Endometriosis: What Can You do About It?

What is Endometriosis?

Endometriosis is a condition where portions of the uterine lining lodge somewhere within the abdominal cavity.  This tissue is sensitive to hormonal changes.  It grows in response to increases in estrogen levels just as the uterine lining does.  This growing tissue causes pressure on surrounding tissues and nerves leading to intense pain.  Sometimes the pain is present throughout a woman’s menstrual cycle, not just at menstruation.  In some women, the pain is both excruciating and debilitating.

What are the Symptoms of Endometriosis?

Endometriosis symptoms include:

1. Intense abdominal pain that worsens before and/or during menstruation.  Women with endometriosis often have to take painkillers during their periods.  Even then, they experience incapacitating pain. Menstrual cramps of any severity may indicate mild, moderate or severe endometriosis.
2. Rectal or bladder pain that is worse around menstruation.
3. Bladder irritability.  The symptoms are sometimes similar to a bladder infection.  But, the symptoms keep recurring despite antibiotic treatment.
4. Infertility.  In some instances, endometriosis blocks the fallopian tubes. If this happens, IVF is necessary for conception.  In fact, that’s why IVF was initially invented.  Endometriosis causes other problems with fertility as well.  If the tubes are not blocked, these other issues are overcome through natural treatment.

What Causes Endometriosis?

There are many theories as to why this tissue is outside of the uterus:

• Gravity.  Doing headstands, or yoga during heavy menstruation allows menstrual blood to flow upwards into the abdomen rather than out.
• Dioxin.  Research on monkeys exposed to dioxin, a pollutant, shows an increase in endometriosis. A study by the Environmental Protection Agency determined that exposure through bleached products like sanitary napkins and tampons was insignificant.  More concerning is the exposure to dioxin through the consumption of beef and dairy products.
• Retrograde flow.  Retrograde flow is menstrual blood that is going the wrong way.  That is, rather than down and out of the uterus through the cervix, menstrual tissue is going up and out through the fallopian tubes.  Retrograde menstrual flow occurs in approximately 90% of all women.  So, this theory alone isn’t enough to explain why some women have endometriosis and others don’t.
• Overly active uterine lining cells.  An enzyme called telomerase is overly active in women with endometriosis.
• Autoimmune.  More recently theories suggest that endometriosis is an auto-immune disorder. Endo patients have high levels of circulating anti-endometrial antibodies. This seems like a chicken and egg situation.  Are the antibodies present because of the endometriosis, or are they causing it?  If endometrial tissue is in the abdominal cavity where it does not belong, the immune system targets it as foreign and creates antibodies against it.  This is what we would expect with tissue that is where it shouldn’t be.
• Coelomic metaplasia.  This theory states that the cells that line your abdomen changed into uterine lining cells.  The theory arises because endometriosis is found in fetuses and in men.  Estrogen dominance is a likely contributor to this.
• Estrogen Dominance.  This means that there is an imbalance between estrogen and the other hormones, like progesterone, that balance it.

Which hormones are involved in endometriosis? How can you tell?

To confirm what the exact hormone imbalance is that is causing or contributing to your endometriosis, there are several testing/information gathering options:

1. Conventional hormone blood tests. Be aware with these tests, that they must be performed at specific points of your menstrual cycle in order to interpret them and determine whether your levels are optimal. The second thing to be aware of is that laboratory ranges for hormones are notoriously broad, and not based on what is optimal or ideal. Even when there are obvious signs of hormone imbalance, women will fall inside these ranges. Your tests need to be interpreted by a naturopathic doctor like myself, who will not rely on conventional ranges, but rather ranges based on optimal hormonal balance.
2. DUTCH testing. DUTCH testing is dried urine testing for not only your hormones, like estrogen, but also all of their metabolites. Metabolites tell us how your body deals with your hormones. This particularly important with regards to estrogen and how your liver breaks it down and excretes it.
3. Basal Body Temperature charting. Checking your temperature first thing in the morning and plotting it in an app helps us to identify if you are ovulating, when you are ovulating, and what your hormones are like before and after ovulating.

Natural Treatment for Endometriosis

My naturopathic treatment plan for endometriosis includes:

1. Preventing the escape of uterine tissue from the uterus
2. Helping your body to remove endo tissue that is already in your abdomen
3. Relieving your pain
4. Reducing excess estrogen
5. Aiding liver detoxification of hormones and hormone-mimicking pollutants (not with the kits from the health food store!)
6. Ensuring intestinal health so that toxin excretion is efficient

Preventing Uterine Tissue from Escaping the Uterus

• Avoid inversions or headstands during heavy menstrual flow
• Reduce dioxin intake from beef and dairy consumption
• Reduce telomerase activity by increasing melatonin
• Address autoimmunity if it’s present
• Balance estrogen and progesterone to resolve estrogen dominance

Remove Abnormal Tissue

Your immune system is responsible for identifying and removing this foreign tissue.  Acupuncture helps to stimulate immune system activity in your abdomen.  This enhances the clean-up of this endo tissue.

Your diet either improves or inhibits your immune system.  We optimize your diet to help your immune system work better.  Immune-boosting herbs also help you to get rid of this abnormal tissue.

Pain Relief

Acupuncture works amazingly well to relieve pain.  Research proves it to be effective to help this type of pain.

Reducing Excess Estrogen

Estrogen activity increases when insulin levels are higher. So, maintaining steady blood sugar and improving your insulin sensitivity help to moderate estrogen activity.  Estrogen-like chemicals from pollution, plastics, pesticides, and other chemicals cause symptoms of excess estrogen.  So, reducing your intake of these helps.

Liver Detoxification

It’s your liver’s job (among about 200 others) to detoxify chemicals, toxins, and excess hormones.  This prepares them for elimination. Only once these substances are fully processed by your liver are they removed from your body.  If your liver is overwhelmed or undernourished, these toxins build up in your system.  Many natural substances aid liver detoxification. For example, vitamin B6, vitamin B12, magnesium, glucarate, I3C and 5MTHF help your liver remove estrogen.

Intestinal Health

Once toxins are processed by your liver they get excreted through your bowels.  Antibiotics or unhealthy diets lead to an unhealthy digestive tract.  These cause the overgrowth of unhealthy bacteria or yeast.  An enzyme  (known as beta-glucuronidase) from certain bacteria, allows these toxins to get recycled rather than removed.   Gut cleanse kits often do little to correct intestinal bacteria and improve intestinal health.  Most only stimulate bowel movements with laxative herbs and/or fiber supplements.  Correcting your gut bacteria requires a generally healthy lifestyle and:

• removing food sensitivities
• taking something to kill off the bad bugs
• using something to restore the good bugs and
• taking something to repair your gut wall.

Benefits of Natural Treatment for Endometriosis

1. Addresses the underlying cause of endometriosis.  This provides a longer-term solution.
2. Prevents recurrence of endometriosis. Estimated recurrence rates after surgery are between 30 and 40% within 5 years.  Many women experience a recurrence within 1-1.5 years.
3. Shrinks existing cysts and reduces pain.
4. Avoids the side effects from drugs.
5. Provides better overall health and hormone balance.
6. Improves fertility.  Sometimes endo impairs fertility by blocking the ovary from releasing an egg or blocking the opening of the fallopian tube.  If the tube is blocked the egg can’t make its way to the uterus for fertilization.  If you have blocked tubes, you will require IVF treatment to conceive. The condition also makes the lining of the uterus less receptive to implantation.  Naturopathic treatment helps the latter source of endometriosis-related infertility.

For help with this or any other health problem, book an appointment here or call the office for more information at 416-481-0222.

Authored by Dr. Pamela Frank, BSc(Hons), ND

Dr. Pamela has practiced as a naturopathic doctor in Toronto since 1999. She has received numerous “Best Naturopath in Toronto” awards. She is registered with the College of Naturopaths of Ontario.

Dr. Pamela Frank uses a natural treatment approach that may include acupuncture, herbal medicine, nutrition, diet, vitamins, supplements, and other natural remedies to restore balance and provide long-term resolution to almost any health problem.

Endometriosis and Natural Treatment Research

Breastfeeding:

Farland LV, et al. History of breastfeeding and risk of incident endometriosis: a prospective cohort study. BMJ. 2017; 358:j3778.
Breastfeeding is inversely associated with the risk of endometriosis, that is, increased breastfeeding equals lower risk.

Chinese Herbal Medicine:

Flower A, et al. Chinese herbal medicine for endometriosis. Cochrane Database of Systematic Reviews. 2012; DOI: 10.1002/14651858.CD006568
Two small studies in this systematic review suggest that Chinese herbal medicine is equally effective compared to gestrinone and possibly more effective than danazol in relieving endometriosis-related pain.

Teenage girls who are too skinny are more likely to develop the painful reproductive disorder endometriosis than their heavier peers, research shows. Source: Queensland Institute of Medical Research

Did you know that endometriosis problems can continue even after a hysterectomy?

August 5, 2008

Scientists have identified an enzyme abnormality that may be the cause of endometriosis

Women who have endo express an enzyme called telomerase in both the early and late stages of the menstrual cycle.  It is normal to express this enzyme only in the early stages of the cycle.  As a result, the lining of the womb is more hostile to early pregnancy.  The cells that are shed at this late stage in the menstrual cycle are more ‘aggressive’.  They are more able to survive and implant outside the uterus. To read more click here – http://www.liv.ac.uk/news/press_releases/2008/08/endometriosis.htm

The good news is that there are natural ways to suppress telomerase activity.

October 1, 2009

Aromatase inhibitors improve pain control in endo

Pharmaceutical aromatase inhibitors cause uncomfortable side effects about half the time.  Women tolerate natural aromatase inhibitors much better.

Resveratrol:

Supplementation with resveratrol as well as an oral contraceptive significantly improved and even resolved painful periods and pelvic pain in endometriosis patients.

Source: Int J Womens Health. 2012;4:543-9. Epub 2012 Oct 10

Vitamin D:

Low vitamin D status is associated with impaired fertility, endometriosis and PCOS.

Source: International Journal of Women’s Health, Volume 3, Pages 25-35, 2011

N-acetyl cysteine (NAC):

Supplementation with N-acetyl cysteine decreased cyst mean diameter, compared to a significant increase in untreated patients.

Source: Evid Based Complement Alternat Med. 2013;2013:240702.

Stem cells:

Identification of stem cells in the endometrium suggests that they are involved in the development of endometriosis.  Source: Histol Histopathol. 2012 Jan;27(1):23-9.

PCBs:

In women aged 20-40, the sum of all polychlorinated biphenyl (PCB) substances was 1.6 times higher in the women diagnosed with endometriosis than in controls. Source: Environ Health Perspect. 2006 July; 114(7): A404.

Hormones:

Loss of progesterone signaling in the endometrium is part of the development of endometriosis. Progesterone resistance is common in endometriosis patients. Source: Semin Reprod Med. 2010 Jan;28(1):36-43. Epub 2010 Jan 26.

Dioxin:

Dioxin, an environmental contaminant, is largely thought to play a part in the etiology of endometriosis.  Source: Environ Health Perspect. 2002 July; 110(7): 629–634.

In a study of infertile women with endometriosis, 8 individuals with endometriosis were dioxin positive compared to 1 woman in the control group.  This suggests a link between dioxin exposure and endometriosis. Source: Hum Reprod. 1997 Feb;12(2):373-5.

Immune Response:

Inadequate immune and neuroendocrine responses are thought to play a part in the pathophysiology of endometriosis.  Source: Semin Immunopathol. 2007 June; 29(2): 193–210.

Iron:

Iron overload was observed in the peritoneal fluid, endometriotic lesions, peritoneum and macrophages of endometriosis patients.  This suggests that iron is a contributing factor in the development of endometriosis. Source: Mol Hum Reprod. 2008 Jul;14(7):377-85. Epub 2008 May 28.

Immune system:

Endometriosis development is facilitated by the quantity and quality of endometrial cells in the abdominal fluid.  It is associated with increased inflammatory activity. Source: Reprod Biol Endocrinol. 2003; 1: 123.

Pollutants:

The level of exposure to polybrominated biphenyls (PBBs) did not increase the risk of endometriosis. But, higher levels of polychlorinated biphenyls (PCBs) exposure did. Source: Ann Epidemiol. 2007 July; 17(7): 503–510.

Polychlorinated biphenyls (PCBs) are not associated with endometriosis risk. Source: Environ Health Perspect. 2010 September; 118(9): 1280–1285.

Exposure to environmental pollutants, particularly dioxins and polychlorinated biphenyls, increases the risk of endometriosis in women. Source: Environ Health Perspect. 2009 July; 117(7): 1070–1075.

Inflammation:

Exposure to environmental toxins induces an inflammatory-like endometrial response that may advance the development of endometriosis. Source: Fertil Steril. 2008 May; 89(5 Suppl): 1287–1298.

Phytochemicals:

The phytochemicals Diindolylmethane (DIM), its precursor Indole-3-carbinol (I3C), and cogener, 2-(Indol-3-ylmethyl)-3,3’diindolylmethane (LTR-1) prevent or reduce symptoms of mastalgia and endometriosis. Source: United States Patent 7,384,972; June 10, 2008

N-acetyl cysteine:

Supplementation with N-acetyl cysteine decreases cyst mean diameter, compared to a significant increase in untreated patients. Source: Evid Based Complement Alternat Med. 2013;2013:240702.

Acupuncture for Endometriosis

A systematic review and meta-analysis of 10 studies looked at the effectiveness of acupuncture and endometriosis. Although lacking blinded RCT, a reduction in pain, as well as CA-125 levels, are associated with acupuncture treatment. Source: Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis.PLoS One. 2017 Oct 27;12(10):e0186616.

DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested on this website.