March is Endometriosis awareness month. A month to shine a light on this debilitating disease which affects 1 in 10 womens and with an estimates 176 million cases world wide.
Endometriosis is a chronic disease in which endometrial like tissue, usually found lining the uterus (endometrium), grows outside the uterus. While this abnormal growth is often found surrounding the ovaries and fallopian tubes or within the peritoneal (abdominal) cavity, in some advanced cases it has also been found in the lungs and brain.
This endometrial like tissue acts like endometrial tissue would if it were within the uterus. It thickens, breaks down and bleeds with every menstrual cycle. However, unlike a normal regular menstrual bleed, this tissue has nowhere to go and becomes trapped. This causes inflammation to the surrounding tissue and organs which causes scar tissue and adhesions to form. This can be problematic in that tissues and organs begin to stick to one another, which causes chronic persistent pain.
Women with endometriosis frequently report symptoms of:
Dysmenorrhoea (painful periods)
Menorrhagia (heavy periods) or breakthrough bleeding
Chronic pelvic pain
Pain during intercourse
Pain upon urination or with passing a bowel movement
Other symptoms such as abdominal pain, nausea, diarrhoea, constipation, and bloating
For a large portion of women with this condition, the pain can be chronic and debilitating, negatively affecting health-related quality of life, personal relationships, and work productivity.
Unfortunately the exact etiology of why rogue endometrial cells begin to spread to other areas of the body is unknown and currently there is no cure for the condition.
There are several theories including:
Retrograde menstruation - This theory proposes that endometriosis occurs due to the retrograde flow of sloughed endometrial cells/debris via the fallopian tubes into the pelvic cavity during menstruation.
Metaplasia - This theory postulates that endometriosis originate from the abnormal differentiation of specialised extrauterine cells (metaplasia) found in the mesothelial lining of the visceral and abdominal peritoneum into endometrial cells.
Hormones - It is certainly worth considering that hormones certainly play a role in the aetiology of endometriosis.The growth of lesions is thought to be regulated by ovarian steroid hormones. Endometriosis is also primarily a disease of women in reproductive age and not usually seen in postmenopausal women.
It's also worth considering the impact of environmental toxins such as dioxin that are considered xenoestrogens due to their ability to mimic the body's natural oestrogen via interaction with receptors.
Immune dysfunction - While endometriosis is not classified as an autoimmune disease, research suggests that there is an increased risk of autoimmune disease in women with endometriosis. Women with the condition have a higher concentration of activated macrophages and decrease cellular immunity and natural killer cells, further substantiating the involvement of the immune system.
These are just a few of the many hypothesised causes for the condition that have lead to the condition is now being understood as a complex, multifaceted disease involving immunity, hormones, environmental and psychological considerations.
Interestingly due to the complexity of the disease its thought that it takes an estimated 5 to 7 years before a diagnosis is made. A general practitioner will base diagnosis on symptoms and may also employ the use of:
Conventional treatment of endometriosis can be divided into either medical or surgical management.
Medical treatments include:
Non steroidal anti-inflammatory drugs (NSAID’s) and analgesics for symptomatic pain relief
Suppression of ovarian oestrogen production through the use of the oral contraceptive, progestins, Gonadorelin Agonists and androgenic agents.
Surgical interventions include:
Periodic removal of endometrial lesions through laparoscopy.
Severing of the spinal nerve pathways responsible for pain.
Partial or complete hysterectomy.
It's important to note that while these options can give some relief, they are not without their own disadvantages. Long term use of pharmaceutical NSAIDs and analgesic medication influences multiple systems such as cardiac, immune, gastrointestinal (GI), renal, vascular, and pulmonary systems through the inhibition of cyclooxygenase (COX) 1 and 2 enzymes. Hormonal treatments are often associated with unwanted effects, delayed conception and recurrence of disease and symptoms when stopped. Laparoscopic surgery does not stop the lesions from forming and often multiple surgeries are required. Removal of the ovaries and/or uterus does not stop the condition despite what was once thought.
Naturopathy & Endometriosis
Naturopathy is considered a whole body, multi modality form of complimentary medicine that utilises a combination of clinical therapies to treat an individual. These therapies include clinical nutrition and dietary modification, herbal medicine, nutritional supplementation, lifestyle intervention, and in some cases homeopathy and physical modalities.
Because Naturopathy is founded on the principal to “treat the whole person” it can be a great adjunctive therapy to any of the above medical and surgical interventions for Endometriosis or to assist the many diverse symptoms associate with the disease. Areas Naturopathy can assist with include:
Supporting sex hormone metabolism and production
An anti-inflammatory diet is recommended for women with endometriosis. A 2013 study on selected food intake and risk of endometriosis suggested a relation between the disease and low intake of fruit and vegetables and high intake of trans fat, ham, beef and other red meat. A literature review published in 2004 on dietary risk for endometriosis showed a high intake of green leafy vegetables and fruit was associated with a lower risk. An anti inflammatory diet incorporates a wide variety of coloured fresh veg and fruits such as dark leafy’s, broccoli, cauliflower, berries, ginger, turmeric, beetroot, celery, pineapple along with coconut oil, bone broths and fresh fish. While avoiding processed foods, dairy, refined carbohydrates, refined sugars, soft drink, soy and over consumption of red meat.
Essential fatty acids found in fish such as salmon, mackerel, sardines, and anchovies. The two primary compounds EPA and DHA are beneficial in relieving pain through their ability to decrease levels of an inflammatory chemical called prostaglandin E2. EFA’s can also be obtained through clean supplements that have had any impurities or heavy metals extracted.
Magnesium is a very important mineral required for over 300+ enzymatic reactions within the body. Magnesium is not only great for supporting the nervous system and aiding muscle relaxation but one study showed that changes in magnesium status were associated with changes in testosterone and sex hormone binding globulin (SHBG). SHGB is a glycoprotein that binds to steroid hormones rendering them inactive. Lower levels of SHBG are associated with higher levels of free active hormones, such as oestrogen. In fact magnesium is one of the most common mineral deficiencies facing Australians. So its not surprise that women with the condition are thought to have reduce magnesium levels. For more on Magnesium check out my blog post: Why We All Needs Magnesium.
Herbal medicine is one such area where the use of particular classes of herbs such as analgesic, antispasmodic, immunomodulating, anxiolytic and adaptogenic herbs can assist with varying aspects. For instance curcumin, an extract of turmeric was shown to suppress the proliferation of endometrial cells by reducing estradiol production.
Lowering environmental toxin exposure - Endocrine disrupting chemicals such as dioxins and polychlorinated biphenyls (PCB’s) have been shown to interfere with the body's natural hormone production. There is increasing evidence that chronic exposure to these type of chemicals is associated with an increased prevalence and severity of endometriosis. Avoid drinking and reheating in plastics, chemical based fake tan’s and other personal care products and eating organic where possible.
Show Your Support:
Want to share your support and raise awareness for Endometriosis? Endometriosis Australia are hosting a national high tea around Australia on the 30th of March. Click HERE for more information.
Disclaimer: The information contained in this article is not intended to be used to diagnose, treat or take the place of any conventional treatment options for Endometriosis.