Signs, Symptoms & Natural Treatment
Endometriosis occurs when endometrial growths develop outside the uterine cavity. Functioning ectopic endometrial glands and stroma typically occur on the ovaries, fallopian tubes, outer wall of uterus, bowel, rectum, ureters or bladder.
Endometrium that grows between the muscular fibres of the uterus is known as adenomyosis. Endometriosis affects up to 10% of menstruating women and causes pain, irregular bleeding and problems with fertility.
Causes of Endometriosis
The exact cause is unknown. Theories include:
- Retrograde menstruation (blood flowing back into the women’s body), coupled with immune dysfunction. Retrograde flow occurs in most women but it is thought that the women with endometriosis may have immune dysfunction such as increased inflammatory mediators, decreased WBC activity and/or an autoimmune reaction, causing endometrial tissue to adhere to other tissues.
- Estrogen excess, causing proliferation of endometrial tissue
- Dysfunctions in embryonic development
- Family history
- Relative estrogen excess (e.g. early menarche, delayed pregnancy, frequent periods): stimulates endometrial growth and suppresses natural killer cell activity.
- Outflow blockage e.g. cervical stenosis, adhesions, imperforate hymen: may cause increased retrograde flow
- Prostaglandin imbalance: increases uterine spasm and fallopian tube diameter which may facilitate retrograde flow.
- Strenuous exercise or sex during menstruation
- Lack of exercise
- Obesity and insulin resistance
- IUD use
- Excessive caffeine and alcohol consumption
Signs and symptoms
- Painful periods: most common symptom (although 33% have no pain); usually starts prior to onset of menses and is described as congestive, heavy, dull or dragging. During period, may become crampy and labour-like.
- Most women with endometriosis have symptoms of PMS e.g. anxiety, mood swings, breast tenderness, bloating etc
- Cycle may be short or irregular, and periods may be heavy
- Some women may also experience pain with bowel movements or pelvic or low back pain.
- Irritable bowel syndrome
- Inflammatory bowel disease
- Bowel obstruction
- Ectopic pregnancy
- Pelvic inflammatory disease
- Urinary tract infection
- Uterine Fibroids
TREATMENT STRATEGY FOR ENDOMETRIOSIS
- Identify and address risk factors
- Decrease inflammatory prostaglandins
- Balance bowel microflora and address SIBO if indicated
- Modulate estrogen levels
- Reduce exposure to xeno-estrogens
- Increase exposure to phyto-estrogens
- Improve liver and bowel clearance of estrogen
- Support immune function and lymphatic clearance
- Balance methylation
- Reduce endometrial lesions / adhesions
- Tone and astringe uterus
- Reduce endometrial adhesions
- Support nervous system
- Address anemia (if indicated)
- Provide symptomatic relief
Diet plan guidelines for Endometriosis
- Fresh, whole food, organic, low GI diet.
- Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil.
- Reduce pro-inflammatory foods such as commercial red meats, sugar, refined grains, alcohol and caffeine
- Reduce total and saturated fats: saturated animal fats encourage growth of intestinal bacteria which produce an enzyme, beta-glucuronidase, which converts estrogen into a form which can be reabsorbed from the bowel. Women on high-fat diets have significantly higher blood levels of estrogen than those on a low-fat diet. We often find beta-glucuronidase at high levels when there is bacterial overgrowth in the gut or SIBO
- Eliminate sugars and refined carbohydrates: insulin resistance is associated with estrogen excess
- Increase dietary fibre and probiotic foods: to promote clearance of estrogen from bowel
- Include bitter foods, cruciferous vegetables (cabbage, kale, broccoli, Brussels sprouts), turmeric and rosemary to improve liver clearance of estrogen
- Include foods that inhibit aromatase activity – white button mushrooms (Chen et al, 2006), cruciferous vegetables, onions and garlic, citrus fruits, many culinary herbs (parsley, dill, oregano, rosemary, sage, coriander), celery, oysters, grapes, berries, red wine and green tea
- Avoid excessive caffeine and alcohol intake, especially just prior to menses
- Ginger 1 g/day: improves symptoms of PMS
- Reduce exposure to xeno-oestrogens: non-organic animal fats, unfiltered water, plastic-wrapped food, microwaving foods in plastic containers, tinned foods, etc.
- Weight loss diet if indicated
Supplements that support Endometriosis
- Fish oils -reduce inflammation
- Vitamin C and bioflavonoids- take 2 hourly during menses, reduces inflammation, reduces aromatisation, supports immune system and repairs capillary fragility,
- Curcumin – anti-inflammatory, supports liver clearance of estrogen, and may help induce clearance of endometriotic tissue
- Indole-3-carbinole (I3C) 300-400 mg/day: supports liver metabolism of estrogen
- B6, methyl folate, B12: methylating factors needed for the metabolism of estrogen
- Magnesium – antispasmodic
- Vitamin E – reduces adhesions and supports circulation
- Vitamin A – supports immune function and tones and astringes uterus
- Vitamin D – (depending on status): supports immune function and reduces adhesions
- Zinc – supports immune function, reduces adhesions and may help induce clearance of endometriotic tissue
- Probiotics: anti-inflammatory, immune support and supports clearance of estrogen
- Herbal Medicine that supports Endometriosis
- Uterine tonics (regulate muscular activity of uterus) – dong quai (principal herb), false unicorn root, true unicorn root, blue cohosh, raspberry leaf
- Anti-inflammatory – ginger, feverfew, turmeric, bupleurum, boswellia
- Hormone regulators – chaste tree, black cohosh, dong quai, red clover
- Liver clearance of Estrogen – St Mary‘s thistle, schisandra, rosemary, turmeric, bupleurum
- Reduction of endometriotic tissue and adhesions: turmeric, baical skullcap, calendula
- Immune regulators – echinacea, astragalus
- Anti-spasmodic – cramp bark, wild yam, peony/licorice, corydalis, valerian, black haw, blue cohosh, black cohosh
- Menstrual flow stimulants – mugwort, blue cohosh, ruta
- Anodynes – corydalis, Jamaican dogwood, pulsatilla, willow bark
- Uterine astringents – ladies mantle, bethroot, yarrow, shepherd‘s purse, raspberry leaf, cinnamon
Lifestyle / Physical measures
- Regular exercise; avoid strenuous exercise during menstrual flow
- Pelvic floor exercises
- Massage may be helpful to relieve pelvic congestion
- Acupuncture may be beneficial
FUNCTIONAL MEDICINE TREATMENT OF ENDOMETRIOSIS
Endometriosis is a common condition that is becoming more prevalent in current times. A tendency toward estrogen dominance, high use of the oral contraceptive pill and diet and lifestyle factors all increase the chance of having complications with the female cycle.
Many other underlying health issues also greatly contribute toward Endometriosis and other menstruation issues. These include poor gut function and bacterial or fungal overgrowth of the colon or small intestine (SIBO), methylation imbalances contributing to the rise is estrogen in relation to progesterone and key vitamin and mineral deficiencies that assist with hormone creation and clearance, often low due to digestion and absorption issues in the gut.
Balancing these underlying conditions is vital in the management of Endometriosis and also to stop the return of endometrium tissue for those patients who have undergone laparoscopy surgery.
We treat patients at our Perth clinic of Advanced Functional Medicine in person and also Australia wide via online video link. If you or a family member are suffering from endometriosis or another menstruation issue we would love to hear from you.
managed to recover from Endometriosis without surgery? What are the measures you took that worked
best for you? Have you investigated your
gut health and methylation in relation to endometriosis? Please leave a comment below.