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What if understanding how endometriosis builds its own blood supply could unlock safer, smarter treatment? We sit down with Professor Gaby Moawad—renowned robotic surgeon, educator, and leader in endometriosis care—to unpack the vascular engine that drives lesion growth, bleeding, and scarring. In five focused minutes, we translate complex molecular pathways into clear takeaways you can use to ask better questions and advocate for better care.
Dr. Moawad explains how hypoxia inside scarred tissue activates HIF alpha, which then boosts VEGF signaling to build new vessels. We explore how inflammation and locally produced estrogen amplify this process, why metalloproteinases (MMPs) cut space for vessels to form, and what immature pericytes have to do with leaky, bleeding lesions. He connects the dots from biology to the operating room: hypervascular lesions on MRI, the “powder burn” color changes created by hemosiderin, and the feedback loop that turns immune dysfunction into chronic pain and fibrosis.
We also touch on therapy frontiers. Anti-angiogenic drugs targeting VEGF show promise but raise concerns about wound healing and fertility. Dr. Moawad highlights where research is headed, including targeted delivery directly to lesions and cellular approaches that modulate endothelial progenitor cells. For anyone navigating diagnosis, imaging, fertility planning, or surgical decisions, this clear, science-backed overview offers a roadmap to discuss options with your care team and understand the trade-offs behind emerging treatments.
If this deep dive helped you see endometriosis through a sharper lens, follow the show, share it with someone who needs clarity, and leave a review so others can find it. Have a question you want answered fast? Send it our way and we’ll bring in the expert voice you need next.

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