the diaphragm. The scale is striking: approximately 10% of reproductive-aged women, 200 million globally. [1] — Renato Tomioka "10% of reproductive-age women: Endometriosis affects approximately 10% of reproductive-aged women, equating to roughly 200 million women gl…" 03:48 Among infertile women, 30 to 50% have endometriosis, and the relationship is causal — if a woman has endometriosis, she faces roughly a 40% chance of infertility. [2] — Renato Tomioka "30–50% infertility in endometriosis: Among women struggling with infertility, 30 to 50% have endometriosis, and if a woman has endometriosi…" 04:30 Tomioka notes the strong genetic signal: approximately 50% heritability and a sevenfold elevated risk for women with an affected first-degree relative. The mechanism he considers most important is retrograde menstruation — menstrual blood flowing backward through the fallopian tubes into the pelvis — which occurs in roughly 90% of all women, yet only 10% develop endometriosis, implicating immune dysregulation (particularly macrophage dysfunction) as the difference-maker.
Endometriosis affects approximately 10% of reproductive-aged women, equating to roughly 200 million women globally.
Among women struggling with infertility, 30 to 50% have endometriosis, and if a woman has endometriosis, she faces roughly a 40% chance of being infertile.
Endometriosis has approximately 50% heritability, and women with a first-degree relative with the disease have about 7 times the normal risk.
Approximately 90% of women experience retrograde menstruation — menstrual flow traveling backwards through the fallopian tubes — yet only about 10% develop endometriosis.
Self-help fails because people are sold one universal cure by the hyper-responders who had a transformative result from it. The real problem is context: every method works for the right person at the right time, which is almost never you just because the author says so.
Spencer Greenberg was once so socially anxious his heart pounded just approaching a stranger. His therapist gave him homework: go to a bar alone, talk to 5 strangers. Starting with asking for the time, he worked up to asking men for hugs — and his anxiety fell dramatically in 6 months.
A person who flies regularly but obsessively checks weather forecasts before every flight is not doing exposure therapy — they're teaching their brain that flying is only safe with the ritual. Safety behaviors prevent the brain from ever learning that the feared thing is actually fine.
The worry-time technique assigns all worries to one scheduled slot (e.g. 5 PM). Every time a worry surfaces, you write it down and ban yourself from engaging with it until that time. When 5 PM arrives, most worries feel trivial and the act of batch-worrying exposes how little it actually accomplishes.
In a randomized study of 20 habit techniques, 'habit reflection' stood out: recall a past habit you successfully built, write down what helped you succeed, then apply those same strategies to your new habit. It works because it's self-adapting — it uses whatever worked for YOU.
The tiny habits technique — always having a minimal version of your habit you can do when life gets in the way — keeps the mental machinery of habit formation from breaking. Paradoxically, people given a tiny-habit fallback option were MORE successful at the full habit, not less.
Fears and worries act like playground bullies — they want to ambush you. But when you deliberately seek them out and choose the time of engagement, they lose their power. The volitional act of starting the fight on your own terms is one of CBT's most underappreciated insights.
Most downtime defaults are things you regret immediately after — phone scrolling, binge TV. 'Glad you did it' activities meet the same need for rest but leave you feeling like you spent your time well. The switch from a bad screen to a documentary, a book, or a walk costs almost no extra effort but compounds into identity over time.
You rarely control your first reactive thought. But you can train your second thought — the response to the trigger — by asking whether your initial reaction is the most helpful one and replacing it with something equally true but more constructive. Over time, that second thought becomes automatic.
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