Endometriosis is a common condition affecting between 10-15% of women. It is a condition where the cells that should only be found within your uterine lining migrate and are found in other areas within your abdominal cavity. The growth of these cells outside the uterus can cause a host of different symptoms depending on the location the tissue is growing on. These cells respond the same way as your normal endometrial tissue to hormone stimulation. This means that they grow and bleed in the same cyclical pattern as the tissue in your uterus. This internal bleeding can lead to areas of scar tissue development, regions of inflammation and pain.
Symptoms of endometriosis will vary from women to women but can include painful and heavy periods, painful intercourse, pain with urination or bowel movements, low energy and concerns with fertility. It is thought that up to 60% of women with fertility concerns have some degree of endometriosis. The diagnosis of endometriosis can be quite difficult and the only way to get a true diagnosis is by doing a surgical procedure called laparoscopy.
The precise cause of endometriosis is still yet to be determined. There appears to be an increase in immune activity in the uterus, with a correlation between supressed immune functions and an increased number and size of lesions. There is a type of immune cell called a natural killer cell. These cells help to keep abnormal cells in check and are suppressed in some women with endometriosis. A different immune cell called macrophages also plays a role in endometriosis. Macrophages have a job to clean up any general debris.
There is an increase in macrophage activity seen in the uterus of women with endometriosis. This may lead to a women’s body identifying sperm as foreign and therefore contributing to infertility. In terms of fertility, endometriosis can lead to scarring on fallopian tubes, adhesions and unruptured follicles in the ovaries are often seen.
It is thought that up to 60% of women with fertility concerns have some degree of endometriosis
What are the risk factors for developing endometriosis?
The most common risk factor is genetic. If your mother has endometriosis there is an 8% higher chance of you having it and about a 5% higher chance if your sister has endometriosis. Women with shorter periods and women with more frequent periods (with shorter time in between) have a higher risk. From a lifestyle standpoint, low activity levels from a young age, high fat diets and the use of intrauterine devices (IUDs) have all been demonstrated to increase the risk. From a hormonal standpoint, having elevated or unbalanced levels of estrogen have been shown to make symptoms worse.
Your liver has the task of breaking down hormones including your estrogens. This includes both your natural estrogens, synthetic estrogens (medications) as well as environmental toxins that can mimic estrogens. As the liver breaks down 80-90% of your estrogens, optimizing its ability to function will help support your treatment. Your liver metabolizes estrogen by attaching it to glucuronic acid and excreting the combo into your intestinal system for removal. The health of your intestinal flora is imperative to your body being able to eliminate the estrogen. If you have an abundance of healthy bacteria in your gut, you can rid your liver of the estrogen it has just worked to detoxify. If, however, you have an abundance of unhealthy bacteria, they can break the bond between the estrogen and glucuronic acid and allow the estrogen to be reabsorbed into your blood stream. Your liver then must work double time to get rid of this same estrogen again.
As you can see endometriosis is a complex multi-factorial condition. To minimize symptoms and further growth we need to address the health of your liver, intestines, immune function and estrogen balance.
High fibre foods can provide significant benefit by helping support the healthy bacteria in the gut and crowd out the harmful ones
Where to begin
1. Nutrition and diet will play a huge role in managing endometriosis.
High fibre foods can provide significant benefit by helping support the healthy bacteria in the gut and crowd out the harmful ones. Increasing fibre by focusing on vegetables, legumes and beans can help improve digestion as well as reduce inflammation which will help reduce pain levels.
Reducing the amount of red meats in your diet. Red meats, when consumed, release a substance called arachidonic acid that promotes inflammation contributing to pain levels. Including plant-based protein sources such as soy, nuts, seeds, beans or legumes in your meals, will assist your body in lowering levels of inflammation. You can also look to substitute fish for meats, as fish contains a type of fatty acid called omega 3s that work to reduce inflammation.
Limit your caffeine intake. Women who have less than the equivalent caffeine of about 6 cups of coffee per month had on average 40% improvement in symptoms compared to women who consumed over this amount.
There is approximately 120mg of caffeine in a cup of coffee, so keeping total intake under 7g is optimal. Some patients I find do significantly better with eliminating caffeine entirely from their diet. Try it for one full cycle and see if you notice a difference. Or as another option I find for some women even it they stop for the week before their period this can have a positive impact.
Focus on including more liver supporting foods and herbs. The family of vegetables known as brassicas includes broccoli, cauliflower, kale, brussel sprouts, cabbage, bok choy and turnips. These vegetables contain a nutrient called indole-3-carbinol or I3C. I3C helps the liver to metabolise estrogens, so can be helpful to assist in the balance of estrogen in the body. Root vegetables such as beets, sweet potatoes, radishes, and artichokes are very nourishing for the liver to also assist in overall function. In general, making sure you are getting a minimum of 5 servings of vegetables per day will go a long way to ensuring you are getting adequate fibre and nutrients to support detoxification.
2. Supporting your stress and nervous system.
When your body is under higher levels of constant stress your adrenal gland makes more of a hormone called cortisol. The body uses your progesterone to make cortisol, so with higher stress levels your progesterone levels can drop leaving the ratio of estrogen to progesterone imbalanced. This allows for higher levels of estrogen that can stimulate endometrial tissue. As well contributing to pain in endometrial tissues, this can also affect the length of a women’s cycle and the heaviness of period flow. Elevated levels of cortisol can also have a negative impact on immune function which also isn’t helpful when it comes to endometriosis.
There are several ways to help your body regulate stress more effectively. One is to add (or continue) regular daily exercise. Doing any type of activity that you enjoy is fine. This could range from walking, biking, dancing, swimming or weights and classes at the gym.
Breathing properly is also critically important to keeping cortisol levels in a good range. Doing either diaphragm or yoga breathing each day, helps keep your body in its relaxation nervous system.
3. Reducing exposure to estrogenic or hormone disrupting toxins.
Hormone disrupting toxins will have the largest impact on hormonal based concerns such as endometriosis as well an on overall fertility and reproductive health. Some examples of common places we will find these chemicals include lotions, makeup, soaps, cleaning products, food storage containers, water supply. The Environmental Working Group (EWG) published a list of the 12 top hormone disrupting chemicals and includes:
Bisphenol- A (BPA)
Per fluorinated chemicals (PFCs)
Optimizing your digestion and liver function are two of the most important ways to not only improve your endometriosis but also to optimize your overall health
We know we have exposure to the majority of these chemicals on a daily basis. Some are easier to avoid than others. This list is not meant to make you panic but to begin to draw awareness to the exposures that we can control.
Why are these types of toxins so problematic? Some of the hormone disrupting toxins will bind to the same receptors that your hormones bind to. This means your body can think you have more or less circulating hormones than you actually do. Some hormone disrupting chemicals will increase the amounts of hormones your body secretes, others will decrease amounts, and some will even mimic the function of the hormones.
As your body’s levels of certain hormones change, this can lead to changes in the menstrual cycle, immune function and how your body responds to stress. Some of these chemicals, for example phalates, link directly to endometriosis.
Toxins are ubiquitous in our environment, so we are never going to be able to get away from exposure. We can however do things to minimize exposure and encourage the body to eliminate and excrete the toxins instead of storing them. One of the best ways to encourage toxins from your body is through sweating. This can be done either through exercise or the use of saunas.
Visit www.ewg.org for more information on where to find these toxins and ways to reduce exposures.
Optimizing your digestion and liver function are two of the most important ways to not only improve your endometriosis but also to optimize your overall health. There are also other nutrients and herbal medicines that can be used to assist with pain so please speak to your Naturopathic doctor or other health provider to see what makes the most sense for you.
Jodie is Naturopathic doctor and Founder of Enhance Fertility Bootcamp program, enhancefertilitybootcamp.com