Endometriosis, or “endo” for short, is a condition where the endometrial tissue, which is normally only found lining the uterus, is found in other areas of the body. This can include the fallopian tubes, ovaries, intestines, and other tissues. Since endometrial tissue responds to the same hormones that control your menstrual cycle, this tissue will bleed no matter where it is found in the body. The bleeding causes an inflammatory reaction that over time leads to scar tissue and adhesions which can disrupt the normal function of the organs affected, especially when it comes to reproduction. The main symptom women with endo report is pain with their period, painful intercourse, or for some, constant pelvic pain. Unfortunately, this condition is pretty common, affecting 6-10% of reproductive age women and can be found in up to 50% of women who experience painful periods or infertility. Although a definitive cause remains unclear, endometriosis is linked to both a hormonal and immune dysfunction. Understanding this allows for better treatment and that is what I want to discuss today.
Endometriosis & Hormone Imbalance
Endometriosis is an estrogen-dependent disorder, since estrogen is responsible for promoting the growth of endometrial tissue. It is well-documented that higher levels of estrogen are associated with the development of endometriosis. This is commonly referred to as a state of “estrogen dominance”. There are many reasons why estrogen can become dysregulated, but one of the well-known explanations is environmental exposure. There are many man-made compounds found in the environment that can disrupt our estrogen levels by mimicking the action of estrogen in the body and binding to estrogen receptors. We call these compounds xenoestrogens. Xenoestrogens are commonly found in pesticides, herbicides, fertilizers, dioxin (from bleach), and plastics. Some of these chemicals, like BPA and phthalates, have been linked to higher rates of endometriosis which is likely due to their estrogenic activity.
The moral of the story: getting estrogen back into balance is critical for treating all women with endo.
Endometriosis & Immune Dysfunction
It is also clear that women with endometriosis have a disruption in normal immune system function. The immune system is meant to identify and remove cells when they are found in areas they should not be in, which may be the first problem in the initial development of endometriosis. Furthermore, women with endo are found to produce more inflammatory substances and tissue-specific autoantibodies –immune cells that cause destruction of the body’s own tissues. This is why endometriosis is now being regarded as an autoimmune condition. It is associated with other autoimmune conditions too, like Irritable Bowel Disease.
Estrogen comes back into play here too, as high levels can suppress our natural killer cells, which are immune cells that do exactly what it sounds like. So this high estrogen can lead to further immune compromise. Therefore, the immune system must be addressed when treating this condition.
What can we do about it?
Although endometriosis can be very difficult to treat, there is a lot that can be done to:
- Decrease the painful symptoms
- Prevent endometrial growths from worsening
- Support fertility
Conventionally, the options include medication, usually the birth control pill and painkillers, surgery, or a combination of both. These options may be necessary, but as always, a naturopathic approach will address the multifaceted causes and reduce the need for long-term use of medications. Treatment must be focused on normalizing the immune system, decreasing inflammation, supporting hormonal balance and improving detoxification.
Here are my top 5 tips for anyone struggling with endometriosis:
- Modify your diet:
I recommend sticking to an anti-inflammatory, paleo diet as a baseline nutritional approach. Here are some additional specific recommendations:
What to avoid:
Foods that increase prostaglandin synthesis, increase estrogen levels or keep the liver busy:
- Alcohol
- Sugar and simple carbs
- Conventionally raised meats
- Gluten
- Studies have shown that when women with endometriosis remove gluten from their diet a large majority report significant reductions in pain.
What to include:
- Spices and herbs that are anti-inflammatories: think ginger, garlic, and turmeric
- Lots of leafy greens and cruciferous vegetables
- Cruciferous vegetables, like broccoli, cauliflower, and Brussel sprouts, have a compound that helps support the liver to promote the proper breakdown of hormones
Looking for a kick-start to change up your diet? Check out my 3-day hormone-balancing meal plan that can help women achieve more balanced estrogen levels. Grab a free copy here.
- Get moving:
Exercise is a great tool that should be recommended to all women with endometriosis.
The benefits include:
- Reduced pain associated with menstruation
- Reduced estrogen levels
- One study showed that five x 1-hour sessions of moderate intensity exercise decreased estrogen levels by 20%.
- Reduced adipose tissue, or fat cells, which produce estrogen
- Increased quality of life, which can be impaired in women suffering from endometriosis
- Support the liver:
The liver is the most important organ for detoxification; it is where your hormones are broken down to be eliminated. Your liver must be functioning optimally to ensure healthy estrogen levels.
- Include liver loving foods every day like beets, dandelion root tea, garlic, and cruciferous vegetables (cauliflower, broccoli, kale, Brussel sprouts, etc)
- Nightly castor oil packs over the liver
- For extra support, a more individualized detoxification program may be recommended by your practitioner
- Promote regular bowel movements:
Once the liver has done its job, it is the responsibility of the gut to ensure elimination of estrogens. If the estrogens are not eliminated, they will be re-absorbed into the bloodstream, further impairing hormonal balance.
- Optimal fiber intake is essential in promoting regular bowel movements
- Fiber is also important to support the optimal balance of microflora in the gut which also support the elimination of estrogen – in some women, a probiotic supplement may be recommended too
- High fiber foods include fruits, vegetables, chia seeds, flaxseeds, beans, legumes and nuts; ensure you are getting at least 25g of fiber each day
- Flaxseeds also help to bind up excess hormone to ensure proper elimination rather than hormones getting reabsorbed in the gut
- Key supplements:
Some evidence-based supplements that can be used to reduce the pain associated with endometriosis, limit the progression of the disease and modify the immune system, include:
- Fish Oil
- N-Acetyl Cysteine
- Melatonin
- Vitamin D – this is one you should have tested by your doctor first!
- Ginger
Endometriosis can be a debilitating condition, but there are treatments options available that could change your life! Although the tips discussed above can be incorporated starting today, I always recommend having a complete health assessment done by a healthcare professional. Everyone is different, and your healthcare should be personalized to you and your individual needs. Plus, endo can be a complex condition and many of the systems may need to be addressed!
To happy hormones & pain-free periods,
Dr. Bronwyn
