A natural approach to Endometriosis

Sep 28

What is endometriosis?

Endometriosis is a gynaecological condition which affects 1 in 9 women in Australia. Endometriosis involves the growth of endometrial tissue outside of the uterine lining (where it is supposed to be), lesions are most commonly found on the ovaries, fallopian tubes, vagina, cervix, bladder, and gastrointestinal tract. New research is leading us to understand that endometriosis is not just a hormonal condition, it is more-so an immune/inflammatory disease that is influenced by oestrogen.

“Endometriosis is an immune condition that is fuelled by oestrogen”

Endometrial tissue is highly influenced by the cyclical changes of our hormones that occur each month. In particular, the hormone oestrogen plays an important role as endometriosis is recognised as an oestrogen-dependant condition. The formation of this endometrial tissue triggers inflammation and can produce scar tissue which may cause severe, debilitating symptoms. These symptoms can have a huge impact on a woman’s physical, mental and emotional wellbeing. However, it is important to note that about one-third of women with endometriosis experience no pain and some women do not develop any symptoms at all. This can result in many women remaining undiagnosed until wanting to conceive and experiencing fertility issues. The exact cause of this condition remains unknown, however, there seems to be a variety of risk factors involved.

Risk factors:

Women aged between 25-30.
High oestrogen (shown on blood test).
Family history (mother/daughter/sister with endometriosis).
Started menstruation at an early age (before age 11).
Heavy menstruation that lasts longer than 7 days.
Shorter monthly cycles (less than 27 days).
Lean body mass and/or low body fat.

Symptoms associated with endometriosis:

Severe pelvic pain throughout the cycle (especially during menstruation).
Pain during and/or after sexual intercourse.
Pain with bowel movements and/or urination (can present as UTI type symptoms).
Pain in the lower back or legs.
Heavy and/or irregular bleeding.
Abdominal bloating.
Nausea.
Fatigue.
Trouble falling pregnant.
Depression and/or anxiety.

How do I know if I have endometriosis?

Speak with a trusted health practitioner if you have been experiencing any of these symptoms. If your doctor suspects endometriosis, they may recommend an internal pelvic ultrasound to detect for larger endometrial lesions or a blood test called serum Ca125. Both ultrasound and blood test are great tools however a laparoscopy is the only way to definitively diagnose this condition as smaller lesions are not seen on the ultrasound and Ca125 may only be elevated in severe cases. A laparoscopy is a surgery where a thin tube with a camera (laparoscope) is inserted through a small incision in the abdomen. The surgeon will look for endometrial implants, adhesions, and cysts and will remove or destroy these if found. The surgeon also determines which stage of endometriosis you have - stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (severe) - based on the location, extent, and severity of endometrial tissue growth. Other conventional treatments for the management of endometriosis includes the oral contraceptive pill to suppress ovulation and a range of pharmaceutical medications for pain relief. Surgery and medications come with both risks and benefits which must be considered on an individual basis. Alternatively, or in addition to these treatments, there are many potent nutrients, herbal medicines and dietary inclusions which can assist in alleviating many of the symptoms associated with endometriosis.

Foods for endometriosis:

Food can be used to reduce inflammation/oxidative damage and assist with hormonal balance via improving the body’s detoxification and elimination pathways. The following foods are great for helping to manage endometriosis symptoms:

Turmeric contains the potent compound curcumin which has been shown to down regulate inflammation and oxidative stress. Curcumin has also demonstrated the ability to act directly on reducing endometrial lesions. Add turmeric powder or freshly grated turmeric to curries, soups or stews or enjoy a wholesome turmeric latte as a coffee alternative.

Flaxseeds may assist in modulating circulating levels of oestrogen by inhibiting the activity of aromatase (CYP19) which converts androgens (aka sex hormones) into oestrogens. Flaxseeds also act by binding to unbound oestrogen in the digestive tract which can then be excreted via the stool, thus reducing the burden of oestrogen in the body. Add one tablespoon of freshly ground flaxseeds to your smoothies, sprinkled over oats or in baked goods such as muffins.
Cruciferous vegetables from the Brassica family such as broccoli, cauliflower, kale and Brussels sprouts all contain a compound called 3,3-Diindolylmethane (DIM) which have been shown to reduce high estrogen levels and support estrogen detoxification via the liver.
Omega-3 fatty acids have exhibited the ability to improve pain associated with endometriosis and reduce pro-inflammatory markers (indicators of inflammation seen in a blood test). Foods rich in omega-3 fatty acids include fatty fish such as salmon (buy wild caught if possible), sardines, tuna, hemp seeds, chia seeds, walnuts, and avocado.
Ginger has demonstrated anti-inflammatory activity via its ability to inhibit prostaglandins (chemicals which initiate inflammation) and reduce oxidative damage. In six clinical trials, ginger was shown to be effective at reducing painful periods. Ginger is also beneficial for digestive complaints (e.g., bloating, cramping, gas) which can accompany endometriosis. Start your day with a glass of warm water with lemon juice and freshly grated ginger, or include fresh/ground ginger to curries, soups and stir-fries.

Herbs and supplement for endometriosis:

Herbal medicines and supplements can be utilised to alleviate painful periods, regulate cycles, reduce inflammation, prevent further abnormal lesion growth and normalise sex/stress hormones. The following herbs and supplements are go-to’s in our clinic for supporting clients with endometriosis (this is not an extensive list, just some of our favourites):

Dong quai has been used for thousands of years in traditional Chinese medicine as a blood-building and tonifying herb. This herb is valuable in treating menstrual disorders such as pelvic pain and irregular menstrual cycles. The pain relief action is potentially due to the active constituent ligustilide which exhibits anti-inflammatory effects.
Cramp bark this herb gets its name for a reason and has been used traditionally to relieve menstrual cramps. Scopolectin, one of the major constituents of this herb, has shown to relax the uterus and reduce uterine spasms which has been proven in both animal and human clinical trials.
Schisandra works on phase 1 and phase 2 liver detoxification which can help to support the breakdown and clearance of oestrogen and prevent oestrogen from recirculating around the body. Schisandra acts as an adaptogen which can assist in regulating stress hormone production and improve our ability to adapt to daily stressors. This herb also demonstrates anti-inflammatory and antioxidant activity which can be attributed to the compound ligans (a type of polyphenol) found in Schisandra.
White peony is effective at treating hormonal imbalances due its oestrogen modulating activity. Peony can inhibit uterine smooth muscle contraction which may help alleviate painful menstruation. Endometriosis can result in reduced uterine blood flow and peony acts as a uterine circulatory stimulant, thus improving blood flow to the uterus. Peony also demonstrates immuno-modulating, anti-inflammatory and antioxidant actions thus helping to reduce the inflammation and oxidative damage involved in endometriosis.
NAC (N-Acetyl Cysteine) is has been shown to reduce endometriosis-related pain symptoms, the size of endometriomas and the levels of serum Ca125. NAC can also help with fertility outcomes in women with endometriosis. One study demonstrated that of 52 patients with reproductive desire, 39 successfully achieved pregnancy within 6 months of starting NAC therapy.

Take home message

Many women are taught to believe that painful or heavy periods are normal and just a part of being a woman. Although common, any type of pelvic pain which interferes with your day-to-day life is not normal and your symptoms should not be disregarded. It is so vital to listen to what your body is trying to tell you as any symptoms you may be experiencing are your body’s way of trying to communicate with you and tell you that something is wrong.

Natural treatment of endometriosis can be used standalone or alongside conventional medicine to assist in reducing symptoms and improving reproductive health. A naturopathic practitioner can assist you in managing this condition by providing an individualised treatment plan which may include specific functional testing, nutritional supplementation, an herbal formula and dietary/lifestyle modifications to target your specific symptoms. A naturopath can work alongside your regular doctor to provide you with the most in-depth and thorough care to treat this multifaceted condition. A naturopath’s goal is to educate and empower their client’s and to ensure they feel seen, heard and supported on their healing journey. With the right tools and guidance, this condition can be managed effectively to enhance your overall quality of life and improve fertility outcomes if wanting to conceive.

References

https://www.who.int/news-room/fact-sheets/detail/endometriosis

https://www.ncbi.nlm.nih.gov/books/NBK567777/#_NBK567777_pubdet_

https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/at-risk#f3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177778/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8972862/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050441/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754412/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122381/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10048621/

https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcp.26401

https://www.endometriosisaustralia.org/about-endo