An update on endometriosis
Severe pain with your period? You might have endometriosis.
Endometriosis was first recognised and described 300 years ago. However it has been an under undiagnosed and under researched female inflammatory condition since then until now.
Fortunately, a few new areas of research are shedding some light on how naturopaths can best support women with endometriosis to reduce pain levels and improve their fertility.
Endometriosis is an extremely painful reproductive condition
An Australian government report released in 2019 told us that 1 in 9 women are diagnosed with endometriosis by the age of 40 to 44. Given that statistic, there's a fair chance at least one of your girlfriends is experiencing endometriosis.
Furthermore, 1.5% of hospitalisations of women of reproductive age are related to endometriosis. These statistics tell us that this relatively unknown condition is quite widespread. In my clinic I see women from the ages of 16 to 46 who are seeking relief from endometriosis, either because they don't want to continue to experience pain, or because they are hoping to fall pregnant in the near future.
It can take endometriosis sufferers on average 6.5 years to get a diagnosis, which is reliant on a laparoscopic procedure to identify the endometrial tissue.
Most women agree that period pain is uncomfortable or even painful. Many women with endometriosis suffer with their pain for a long time without seeking help because our society has normalised period pain. I have previously written a blog to discuss the type of period pain that is normal, and what is considered severe, so please check this out if you're wondering if you might have endometriosis.
Please also keep in mind that pain levels are not always a reliable indicator of the extent of your endometriosis.
New research and it's impact on the way I support women with endometriosis:
There is still so much research to be done on endometriosis before we can understand exactly what causes it and why some women get it and others don't. In the past the focus of naturopathic support has been on pain management and tissue healing, however due to exciting recent studies, our options for working with women with endometriosis have expanded.
1. The immune system is involved in endometriosis
Supporting a healthy immune system is now our primary aim when trying to improve endometriosis. A 2018 report published in Japan found that endometriosis is likely to be a result of a disorder of the immune system.
Some women may have a genetic predisposition to immune dysfunction. However for many, the immune system trigger might be food such as diary or gluten; or bacteria that has translocated from the gut to the pelvis (see more below); or foods containing nickel (see more below), or a diet lacking in the nutrients to support the immune system.
The first step is to reduce any foods that cause immune activation such as dairy and gluten. Removing dairy from the diet is often a game changer for women with endometriosis, so this is where I often start. Often women are very open to the idea of not eating dairy products because they have long suspected they might be intolerant to them.
If there is no positive change after a few months, or if there is Coeliac disease somewhere in the family, I will also recommend the removal of products containing gluten such as bread and pasta.
I recommend supporting the immune system with herbal remedies and nutrients such as zinc, NAC, turmeric, berberine and echinacea. I mix up individualised herbal remedies for each client, dependant on the symptoms she has and what we suspect is the underlying cause of her endometriosis.
2. High estrogen levels worsen endometriosis
Women experience symptoms of high levels of estrogen when they have heavy menstrual bleeding and clotting. The higher the estrogen levels, the more the endometrial tissue will thicken during a menstrual cycle. This will increase the likelihood of heavy, painful periods when you have endometriosis.
There are a few ways to improve the high estrogen levels and the decision will depend on the type of symptoms that a woman presents with and the results of any tests that we have done.
I may recommend cutting out dairy products; reducing histamine foods; liver and bowel support with diet changes and herbal medicine; supporting gut dysbiosis, Calcium D-glucarate; or supporting progesterone levels with herbal medicine.
The early stage of perimenopause is a time when we naturally have less progesterone and relatively higher levels of estrogen. This is a time when endometriosis can flare up and worsen (as well as a host of other symptoms). Perimenopausal women can usually benefit from natural progesterone support and cutting back on histamine foods.
3. Bacterial contamination hypothesis for endometriosis
Studies are suggesting that up to 90% of women with endometriosis also have an irritable bowel and regularly experience constipation or diarrhoea or both.
Some of these women have been diagnosed with IBS or SIBO, however the symptoms can overlap with endometriosis, making it difficult to distinguish the cause of the pain. For example, endometrial tissue can often be found in the bowel and rectum, so cyclical bowel pain can be endometriosis and not food intolerances.
A study published in 2018 found the menstrual blood of women with endometriosis had more E.coli than women without endometriosis and suggested that the bacteria may have translocated from the gut to the pelvis. The study also found that the protective vaginal bacteria Lactobacillus was reduced in women with endometriosis.
Healthy gut and vaginal microbiome can be supported with antimicrobial herbal medicines such as berberine, and prebiotic foods. I regularly test for microbial imbalance in my endometriosis clients using a stool test called GI map and then select specific herbal medicines, targeted probiotics, and prebiotic foods as indicated to support the woman's microbiome and resolve intestinal permeability.
When I work with women experiencing endometriosis I prioritise dealing with the IBS or the SIBO and focus on regulating bowels to resolve constipation and other digestive symptoms.
I also work to reduce any bacterial or yeast overgrowth that might trigger the immune system and cause inflammation.
The bacterial contamination hypothesis is an exciting new development in the understanding of endometriosis and I am observing the similarities between stool test results of endometriosis with interest.
4. Nickel allergies are a risk factor for endometriosis
A 2015 study discovered that a nickel allergy is a risk factor for endometriosis. The research was done over a period of 11 years and including around 5000 female participants in South Korea. This study also supports the idea that the immune system is involved in worsening endometriosis.
Nickel allergy is a common cause of contact dermatitis since nickel is found in jewellery and skin care products. I now ask the women I work with if they have reactions to jewellery and then support them by reduce nickel in their diets and skin care products.
Moving forward with endometriosis
With the way that our research and clinical experience is expanding, I'm sure that endometriosis will soon be better understood and more talked about than it is now. If you have endometriosis and you are interested in implementing some of the ideas I have suggested in this blog, please get in touch for a consultation or a free discovery session.
I would be delighted to be part of your support team.
Hi! I'm Simone Jeffries. I am a naturopath, nutritionist, herbalist and certified wellness coach. I am also a foodie and an advocate for a whole food diet.
The information in this blog is from my Bachelor of Health Science degree, experience from working with women in my clinic, and continuing research.
This blog is for information only and not intended to take the place of medical advice. Please seek assistance for any medical concerns.