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Does endometriosis control your life?

Written by

Deborah Freudenmann BHSc

Between 6% and 10% of women, in reproductive years, and 20-50% of women with infertility problems are affected by endometriosis.

Most common among women aged between 25 and 30 years.
Endometriosis is an inflammatory and hormonal condition where the tissue that normally lines the uterus, called the endometrium, can be found in other locations of the body where it’s not supposed to be. The most common area to find the growth is in inside the abdominal cavity, where it can progress to the peritoneum which covers the intestines, bladder, fallopian tubes and ovaries. Just like the uterine lining, the endometrial tissue is also triggered to shed during our monthly cycles. This trigger is caused through hormonal changes that signal your period to start and also causes the other tissue to bleed. The shedding of the blood is extremely irritating to the nerves present in the abdomen, causing much of the pain associated with endometriosis. This irritation, over time and the subsequent inflammation leads to the formation of scar tissue that can cause the pelvic and abdominal organs to develop adhesions. Adhesions cause organs to become less mobile and rather stick together which can result in bladder and bowl pain, constipation, ovulation pain, severe menstrual cramping and pain, infertility, chronic pelvic pain and painful intercourse.

Many women affected by endometriosis often have a significant delay in diagnosis. This makes it difficult to determine the exact correlations between diseases. From various studies, researchers have found women can go anywhere from 7 to 11 years after symptoms show before being diagnosed.

Endometriosis can be difficult to diagnose by symptoms alone. Many common diseases such as ovarian cysts, pelvic inflammatory disease, irritable bowel syndrome, sexual abuse, and inflammatory bowel disease all share similar symptoms.

Endometriosis may worsen over time causing further pain; this pain is also subject to change as the nature of the disease changes.

Root causes and risk factors

There are a variety of root causes which include:

  • Obstruction of menstrual flow
  • Retrograde of menstrual flow
  • Hormonal imbalances as the growth and progression of endometriosis is actually dependent on the hormone estrogen
  • Increased levels of estrogen production induce prostaglandin E2 formation, which is a strong mediator of pain and inflammation
  • Inflammation, higher inflammatory response, increased inflammatory markers such as IL-1, IL6, TNF-a, COX-2
  • Impaired cell-mediated immunity
  • Autoimmunity – endometriosis is linked with a greater likelihood of developing autoimmune diseases such as multiple sclerosis, lupus, rheumatoid arthritis, hypo and hyperthyroidism, and fibromyalgia.
  • Symptoms of lower pelvic pain, discomfort and heaviness have often been discussed as pelvic congestion and associated with a general lymphatic congestion.
  • Abnormal bowel flora and increased intestinal inflammation – it’s been found that women with endometriosis have altered gut microbiomes with lower concentrations of lactobacilli and higher amounts of gram negative bacteria
  • It’s common to have pre-menstrual symptoms including bloating, breast soreness, mood swings, constipation, food cravings, anxiety and headaches.
  • Shorter menstrual cycles
  • High inflammatory diet
  • Limited or lack of physical movement – women who exercise on a regular basis may have reduced endometriosis symptoms as it decreases the rate of estrogen production
  • Intrauterine contraceptive device has been shown to increase incidence of endometriosis – this could be due to increasing degree of retrograde flow
  • Higher exposure or levels of endocrine disrupting chemicals – found in the environment, food, products and household dust that affect the body’s hormones
    Examples of endocrine disrupting chemicals include:
                – DDT, chlorpyrifos, atrazine found in pesticides
                – BPA, phthalates, phenol found in plastics
                – Flame retardants, PCBs found in electronics and building materials
                – Perfluorochemicals found in textiles, clothing, non-stick food wrapping
                – Parabens and UV filters found in personal care products and sunscreen

The conventional treatment approach

Since endometriosis is a chronic disease, treatment is often an ongoing process. Affected women may have distinct conventional treatment plans which can be a combination of medical and surgical procedures. Common treatments are:

  • Hormonal contraceptives (IUD, birth control pills, patches…)
  • Pain medication and anti-inflammatory drugs to ease pain
  • Progestin Therapy, often tried after a six months’ period not having any success with pain killers. Progestin is a synthetic progesterone which studies have demonstrated can have an increased risk of breast cancer development
  • Hysterectomy
  • Surgery – laparoscopic ablation of implanted endometrial tissue can reduce pain in some cases however usually recurrence of pain occurs in a few months for up to 60% of women

The functional medicine approach

Establishing the root cause

Endometriosis as discussed above is not a linear condition but rather a multifaceted one. Factors such as increased inflammation, poor immune response, imbalanced gut microbiome, poor estrogen liver clearance, high levels of estrogenic activity, toxins… can individually or in combination significantly impact endometriosis.

While every woman experiences endometriosis differently due to their personal history, environmental and lifestyle exposures, some key root causes are relevant to consider:

Reducing inflammation

Endometriosis is a chronic inflammatory disease, characterized by an altered function of immune cells. The presence of inflammation may actually encourage endometrial tissue… Ozone therapy is effective in addressing not only inflammation but also activating the antioxidant pathways through Nrf2. Moreover, ozone therapy can increase overall oxygenation alongside reducing inflammation which may alleviate some pain.

Supplements which have been found effective to reduce inflammation in endometriosis cases include:

  • High quality omega 3 fatty acids
  • Curcumin
  • Boswellia serrata
  • Vitamin D

Preventing and repairing damage with antioxidants

Antioxidants can help prevent as well as reverse local tissue damage from inflammation and oxidative stress. Vitamin E and C, both of which possess a large amount of antioxidant properties have been found useful in endometriosis. In addition to Vitamin E and C, supplementation with selenium, zinc, N-acetylcysteine, green tea, pine bark (pycnogenol) and resveratrol have been found to be beneficial.

Balancing hormones and supporting liver detoxification

Inadequate estrogen excretion may result in excess circulating estrogens – worsening symptoms of endometrioses.

Zinc, vitamin B6 and magnesium synergistically work together to support hormones synthesis and specifically the production of progesterone. Magnesium also impacts the detoxification of estrogen metabolites in the liver and bowels – thus a deficiency can contribute to circulating estrogen levels. Including cruciferous vegetables such as broccoli (or supplemental with DIM) can help support healthy estrogen metabolism.

Supporting immune function

When it comes to addressing our immune system, removing the underlying causes is the important. There are many factors which can ultimately cause a compromised immune response such as…

Nevertheless, the immune response to endometriosis is not that different to other common autoimmune conditions each with leaky gut at their core. Therefore, addressing the lining of our gut is important.

Zinc: impairs intestinal permeability commonly known as leaky gut and supports immune function. Not only that, zinc is responsible for hundreds of enzymatic reactions, it reduces inflammation and promotes healing of endometrial lesions.

Eating anti-inflammatory foods, limiting refined and processed foods which are known to weaken the immune system. Removing gluten and or gluten from the diet can certainly help, as both are known to increase gut inflammation in some individuals. Including probiotic supplementation and probiotics from foods is beneficial to help restore microbial balance.

Avoiding environmental triggers/reducing toxins

Endocrine disruptors are chemicals (they can also come from natural sources, like soy) that interfere with our hormonal system by mimicking it. This can happen in different ways. Some copy a natural hormone, tricking the body to respond or respond at inappropriate times. Some block our hormones from having effect, or they directly stimulate our endocrine system, causing an overproduction or underproduction of hormones in our bodies.

The accumulated effects of these disruptions are huge! Endocrine disruptors have been related to fertility problems, reproductive conditions such as endometriosis including underdevelopment and behavioral abnormalities in children, as well as the development of cancer. They can cause harm to our bodies even long after exposure has stopped, extending throughout our life time, and even influencing future generations.

Implementing a healthy anti-inflammatory diet

Increased trans-unsaturated fatty acid (fried foods, dressings, crackers) consumption leads to a greater risk of developing endometriosis. However, increased omega-3 fatty acid intake corresponds to a lower risk of developing endometriosis. Another study suggests decreasing animal meat and trans-fat consumption. Instead, individuals should increase the amounts of fruits, green vegetables, and long-chain fatty acids in their diet.

Diet Tips:

  • Green vegetables
  • Fruits
  • Essential Fatty Acids (fish, olive oil, chia seeds, linseed, some nuts)
  • Turmeric- anti-inflammatory
  • Ginger Tea- anti-inflammatory
  • Low animal meat consumption, specifically red meats
  • Decreased processed and fried foods

Supporting stress response

Stress impacts our health in so many ways and is a very important factor to address when supporting endometriosis. Stress sets up a vicious cycle by increasing cortisol and adrenaline levels – overtime chronic stress can result in an inability to manage our inflammation levels. Causing an aggravation of symptoms and pain experienced by women.

There are so many ways to help support our stress response, specifically focusing on our vagal nerve!

Improving sleep

Although the symptoms of endometriosis can often impact sleep quality getting less than 7 hours a night can actually increase stress and reduce pain resilience. Aim to prioritize sleep by keeping a regular bedtime and waking time – this will benefit our circadian rhythm and hormone balance. Creating a healthy bedtime routine can often benefit, drinking a sleepy time tea, reading a book…

Try to avoid all screens at least 1 hour before bed (including TV, phone and computer), switching off your mobile phone or at least airplane mode, unplugging as many electronic devices in your room and lastly avoiding fluorescent light.

It has been noted that melatonin can actually reduce pelvic pain (including pain with sex) due to endometriosis. If sleep is disturbed melatonin (a hormone that regulates our sleep and wake cycle) can help improve not only quality of sleep but also pain levels.

Moderate exercise

Of course exercise is difficult if a woman is experiencing a lot of pain, however in saying that often gentle forms of exercise can actually help lower inflammation, release endorphins and ultimately reduce pain. Try including practices such as yoga, Pilates, walking, cycling into your weekly routine. Always remember, high intensity exercise or prolonged/excessive exercise can increase inflammation, cortisol levels and actually disrupt our hormones.

Acupuncture

Acupuncture is commonly used for chronic pain and various gynecological conditions. It has been found that acupuncture is an effective pain relief for chronic pelvic conditions such as endometriosis.

Important takeaways

Endometriosis is a complex condition with many interconnecting systems as you can see. It is likely that the condition is multifactorial and a number of treatment approaches are required. Often in reproductive conditions such as endometriosis, it is easy to over focus on one factor such as hormones… however only addressing hormones is just ONE factor in the whole picture. This is why a comprehensive Functional Medicine approach is necessary to find and remove all the underlying causes.

Share your thoughts with me and leave a comment!

4 Responses

  1. Hi Deborah.
    I thank you for your e-mail. You done a very professional job on your subject of Endometriosis, it was outstanding
    You covered every thing from A-B. Your father must be proud of you. Keep the good work up Deborah. We need people like you..

    1. I definitely am. She is amazing and has such a big vision for TRULY HEAL. Nice to see also that a lot of younger people join our ranks to carry this knowledge into the future. Bless you all.

  2. Thank you, Deborah, for this in-depth article on endometriosis. I will file it away carefully for future use. Very useful.

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