I have endometriosis, what now?
Endometriosis
Struggling with severe abdominal pain, period pain, fatigue, depression, painful intercourse, bladder,
and bowel pain?
Have you heard of Endometriosis?
Endometriosis is an inflammatory disease where the tissues, like the uterine lining (endometrial tissue) grow in places other than inside the uterus. It is chronic, debilitating and is associated with pelvic pain and infertility.
Endometriosis lesions can grow in and around the uterus and ovaries and on the fallopian tubes… lesions that grow on the ovaries are known as chocolate cysts (not so tasty!), and occasionally they can move to almost any part of the body. This endometriosis tissue responds to messages from the ovaries, meaning it bleeds every month when you have your period. Overtime this leads to inflammation, scarring and can cause organs to stick together (adhesions) which then causes an increase in pain.
In Australia, endometriosis affects around 11.4% of females of reproductive age, that is around 830,000 females – a staggering number! Unfortunately, most women suffer for a long time before diagnosis – an average of 8 years (usually women are aged 30-34 years at time of diagnosis), with many women misdiagnosed initially! This is as a result of symptoms being like other disorders such as primary dysmenorrhoea, ovarian cysts, and pelvic inflammatory disease. Additionally, bowel and bladder disorders and fibromyalgia have symptoms that overlap with endometriosis, so it is no wonder it takes so long to get diagnosed!
Interested in knowing more? Keep reading…
The most common symptoms include:
abdominal and pelvic pain – can be so severe that it impacts on your ability to participate in education, work, sport, life!
heavy periods often with clotting
irregular bleeding
bleeding from bladder or bowel or changes in urination or bowel movements (such as frequency or urgency) and often associated with pain on urination or bowel movements
bloating
fatigue
anxiety and/or depression usually related to pain but also impact on quality of life
infertility.
However, whilst these are common symptoms, not every woman with endometriosis will experience all of these, and some women are asymptomatic (this may sound good, but these women miss out on early treatment and often find out because of infertility).
Diagnosis can include clinical examination, ultrasound (abdominal, vaginal, and rectal) and MRI however these methods are dependent on the practitioner skill and are more effective for site-specific lesions. The gold standard for diagnosis currently is laparoscopy (keyhole surgery) with biopsy. A laparoscopy is performed under general anaesthetic where a thin telescope with light (laparoscope) is inserted into the abdomen through a small incision in the belly button. During the procedure the surgeon can identify the endometriosis lesions and remove.
There are currently four recognised stages of endometriosis:
Stage 1 – minimal: small endometrial lesions, inflammation and mild adhesions;
Stage 2 – mild: as for Stage 1 but with many lesions and scarring; adhesions between uterus and rectum (referred to as Pouch of Douglas);
Stage 3 - as above with the addition of adhesions involving the ovaries;
Stage 4 – as above with the addition of scarred nodules and adhesions to other organs such as bladder and bowel which changes the shape of the pelvic organs.
Some women have an increased risk of developing endometriosis – retrograde menstruation (menstrual blood travels backwards into pelvis); family history; early onset of periods (before age 11); frequent and short cycles; immune system dysfunction.
Causation remains unclear however physiological, biological, and environmental factors may contribute. This is where nutritional medicine can help.
Below are some additional factors to be aware of:
In addition to estrogen excess and inflammation, dysfunction with the immune system can initiate endometriosis. The immune system which is designed to break down endometrial lesions does not work as effectively as it should therefore they remain causing symptoms. Bacterial toxins in the pelvic microbiome (called LPS) get translocated from a leaky gut explaining why many women get symptomatic relief after a course of antibiotics. Gut health is a very important consideration in helping with endometriosis symptoms.
Iron deficiency anaemia is common amongst women with endometriosis due to heavy blood loss and clotting. However, there is some research which highlights issues with iron metabolism in women with endometriosis. Iron is an oxidant which means it can worsen inflammation. In this situation, iron supplementation can often worsen endometriosis symptoms.
Environmental toxins such as chemicals, pesticides, dioxins, heavy metals, and mould can play a role in endometriosis development due to their load on the immune system and inflammatory nature.
One of the hypothesised triggers for endometriosis is the retrograde menstruation theory. While research is limited, tampons and moon cups may increase the risk of retrograde menstruation. They also increase the risk of bacterial contamination potentially causing Toxic Shock Syndrome.
Certain foods are inflammatory which can exacerbate endometriosis symptoms including gluten, dairy products, and histamine rich foods such as red wine, fermented foods, hard cheeses, smoked meats, and avocado. Speak to us on how we can assist with identifying if any of these foods are a trigger.
When you have endometriosis and it is impacting on your life you may need a support team including an integrative GP, physiotherapist, counsellor, and a nutritionist.
At Pretty Simple Nutrition we can investigate and identify the contributing factors and personalise your treatment plan taking into consideration your symptoms, diagnosis, lifestyle, and dietary requirements.
To find out how we can help, contact us …
REFERENCES
Briden, L. (2021). Hormone Repair Manual (1st ed.). Pan Macmillan Australia Pty Ltd.
Gruber, T. M., & Mechsner, S. (2021). Pathogenesis of endometriosis: The origin of pain and subfertility. Cells, 10(6), 1–14. https://doi.org/10.3390/cells10061381
Hogg, S., & Vyas, S. (2018). Endometriosis update. Obstetrics, Gynaecology and Reproductive Medicine, 28(3), 92–94. https://doi.org/10.1016/j.ogrm.2017.12.003
RANZCOG. (2021). Endometriosis Clinical Practice Guidelines. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s Health/Statement and guidelines/Clinical - Gynaecology/Endometriosis-clinical-practice-guideline.pdf?ext=.pdf
Taylor, H. S., Kotlyar, A. M., & Flores, V. A. (2021). Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. The Lancet, 397(10276), 839–852. https://doi.org/10.1016/S0140-6736(21)00389-5