By Dr. Shawna Darou, ND
Endometriosis is a hormonal condition that appears to be growing in frequency at an alarming rate. I have some theories as to why, and we’ll get to those below. The good news is though that you can balance your hormones, reduce pain and improve fertility with endometriosis, and a lot of this has to do with diet and nutrition.
With endometriosis,there is abnormal growth of uterine lining cells, in places outside of the uterus. These cells outside of the uterus are called ‘endometrial implants’ and they can attach themselves to the fallopian tubes, ovaries, intestines, bladder, outside of the uterus, and sometimes travel farther to the liver and even the lungs. During menstruation, these cells are activated, creating pelvic pain, and pain wherever the implants have attached. The amount of pain experienced is variable – some women with quite severe endometriosis do not have significant pain, and others are incapacitated by it. Due to inflammation, immune imbalance and also structural changes, endometriosis can cause difficulties with fertility.
Signs that you may have endometriosis include:
- Very painful periods (the kind that requires ibuprofen or stronger medications regularly dosed through the day)
- Pain or cramping with intercourse
- Diarrhea at the start of menstruation
- Pain and cramping in the week leading up to menstruation
- Pain from the very first period at puberty
- Pain during bowel movements and /or urination
Endometriosis is often given a speculative diagnosis based on symptoms, as the only accurate way to diagnosis is through laparoscopic surgery.
I also consider endometriosis to be an autoimmune condition, meaning the immune system is dysregulated. It is also one of the ‘estrogen-dominant’ conditions, where estrogen levels are not adequately balanced by progesterone, or estrogen is not detoxified effectively.
There are several steps to take with endometriosis to reduce pain and improve fertility:
- Food intolerances – the presence of food intolerances increases immune system stress and inflammation in the body. This is tested with an IgG food intolerance panel for accuracy. I commonly recommend removing gluten and dairy from the diet to reduce inflammation and pain.
- Intestinal dysbiosis – there is a high association with women with intestinal dysbiosis, frequent antibiotic use and high intestinal yeast and the development of endometriosis. Disruption of the gut microbiome, and subsequent intestinal permeability is one of the causal factors that leads to immune dysregulation.
- Hormone panel, testing for three types of estrogen: estrone, estradiol, estriol and progesterone to show whether there is clear estrogen dominance or poor liver and colon detoxification of hormones. Keep in mind that with endometriosis, hormone levels are usually normal.
- Inflammation through diet – a diet that is inflammatory due to high intake of red meat, sugar, white flour, fried foods or alcohol can greatly increase pain and inflammation in the body.
- Weight – carrying extra weight, increases estrogen levels (estrone, one of the stronger stimulating estrogens is produced by fat cells);
- Stress – high stress affects hormone balance, in particular when cortisol levels are high, progesterone drops leading to more estrogen dominance.
- Emotional health – in many cases of endometriosis, there is history of significant emotional stress in childhood and as a teenager. Perhaps the exposure to high stress hormones at a young age impact the development of the reproductive system and immune regulation.
A typical treatment plan for endometriosis is aimed at reducing inflammation, balancing the immune system and gut microbiome.
Diet can have a profound impact on lowering pain due to endometriosis, and in some cases plant-based, or others a more Mediterranean diet can greatly reduce pain. Lowering saturated fats from animal products, and greatly increasing the intake of vegetables does make a difference.
Inflammatory foods that should be reduced include: meats (especially pork and beef), eggs, dairy products, all fried foods, alcohol, sugar and peanuts. In addition, and food that you have an intolerance to will also increase inflammation (and pain), and should be eliminated.
Many women with endometriosis also experience a significant reduction in pain with a gluten-free and cow’s milk dairy-free diet, as a way to reduce inflammation. One thing to note is that it can take several months of eating gluten-free to notice a reduction in pain.
Rebalancing the gut microbiome:
A plan to work on digestive health and rebalance the gut microbiome will also reduce pain and inflammation.
- There is an enormous impact with gut health and inflammation (article here), and we may start with a stool analysis, or following a ‘5R’ protocol – remove, restore, repair, reinoculate, relax.
- There is association with pathogenic gut bacteria in the uterus and pelvic cavity as possible trigger for endometriosis growth.
- Intestinal permeability is the link between gut imbalance and systemic inflammation.
Addressing pelvic circulation
Endometriosis is often characterized as having significant pelvic adhesions, and blockages which are part of what create the immense pain. There are some very helpful tools to improve pelvic circulation and and reduce adhesions:
- Castor oil packs on the abdomen
- Arvigo massage therapy
- Acupuncture treatment
If you or someone you know if suffering from what sounds like endometriosis, please encourage them to see a naturopathic doctor and begin some of the steps listed above. MANY women are undiagnosed for years and even decades.
And of equal importance, I believe that many cases of endometriosis can be prevented in young girls by addressing food intolerances, inflammation through diet, and especially by treating he gut microbiome, especially if there have been many round of antibiotics before puberty. All of this along with staying active to maintain optimal weight, and being mindful of estrogen mimicking chemicals could greatly reduce the incidence of endometriosis in our children.