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1 in 10 women are thought to suffer from endometriosis. However, this may be under-reported due to many being asymptomatic, with lesions discovered only after investigations for other conditions.
For those with symptoms, it can be debilitating and have a devastating impact on quality of life.
The current medical treatment involves hormonal pharmaceuticals such as the oral contraceptive pill, surgery, and pain medications, all with potential long and short term side effects.
It can be argued that this approach does nothing to address the underlying cause of endometriosis and instead just suppresses or temporarily relieves symptoms.
So, in this post, I take a look at the functional medicine or holistic health approach to treating endometriosis and discuss:
Why I believe the oral contraceptive pill is NOT the answer.
What lifestyle changes and supplements can make a huge difference for those with endometriosis, and
why endometriosis is not really a hormone condition, but an inflammatory disorder with an abnormal immune response.
What is endometriosis, what are the symptoms, and how is it diagnosed?
If you're new to the condition that is endometriosis you may want to head on over to "The quick guide to endometriosis" before reading on. There I'll answer all those questions and more.
But essentially endometriosis is when the tissue that sheds from the uterus as part of a women's normal menstrual cycle is found outside the uterus, where it shouldn't be. This extra-uterine endometrial tissue also responds to the hormonal changes that trigger shedding or bleeding. This promotes inflammation and can over time lead to the formation of scar tissue and adhesions.
What is the cause?
No one truly knows! There are several theories, from a back flow of menstrual tissue through and out the Fallopian tubes (retrograde menstruation), to tissue metaplasia where certain epithelial tissue retains its ability to transform into menstrual tissue.
But other factors are certainly involved including a favourable hormonal environment and altered immune and inflammatory responses in genetically susceptible women.
Inflammation is excessive in endometriosis sufferers.
Elevations of inflammatory markers are commonly seen on blood tests. Does the excessive inflammation result in immune dysfunction, preventing the clearing up of endometrial lesions?
Some researchers argue that endometriosis may even be an autoimmune condition.
Studies have indicated a tendency toward autoimmune conditions in those with endometriosis. It is also well known that once you have an autoimmune disease you're a sitting duck for another later in life.
So, what inflammatory and immune factors seem to be involved?
Environmental toxins
Patients with endometriosis seem to have higher levels of toxins present in blood samples. Increased blood levels of dioxin and PCBs (polychlorinated biphenyl) have been associated with deep endothelial nodules.
It is therefore recommended that endocrine disruptors like bisphenol A, parabens, pthalates, pesticides, dioxins, PCBs, plasticizers, solvents and formaldehyde are avoided.
Infection
"Women with endometriosis have a high level of gram-negative bacteria in the pelvic microbiome and researchers think that the toxin LPS (lipopolysaccharide) from those bacteria could play a role in the development of the disease".
Lara Briden, naturopathic doctor and author of "Period repair manual".
LPS is a known inducer of inflammation and immune dysfunction. Plus, its presence in the blood is an indicator for a "leaky" gut. This hints that the gut is the likely origin of the bacterial toxin.
Poor gut health
Ideally, the gut wall should provide a barrier between the outside world and the inner circulatory system of the body. This selective barrier should allow small essential nutrient particles in and keep larger toxins out. However, in this day and age, increased intestinal permeability, also known as a "leaky" gut, is common. Entering the blood are toxins and even food (protein) particles that shouldn't be there, triggering an inflammatory immune response.
So, what causes a leaky gut? Food sensitivities, a candida overgrowth, smoking, infection, dysbiosis, nutritional deficiencies (like zinc, vitamin D and vitamin A, as they help to maintain gut integrity), stress, low stomach acid and poor digestion (due to low zinc, B1, B6, stress, antacids and other medications).
A healthy gut is essential for so many reasons. There's a reason it's said, "look first to the gut". (Learn more with "Leaky gut - can this be destroying your health?")
Poor detoxification
Excessive toxic load from environmental exposure means that the body's ability to detoxify is strained. The body can then struggle with even its normal metabolic processes where it converts toxic metabolites into less dangerous substances.
One example is with estrogen hormones. There are "good" and "bad" estrogens. The "bad" estrogens become elevated when the detoxification organs (particularly the liver) are not functionally optimally.
Since estrogen strongly stimulates the growth of endometriosis lesions, and "bad" estrogens can increase your risk of certain cancers, it is important to make sure that detoxification is not compromised.
A methylation issue due to a mutation to the MTHFR gene can also interfere with detoxification and promote inflammation.
Stress and adrenal dysfunction.
We know that stress can have an impact on gut health and integrity, but stress can also cause hormonal imbalance because of its effects on the endocrine system.
Stress can cause the kidneys to convert hormones like progesterone to cortisol. Low progesterone levels can then mean high estrogen symptoms, fuelling endometriosis growth. Cortisol can also have pro- inflammatory effects depending on its concentration.
Why are hormonal contraceptive pills used to treat endometriosis? And why do holistic practitioners not recommend them?
Hormonal contraceptives are used to suppress menstruation or replace it with a milder version of menstruation, called a “withdrawal bleed”. Suppressing menstruation stops the lesions bleeding and abolishes ovulation, which can help with the pain but does nothing to address the underlying cause.
The oral contraceptive pill essentially is temporary, chemically induced menopause! Which when you say it like that, doesn't sound like a great idea, does it?
The pill is also associated with a higher risk of breast, cervical, liver and brain cancer. Then there are the side effects. From weight gain, moodiness, to even depression and suicidal thoughts. (See "The nine major myths about the pill").
Recurrence of symptoms is common after medical treatment with hormonal contraceptives and even surgery. Given that endometrial lesions can become malignant and that there is a 50% increase in the risk of epithelial ovarian cancer, addressing the cause so it doesn't recur seems like a much better approach.
What is the functional medicine or holistic health approach to treating endometriosis?
1. Address lifestyle, environmental toxin exposure, diet and stress.
Remove any foods your body finds inflammatory. These are most commonly gluten, dairy, sugar and sometimes eggs. Not sure which? Start with going dairy free for a few months. Lara Briden, author of the Period Repair Manual has found dairy to be a common issue in women with hormonal / period issues. See her blog post here.
Avoid processed foods, trans fats, refined oils and inflammatory foods. AVOID sugar!
Consume fresh veggies and make sure you're getting enough fibre, healthy fats and protein in your diet.
Aim for organic. Try to avoid food contaminated with pesticides and herbicides. Use a pesticide reducing spray or at least avoid the dirty dozen.
Be wary of caffeine.
Limit or avoid alcohol.
Go natural with your household and personal care products. Including perfumes and fragrances. Endocrine disruptors are commonly found in these products. (For natural products I love, visit the shop, for recommendations).
Avoid food that comes in soft plastic wrap or is stored or microwaved in plastic.
Avoid tinned food (lined with BPA). Store food in glass containers.
Avoid plastic water bottles (even if BPA-free, because we might find that the substitutes are just as problematic!)
Get enough sleep. The sleep between 10pm and 2am is most beneficial for your adrenal glands.
Find ways to manage stress.
Get moving. Exercise has so many benefits.
Too much? Make one change a week, and you'll get there.
2. Address poor gut health, poor digestion, any infection or overgrowth.
This is where you're likely to need help.
Is your stomach acid low? (By the way, reflux and heartburn is often not caused by excess stomach acid! Read more here.)
Are you deficient in nutrients like zinc, vitamin B1 or B6 (P5P) that aid stomach acid production?
Are you deficient in zinc, vitamin D or vitamin A that help maintain gut integrity?
Do you have a small intestinal bacterial overgrowth (SIBO)?
Do you have a candida overgrowth or a "leaky" gut?
Do you need herbal anti-microbials like berberine ?
Are there certain foods you should be avoiding?
It's important not to miss this step as the gut plays a role in detoxification, immune function, brain function and through nutrient absorption, every other function of the body.
3. Address stress levels and support the adrenals and/or thyroid if needed.
Is a herbal adrenal support or a glandular re-builder needed?
Do you have any nutrient deficiencies? Like iron, selenium, iodine, zinc (again).
What are you doing to manage your stress? Have you tried the Emotional Freedom Technique (EFT), meditation, yoga, essentials oils or exercise?
4. Aid detoxification.
Does your liver need support with Indole-3-carbinol or a herb like milk thistle?
Do you have the MTHFR gene mutation which can have an impact on your body's ability to detoxify and protect your genes?
Do you need active B vitamin supplementation?
Do you need to increase your water intake?
Do you need to decrease your alcohol intake?
Are you constipated? What's your stool transit time? Is your gut "leaky"?
NOTE: It's important to make sure gut integrity is maintained before using any detoxification or "bug-killing" herbals. Otherwise you could just be releasing the toxins back into your blood stream, which won't help and likely make you feel worse!
5. Is anti-inflammatory and anti-oxidant support required?
Turmeric (curcumin), ginger, boswellia (frankincense), omega 3 fatty acids, zinc, melatonin, echinacea, L-glutathione or N-Acetyl-Cysteine (NAC) may be helpful.
For them to be effective the quality of the supplement and the dose is important.
NAC is an amino acid derivative that supports the production of glutathione in the liver, which is a potent antioxidant and natural detoxifier. It has shown promise for the treatment of endometriomas, decreasing the size of ovarian cysts in one study.
Nordic naturals have a product containing pure cod liver oil (for omega 3s), curcumin, L-gluthathione and NAC called Omega Curcumin. This could be a good option for anti-inflammatory support.
In one study, women taking melatonin had an overall 80% reduction in the need for pain medication. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue.
A product containing gotu kola, grapeseed extract and ginkgo biloba is also recommended by some holistic practitioners for its potential to support blood flow (particularly micro-circulation) to tissues. This could aid healing, and reduce scar tissue or adhesion formation.
6. Balance hormones.
This is the final step in the puzzle because if you've supported detoxification through improving gut health, reducing xeno-estrogen and toxin exposure, plus reduced stress and improved adrenal function, you should be well on your way to better hormones naturally.
However sometimes additional help is required, with estrogen reducing supplements such as calcium-d-glucarate or natural progesterone or the herb vitex agnus (chaste tree) to increase progesterone levels.
(Note: Progestin in the contraceptive pill is NOT progesterone).
Zinc
I must once again mention the mineral zinc. It plays a role in so many crucial body processes, including immune support, detoxification, gut health, fertility and hormonal health. Women with endometriosis have been found to have low zinc levels. So zinc status should always be considered in anyone with endometriosis or any hormone or fertility issue.
The risks! One final note.
Along with an increased risk of ovarian cancer, women with endometriosis are at a much greater risk of heart disease. The risk was highest among women under 40 years of age, and in those who had undergone a hysterectomy (removal of uterus) or oophorectomy (removal of ovaries). Why? Probably due to the underlying inflammatory factors and/or the use of non steroidal anti-inflammatories used to treat the chronic pain.
Following a natural holistic approach in the support and treatment of endometriosis is beneficial not just for symptom relief (without the side effects of drugs or surgery), but also for long term overall health and well-being. What other chronic illness could you be preventing by addressing inflammatory factors and improving detoxification and gut health???
References:
Lecture by Dr Ronda L. Nelson, PHD, MH, CNC for The Functional Medicine University:
Endometriosis: Etiology, Clinical Evaluation and Holistic Management
Lara Briden. Author of the book: Period repair manual: Natural Treatment For Better Hormones and Better Periods. (A must read!)
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Schwertner A, Conceição Dos Santos CC, Costa GD, Deitos A, de Souza A, de Souza IC, Torres IL, da Cunha Filho JS, Caumo W. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013 Jun;154(6):874-81. doi: 10.1016/j.pain.2013.02.025.
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