Understanding Endometriosis
Say no to ENDO…...
It is estimated that 190 million women worldwide are affected with Endometriosis, a debilitating condition that can play havoc with mood, hormones, libido, pain, energy levels and infertility.
On average it can take 12 years from the onset of symptoms to a definitive diagnosis and then even longer to address and treat the underlying causes.
This in turn may lead to the condition worsening as endometrial like cells proliferate, invade and implant elsewhere in the body.
What is Endometriosis?
Endometriosis is an estrogen- dependent, benign, inflammatory disease where endometrial like tissue grows outside of the uterine cavity. The peak prevalence of endometriosis occurs in women 25-35 years of age. However the disease has been reported in younger girls whom have not commenced menstruation, postmenopausal women and even men [1-4].
Where is Endometriosis found?
Histological reports have found endometrial lesions in the following areas of the body
Reproductive organs
Gastrointestinal region
breasts
Kidney & adrenal glands
Urinary tract
Spinal column
peripheral and central nervous system
Chest cavity (lungs and around the heart)
Prostate [5-6]
Symptoms of endometriosis?
The symptoms of endometriosis are different for everyone, the pattern of your pain can often indicate the location of your endometriosis and thus help with treatment options. Although some women have no or minimal symptoms it is still important to have the correct diagnosis to best support your hormones.
Symptoms may include:
Pain
Infertility
Bowel issues such as IBS
Bladder problems such as recurring UTI’s
Heavy menstrual bleeding
Endometrioma (ovarian mass)
Chronic fatigue symptoms
Emotional disturbances
What Causes Endometriosis?
The cause of endometriosis remains uncertain but appears to be multifactorial. A number of theories have been postulated for further research such as the Sampson theory, Coelomic Metaplasia theory, embryonic rest theory and lymphovascular metastasis theory. Other causes may include one or more of the following [4,7,8].
Genetic Factors
Immune dysfunction
Hormonal imbalance
Abnormal endocrine signalling
Imbalanced cell proliferation
Sampson theory of retrograde menstruation
Lymphatic dissemination
Infectious or environmental triggers
Oxidative stress
Inflammation
Alterations in the gut microbiota
Liver damage
Long term hormonal therapy
How is endometriosis diagnosed?
The only way to be 100% certain of the diagnosis is to have a laparoscopy. This is a surgical procedure where a thin telescope is placed into your belly button to allow your gynaecologist to see inside and assess the organs of your pelvis and abdomen whilst taking a biopsy (tissue sample) for diagnosis.
As the cause of endometriosis is multifactorial the treatment approach should be the same to address all facets of the disease and its many causes. Over the years working both in the medical and complementary medicine worlds an integrative approach with the commitment to make the necessary changes and adjustments is required to achieve the best outcome.
What is the best treatment for Endometriosis?
Treatment for endometriosis falls into three broad categories
Medical treatment with medications such as pain relief and hormonal therapy to suppress estrogen production
Surgical to remove endometriosis. However surgery is unable to remove the microscopic endometriosis and this is why endometriosis is likely to proliferate and grow again.
Complementary treatments such as dietary adjustments, counselling, herbal medicine, physical therapy and acupuncture.
Receiving the right treatment will depend on your symptoms, your genetic profile, the severity of the condition and whether you are trying to become pregnant or maintain your ability to have children.
Diet and lifestyle
As endometriosis is an estrogen driven inflammatory condition it is imperative to make diet and lifestyle changes to minimise exposure to environmental and plant based estrogens along with assisting estrogen metabolism and reducing inflammation.
Treatment should be individualised to achieve the best response however some guidelines to assist in the management of endometriosis:
Avoid food intolerances and allergens that may exacerbate inflammation. Food intolerance testing is ideal to discover what foods you are reacting too.
Avoid foods that are estrogenic such as soy based products.
Know your genetic profile and expression of genes such as MTHFR, COMT and PEMT to establish underlying genetic reasons for estrogen issues, immune response and antioxidant production. This will also enable a tailored dietary, lifestyle and supplement protocol for you to assist with estrogen metabolism.
Avoid toxins that may mimic estrogens in the body such as dioxins, pesticides and polychlorinated biphenyls (PCB’s).
Assist estrogen metabolism with cruciferous vegetables such as broccoli, brussel sprouts and cauliflower. These vegetables are a rich source of sulfur containing compounds known as glucosinolates. When chewed they generate indole-3-carbinol.
Ensure good gut and liver health to assist with estrogen and toxin metabolism.
Moderate to intense frequent exercise has shown to reduce the size of endometrial lesions in some studies.
Stress less as stress may contribute to the development and severity of endometriosis through dysregulation of the hypothalamic-pituitary axis and promoting release of inflammatory markers
Chinese Medicine Approach and Endometriosis
Traditional Chinese medicine alongside conventional medicine utilises a number of different approaches and techniques to treat the symptoms of endometriosis using diet therapy, manual techniques, acupuncture and Chinese herbal medicine. To date research has shown some promising results however more research is required in this area.
Acupuncture has shown to reduce pain and serum markers associated with endometriosis, according the authors of a systematic review. The results showed that acupuncture yielded better reductions in pain associated with dysmenorrhoea, and led to a better reduction in peripheral blood CA-125 (a marker for endometriosis) when compared with control interventions [9].
Whilst a recent research article showed that Acupuncture increase’s the release of endorphins, the body’s own ‘feel-good’ chemicals, which play an important role in the regulation of physical and emotional stress responses associated with pain and digestive issues. [10-11].
Endometriosis the future
The complex nature of endometriosis and misconceptions around menstruation and infertility have led to delayed diagnosis and many hit-and-miss treatments. Myths continue to surround the endometrial phenomena such as ‘surgery will cure my endometriosis whilst medical/surgical classifications continue to evolve as consensus on classification is debated. Meanwhile many women continue to suffer.
It is time for women to take control educate and empower themselves to address the underlying reasons for endometriosis. Finding this can seem overwhelming and can take time. For some it is a matter of months some years. But remember every small step towards change is better than staying where you are.
If you would like to take the first step contact us or book an appointment on line
References:
1. Pinkert TC, Catlow CE, Straus R. Endometriosis of the urinary bladder in a man with prostatic carcinoma. Cancer. 1979;43:1562–7.
2. Fukunaga M. Paratesticular endometriosis in a man with a prolonged hormonal therapy for prostatic carcinoma. Pathol Res Pract. 2012;208:59–61.
3. Simsek G, Bulus H, Tas A, Koklu S, Yilmaz SB, Coskun A. An unusual cause of inguinal hernia in a male patient: Endometriosis. Gut Liver. 2012;6:284–5.
4. Schenken, R, Barbieri, R, Eckler, K 2019, Endometriosis: Pathogenesis, clinical features, and diagnosis, Up to date 2019.
5.Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril 2006; 86:298.
6. Jenkins S, Olive DL, Haney AF. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol 1986; 67:335.
7. Lasmar, Ricardo Bassil, Lasmar, Bernardo Portugal, & Pillar, Claudia. (2012). Diagram to map the locations of endometriosis. International Journal of Gynecology & Obstetrics, 118(1), 42-46
8. Sourial, Tempest, Hapangama 2014, Theories on the pathogeneses of endometriosis International journal of reproductive medicine 2014.
9. Xu, Wenli, Li, Ahao, Bu, Song 2017, Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis, PLoS One. 2017.