Endometriosis is when tissue that normally lines the inside of the uterus, also called the endometrium, grows in places in the body that are outside of the uterus. This tissue growth usually involves the female organs, ovaries, Fallopian tubes, the pelvic peritoneum, and recto-vaginal septum. Though, sometimes it extends beyond these organs into the lungs, and even the brain.

Endometriosis is not an infection. It is not contagious, and it is not cancer.

Endometriosis is the result of an estrogen/progesterone imbalance. It has even been identified inside males who have been exposed to estrogen treatments. The condition is often painful.

The tissue acts much like endometrial tissue, thickening, breaking down and bleeding with each menstrual cycle. However, the endometriosis tissue does not have a means of exiting the body. So, it becomes trapped. This can lead to cysts in the ovaries, endometriomas, irritating surrounding tissue, and eventually scarring and adhesions which can cause pelvic tissues and organs to stick to each other.

Everyone’s level of pain varies and doesn’t necessarily indicate the severity of endometriosis. Some common symptoms include:

• Pelvic pain
• Dysmenorrhea, painful menstruation
• Pain during ovulation
• Leg pain or Sciatica during menstruation
• Lower back or abdominal pain
• Pain with intercourse
• Pain with urination or bowel movements
• Excessive bleeding
• Loss of dark or old blood before menstruation or at the end of a cycle
• Inter-menstrual bleeding, bleeding between periods
• Frequent infections such as candida, thrush
• Feeling faint or fainting during monthly cycle
• Lethargy
• Fatigue
• Depression
• Nausea
• Diarrhea or constipation, bloating, or nausea
• Infertility
• Ovarian cancer

Since endometriosis has similar symptoms to other disorders, it is often misdiagnosed as pelvic inflammatory disease PID, ovarian cysts, or irritable bowel syndrome IBS. Endometriosis is often associated with endometrial tissues growing outside of the uterine wall, adenomyosis as well as fibroids. It is difficult to differentiate between the root cause being adenomyosis, uterine fibroids, and endometriosis. To accurately diagnose endometriosis, you must use laparoscopy, an operation where a camera is inserted into the pelvis through a small incision near the naval.

The exact cause of endometriosis is not usually clear. Some reasons may include retrograde menstruation where some blood flows back through the Fallopian tubes into the pelvic cavity instead of leaving the body; an induction theory where immune or hormonal factors promote transformation of peritoneal cells that line the inside of the abdomen; embryonic cell transformation where estrogen transforms the embryonic cell in its earliest stage of development; surgical scar implantation after a surgical hysterectomy or C-section where endometrial cells attach to the surgical incision; endometrial cell transport where blood vessels or lymphatic fluid transports the endometrial cells to other parts of the body; or, an immune system disorder where the immune system makes the body unable to recognize and destroy endometrial-like tissue which is growing outside of the uterus.

Whatever the reason, a few treatment options are available that range from relieving the pain to surgical or hormonal treatments. Though, there are certainly alternative natural methods of alleviating the pain and restoring healthy, balanced hormones.

The conventional endometriosis treatment involves pain relievers, NSAIDS, GnRH agonists Lupron, oral contraceptives, or surgery. Although, if the endometriosis is caused by estrogen dominance, progesterone may serve as the key to breaking the cycle of estrogen dominance. A non-synthetic progesterone supplementation is a more natural alternative approach.

Statistics

Worldwide, there is approximately 200 million women with the disorder. About 6.5 million of these women are in the United States. Endometriosis affects 10-15% of women in childbearing age with more than half the pelvic pain experienced by teenage girls stemming from endometriosis.

Half the women suffering from infertility have endometriosis.

Those who suffer from endometriosis have several risk factors that include:

• One or more relatives with endometriosis
• Early menstruation
• Shorter menstrual cycles
• Heavy menstruation
• Later menopause
• High levels of estrogen
• Low body mass index
• Never giving birth
• Reproductive tract abnormalities or a medical condition that blocks healthy menstruation flow

Endometriosis typically becomes more evident several years after menarche, when menstruation first begins in the female. Often, pregnancy temporarily alleviates symptoms. Endometriosis may completely go away when menopause begins unless estrogen is taken.

Foods to Avoid

Reduce intake of trans fats, sugar, processed food, alcohol, and caffeine. Since environmental chemicals, such as dioxins or polychlorinated biphenyls PCBs may increase the severity of endometriosis, it’s a good idea to avoid foods that contain high levels of these. Cut back on saturated fats, especially dairy with high levels of fat and red meat that come from hormone and antibiotic injected animals. Some studies indicate that consuming red meat puts a woman at much higher risk for endometriosis. In my opinion you must be checked first before you make any nutritional changes.  Contact a Naturopath who can give you more specific advice based on your lab results.

Foods that Help

Increase your intake of antioxidants and try an anti-inflammatory diet. Increasing the amount of fresh fruits and vegetables that you eat will put you at a lower risk for endometriosis. Plant-based chemicals called isoflavones may help reduce the symptoms of endometriosis since they inhibit aromatase. Also, indoles, an organic compound may help. Some great food sources of isoflavones and indoles include:

• blueberries
• bok choy
• bone broth
• broccoli
• Brussels sprout
• cabbage
• cauliflower
• celery
• chia seeds
• chickpeas
• fava beans
• ginger
• green leafy vegetables
• parsley
• peanuts
• pistachios
• kale
• salmon
• soybeans

Emotional Component

Not only does your body react to hormonal imbalance with potential mood changes, but the frustration of not being able to get a quick diagnosis and relief also weighs heavy on emotions. It takes an average of 7 and a half years from the first doctor visit to getting a firm diagnosis.

Herbs and Vitamins that Help

Some find Chinese herbs to be helpful. Others turn to green tea which has similar components as progesterone in inhibiting aromatase. It also is an anti-angiogenic.

Some herbs that may be beneficial include:

• Ginger may reduce pain and ease nausea.
• Ashwagandha may help to reduce stress.
• Vitex, Chaste Tree, is used for hormone imbalances since it causes estrogen to be less available.
• Motherwort is used to gently soothe cramps and pain.
• Rosemary is used as an anti-inflammatory.
• Flax seeds also have anti-inflammatory properties
• DIM, diindolylmethane is a supplement derived from natural plant-based components found in cruciferous vegetables.
• Beta-carotine helps with immunity and fighting inflammation
• N-acetyl cysteine NAC may reduce the size of cysts.

Omega-3 Fatty Acids may help alleviate inflammation and keep bad prostaglandins that cause cramping at bay. Find Omega-3 Fatty Acids in salmon, mackerel, sardines, and anchovies.

Chamomile may have a calming effect that could help alleviate pain caused by endometriosis. At least one study published in the Journal of Cellular Physiology, suggests that chamomile contains chrysin, an isoflavone which triggers apoptosis cell death in excess uterine tissues. When chamomile is mixed with a similar component, honey, it may be even more beneficial.

Resveratrol is a plant-based nutrient that may inhibit aromatase associated with estrogen activity and COX-2 enzymes which is linked to the pain. It can be taken as a supplement, and is also found in grapes, peanuts, and mulberries.

Turmeric contains anti-inflammatory and antioxidant components called, curcumin. Curcumin has been shown to inhibit the production of estradiol in studies.

Digestion Effect

As with many ailments, the gut flora and balance of microorganisms play an important role. Choose foods high in dietary fiber to keep this in check. These fiber-rich foods may also play a significant role in reducing inflammation and breaking down estrogens. Endometriosis is associated with inflammation that presents itself as elevated cytokines and homocysteine levels which put women at a higher risk for autoimmune diseases like Ulcerative Colitis, Grave’s, Crohn’s, Hashimoto’s, and Celiac disease as well as an increased risk of non-Hodgins lymphoma, melanoma, ovarian endometrioid, and clear-cell cancer.

Essential Oils that May Help

• Peppermint has antioxidant properties and may reduce pelvic pain and cramps caused by endometriosis.
• Lavender has been studied and shown that women reduced menstrual cramps by using lavender oil.
• Cinnamon, clove, and rose oils may also be beneficial in reducing pain and bleeding, especially when mixed with lavender oil and applied during massage with almond oil.
• Heat through warm baths, hot water bottles, or heating pads can be used to relax pelvic muscles and reduce pain.
• Massage castor oil directly onto the abdomen. Mix with a few drops of lavender to help relax pelvic muscles.
• Pelvic muscle massages can help relax and reduce pain and inflammation. Add a few drops of lavender essential oil for even more relaxing benefits.

Stress Effect

Endometriosis can cause high levels of stress due to the hormonal imbalance effect on the body, the pain, and the difficulty in diagnosing it. Many turn to acupuncture or massage therapy when they are seeking relief from pain and stress. The stress hormone is known as cortisol, and studies have shown that women with advanced endometriosis had significantly higher levels of cortisol.

Managing stress is very important when it comes to treating endometriosis. Whereas, the symptoms may be the cause of your stress, stress may make the symptoms worse creating an endless cycle. Never neglect self-care. Whatever relaxes you is important to practice. Some turn to yoga, stretching meditation, and prayer.

Exercise regularly. It helps with healthy blood flow throughout the body and may help the woman produce less estrogen. Studies have shown that the more intense exercise you partake in regularly, the less likely you will be to ever develop endometriosis in the first place. It also helps reduce stress by releasing endorphins from the brain.

Hormones That Affect or Are Affected

Endometriosis is an issue with estrogen dominance. Estrogen is a very important hormone but needs to be kept in balance. Estrogen is the female hormone and is what makes a woman, a woman. Estrogen supports the female organs which support human life and reproduction. Estrogen is the hormone that stimulates the growth of endometrial and breast tissue at puberty and then monthly stimulates the growth of the follicle which releases the egg to be fertilized or for menstruation to begin. This hormone supports vaginal tissues. It also stores fat to help with pregnancy, prevents bone loss, supports the transportation of glucose across the blood brain barrier, and maintains collagen levels in connective tissues and in the skin. It also helps in the synthesis of neurotransmitters, such as dopamine and serotonin.

Endometriosis lesions express aromatase and synthesize their own estradiol from testosterone. This creates more estrogen and inflammation and contributes to estrogen dominance. If left untreated, the estrogen dominance that causes endometriosis snowballs into forming more endometriosis, more estrogen production and more inflammation. It may eventually lead to cancer.

Progesterone cream derived from non-synthetic sources such as Mexican wild yam or soy, may inhibit the growth of endometrial cells and the angiogenesis, development of blood vessels, that feed the uterine growth. The cream should be applied to either the wrists, inner arms, inner thighs, or upper chest as recommended by your doctor. Make sure you are monitored by a doctor when using progesterone since too much can throw hormones out of balance the opposite direction to produce mood changes, depression, weight gain, water retention, or abnormal menstrual bleeding.

Salivary hormone testing to test the Pg/E2 ratio is highly recommended to determine a progesterone-based treatment plan.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737931/
2. Journal of Cellular Physiology chamomile study – https://onlinelibrary.wiley.com/doi/abs/10.1002/jcp.24620
3. Curcumin and endometriosis – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941414/
4. Peppermint – https://www.sciencedirect.com/science/article/abs/pii/S2210803316300240?via%3Dihub
5. Massage – https://www.painmanagementnursing.org/article/S1524-9042(10)00067-6/abstract
6. Cortisol and endometriosis – https://www.ncbi.nlm.nih.gov/pubmed/16906287