Endometriosis is the second most common gynaecological condition in the UK. According to figures by Endometriosis UK, the condition affects around 1.5 million women and those assigned female at birth, a number that makes it as prevalent as diabetes. But you don’t hear as much about it, do you? Medical misogyny at work again? It can take up to eight years to get a diagnosis via conventional medicine!
What causes endometriosis?
The main risk factor for endometriosis is heredity. Women with a mother or a sister who has endometriosis have an increased risk. Also, women with shorter menstrual cycles and a longer duration of flow have been found to be at higher risk for endometriosis. Several abnormalities in detoxification enzymes, tumour suppressor genes and other genetic factors occurring in multistep fashion may be involved both in the development and the progression of the disease according to experts, so genetic testing might help to try and offset some of those issues. See the Genetic Tests page here.
Endometriosis has long been thought of as an oestrogen-dominant condition. However, further research shows that endometriosis first leads to progesterone resistance. It is actually this progesterone resistance that leads to oestrogen dominance as a result. In a healthy menstrual cycle, oestrogen and progesterone must communicate and function in the exact balance.
Another association that research has discovered is the connection between the gut microbiome and endometriosis, which concluded that there is a significant difference between the gut microbiome of women with endometriosis and those without. However, research is still unclear on which is happening first. If altered gut bacteria contribute to endometriosis or if endometriosis contributes to altered gut bacteria.
Phthalates are chemicals found in our environment and are known as endocrine disruptors, meaning they can have a direct influence on hormones. These specific chemicals have been found to have an association with women who have endometriosis.
Is endometriosis an autoimmune condition?
There’s an inflammatory element to endometriosis that indicates it may be autoimmune related but the causes are still not fully understood. There’s an excellent article on Healthline that is not too sciency. For those looking for a deeper scientific dive into the causes, Pubmed has a systematic review and meta-analysis from a 2019 edition of Human Reproduction Update that looks at the links between endometriosis and autoimmune conditions. You can read that here. Use Cyrex 5 to check for autoimmune processes in the body.
Endometriosis symptoms
The NHS recommends keeping a symptom diary for those who suspect they may have endometriosis and Endometriosis UK has a template you can use.
Symptoms can vary but include:
- Diarrhoea or constipation during a menstrual period.
- Fatigue or low energy.
- Heavy or irregular periods.
- Pain with urination or bowel movements during a menstrual period.
- Spotting or bleeding between menstrual periods.
In some cases, symptoms begin with the onset of menstruation, but in most women, symptoms begin later and worsen progressively over time. The triad of symptoms is dysmenorrhea (period pain), dyspareunia (pain with vaginal intercourse) and infertility.
Acute pain occurs before the onset of menses; it can last for a day or two during the menses or throughout the month. In some women, vomiting, diarrhoea, and fainting can occur concurrently with the intense pelvic/abdominal cramping and even labour-like pains. Other pains can involve a chronic bearing-down pain and pressure in the lower back, with pain sometimes radiating down the legs.
There is not necessarily any correlation between pain and the extent of disease. Women with fixed ovaries and large endometriomas may report only mild discomfort, whereas those with visibly smaller lesions may report severe chronic pain. Upon surgery, these lesions are found to extend more deeply and they are possibly more influenced by circulating oestrogens. Research has found that the severity of symptoms is correlated with the depth of the lesions rather than the number of lesions.
Other symptoms may include pain with urination or bowel movements, bleeding from the nose/bladder or bowels, and fatigue.
Might be an idea to have an overall hormone health check done. I like the FDX Femme Ultra best if you can as it gives you a whole wide look at lots of parameters we can use to see if anything in exacerbating the problem.
Diagnosing endometriosis
A laparoscopy – a surgical intervention – where a surgeon passes a tube through a small cut in the abdomen to see if they can spot endometriosis tissue is, according to the NHS, the only certain way to diagnose.
Physical examination and ultrasound is also often used if the condition is suspected.
Blood testing can offer a non-invasive way to assess imbalances that may be endometriosis related, such as hormones, inflammation markers and blood sugar levels, which may all play a role in the condition.
There is a new saliva test (June 23) which has 95% accuracy for first diagnosis. You can see more information on that here.
I would generally do a gut test, hormone test, look for the inflammation hs-CRP marker, the CA-125 genetic marker (which is not just for endometriosis but can show up and be a clue in some women), check for anaemias (iron, B12, folate), chemicals with a Cyrex 11 and a Cyrex 3x for gluten related illness (if still eating gluten) and/or a Cyrex 4 for cross-reactive gluten foods where the body still thinks it is having gluten and reacts in an inflammatory way. You can see all lab tests here – ask me if you get stuck.
Treating endometriosis
Diet is important and the main principles seem to be:
•Reduce inflammatory foods, especially sugar, caffeine, dairy, red meat, and alcohol and increase anti-inflammatory foods like turmeric, ginger, flaxseeds and seaweed seasoning.
•Enhance detoxification mechanisms.
•Increase dietary fibre to promote optimal transit time and optimal gut flora.
•Increase omega-3 fatty acids and reduce trans fats.
Also include foods rich in indole-3-carbinol, such as broccoli, Brussels sprouts, cabbage, and cauliflower. And keep caffeine to a minimum.
Over the years, I’ve also found that wheat, gluten and dairy often crop up a lot as the main cause of inflammation in the tissues, so do also consider those. See Allergy & Intolerance testing here.
People always ask about soya and whether they should have it or not. The isoflavones in soya products and the lignans in flax seeds may be helpful, in fact. Some people claim that these phyto-oestrogen compounds should be avoided, thinking that they would stimulate the growth of endometriotic implants, much as oestrogen might. However, the evidence supports the inclusion of soy in the diets of women with endometriosis. A Japanese study demonstrated that a moderate intake of soy isoflavones was associated with a decreased risk of premenopausal hysterectomy. Because some of the surgeries involved endometriosis, these results led the authors to conclude that moderate soy intake may decrease the risk for endometriosis. Everything in moderation and make sure it is good quality soya (tofu, fresh soya milk etc), not processed stuff (such as soy protein isolates).
Supplements for endometriosis
The most commonly recommended supplements include:
- Vitamin E: 400 to 800 IU a day
- Fish oil: 1000 mg EPA+DHA a day
- Beta-carotene: 50,000 to 150,000 IU a day
- Vitamin C: 6 to 10 g in divided doses
- B complex: 50 to 100 mg B vitamin complex a day
- Selenium: 200 to 400 mcg a day
- Lipotropics: 1000 mg choline and 1000 mg methionine or cysteine three times a day
- Pycnogenol: 60 to 150 mg a day
There are also several herbal medicines touted to help. Speak to a herbalist about a mix including Chaste tree, dandelion root, prickly ash, and motherwort tincture. - Homeopathically, Turska’s formula can help and that includes aconite, bryonia, gelsemium and phytolacca – speak to a homeopath.
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