ENDOMETRIOSIS
An endometriosis diagnosis can be a relief for some women as recognition of the often debilitating menstrual symptoms they have been experiencing is acknowledged - often intense pain, heavy bleeding, chronic pelvic pain and also affecting mood and mental health.
For most women it has been quite a journey to gain this recognition, perhaps even years with visits to the GP and even may have involved visits to the Emergency Department. Once the diagnosis is provided it seems that there is a new understanding now afforded to the endometriosis woman amongst family, friends and workplace.
Endometriosis is a condition that affects 10% (200 million worldwide) of women, although this number is considered an underestimation as clinical diagnosis is difficult, invasive & expensive.
In Australia 6% of women receive a clinical diagnosis by age 40-44 yrs.
The endometriosis condition is unique to each and every woman. For this reason the treatment of endometriosis requires a very individualised approach. The underlying pathology, level of diseased tissue, triggers and causations, inflammation, symptoms experienced, other tissue involvement are all very unique for each and every woman.
As numbers and awareness of the condition is growing, there has been an increased level of research and understanding of endometriosis and adenomyosis.
Endometriosis is the growth of endometrial-like tissue outside the uterus.
Adenomyosis is specifically the location of this tissue in the uterine muscular wall causing an enlarged uterus.
This endometrial-like tissue varies from endometrial tissue in its behaviour - it is inflammatory with immune dysregulation; it proliferates and infiltrates; causes oxidation; is capable of migration, invasion and fibrosis; and is dysbiotic.
Endometriosis can cause: Dysmenorrhea (painful periods) , heavy menstrual bleeding, intermenstrual/chronic pelvic pain, dyspareunia (painful sex), gastrointestinal disturbances such as IBS, infertility, depression/anxiety/fatigue, and, conversely can be without any noticeable symptoms. In addition, Adenomyosis can often have a palpable, visibly bloated and enlarged uterus.
How Does Endometriosis Start?
The exact origin of the condition remains unknown. The main theory of disease origin was made in 1921 and describes retrograde menstruation - a hyperperistalsis of uterine muscle that causes blood containing endometrial cells to flow up through the fallopian tubes, and migrate, implant, and grow in the pelvic cavity.
Yet there is a high degree of retrograde flow seen in many women that do not have endometriosis, so it is considered that there are other factors which must contribute to disease progression such as: genetic and epigenetic factors, hormonal influences, immune dysregulation, dysbiosis (gut bacteria imbalance), diet and lifestyle, and environmental factors (such as chemical exposure).
How Do I Know if I have Endometriosis?
In the past the gold standard for diagnosis has been surgery, however more recently there has been greater acceptance for using ultrasound and MRI in conjunction with non-invasive clinical pathology biomarkers - hormone and inflammatory biomarkers by blood test. A consideration of each individual case will determine risks and benefits and whether surgery or a non-invasive approach is right for you.
Recommended considerations when making your method of diagnosis choice can include:
Extent of menstrual symptoms and impact on quality of life;
affordability;
access to well-experienced surgeon;
fertility implications; and
associated conditions and impact on health
Assessing and Treating Endometriosis from a Naturopathic Perspective
Hormonal Considerations
Endometriosis is an oestrogen-driven disease - the endometrial like tissue that is outside the uterus creates its own self-sustaining oestrogenic environment through a number of mechanisms. Often progesterone, your oestrogen balancing hormone, is suppressed.
Female Hormone Assessment by blood test will assist in determining your oestrogen exposure and guide treatment approach. Working with this data to decrease your likely high oestrogen load may assist with symptoms (especially pain and heavy menstrual bleeding), and possibly reduce further growth of tissue. In naturopathic clinic all factors that influence your hormone levels are assessed to determine appropriate action and support, ie your hormones, your receptor activation, hormonal enzymes, stress implications, digestive health.
Environmental Factors - Endocrine Disrupting Chemicals (EDCs)
EDC exposure is likely to influence endometriosis risk & severity. Evidence of increased risk with exposure to: phthalate esters, bisphenol A (BPA); organochlorinated environmental pollutants (OCPs); and heavy metals.
Genetic & Epigenetic Factors
A series of cumulative genetic and epigenetic incidents that may have or need to have occurred before disease establishment. This includes inherited DNA, peri-natal and childhood factors, and polymorphisms. Polymorphisms are gene variations that can affect detoxification processes.
Microbiome
Dysbiosis, an imbalance of gut bacteria, is associated with increased incidence and symptomatology of endometriosis. Gut bacteria can influence endometriosis on many levels including oestrogen clearance, immune dysfunction, and histamine production.
Immune Dysregulation. Endometriosis - “a wound that does not heal”
Chronic inflammation and oxidation are key features of the disease establishment and progression of endometriosis. The adhesion of the endometrial like tissue outside the uterus
involves the release of many inflammatory markers that are part of the sustaining picture for endometriosis.
Histamine
Histamine levels can contribute to the associated inflammation, pain, heavy bleeding, dysregulated hormones, infertility and mood changes of endometriosis. Oestrogen and histamine have an inter-related self-sustaining relationship that can exacerbate the above systems.
Dietary and Lifestyle factors
Clinical evidence is limited for dietary factors, and endometriosis sufferers who have a wonderful whole food anti-inflammatory diet may continue to suffer debilitating symptoms.
Reduce Your Risk: increased fruit and vegetables; high fibre intake; mediterranean diet; Omega 3s polyunsaturated fatty acid intake; vitamin A & C; regular exercise
Lifestyle Factors Which Increase Risk: excess red meat; higher carbohydrate with high GI intake; alcohol, high psychological stress & poor sleep.
MEDICAL MANAGEMENT
Medical management involves either surgery, pharmacological treatment or both. Understanding your unique presentation of endometriosis, and supporting your health holistically can in many cases substantially ease symptoms and improve your day to day quality of life. Supporting your own health is not only self-empowering, but may also reduce the need for or level of medical management.
NATUROPATHIC MANAGEMENT AND TREATMENT
Functional medicine management, naturopathy, involves undertaking targeted therapeutic action to support all of the factors as described above that may be contributing to your unique endometriosis and adenomyosis picture. It involves working collaboratively with your health team to achieve your best health. Unfortunately there is not one single treatment or approach, a magic pill! But, much relief can be found such that your day to day quality of life is not impacted.
Understand that endometriosis is a complex and multifaceted condition, and, living with endometriosis can involve infertility, menstrual and pelvic pain, heavy bleeding, and anxiety & depression. Definitive diagnosis requires laparoscopy and biopsy, however other less invasive assessments can contribute to a high clinical certainty and significantly influence management strategies. In conjunction with clinical pathology and testing, treatment and management can then be tailored to your unique picture.
Please reach out and book an appointment or pop in and visit the apothecary if you would to discuss further whether naturopathic treatment can help you.