Endometriosis – it’s a very complex disease, and though it is relatively common, affecting between 10-15% of menstruating women, remains largely misunderstood.
What is Endometriosis?
A woman’s uterus is normally lined by endometrial cells and tissue, which is shed and expelled from the body on a monthly basis (except when a woman becomes pregnant), this being the period. This endometrium is under the influence of female hormones, including estrogen and progesterone.
Endometriosis occurs when endometrial cells and tissue begin to accumulate and grow in other areas of the body, typically but not exclusively, the pelvic region. The displaced tissue and cells cause irritation to the nerve endings of these organs, and interferes with their functions. Not only that, the cells cannot be expelled from the body as the regular uterine endometrial cells are, so the cells continue to grow, causing inflammation in those areas. This can lead to a host of symptoms including pelvic pain (often severe), irregular menstrual bleeding, infertility and occasionally even bowel and bladder symptoms. Since those “endometrial-like" tissue and cells (those in the areas outside the uterus) are still influenced by normal hormonal fluctuation and tend to respond in a similar way to normal uterine cells, symptoms will often worsen and/or change with the menstrual cycle. They also will diminish after menopause when hormonal changes are greatly reduced.
There are many reasons that doctors fail to properly comprehend the illness including:
The variable age of onset: Some women experience symptoms at menarche while others don’t experience any problems until later and these tend to become progressively worse until menopause.
The timing of pain: Acute pain may occur the day prior to menses lasting for a day or two, may occur partway through ones cycle for a short time or even last throughout the cycle with only a few days respite following a menses.
The symptoms themselves: May range from mild discomfort and cramping to incapacitation and disruption of normal functioning, can include vomiting, diarrhea and fainting pain or even feel like intense labour-like pain that can spread across the back and pelvis and radiate down the legs. Some women even report pain with urination and bowel movements and possibly bleeding from the nose, bladder and/or bowels.
The causes and risk factors: There are many theories, all supported by evidence in different populations, about what the initiating/confounding factors might be, but no clear answers at this point.
The main risk factor seems to be heredity, meaning that if you have family members who have endometriosis, you may have a 6 times greater chance of developing it yourself. Women with irregular cycles, those with altered estrogen levels, women who experience a high degree of life stress (especially from a young age), inactive women and those who consume a high fat diet may also be at increased risk.
Some other causes that may play a role include environment (exposure to xenoestrogens, radiation and other chemicals/toxins), disordered liver and or gut (intestinal) function or possibly altered/suppressed immune function (“causing” the body to produce auto-antibodies against ovarian and endometrial cells), among others.
Regardless of the causes, symptoms, timing or severity, endometriosis can be a disabling condition that requires timely recognition and treatment. Due to the complexity, management may take different paths depending on the individual, their needs and goals.
Unfortunately, the only known “cure” for endometriosis is surgery, and even more disappointingly, this is not even effective for a large percentage of individuals. Recurrence rates can vary up to 20% after 1 year to up to 40% after 5 years depending on the particular treatment and the individual. Highest success is with total hysterectomy, thus removal of the uterus, fallopian tubes and ovaries, but this therapy is fraught with serious disadvantages and side effects including infertility, the requirement for hormone replacement therapy, increased risks of some cancers, etc. Prescription drugs can help with symptom management, but they come with their own side effect profiles and are similarly not helpful for many individuals.
In Naturopathic Medicine, we help to remove likely causes of pain and then work to help your body to heal itself thus improving symptoms and helping to prevent future discomfort. This is in contrast to commonly recommended medical such as surgery and pharmaceuticals. Treatment plans are highly individualized, due to the aforementioned complexity of the disease.
Some of our cornerstones of naturopathic therapy in regards to endometriosis involve:
Recommendations will include consuming a whole food diet low in saturated fats, red meat and processed foods/food additives and high in fiber, vegetables, cold-water fish, nuts and seeds, and incorporating foods that help fight inflammation and modulate hormone balance. Eating organic foods as much as possible to reduce exposure to pesticides, herbicides and other such substances, as well as the avoidance of xenoestrogens, chemicals, solvents, heavy metals and sources of radiation. Avoiding alcohol, caffeine, nicotine and other drugs, which can negatively affect hormone levels is also recommended. Important too is ensuring optimal liver, digestive and bowel function to facilitate appropriate nutritional assimilation as well as exogenous hormone and toxin elimination, and of course incorporating regular exercise is a very important factor.
Many minerals, vitamins, cofactors, essential fatty acids and other therapies can me exceptional aids in the management and treatment of endometriosis. They are used to decrease pain, inflammation and other related symptoms, help regulate hormone balance and improve exogenous estrogen clearance, enhance overall immune function, optimize liver and bowel function so that estrogen clearance is unhindered and reduce stress, one of common contributors to the disease.
There are certain herbs that are well known through history to be extremely potent and useful especially in the treatment of women’s conditions. Herbal therapies like Vitex agnus-castus (Chasteberry), Leonorus cardiaca (Motherwort), Xanthoxylum americanum (Prickly Ash), among many others, are used successfully to affect hormone balance, decrease cramping and pain, stimulate blood flow, relax muscles, etc. Your Naturopath will be able to help determine which herbs or combinations of herbs are ideal for you.
The use of acupuncture can be very effective in establishing hormone balance, reducing pain and improving stress management. It is gentle, relaxing and an ancient traditional therapy used successfully by millions of people every day. Acupuncture involves the use of very small thin needles to stimulate specific points along the meridians of the body thus helping to balance the Qi (life force) in order to achieve overall health.
The variety and discrepancy in complaints/concerns commonly found in women with endometriosis, the long list of associated risk factors and conditions that may predispose them to developing this often debilitating long-term disease are extremely complex and frequently difficult to manage. Investigation into and discovery of probable causes and confounding factors that can be impacting patients can help to direct a course of natural treatment that greatly improve day to day functioning.
If you or someone you know is suffering from endometriosis it’s worth taking the time to consult a Naturopathic Physician. We have the skills and tools at our disposal to help you achieve optimal physical, mental and emotional health thus minimizing/eliminating pain and discomfort, preventing ongoing symptoms and thus improving long-term quality of life! You deserve to be pain and symptom free!
Dr Katarine Holewa, ND