The Silent Epidemic In Women

While we are going to analyze and talk about today’s topic from a more medical standpoint, I hope you will read to the end where I’ll share resources and ways to holistically think about approaching treatment for endometriosis. I would also love to hear from you if this topic resonates. No one should live in pain and no one should live without hope of being pain-free. I hope that each of you can share with a woman you love and that in this, she will find a new nugget of information that may shape her trajectory towards healing.

What is Endometriosis?

Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity. Once the endometrial tissue arises outside of normal locations, it becomes under control of hormonal influence, periodically proliferating and bleeding in response to hormones. Symptoms include pain in the lower part of the abdomen 5 to 7 days before peak menstruation. This is considered acquired dysmenorrhea, and the pain is more severe than typical pain associated with menses (Banasik & Copstead, 2019). Women may experience a range of discomfort ranging from mild to extreme pain. Ten to 15% of menstruating American women experience this diagnosis.

Symptoms include:

• Dysmenorrhea, dyspareunia and infertility

• Pelvic tenderness, tender ovaries, adhesions, altered pelvic position

The primary risk factor in hereditary. If you have a mother or sister with endometriosis, you are more likely to experience it as well. Women with shorter menstrual cycles but of longer flow duration are also at higher risk. Lack of exercise from a young age, a high-fat diet, use of intrauterine devices, and unbalanced estrogen levels put you at greater risk. Women with a greater number of adhesions and endometriosis have reported abuse in their history.

The immune system may play a role in this disease as well. It’s not super well defined or clear cut, but we do know that women with endometriosis have increased immune action within the pelvic cavity and there have been reported antibody reactions to the presence of sperm. It make sense then, that immune system dysfunction may also be a risk factor for endometriosis.

There are several additional hypothesized risk factors including: prenatal exposure to high levels of estrogen, exposure to environmental estrogens or endocrine disruptors such as PCBs/weed killers/plastics/detergents/cleaners, long-term dioxin exposure and impaired liver metabolism/excretion of estrogens.

As you read through treatment strategies, you’ll notice that many foods and supplements support T-cells within the immune system. This is important because research shows that women with endometriosis do not have typical immune system functioning in the pelvic cavity. Specifically, they have suppressed natural killer (immune) cells and high levels of antibodies against ovary and endometrial cells as well as high levels of other specific immune cells. What this means is that the immune system is out of whack (yes, that’s the technical term) and the T-cells can help to bring it back into balance

Ok, let’s dig into how we can address endometriosis with a holistic approach…

The complementary and alternative protocol (AKA not your average approach)

Endometriosis is inflammatory in nature and it has therefore been hypothesized that focusing on a diet that is anti-inflammatory that supports healthy immune and hormonal systems may help with the underlying causes. The steps to approaching endometriosis according to Pizzorno & Murray in the Textbook of Natural Medicine (2013) are outlined as follows:

1) reduce inflammation and increase anti-inflammatory foods,

2) enhance detoxification pathways,

3) increase dietary fiber to promote healthy gastrointestinal tract, and

4) increase omega-3 fatty acids and reduce “bad” fats. Supplements can also be helpful in addressing the hormonal balances present in endometriosis. 

Diet goes a long way…

Women who consume higher levels of omega-3 fatty acids have a 22% less chance of being diagnosed with endometriosis (Pizzorno & Murray, 2013). Research suggests that women who have a lower ratio of omega-3 to omega-6 (which is ideal), have a lower production of inflammatory cytokines IL-8 and vice versa, establishing the importance of omega-3 in decreasing the inflammatory response within the body. 

A diet high in fiber and plant based foods has been shown to be helpful in the treatment and management of endometriosis. Fiber slows the transit time of food through the gastrointestinal system and improves the gut flora, crowding out the flora that allows estrogens to circulate throughout the body. Diets high in red meat are higher in arachidonic acid which promotes inflammatory prostaglandins and therefore exacerbate the pain response. 

Focusing on anti-inflammatory foods is important, but it is also important to restrict consumption of foods that create inflammation and estrogen levels within the body. These foods include sugar, red meat, caffeine, dairy, and alcohol. One study looked at women with endometriosis and examined the effect of reducing simple carbohydrates, eliminating caffeine and alcohol, and adding in omega-3 and omega-9 fatty acids. There was a significant reduction in symptoms. Caffeine consumption has a positive correlation with incidence as does dairy. Diary can increase the production of prostaglandins which causes inflammation, smooth muscle contraction, and vascular constriction, all key elements of endometriosis and the pain it causes. Additionally, alcohol consumption depletes the body of B vitamins, which help to slow the metabolism of estrogen. 

The importance of blood sugar balance cannot be underestimated as well. Imbalance in glucose and insulin can sneakily lead to inflammation years before your test results show there is an issue. If you have excess weight around your body, you have an issue with glucose and insulin. And likely toxicity too (see the next sections). As part of addressing inflammation, assessing your processed carbohydrate intake and the frequency at which you are during the day must be taken into account and addressed. This is something we do a TON of work around inside my program, Reclaim Your Metabolism. We get to the root of issue, we don't just apply bandaids. 

Supporting detoxification pathways

The liver is one of our key organs that support detoxification, primarily to rid the body of toxins and metabolites. Foods that support the liver include carrots, beets, and foods from the cabbage family. Broccoli, brussels sprouts, and cauliflower play a role in excreting estrogen. Carrots, artichokes, lemons, dandelion greens, watercress and burdock root are powerful “liver-cleansing” foods. Soaked and ground milk thistle seeds can also help with liver function. Fucus, a seaweed, helps to stimulate T-cell production (part of the immune system defenses) and also absorbs toxins.

Supplements 

Supplements can support a healthy diet by providing higher doses of certain nutrients and antioxidants that help decrease inflammation. Vitamin C and E can support the immune system and limit autoimmune progression as well as correct abnormal hormone ratios. If a patient is unable to consume enough omega-3 fatty acids within the diet, supplementation may be necessary. Additionally, consumption of both gamma-linoleic and alpha-linoleic acids help reduce inflammation at the tissue level. Turmeric has also been shown to reduce pain and inflammation and is frequently used in Ayurvedic medicine. Cao, Wei, Zhou, Zhang, Guo & Zhang (2017) found that in vitro turmeric decreased endometrial cell growth and proliferation. Micozzi (2019) recommends taking 500mg/day which may be difficult to get in food and therefore supplementation may be warranted. 

Beta-Carotene is not only a powerful immune system player, reducing inflammation and tumor growth, but it has also been shown to moderate the effects of interleukin-6, an inflammatory mediator that has been implicated in endometriosis.

Pine bark extract is an incredible extract from the bark of the French maritime pine tree. It contains polyphenols, phenolic acids, catchins, taxifolin, and procyanidins. It has been found to inhibit inflammatory cells. In a small study of 60 women, after 4 weeks of pine bark use showed slow but steady improvements over the standard treatment group. Symptoms were reduced 33%, going from “severe" to “moderate.” While the traditional treatment suppressed menses and drastically lowered estrogen levels (which unleashes a whole host of awful side effects), the pine bark group maintained normal estrogen and menses. Five of the 30 women in this group became pregnant. Considering endometriosis is a major limiting factor in conception, I’d say these are pretty promising results.

Ensuring adequate B-vitamin status may be important to determining if the body is able to excrete inactive estrogen by the liver. Selenium aids in detoxification processes in the liver and also supports a healthy immune system. 

Botanicals may also be appropriate for acute pain management. A tincture of chasteberry, dandelion root, prickly ash, and motherwort used 3x/day can help with symptom and pain management (Pizzorno & Murray, 2013). 

Bioidentical progesterone cream can help decrease serum estrodiol by decreasing the number of receptors for it. This works based on the premise that excess estrogen is one of the main causes of endometrial pain. Bioidentical progesterone is best used under medical care and alongside a comprehensive holistic treatment plan.

Exercise

A meta-analysis found that there were no differences in pain or severity of endometriosis for those that exercised and those that didn’t. There are significant limitations in how researchers have studied exercise and endometriosis. Exercise, particularly moderate exercise, is known to support multiple facets of health and decrease inflammation and should be considered in an endometriosis treatment plan. Walking, biking, yoga, and barre style workouts provide benefits without excess stress on the body as higher impact activities might. Exercise will also improve your body's response to glucose and support insulin sensitivity, which is another reason it is anti-inflammatory by nature. 

Overall it seems that pain management, reduction in inflammation and inflammatory processes, and hormones balancing are the best approaches to a complementary and alternative protocol for endometriosis. 

Beauty products

If you are at risk for endometriosis or have it already, it is more important than ever to switch over your body and skincare products to safer brands. Research shows that high levels of the toxins that reside in typical “on the shelf at Target” beauty products have the ability to affect your estrogen levels. (Not to knock Target—they have a growing safer beauty collection—I just know that’s where most of you shop!). Go to EWG.org to find what brands are the best in this category—Beautycounter is hands down my fave, not only because their products are the safest on the market and third party tested, BUT they work. That is a hard combo to find. 

If this all seems overwhelming, I agree. A disease like endometriosis has so many tentacles to it, it’s hard to know where to start. I recommend meeting with a holistic practitioner and completing a food sensitivity and micronutrient panel. If you have been battling endometriosis for any amount of time, stop guessing what role your diet might be playing. Find out where you are deficient and what foods are triggering an immune response in your body. I also recommend finding a holistic nutritionist or health coach who specializes in autoimmune diseases and start meeting weekly to keep you accountable and monitor your progress.

Endometriosis can be manageable. Like any other disease, it takes time, commitment, and knowledgeable providers working with you and for you. You deserve it.

Here’s to your health,

Katie

References

Banasik,  J.L. & Copstead, L.C. (2019). Pathophysiology, (6th Ed.). Elsevier.  

Bonocher, C.M., Montenegro, M.L., Rosa e Silva, J.C., Feriani, R.A. & Meola, J. (2014). Endometriosis and physical exercises: a systematic review. Reproductive Biology and Endocrinology; London, 12(4). DOI:10.1186/1477-7827-12-4

Cao, W., Wei, Y.,  Zhou, Q., Zhang, Y., Guo, X. &  ZHANG, J. (2017). Inhibitory effect of curcumin in human endometriosis endometrial cells via downregulation of vascular endothelial growth factor. Molecular Medicine Reports; Athens, 16(4), 5611-5617. DOI:10.3892/mmr.2017.7250

 Pizzorno, J.E. & Murray, M.T. (2013). Textbook of Natural Medicine, (4th Ed.). Elsevier.