Endometriosis (or ‘endo’) is a female reproductive disorder that affects around 1 in 10 women meaning there are 176 million women worldwide are affected with endometriosis today. It’s incredibly common but like all period problems, it’s not normal. It’s not normal to suffer from debilitating pain every month. Life is truly too short for so many women to suffer from this crippling disease and on average women will suffer from its symptoms for 12 years until they are properly diagnosed.
What is endometriosis?
Endometriosis is a chronic (‘long term’) inflammatory condition where cells that normally line the uterus (‘endometrium’) grow in other areas such as the bowels, pelvis, liver, lungs and even eyeballs.
When these cells grow in places where they don’t belong, 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).
It’s a progressive condition that worsens over time. As the endo cells are similar to the ones found in the ones lining the uterus, they’re also stimulated by the same hormonal cycle and each month the endometrial like cells get thicker and thicker.
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 affected by so severely affected by endometriosis that the normal anatomy has become distorted and some organs will morph into one.
What causes endometriosis?
Medical professionals still don’t know what causes endometriosis, but we do know that it’s likely combined genetic and environmental factors. 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 dysregulation
In endometriosis, the immune system fails to prevent the growth of endometrial tissue outside the uterus. Researchers believe this is because women with endometriosis have defective immune systems which allow abnormal cell growth and resulting inflammation to occur. Additionally, women with endometriosis are at increased risk for developing other autoimmune conditions such as allergies (to foods, pollen, perfumes, etc.), thyroid disease, rheumatoid arthritis, asthma and lupus which further supporting the defective immune system theory.
Although it is an inflammatory condition, endometriosis is an estrogen-dependent condition and excessive estrogen levels will often worsen and exacerbate endometriosis. Estrogen (specifically E2) is a major driver for the growth and maintenance of endometrial tissue in addition to worsening the inflammation and pain associated with endometriosis.
We know women who have family members who have or had endometriosis such as their mother, sibling, aunt or grandmother are seven to ten times more likely to develop endometriosis.
Retrograde menstruation refers to when blood flows back into the fallopian tubes instead of normally out through the vagina. This blood contains endometrial cells and allows the endometrial tissues to grow and develop in areas outside the uterus. Certain conditions could cause or contribute to retrograde menstruation such as excess estrogen, uterine growths, structural defects of the reproductive organs, and obstructions in the vagina or cervix.
Signs and symptoms of endometriosis (does it cause infertility?)
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, infertility, fatigue, frequent urination, irregular periods and painful sex.
- Chronic pain
Women with endo can experience pain differently. Women can 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 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 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 endometrial tissue growth may block the fallopian tube to prevent fertilisation from occurring. Lastly, as painful sex is one of the main symptoms of endometriosis, women may feel more reluctant to engage in sexual activities.
However, it is 100% possible to fall pregnant and to deliver a healthy, happy bub. 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. An endometriosis diagnosis shouldn’t stop you from having a family is you decide to do so.
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. An HCP will ask you about your menstrual cycle, and recommend an ultrasound, MRI and/or perform a pelvic examination when they suspect endometriosis. An ultrasound, MRI or pelvic examination aren’t always reliable and cannot diagnose endometriosis, but they can certainly help serve as a starting point to diagnose the condition.
The “gold standard” and the only way to test and confirm for endometriosis is laparoscopy or a “keyhole surgery”. This is an invasive process and involves inserting a tiny tube into the abdomen where the doctor will then observe the internal organs to confirm the presence of endometrial tissue inside the pelvis, surgically remove some tissue and analyse the excised tissue. Laparoscopy is also a conventional treatment method for endometriosis and will involve surgically cutting out the misplaced endometrial cells from the surrounding organs.
If you don’t yet already, write down on a notebook or download a period app on your phone (such as “Flo”, “Clue”, “Eve” or “Period Diary”) track your menstrual cycle and all your period symptoms. 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 to correctly diagnose you for endometriosis.
Treatment options: conventional & natural
- The Conventional Approach
Usually, doctors will prescribe the oral contraceptive pill and pain killers such as ibuprofen.
These are effective at treating the symptoms such as reducing pain and heavy bleeding but aren’t useful for treating the root issue. Pain killers such as non-steroidal anti-inflammatories (NSAIDs) and over the counter (OTC) drugs can provide pain relief by blocking prostaglandins (the chemicals that cause pain).
Hormonal therapy such as the oral contraceptive pill (OCP), progestins and gonadotrophin-releasing hormone (GnRH) agonists are prescribed to suppress the natural hormonal cycle to slow the hormonally driven growth of endometrial tissue and manage the symptoms of endometriosis. However, these are associated with potential side effects such as nutrient depletion, hot flushes, mood disorders, loss of libido, nausea and weight gain.
Another treatment option is laparoscopic surgery where doctors will surgically cut out the endometrial tissue. This will help to reduce pain and improve your chances for fertility. Other surgical methods to treat and remove endometrial tissue include a laparotomy, bowel surgery and hysterectomy (complete removal of the uterus, only considered as a last resort treatment). However, endometrial tissue may grow back, surgical methods are invasive, and hence individuals must consider the risks and benefits before deciding to take this route.
- The Natural Approach
Reduce Inflammation through an anti-inflammatory diet
A standard Australian diet (SAD) high in processed foods, sugar, saturated fat, trans fat and refined carbohydrates. This diet promotes inflammation and as inflammation is a key driver in the pathogenesis of endometriosis, a SAD will only exacerbate symptoms of endometriosis. Hence, to manage this condition, focusing on an anti-inflammatory diet is key. When I think of an anti-inflammatory diet, I think of the ‘rainbow’ and focus on making my plate as colourful and minimally processed as possible.
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”
Love your gut
Our bodies naturally excrete estrogen via our liver (our main detoxification hormone) and bowels. When our liver and/or gut is not in optimal health and functioning as it should, it compromises our ability to remove estrogen. When we are not moving our bowels regularly, 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 we should increase our intake of 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 (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.
We can support our liver health by consuming adequate protein, water, 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). Try out “Half Moon Tea” in the Endometriosis Support 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.
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 “Acne Moonbox” which contains natural, organic and cruelty-free skincare products to nourish your skin without the chemicals!
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 are a huge drivers for worsening 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 women with endometriosis are more likely to suffer from mood disorders (such as depression and anxiety) compared to women without endometriosis.
However, it’s also completely understandable to want to curl up in bed and hold a hot water pack to our lower abdomen when endometriosis pain hits. I recommend tuning in to your body and listening to how you feel before exercising. Some women may find high-intensity exercise such as a HIIT class or running can worsen their fatigue and muscle pain as these activities are more stressful. Also, high-intensity exercise can increase the risk for anaemia due to its high impact nature which is often already common in women with endometriosis.
Try joining a slow gentle pilates or yoga class which can stretch out and strengthen the pelvic area muscles. Or bring out your inner mermaid and try swimming which is a great low impact cardiovascular activity. Otherwise, a gentle walk for 20 minutes in the sunlight can do wonders for your mood, energy and overall health. I would also recommend seeking out support from an exercise physiologist specialising in female health or pelvic floor specialist to help guide you through exercises that will support (and not aggravate) your endometriosis.
Stress is inflammatory and releases inflammatory mediators which in turn increases pain in endometriosis. It also reduces our progesterone level (our other major sex hormone) resulting in higher estrogen to progesterone levels. Whilst we cannot control life stressors sometimes, we can certainly develop a toolbox to help us cope when things get a little tough. Starting our days off with less social media and more gratitude (through journaling or meditating), speaking kindlier to ourselves and allowing ourselves adequate rest are all some ways to help take care of our mental health.
Final Thoughts & Recommendations
Endometriosis is a chronic condition, and it can be scary to go about treating it alone. But you don’t have to go about it alone and there is support available (including us!). At Moonbox, we’ve created resources to support you on your journey to manage your condition. We’ve created an “Essentials kit” specifically for endometriosis and a “Happy hormones, happy periods E-book” bundle to educate and give you the tools to beat endo (for real!). It’s empowering to take your hormonal health into your own hands and to make dietary and lifestyle changes that will significantly improve your quality of life.
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