Endometriosis is a common condition affecting between 10-15% of women. It is a condition where the cells that should only be found within your uterine lining migrate and are found in other areas within your abdominal cavity. The growth of these cells outside the uterus can cause a host of different symptoms depending on the location the tissue is growing on. These cells respond the same way as your normal endometrial tissue to hormone stimulation. This means that they grow and bleed in the same cyclical pattern as the tissue in your uterus. This internal bleeding can lead to areas of scar tissue development, regions of inflammation and pain.
Symptoms of endometriosis will vary from women to women but can include painful and heavy periods, painful intercourse, pain with urination or bowel movements, low energy and concerns with fertility. It is thought that up to 60% of women with fertility concerns have some degree of endometriosis. The diagnosis of endometriosis can be quite difficult and the only way to get a true diagnosis is by doing a surgical procedure called laparoscopy.
The precise cause of endometriosis is still yet to be determined. There appears to be an increase in immune activity in the uterus, with a correlation between suppressed immune functions and an increased number and size of lesions. A different immune cell called macrophages also plays a role in endometriosis. Macrophages have a job to clean up any general debris. There is an increase in macrophages activity seen in the uterus of women with endometriosis. This may lead to a women’s body identifying sperm as foreign and therefore contributing to infertility. In terms of fertility, endometriosis can lead to scarring on Fallopian tubes, adhesions and unruptured follicles in the ovaries are often seen.
So what can you do to support your fertility if you have endometriosis?
- Nutrition and diet will play a huge role in managing endometriosis.
High fiber foods can provide significant benefit by helping support the healthy bacteria in the gut and crowd out the harmful ones. Increasing fiber by focusing on vegetables, legumes and beans can help improve digestion as well as reduce inflammation which will help reduce pain levels.
Reducing the amount of red meats in your diet. Red meats, when consumed, release a substance called arachidonic acid that promotes inflammation contributing to pain levels. Including plant-based protein sources such as soy, nuts, seeds, beans or legumes in your meals, will assist your body in lowering levels of inflammation. You can also look to substitute fish for meats, as fish contains a type of fatty acid called omega 3s that work to reduce inflammation.
Limit your caffeine intake. Women who have less than the equivalent caffeine of about 6 cups of coffee per month had on average 40% improvement in symptoms compared to women who consumed over this amount. There is approximately 120mg of caffeine in a cup of coffee, so keeping total intake under 7g is optimal. Some patients I find do significantly better with eliminating caffeine entirely from their diet. Try it for one full cycle and see if you notice a difference. Or as another option I find for some women even it they stop for the week before their period this can have a positive impact.
Focus on including more liver supporting foods and herbs. The family of vegetables known as brassicas includes broccoli, cauliflower, kale, Brussel sprouts, cabbage, bok choy and turnips. These vegetables contain a nutrient called indole-3-carbinol or I3C. I3C helps the liver to metabolize estrogens, so can be helpful to assist in the balance of estrogen in the body. In general, making sure you are getting a minimum of 5 servings of vegetables per day will go a long way to ensuring you are getting adequate fiber and nutrients to support detoxification.
- Supporting your stress and nervous system.
When your body is under higher levels of constant stress your adrenal gland makes more of a hormone called cortisol. The body uses your progesterone to make cortisol, so with higher stress levels your progesterone levels can drop leaving the ratio of estrogen to progesterone imbalanced. This allows for higher levels of estrogen that can stimulate endometrial tissue.
There are several ways to help your body regulate stress more effectively. One is to add (or continue) regular daily exercise. Doing any type of activity that you enjoy is fine. This could range from walking, biking, dancing, swimming or weights and classes at the gym.
Breathing properly is also critically important to keeping cortisol levels in a good range. Doing either diaphragm or yoga breathing each day, helps keep your body in its relaxation nervous system.
- Reducing exposure to estrogenic or hormone disrupting toxins.
Hormone disrupting toxins will have the largest impact on hormonal based concerns such as endometriosis as well an on overall fertility and reproductive health. Some examples of common places we will find these chemicals include lotions, makeup, soaps, cleaning products, food storage containers, water supply. The Environmental Working Group (EWG) publishes a list of the 12 top hormone disrupting chemicals some of these include bisphenol- A (BPA), phthalates, fire retardants, lead, mercury and organophosphate pesticides.
For more information about endocrine disruptors please read the blog post from May 20, 2020. – Are endocrine disrupting toxins impacting your fertility.
Optimizing your digestion and liver function are two of the most important ways to not only improve your endometriosis but also to optimize your overall health. There are also other nutrients and herbal medicines that can be used to assist with pain so please speak to your Naturopathic doctor or other health provider to see what makes the most sense for you.
Dr. Jodie Peacock ND
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