ENDOMETRIOSIS

Endometriosis is a complex, chronic and common condition whereby tissue similar to the lining of the uterus (or womb) grows in other places, such as the fallopian tubes, ovaries, bladder or the bowel. Endometriosis is a whole-body inflammatory disease, it is not just a reproductive disorder. The average time taken from the onset of symptoms to a diagnosis of endometriosis is 7-10 years. Unfortunately, this means there are many people walking around with undiagnosed endometriosis.

Symptoms of endometriosis:

• Pain – by far the most common symptom of endometriosis, this may include:

  • Period pain – this can range from being mild to completely debilitating

  • Rectum, bladder, pelvis or leg pain during a menstrual period

  • Pain during or after sex

  • Abdominal/intestinal pain

  • Painful defaecation (dyschezia) 

  • Pain on urination

  • Painful ovulation (Mittelschmerz)

  • In some cases, endometriosis causes no pain at all

• Digestive problems – especially during menstrual bleeding

  • Constipation

  • Diarrhoea

  • Painful bowel movements

  • Rectal bleeding

  • Nausea

  • Vomiting

  • Abdominal bloating (also known as “endo belly”)

• Bladder problems

  • Urgency

  • Frequent urination

  • Painful urination

• Headaches

• Fatigue

• Spotting/bleeding between periods

• Recurrent miscarriage

• Infertility

What causes endometriosis?

The exact cause of endometriosis is not yet known. Originally it was thought that retrograde menstruation was the cause – whereby menstrual fluid flows back through the fallopian tubes and into the pelvis cavity. This theory has been somewhat debunked now as it is known that retrograde menstruation occurs in most women yet only ten percent of them develop endometriosis. Newer research has explored the following:

Endometriosis and hormones:

Endometriosis is not caused by oestrogen, but its thought that oestrogen and the incorrect metabolism of oestrogen may worsen the condition as it stimulates the growth of endometrial tissue. Oestrogen is a sex hormone made by the ovaries and the adrenal glands. It is crucial that oestrogen is in the correct ratio with progesterone, another sex hormone which is made when we ovulate (release an egg each month). Conventional medical treatment of endometriosis is to shut down oestrogen production (via the contraceptive pill), though the issue with this is that it also suppresses ovulation and the production of progesterone – the hormone which keeps oestrogen in balance and provides a feeling of calmness. Progesterone slows the growth of endometriosis, so is not something we want to shut down, and we need oestrogen for other aspects of health such as cardiovascular protection, bone density and brain health.

Endometriosis and the immune system:

Most of the research now is indicating that immune dysfunction is the primary trigger of endometriosis. The immune system is responsible for the inflammatory cytokines and other immune chemicals which promote the growth of endometriosis lesions. Hormones and the immune system are closely connected. Endometriosis shares many features with other autoimmune conditions, such as rheumatoid arthritis. It is not yet classified as an autoimmune condition – researchers are still figuring this out, but it may increase the risk of other autoimmune conditions due to the immune dysregulation involved. It’s also possible that there are infectious/microbial triggers for endometriosis and new testing is currently being developed to help identify this.

Digestion and endometriosis:

Digestive problems and endometriosis go hand in hand. Endometriosis has the potential to grow in the bowel and directly cause digestive symptoms, but digestive problems can also worsen endometriosis – because up to 90% of the immune system is located in the digestive tract. The digestive inflammation triggers the immune system which exacerbates the endometriosis, which further impacts digestion – a vicious cycle occurs. Addressing digestion is a very good place to start when beginning the road to manage endometriosis.

The microbiome/gut bacteria:

The microbiome is the trillions of bacteria, viruses, fungi and protozoa which reside in and on us. The microbiome influences everything from our digestion to our mood to our immune system to our weight. The cells of the microbiome outnumber the amount of human cells 10:1 – we are far more bug than we are human. We have a digestive microbiome, skin microbiome, lung microbiome, oral microbiome, ovarian microbiome, vaginal microbiome, uterine microbiome, even the placenta which was once thought to be sterile has its own microbiome! It is known that these microbiomes play a large role in both health and disease. In endometriosis, the microbiome is imbalanced. There is too many of the wrong type of gut bacteria within the digestive tract, which produce a toxin called lipopolysaccharides (LPS) which promotes inflammatory signalling and endometriosis. Many researchers believe this to be the cause of endometriosis. The microbiome should be a key consideration in the management of endometriosis.

Genetics:

There is a large genetic component to endometriosis. If your mother or sister has endometriosis, you are more likely to develop it. Though, more and more is being discovered about epigenetics and the potential to turn on and off the expression of different genes with our diets, lifestyles and environments – a fascinating area of research and one that will hopefully uncover more treatment options for the management of endometriosis in the future. Some of the known triggers for activating genes are infections, aberrations in the microbiome, chronic stress, and exposure to environmental toxins such as dioxins.

Environmental toxin exposure:

It has been confirmed that endometriosis has been linked to dioxin exposure in the womb, meaning before you are even born you may have been predisposed to the disease. There are many other endocrine disrupting chemicals known to influence the delicate balance of our hormones, for example xenoestrogens which interfere with oestrogen levels. Reducing chemical exposure when managing endometriosis is essential. Household cleaning products, beauty products, hair products, make-up, body wash, nail polishes – all need to be scrutinised.

Diagnosis of endometriosis:

Imaging such as ultrasound is generally the first port of call to identify endometriosis, but is often not sensitive enough to detect endometriosis. A negative ultrasound does not exclude endometriosis. If ultrasound is negative, but endometriosis is suspected, then a laparoscopy (keyhole surgery) is the next step. This is obviously invasive, and thankfully the search is underway for a more simple test to accurately diagnose endometriosis with options for testing including blood, saliva, urine or even a menstrual blood test.

Treatment for endometriosis:

Conventional treatment for endometriosis is centred around surgery to remove the endometrial lesions, and drugs to suppress oestrogen such as the contraceptive pill and the contraceptive injection (Depo-Provera). Unfortunately side effects of such drugs can include depression, anxiety, weight gain, osteoporosis and more. Analgeics and non-steroidal anti-inflammatory drugs i.e. neurofen are also offered as painkillers, however these can be damaging to both the digestive tract and the microbiome.

Natural treatment for endometriosis:

Naturopathic treatment of endometriosis is expansive and considers the whole body. Dietary management is essential and there is strong evidence that some key foods must be avoided – gluten and cow’s milk being two of them.

Turmeric is the most researched herbal medicine thanks to it’s potent anti-inflammatory activity. However there are many other herbs and nutrients which can be used to manage endometriosis, depending on the individual. As always, quality and the correct dose is important and it is best to speak to a qualified healthcare practitioner rather than self prescribing with low dose, poor quality supplements from the supermarket or online.

Due to the complexity and chronicity of endometriosis, and the many factors which may be involved for each individual – treatment should always be unique. One size does not fit all. As discussed, digestion, immunity, hormones, the microbiome, toxin levels and stress all need to be considered. Emotional support is also important.

For further information on the natural management of endometriosis including hormone and microbiome testing please contact hello@bridgetbnaturopathy.com