Behaviors

Avoid estrogen-containing birth control for endometriosis, because estrogen can cause the implants to grow.

Limit estrogen-suppressing pills to no more than 2 years because of the risk of bone loss.

After endometriosis surgery, she places a progesterone IUD before sending patients home.

For stage 3 or 4 endometriosis, she may add GnRH antagonists after surgery for 6 months up to 2 years, depending on stage and symptoms.

For patients with endometriosis after delivery, place a progesterone IUD at the postpartum visit, around 6 weeks postpartum, to help suppress recurrence.

Women should calculate their lifetime breast cancer risk using the Tyrer-Cuzick tool, and this should be known routinely. The result can guide decisions about earlier imaging.

If lifetime breast cancer risk is 20% or higher, start breast imaging at age 30 instead of waiting until age 40.

For women with dense breasts and a high risk of breast cancer, add breast ultrasound to mammography.

Women with a lifetime breast cancer risk of 20% or more should ask for a breast MRI in addition to a mammogram and ultrasound.

Women with family history of breast, ovarian, pancreatic, prostate, and related cancers should ask whether they qualify for genetic cancer testing.

For very high breast cancer risk, undergo imaging every 6 months, alternating mammogram/ultrasound with MRI.

She presents prophylactic double mastectomy as an option for women at very high breast cancer risk, described as north of 35% lifetime risk.

In young patients with PCOS, include ApoB testing as part of cardiovascular risk assessment.

In young patients with PCOS, check lipoprotein(a) status.

For perimenopausal women, check APOE4 status to assess dementia risk.

Discuss or check bone density as part of a proper well-woman exam.

She includes colonoscopy discussion as part of comprehensive well-woman care.

If you have endometriosis and are trying to get pregnant, have had a miscarriage, or have a personal or family history of autoimmune disease, ask for a full autoimmune panel.

Refer patients with PMDD to a psychiatrist to assess for underlying chronic anxiety or depressive disorders.

Always pair estrogen hormone replacement with progesterone in patients with endometriosis, even after hysterectomy.

Use hypnosis to manage anxiety enough to re-expose yourself to a phobia or trauma in a controlled way, rather than avoiding it, so you can build broader and less negative associations and restructure your understanding of the experience.

Voluntarily confront trauma, pain, insomnia, or other difficult experiences rather than being passively overwhelmed by them; the deliberate choice to face them is emphasized as therapeutically important.

Go outside in daylight two or three times per day; practical examples given include taking lunch outside and taking calls outside. This is presented as a practical way to increase healthy light exposure, especially for people working indoors under LED lighting.

Do not use lasers on eyes or skin unless there is a profound medical reason and trained medical oversight; host explicitly warns against lasers for consumer use.

Place a 40-watt incandescent desk lamp on the desk and simply work around it; direct staring is not required.

If not getting outside enough or working in LED-rich environments, supplement with long-wavelength light exposure from a device. Host says he personally does this early in the day and sometimes closes his eyes for portions of the session based on comfort.

Limit close-up screen work in kids and increase reading/viewing distance; avoid excessive close work within about a foot or two because close work plus screens is linked to myopia risk.

Dim incandescent or halogen bulbs to preserve infrared output while reducing visible brightness; this may help bulbs last longer and, in the evening, may avoid melatonin disruption. A dimmed halogen lamp can also be used in the evening without strongly disrupting circadian rhythm.

Avoid tinted windows, including in classrooms, because they reduce beneficial light exposure and block helpful wavelengths when possible.

Use a safe candle at the desk or nightstand while reading in the evening to add some long-wavelength light.