Period Problems
What is endometriosis?
Endometriosis (or ‘endo’) is a very common female reproductive condition that affects around 1 in 10 women, affecting people of any age, gender and race. We are going to discuss endometriosis, what causes it, the symptoms and treatment options.
Endometriosis is a chronic (‘long term’) inflammatory condition where growth of tissue that is similar to uterine lining occurs in other areas of the body such as the fallopian tubes, ovaries, bowels and lungs.
When these cells grow in irregular areas, the body triggers an inflammatory cascade to affect other body systems. Often, individuals with endometriosis will experience additional symptoms and disorders such as interstitial cystitis, IBS, SIBO, mood disorders and fatigue (just to name a few). Endometriosis can significantly impact one’s quality of life, for some it can be debilitating and then for around 20-25% of women they may not experience symptoms which can make diagnosis more challenging.
Healthcare professionals (HCPs) will classify the condition based on its severity: minimal, mild, moderate, severe or stage 1 to 4. In stage 1, endometriosis will scatter on the pelvic cavity as surface lesions. In stage 2, endometriosis will be more spread out and will appear on surrounding tissues such as the ovaries. In stage 3, more organs become affected and there are cysts and scar tissues (adhesions). And finally, in stage 4, most of the surrounding pelvic organs have been so severely affected by endometriosis that the normal anatomy has become distorted and some organs will morph into one.
What causes endometriosis?
Unfortunately endometriosis research is underfunded and medical professionals still don’t know what causes endometriosis. Research suggests that there are correlations between the condition and factors such as immune dysfunction, inflammation, genetics, and environmental toxins. Additionally, certain risk factors can increase your chance of developing endometriosis. Read on for possible causes of endometriosis and its associated risk factors.
Immune system dysfunction & endometriosis
In endometriosis, immune dysfunction is what inhibits the immune system in clearing lesions and promoting lesion growth. Researchers believe immune dysfunction to be caused by a combination of factors like genetics and epigenetics.
Excessive Estrogen & endometriosis
Although endometriosis is an inflammatory condition (not a hormonal condition), it is however estrogen-dependent and excessive estrogen levels will often worsen and exacerbate the condition. This is why addressing hormonal health and getting estrogen in balance is part of an effective treatment plan. Limiting exposure to environmental toxins also comes into play here as certain toxins affect estrogen levels and potentially contribute to the progression of the disease.
Environmental factors & endometriosis
Some research suggests that environmental toxins play a role in endometriosis with chemicals such as PCBs and dioxins increasing the risk of the condition by impacting immune function, hormones and growth factors.
Signs and symptoms of endometriosis
Firstly, it’s important to note, some women may experience none, some or all of these symptoms which unfortunately makes diagnosing endometriosis more difficult. However, the most common endometriosis symptoms are chronic pelvic pain, heavy bleeding, fertility challenges, fatigue, frequent urination, irregular periods and painful sex.
Chronic pain
People with endo can experience pain differently. Some may experience pain in the pelvis, lower abdomen, back, rectum, vagina, bladder and even diaphragm (depending on where the endometriosis has spread). They may experience pain any time of the month, before their period, during their period, after their period, during sex, during urination, and/or when they have a bowel movement. Pain is often described as ‘knife-like’, heavy, sharp or radiating. Often the pain will be so severe that affected individuals will be unable to engage in normal activities such as work, school/university and socialising.
Irregular and heavy periods
Women with endo will often experience heavy bleeding requiring them to change pads or tampons 2-3 times or more each hour. This bleeding may occur with or without clots. Some may bleed for longer than what’s considered normal (over 7 days) and bleed irregularly (bleeding before a period is due or skipping months altogether).
Endometriosis & infertility
Endometriosis is linked to an increased incidence of infertility and infertile women are up to 8 times more likely to have endometriosis compared to fertile women. Several mechanisms may play a role in this association including disrupted anatomy, irregular and anovulatory periods, and inflammation.
When there are elevated levels of inflammation, such as in endometriosis, it creates an unfriendly environment for fertilisation and implantation. Additionally, anatomical distortions, scars and adhesions caused by lesion growth may block the fallopian tube to prevent fertilisation from occurring.
However, many people with endometriosis successfully fall pregnant! If you do decide to start trying for a baby, speak out to a trusted healthcare professional and build a team to help support you during preconception and pregnancy. Your team may include individuals such as your general health care practitioner (GP), gynaecologist, naturopath, nutritionist, midwife and doula.
How to test for endometriosis
If you relate to the symptoms mentioned above, then please seek out assistance from your general healthcare practitioner (HCP) and/or gynaecologist. Endometriosis is important to treat as early as possible as early treatment can prevent the disease from progressing into the more latter and severe stages.
There is no other test such as a blood test, scan, or fluid sample to confirm the presence of endometriosis. A health care provider will ask you about your menstrual cycle, and may recommend an ultrasound, MRI and/or perform a pelvic examination when they suspect endometriosis. An ultrasound, MRI or pelvic examination cannot diagnose endometriosis, but they may help serve as a starting point towards diagnosis.
The “gold standard” and the only way to test and confirm for endometriosis is laparoscopy or a “keyhole surgery”. This involves inserting a tiny tube into the abdomen where the doctor will then observe the internal organs to confirm the presence of lesions.
If you don’t already track your menstrual cycle, now is the perfect time to start! Download a period tracking application (such as “Flo”, “Clue”, “Eve” or “Period Diary”) or keep a journal. Track the length of your cycle, the length of your bleed, the pain you experience (where, when, how long for), the heaviness of your cycle, your mood, energy, bowel movements/habits and frequency of urination. This can help you and your doctor identify potential indicators of endometriosis.
Treatment options: conventional & natural
The Conventional Approach
Laparoscopy
A treatment option for endometriosis is a laparoscopy which involves surgical excision of the lesions. This can be effective for pain and fertility.
Hormonal suppression
Hormonal birth control is the most common solution provided by doctors to manage endometriosis. It works by inhibiting ovulation and inducing estrogen deficiency. This in turn slows the growth of the lesions, and whilst it can offer short-term symptom relief it does not cure the disease and unfortunately isn’t without side effects.
Mirena intrauterine device (IUD)
The Mirena IUD is another conventional treatment option that works locally to suppress the uterine lining and lesions without inhibiting ovulation.
The Natural Approach
Addressing your diet
An anti-inflammatory diet can have a huge impact on pain associated with endometriosis.
A standard Australian diet (SAD) is high in processed foods, sugar, saturated fat, trans fat and refined carbohydrates. This diet promotes inflammation and as discussed inflammation is a key driver in the pathogenesis of endometriosis. Hence, to help manage the condition, focusing on an anti-inflammatory wholefoods, nutrient dense diet can really help towards improvements. Foods like turmeric & ginger (found in Luna’s Gold), cruciferous vegetables, garlic, fermented foods and leafy greens support detoxification and lower inflammation.
Food intolerances are common in people with endo, which is why it’s crucial to discover which foods work for you, and those that do not. Its not about “restricting” yourself, but discovering the diet that makes you feel your best and helps to manage your endo symptoms.
Note: Diet plays a big role when it comes to endometriosis management, however it’s important to understand that diet as part of a larger holistic approach is most effective and not to be expected to solely manage symptoms alone.
Anti-inflammatory foods include:
Fresh fruits & vegetables such as pineapple, beetroot, berries, citrus fruits and apples. Find these antioxidant-rich vegetables in our Luna’s Beets
Green leafy vegetables such as kale, romaine and arugula.
“Good fats” found in oily fish, avocados, nuts and seeds. Find these good fats in our Earth Seeds.
Spices such as turmeric, ginger, cinnamon and clove. Find these anti-inflammatory spices in our Luna’s Gold Adaptogen Elixir.
Support the elimination of estrogen
As mentioned previously, excess levels of estrogen play a large role in the pain cycle of endometriosis. So supporting the body’s metabolism of estrogen (the breakdown and elimination from the body) is a natural approach that can help make a difference. Estrogen is processed through the liver, and then excreted through the bowels so if these pathways are not functioning optimally it compromises our ability to remove estrogen resulting in excess estrogen and exacerbating endometriosis. This is why a focus on supporting liver function and gut health is important.
Improve your gut health
We literally poop out estrogen! So when we are not moving our bowels regularly each day, we are more likely to build toxins in our body and recycle estrogen resulting in hormonal imbalance and estrogen dominance.
To support our digestive system and improve our bowel regularity, increasing your intake of fibre helps with the elimination of estrogen along with consuming more probiotics (beneficial microorganisms or “good bugs” in our gut) and prebiotics (foods that support and feed our “good bugs”). Probiotic-rich foods include kimchi, yoghurt, kefir, sauerkraut and pickles. Prebiotic-rich foods include apples, green bananas, garlic, artichoke and onions.
Detoxify naturally with your liver
Whilst, unfortunately, ‘detox’ has become synonymous with juice cleanses or skinny teas – our bodies are completely capable of detoxifying themselves (a matter of fact, they’re doing it all right now!). The liver is one of our major detoxification organs and is responsible for removing excess estrogen and regulating the balance of female sex hormones. Its nutrients like B vitamins, magnesium, DIM and bioflavonoids that support liver detox phases 1 and 2 that processes estrogen. You can obtain these nutrients through a wholefoods balanced diet and supplementation if necessary for you. Focusing on consuming adequate high quality protein, drinking lots of filtered water, organic whole grains, cruciferous vegetables (think broccoli, bok choy, cauliflower, turnips and kale) and reducing foods that burden our liver (think packaged foods, refined sugars and alcohol) is key. Try out Half Moon Tea in the Endometriosis Moonbox which has been specifically formulated by our naturopath to support your liver. It’s caffeine-free, 100% organic and contains liver supporting herbs such as dandelion root, fennel seed, lemon peel and spearmint. Consume 1-2 cups daily to reap the most benefits.
Lifestyle
Reducing your exposure to environmental estrogens
Xenoestrogens refer to endocrine disruptors found in our environment that have estrogen-like effects. They’re found in plastics (such as plastic containers and water bottles), beauty products, skin care products, and perfumes. They can not only disrupt the natural balance of our hormones but also imbalance our immune system and increase inflammation. We can reduce our xenoestrogen exposure by using glass or other non-plastic cutlery and food storage, switching to more natural beauty products and consuming organic, hormone-free meat and dairy products. Detox your skincare with our Skincare Bundle which contains natural, organic and cruelty-free skincare products to nourish your skin without the chemicals!
Exercise
Exercise can have so many benefits that are unrelated to changing our physical appearance or fitness level. Hormonally, exercise can reduce excess estrogen and oxidative stress levels, which we now know worsen endometriosis-associated pain and inflammation.
Exercise releases endorphins which act as natural ‘painkillers’ i.e., they reduce an individual’s pain sensitivity. These endorphins also have a mood-boosting effect which is important as people with endometriosis are more likely to suffer from mood disorders (such as depression and anxiety) compared to people without endometriosis.
However, it’s also completely understandable to want to curl up in bed and hold a hot water bottle when the pain hits. So when it comes to exercising throughout the month, always tune in to your body and how you are feeling physically, energetically and emotionally and meet yourself there.
Pilates and yoga are powerful ways to strengthen the pelvic area muscles and receiving support from an exercise physiologist specialising in female health or pelvic floor specialist can be beneficial to help guide you through exercises that will support (and not aggravate) your endometriosis.
Manage stress
Stress causes hormonal havoc, it is inflammatory and releases inflammatory mediators which in turn increases pain in endometriosis. It also reduces our progesterone levels (our other major sex hormone) resulting in higher estrogen to progesterone. Whilst life’s stressors are often out of our control, it is within our control as to how we respond to stress. It is thn our response to stress that in turn determines how it impacts our health. Developing a toolbox to help you cope when things become challenging is so important. This may look like meditating, journaling, a gratitude practice, nature walks, breathwork, less screen time, calling a friend, more rest, long baths etc. Discover what works best for supporting you.
Final Thoughts & Recommendations
Endometriosis is a chronic condition, and there is no one treatment that is going to be effective for every person. There is no cure however there are ways in which you can manage the condition and improve your quality of life. Since endometriosis is complex, a long-term, teamwork approach is best in investigating and discovering the most optimal support for your health and individualised needs. A natural approach alone may work for some people, and for others combining a natural approach with surgery and/or medications works best. It is going to be different for each person and there is no shame in any approach you choose to take which helps you to feel better.
Want personalised support for managing your endometriosis and improving pain long term? Apply to work with Nikki for 1:1 Nutrition & Hormone Coaching here.
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