Podbit · The Peter Attia Drive
In deep infiltrating endometriosis and adenomyosis, up to 37% of lesions carry the same oncogenic mutations (KRAS, PIK3CA) that drive cancer growth. But fibrosis traps them. It is, biologically, a 1,000-horsepower engine inside a golf cart.
Where this was said
At 14:10 · chapter starts 13:25
Tomioka opens this section with a claim that reframes the conversation: adenomyosis is 'the missed disease.' While endometriosis gets most of the attention, adenomyosis — where endometrial-like tissue invades the myometrium — may affect up to 20 to 30% of women, making it potentially two to three times more common. [1] — Renato Tomioka "Adenomyosis prevalence up to 20–30%: Adenomyosis may be even more prevalent than endometriosis, affecting up to 20–30% of women, yet it rem…" 15:46 Though they share molecular features (progesterone resistance, aromatase overexpression, oncogenic mutations), single-cell transcriptomics — citing a paper by Linda Judis — shows they are distinct diseases with different pathways. The mechanism of adenomyosis is described as TIAR (tissue injury and repair): the endometrium breaches the junctional zone, typically after C-section, curettage, or miscarriage, and infiltrates the muscular wall, forming cysts and echogenic buds that enlarge and soften the uterus. Critically, up to 70% of endometriosis patients may have concurrent adenomyosis [2] — Renato Tomioka "Up to 70% of endo patients have adenomyosis: Up to 70% of women with endometriosis may also have some degree of adenomyosis, a comorbidity …" 17:18 — a co-occurrence Tomioka believes has been a hidden confounder in implantation studies. Unlike endometriosis, adenomyosis is definitively cured only by hysterectomy, making fertility preservation a fundamentally different challenge for affected women.
Adenomyosis may be even more prevalent than endometriosis, affecting up to 20–30% of women, yet it remains underdiagnosed and underappreciated.
Up to 70% of women with endometriosis may also have some degree of adenomyosis, a comorbidity with major implications for fertility treatment.
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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