Endometriosis is a common condition that affects 10-15% of women of reproductive age and occurs when pieces of the womb lining (endometrium) grow in areas outside of the uterus. The tissue responds to hormonal changes throughout the menstrual cycle the same way that the uterine lining does; thickening and shedding, however it is unable to leave the body as it can with menstruation.
The endometrial lesions can vary in severity and location, with the most common areas being the uterosacral ligaments, ovaries, pelvic peritoneum and fallopian tubes. In advanced stages, lesions can be found on the gastrointestinal and urinary tracts, chest and soft tissues. Despite most women with endometriosis experiencing severe debilitating pain and other associated symptoms, it can take an average of 7 years to diagnosis. It is also important to note that some women may experience no symptoms at all, and endometriosis may only be diagnosed when issues with fertility arise, or they undergo procedures such as hysterectomy later in life.
So what causes endometriosis and how does it progress?
To date, there are numerous hypotheses as to how endometriosis develops, however it is widely understood to be a multifactorial condition which is influenced by both a person’s genetics and their environment.
Below are the most likely and supported theories.
Retrograde menstruation – This theory suggests that endometrial tissue exits via the fallopian tubes and into the pelvic cavity and ovaries. The theory however, does not explain endometriosis in new-borns, pre-pubescent girls or males.
Coelomic Metaplasia – This theory suggests that endometrial tissue develops from the metaplasia (changing from one type of cell to another) of tissue that are present in the mesothelial lining of the abdominal and visceral peritoneum. It is believed that endocrine disrupting chemicals promote the metaplasia.
Immune Dysfunction - Women with endometriosis are believed to have an altered immune system due to the endometrial tissue’s ability to evade immune defences as the disease develops.
Inflammation and oxidative stress – This can occur as the DNA of the endothelial cells are damaged, leading to oxidative stress. Oxidative stress will lead to inflammation which promotes endothelial growth.
Oestrogen excess/progesterone resistance – Various factors can lead to an excess of oestrogen, which is known to stimulate the growth of endometrial tissue. In healthy individuals, progesterone reduces oestrogen and therefore endometrial growth, however in those with endometriosis, there is evidence of progesterone resistance of the endometrial tissue.
Lymphatic and vascular dissemination – Endometrial tissue can move through the lymph and vascular systems, implanting in the less common areas associated with endometriosis.
Bacterial contamination – This suggests that bacteria from the lower genital tract moves and infects the upper genital tract where it infects the menstrual blood. The presence of bacteria then leads to inflammation which stimulates the growth of endometrial tissue.
The Four Stages of endometriosis
When diagnosed, the severity of endometriosis is determined by number, location and depth of endometrial lesions.
Various risk factors are thought to contribute to the pathogenesis of endometriosis and can include:
Early menarche (Getting your period at a young age)
Shorter menstrual cycles
Alcohol and caffeine intake
Low body weight
Soy exposure in infancy
Exposure to endocrine disrupting chemicals both prenatally and in adult life
Prenatal oestrogen exposure
Signs and symptoms of Endometriosis
The symptoms experienced by each individual endometriosis sufferer can vary greatly and it is important to note that you do not need to experience all of the symptoms below to have endometriosis, or any symptoms at all. The symptoms someone experiences will vary and are typically based on their stage of endometriosis and the location of endometrial lesions.
Painful periods (Dysmenorrhea)
Pain during sex (Dyspareunia)
Pain when urinating (Dysuria)
Heavy periods (Menorrhagia)
Pain when opening your bowels/defecating
Pain at ovulation (Mittelschmerz)
Anaemia (Low iron)
Pelvic or abdominal pain
The gold standard for diagnosing endometriosis is laparoscopy. This is a process by which a small incision is made close to the belly button and the abdomen is inflated with carbon dioxide. A laparoscope is then inserted through the same tube which enables the surgeon to view the abdominal and pelvic cavities and identify endometriosis. Excision (removal) of the tissue is performed the same way.
Note: Until recently, transvaginal and transabdominal ultrasound was not considered a useful tool for diagnosis due large in part to the challenge in identifying small masses. There are now however highly skilled experts that can identify much smaller lesions of only a few millimetres via ultrasound.
What else can endometriosis look like?
One of the reasons endometriosis can take so long to diagnose is that a large number of the symptoms are non-specific to endometriosis itself.
So what can we do to help?
Nutritional medicine aims to not only reduce inflammation and pain, but to assist in liver detoxification (clearance of hormones), modulation of immune function and to optimise gastrointestinal function which all work on the pathways that are involved in the development and progression of endometriosis. As with any multifactorial condition, no one case can be treated the same as what may apply to one patient, may not apply to another.
The below are some of my favourite nutrients and functional foods when it comes to treating Endometriosis in my patients.
N-acetyl cysteine (NAC) – A potent antioxidant that can reduce dysmenorrhea, chronic pelvic pain and dyspareunia associated with endometriosis and either reduce or resolve endometrial cysts.
Vitamin E – A potent antioxidant and anti-inflammatory that can reduce dysmenorrhea, chronic pelvic pain and dyspareunia associated with endometriosis.
Omega-3 fatty acids – Help by reducing inflammation and potentially slow the growth of endometrial implants.
B vitamins – Support liver function and hormone metabolism.
Broccoli/Broccoli Sprouts – Potent antioxidant, anti-inflammatory and anti-proliferative and supports oestrogen metabolism.
Curcumin (Turmeric) – Potent anti-inflammatory and antioxidant that works on the pathways involved in endometriosis, slows progression and growth, supports detoxification (clearance of hormones) and activates apoptosis (death and removal of endometriotic cells).
Cinnamon – Potent anti-oxidant with astringent abilities that can reduce menorrhagia (heavy periods). It can also stimulate circulation within the pelvic region which can help to reduce pain.
Rosemary – Helps in oestrogen metabolism/detoxification and supports liver health.
Green tea – Can inhibit the growth and development of endometriosis and potentially assist in the regression of lesions.
Probiotics – Can assist in optimising gut health, supporting immune function and reducing inflammation.
Don’t use tampons – possibly contributes to theory of retrograde menstruation
Use only organic sanitary products – Commercial sanitary products contain dioxin, bleach and other chemicals which disrupt natural hormone balance
Try and get regular exercise which can assist in reducing oestrogen levels
Avoid exposure to environmental and lifestyle pollutants – This includes plastics (even BPA free), personal care products, non-organic foods, tap water, cookware, cleaning products, pesticides, and herbicides.
Limit coffee and alcohol intake – They can increase oestrogen and burden on the liver.
Optimise sleep quality and quantity – Adequate sleep helps to keep inflammation at bay, balance hormones and allow the body to heal.
Eat organic where possible – Check out my post on the most affordable ways to eat clean.
Ensure you are eating a high number of fruits and vegetables, with extra cruciferous (broccoli and cauliflower) vegetables and lots of leafy greens.
Follow an anti-inflammatory diet – Avoid dairy, gluten, sugar and trans-fats and increase anti-inflammatory foods.
Identify and remove any food intolerances.
Increase omega-3 intake – Wild caught salmon, herring or mackerel, walnuts, chia seeds.
Increase anti-oxidant rich foods to stimulate hormone metabolism – Broccoli (and broccoli sprouts), garlic, organic berries, rosemary, citrus and organic dark chocolate.
Consider a low histamine diet to reduce oestrogen production and manage pain.
Ensure you are consuming adequate fibre – Excess oestrogen is excreted via the bowels.
Remove soy and soy-based products.
Avoid meats that are treated with hormones.
For some guidance and suggestions around eating an anti-inflammatory diet, I have put together a free 3 day anti-inflammatory guide, which you can download here.
What are people saying?
"I suffered for many years from painful periods and chronic pain due to endometriosis. I could not manage my pain and other symptoms even after multiple surgeries. Megan approached my endometriosis in a different way from other health care professionals. If it wasn’t for Megan and her method of treatment I would still be in chronic pain daily. I am now essentially pain free and able to live a normal life" - Fin - 19 yo
Endometriosis is one condition that I feel needs a truly collaborative approach between both natural and western medicine to reduce both the physical and emotional trauma that often goes with this sometimes-debilitating disease.
The important thing to know is that there are always things that can be done to support your body, greatly reducing your symptoms, and dramatically improving your quality of life.
If you, or someone you know needs some support with endometriosis, please feel free to reach out.