WHAT IS IT?
When tissue cells outside the womb behaves like the type of tissue (endometrium) that normally lines the uterus. Each month these cells react similarly to the hormonal changes that affect those in the womb, building up and then breaking down and shedding. When this shedding occurs, blood, which is trapped in the abdomen, irritates the nerves in the abdomen, causing much of the pain associated with endometriosis. Over time, this shedding leads to chronic inflammation and the formation of scar tissue. Additionally, the endometrial cells cause abnormal immune responses in that tissue, leading to further chronic inflammation and scarring.
The most common place for these cells to be found is the abdominal cavity where it can land on the peritoneum, the thin layer that covers the inside of the abdomen, the ovaries, and fallopian tubes.
Despite many theories, it is not known exactly why this happens. What is known is that it is an inflammatory condition with an abnormal immune response, and it is triggered by cyclic hormonal changes, environmental hormonal exposures, and other factors that cause inflammation.
WHO GETS IT?
About 10% of women worldwide. It is the second most common gynecological condition in the UK. On average it takes 7.5 years from onset of symptoms to get a diagnosis. The rates of endometriosis are rising, most likely due to chronic exposure to environmental toxins and chemicals.
WHAT ARE THE SYMPTOMS?
Common symptoms of endometriosis include: extreme cramping during menstruation that sometimes cannot be relieved with NSAIDS (for example ibuprofen), long and/or heavy menstruation, flu like symptoms around menstruation and ovulation, abnormal or irregular bleeding, chronic and sometimes severe pain between periods especially around ovulation, constipation and bloating, painful sex, urinary problems, lower back ache, and chronic fatigue.
Endometriosis typically progresses and worsens over time as the chronic inflammation leads to accumulation of scar tissue leading to “adhesions” that cause the organs like the intestines and bladder to become fixed in place resulting in pain with bowel movements and urination, and painful sex.
Not all women experience symptoms, and some only discover they have it when they experience difficulty getting pregnant. Endometriosis is one of the most common causes of infertility, causing as many as 50% of cases. As many as 30-40% of women with endometriosis will experience fertility problems.
The percentages of women with endometriosis reporting various symptoms is:
- Painful periods (79%)
- Pelvic pain (69%)
- Pain with sex (45%)
- Bowel upset (e.g., constipation, diarrhea) (36%)
- Bowel pain (29%)
- Infertility (26%)
- Ovarian endometrial mass/tumor (20%)
- Pain with urination (10%)
- Other urinary problems (6%)
Conventional medicine mostly aims at symptom relief through medications and surgery, though these come with their own risks.
Chronic use of recommended pain medications can provide temporary relief, but they do have risks including long-term damage to the gut lining.
Hormonal therapies, such as oral contraceptives, progestins, and GnRH agonists can relieve symptoms of mild to moderate pain but also have potential short and long-term side effects, and don’t get to the root causes of the problem.
Surgical removal of endometrial tissue can relieve symptoms for as a long as 2 years, but in most women the symptoms do eventually return, and the procedure itself increases the likelihood of forming scar tissue.
Hysterectomy is sometimes recommended, but this is not an option for women who want to become pregnant. While it is sometimes helpful when all else fails or if symptoms are unbearable, it is major abdominal surgery and comes with all associated risks, so get more than one opinion about having this done.
We know that endometriosis is an immune and inflammatory problem that is triggered by cyclic hormonal changes and worsened by chronic environmental toxin exposure. Exposure to a class of chemicals called endocrine disruptors (which mimic hormones), as well as other environmental toxins that increase our inflammation and disrupt the normal functioning of the immune system has been implicated in endometriosis.
The natural approach aims to support an optimal immune response, reduce inflammation and pain, promote natural detoxification of environmental toxins, and help to balance hormones. A comprehensive approach incorporates an anti-inflammatory diet as well as suplementation from each of the categories below.
It can take about 6-12 months to see a reduction in the overall number of endometrial implants in your abdomen (usually detected by laparoscopic evaluation). However, it is not necessary to follow up with laparoscopy if your symptoms improve. Your symptoms can be your guide that you’re getting better, so it is ideal to keep a record of how you are feeling on a 1-10 scale during the times your pain is typically at its worst.
Your first step is to reduce inflammatories and toxins. Check your environment for common environmental toxin exposures (especially from food and food packaging) that increase your estrogen load (xenoestrogens).
An anti-inflammatory diet includes up to a pound of combined fresh vegetables, especially leafy greens (kale, collards, broccoli, Brussels’s sprouts) and fresh fruits (especially berries) each day.
The main triggers to remove for an anti-inflammatory diet are dairy products, gluten-containing products, all corn, most sugar, and red meat. So if you are suffering from endometriosis, choose a plant-based diet with no red meat. Avoid pesticides and herbicides. If you do eat any meat, it should be organic to avoid chemicals used in meat production that might be adding to your problem.
While they may seem like no big deal because everyone uses them, plastics are major sources of xenoestrogens that can wreak hormonal havoc and cause or worsen endometriosis. Do your best to avoid foods that come in soft plastic wrap, are stored or microwaved in plastic, and plastic water bottles.
Caffeine may exacerbate endometriosis in some women, so if you’re drinking coffee each day, try a couple of months without it. On the other hand, green tea is antioxidant and may be especially beneficial if you have endometriosis.
Keeping your blood sugar steady is also important for keeping inflammation in check, and keeps you from binging on inflammatory sugar and baked goods.
Being overweight increases the likelihood of being estrogen dominant; appropriate weight loss can also be very helpful in reducing general inflammation. The anti-inflammatory diet is a great way to lose weight without having to work too hard to try!
HERBS & SUPPLEMENTS
Here are some herbs and supplements to add to your anti-inflammatory diet. These should not be taken during pregnancy, but can be taken up until conception – just discontinue when you try to get pregnant, and resume if you have not conceived, and they can be taken while you are breastfeeding.
By taking a combination of these, not only will inflammation be reduced, but these herbs also relieve pain over time.
- curcumin (from turmeric)
- bromelain (from pineapple
- quercetin (from apples, onions, and other plant sources)
- ginger root
Antioxidants help to prevent and reverse local tissue damage from inflammation. Some of our best antioxidants come from foods highest in vitamins E, A, and C. Some powerful antioxidants include:
- Resveratrol (from red grapes)
- N-acetylcysteine (NAC)
- pine bark
- green tea
NAC is a powerful antioxidant with some impressive data behind it specifically for endometriosis. In a 2013 study of 92 women in Italy, 47 took NAC and 42 took a placebo. Of those who took 600 mg of NAC three times a day, three consecutive days each week for three months, 24 patients cancelled their scheduled laparoscopy due to a decrease or disappearance of endometriosis, improved pain reduction or because they had gotten pregnant! Fourteen of the women in the NAC group had decreased ovarian cysts, while 8 had a complete disappearance; 21 had pain reduction and 1 became pregnant. In the other group, only 1 patient cancelled surgery. A total of 8 women got pregnant in the NAC group, while 6 did in the placebo-only group.
In yet another study of an antioxidant herb, this time pycnogenol from pine bark, women taking 30 mg twice daily for 48 weeks showed a 33% reduction in pain, including severe pain, and while the pain reduction was not as strong as hormonal treatment, it actually persisted without relapse, unlike the medication group. Further, 5 women in the pycnogenol group became pregnant.
When estrogen is running wild, it not only increases the size and number of the endometrial tissue, but certain forms of it also contribute to inflammation.
Getting enough dietary or supplemental fiber and having a daily bowel movement are essential for reducing inflammation, overall body toxin load, and eliminating excess estrogen from your system.
- Take 1-2 TBS of freshly ground flax seed daily in a smoothie, or mixed into food, and if constipation is a problem, natural treatments are available.
You should start to get some pain relief within a few hours of taking the pain supplements. These can be taken with or in place of the herbs mentioned in the above section on inflammation – there will be some crossover, but that’s ok.
- Ginger root powder at a dose of 500 mg 2-4 times/day has been shown to reduce pain equal to the effects of ibuprofen.
- Jamaican dogwood
- cramp bark
- devil’s claw
One study demonstrated that 10 mg of melatonin per day significantly reduces chronic pelvic pain due to endometriosis, pelvic pain during menses and during sex, pain during urination and associated with bowel movements, to the tune of an overall 80% reduction in the need for pain medication in women taking it. At this dose, melatonin supports the body’s natural detoxification processes. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue. It is recommended to start at 1-3 mg/day, and build up, and preferably take it in the evening, as it can make you feel tired. It is the natural substance that increases at night in our brains to tell us to get some sleep!
Acupuncture in one study has been shown to possibly be helpful for endometriosis pain.
Alternating hot and cold sitz baths (sitting in a very shallow bath) stimulates pelvic circulation, getting good blood and lymph flow moving to help wash out inflammation and toxins.
Numerous environmental toxins in our food, food packaging, air, water, homes, and workplaces increase our hormone burden, cause inflammation, and also have the capacity to cause our immune cells to malfunction. As mentioned above, avoiding these chemicals whenever we can, such as in our foods, body products and cosmetics, household cleaners, and treated cookware and fabrics can reduce body burden. However, given how common these are, if you are suffering from endometriosis, avoiding toxins is not enough – your body can need some extra detoxification support.
Some of the supplements already mentioned, including NAC, curcumin, resveratrol, and quercetin all support natural detoxification, so you’re already ahead of the game here! One additional supplement which is excellent for supporting the detoxification and elimination of excess hormones is:
BREAKING UP ADHESIONS
In addition to the recommendations above, you can work with an Arvigo Massage Therapist or a physical therapist who is skilled in pelvic pain from endometriosis. These therapies are important for helping to break up adhesions. While some of the anti-inflammatory supplements, particularly the enzymes, may help with this to some degree, the addition of physical manipulation can really help to break down scar tissue.
I hope this article helps you to create an endometriosis healing plan that works for you, relieves pain and adhesions, and gives you back your life and hope!