Endometriosis

Treating Painful Endometriosis

Endometriosis impacts one in ten women and a total of 176 million worldwide.  Women suffering the disease live with excruciatingly painful periods, pain during intercourse or urination, diarrhea, bloating and weight gain.  It can also negatively impact a women's mood, energy, appetite, sleep, stress levels, ability to exercise, blood sugar balance and cravings.  

Many women think these symptoms are part of a normal period and it can often take up ten years to diagnose the condition. However, the longer endometriosis is left, the more likely it is to impact a women's fertility and impact her life. 

March is Endometriosis Awareness Month to help women identify and treat Endometriosis and stop it disrupting their life. 
 

What is Endometriosis?

Endometriosis is best defined as an inflammatory disease in which bits of uterine lining (that sheds when you have a period) grow throughout the pelvis on structures such as ovaries.  It causes pain (sometimes severe), scarring and infertility.

Risk factors include genetics and exposure to toxins such as pesticides and dioxins.  The microbiome (good bacteria) also plays a role.  For example, endometriosis sufferers have high levels of gram-negative bacteria and the bacterial toxin LPS (lipopolysaccharide) in their pelvis, which has been shown to actively promote endometriosis.

Endometriosis is common and often starts young (although it can take 10 years to diagnose).  One study found that two-thirds of teens reporting chronic pelvic pain will eventually go on to be diagnosed with endometriosis. 

Signs and Symptoms of Endometriosis

Severe Period Pain
Women can suffer extreme period pain with endometriosis causing absence from work, school or social events.   Women may have vomiting or nausea and require high dose painkillers to prevent the pain.

Infertility
The endometrial tissue lesions from endometriosis can block the fallopian tubes stopping the sperm and egg meeting which can cause infertility.

Diagnosis of Endometriosis

Diagnosis of endometriosis is quite tricky at the moment because there is no straightforward blood test (although this is very close to being available).  It usually requires you to fit many of the symptoms and then a pelvic exam or ultrasound will be undertaken.  If they can’t see or feel any lesions from this surgery, you may be referred for a laparoscopy.  This is a surgical procedure where they make an incision near your navel for a laparoscope (camera) to fit in and find endometrial tissue.  If they do find it, it can often be removed there and then so you only need the one surgery.

Treatments for Endometriosis

Below are the conventional medical treatments and functional or natural medical treatments.  Many women will benefit from a combination of both conventional and functional or natural treatments.

Conventional Medical Treatments:

  • Hormonal birth control: Hormonal birth control is generally prescribed as a treatment for endometriosis pain.  Although endometriosis is not a hormonal condition, hormonal birth control stops ovulation and the production of estrogen.  This slows the growth of the endometrial tissue but is not without side effects and the evidence for its effectiveness on pain is lacking.
  • A Cochrane review concluded that there was insufficient evidence that hormonal birth control improved pain in endometriosis.  Additionally, a recently released study of one million Danish women, found that those taking the oral contraceptive pill are 23 percent more likely to be diagnosed with depression and those taking the combined oral contraceptive were 34 percent more likely.
  • The Mirena coil: can be a great alternative for some women with endometriosis.  It stops endometrial tissue growing but doesn’t shut down ovulation and estrogen.
  • Laparoscopy: (Surgery to identify and remove the lesions): Removing the lesions help relieve the pain and improve fertility, but the research shows that they grow back within five years in 50 percent of cases.  This is why surgery needs to be combined with the functional medicine treatments to address the immune/biome component and slow/stop the tissue growth.

Functional or Natural Treatments:

Functional medicine focuses on treating the root cause of disease, so it focuses on the immune component of endometriosis.  I have seen many cases where this works well combined with surgery.  For many women, it can slow or even stop the growth of the lesions, but they most likely need to have the existing tissue removed by surgery.

Remove foods that may promote inflammation

  • Gluten can promote inflammation even in non-coeliac patients.  Seventy-five percent of women with endometriosis reported a statistically significant reduction in pain after 12 months on a gluten-free diet.  This wasn’t a small study either, with 207 endometriosis patients included.
  • Dairy, especially A1 casein protein-containing (conventional) dairy can also promote inflammation.  While the research is not available for the effect on endometriosis symptoms, and to be fair is still in its infancy for A2 milk in general, both human rat studies have shown a higher level of inflammation with A1 milk products.

    Additionally dairy stimulates insulin which worsens PCOS symptoms in most women.  So if you have both PCOS and endometriosis, remove dairy entirely for at least three to six months and see if this helps your symptoms.
  • Try a LOW FODMAP diet. As well as the above dietary recommendations, a low FODMAP diet has been found to help relieve the symptoms of endometriosis.  FODMAPs are food for your bacteria, and when fed the bacteria cause the abdominal pain you might be experiencing.  By removing the FODMAPs, you reduce the bacterial overgrowth and potentially improve your symptoms.

Take Supplements and Nutrients:

  • N-Acetyl Cysteine (NAC) NAC is a potent anti-inflammatory supplement as it’s the precursor to the mother of all antioxidants, glutathione.  NAC is known as the master antioxidant because it gobbles up 100 inflammatory molecules compared to the five other antioxidants like vitamin C does.  NAC has been shown to be super effective for women with endometriosis.  Fifty percent of women in the study that were treated with NAC had such amazing improvements in their symptoms they actually cancelled their laparoscopy!
  • The amount of NAC used in the study was 600mg three times a day for three consecutive days in the week and then four days without.
  • Berberine has several anti-inflammatory actions.  It repairs intestinal permeability (thereby improving autoimmunity) and neutralises the bacterial toxin LPS.  Caution: Do not take berberine if you are pregnant or breastfeeding, and do not take for more than three months continuously except under supervision.  Be cautious when combining with other medications.
  • Probiotics.  In one clinical trial, the probiotic strain Lactobacillus Gasseri (OLL2809) stimulated natural killer cells and significantly reduced endometriosis pain after just 12 weeks.  I often prescribe a two-month course of berberine followed by a two-month course of a probiotic.
  • Turmeric reduces the size and activity of endometriosis lesions.  It works by reducing the inflammatory cytokine NF-kappa B and by blocking estrogen’s stimulating effect.  Turmeric works best as a concentrated capsule or tablet.  It’s safe for long-term use.
  • Zinc is a key anti-inflammatory nutrient and has been demonstrated to be deficient in endometriosis-sufferers.  Zinc repairs intestinal permeability (thereby improving autoimmunity) and reduces prostaglandins and pain.
  • Other helpful treatments could include selenium, rosemary, DIM (diindolylmethane), fish oil, castor oil packs and natural progesterone.

Source: Lara Briden's Healthy Hormone Blog Lara Briden is a naturopathic doctor with 20 years experience in women's health and the author of Period Repair Manual.  Clare Goodwin, the PCOS Nutritionist has also contributed to this page.