Treating Endometriosis: a multi-modality approach

One in ten women in Australia suffers from some level of Endometriosis. In some women it can cause intense pain and fatigue, in others it causes no symptoms at all. It is best to address endometriosis using an integrative approach that includes diagnostic and surgical techniques from traditional medicine and treatment with naturopathic medicines.

What is Endometriosis

Recently on a facebook post, well known fertility specialist Dr Andrew Orr compared Endometriosis to rust, a “pesky weed with a never ending life cycle”. Endometriosis occurs when uterine tissue from the endometrium (the lining of the womb you shed every month as your period) wander to parts of the body where it does not belong. Sometimes it can wrap around your ovaries, grow up the back of your vagina, adhere to the digestive organs, spread along the walls of the pelvic cavity and lodge itself inside your hips. It has even been found in the lungs, heart and eyes. It can literally wander and proliferate anywhere.

The problems caused by Endometriosis (such as pain, fatigue and infertility) come when this wandering endometrial tissue grows where it should not be. Like your period, the tissue starts to swell in the second half of your cycle. But unlike your period, by the time day 28 (or whatever day you get your period) rocks around, it becomes trapped between layers of tissue with no where to go. The pressure builds up as does the pain. Sometimes the pain can be caused by the sticky endometrial adhesions glueing your organs together too. The this kind of pain can be totally horrific. So horrific it has been compared by many women to child birth.

So what causes the Endometriosis itself?

The current line of thought in conventional medicine is that Endometriosis (and the initial wandering of Endometrial cells) may start in utero (when you’re inside your mothers womb). Other studies suggest that it’s actually an autoimmune condition, indicated by the presence of inflammatory cytokines and tissue specific autoantibodies. It is definitely an issue of not enough progesterone (at site of tissue), and of too many oestrogen metabolites overloading the liver (otherwise known as poor estrogen clearance). It has also been shown that once endometriosis lesions are formed they start to produce their own endogenous estrogen. The condition can also be made worse made worse by retrograde blood travelling up the uterus, and the British Journal of medicine even mentions spiritual uncertainty and emotional stress as 2 main causes of the condition. It is a disease with multiple causes and underlying pathologies that requires a multi-modality response.

What you need to know about the diagnosis of Endometriosis

The average diagnosis time for Endometriosis is 7 years. You can have next to no Endometriosis and have chronic pain, or be riddled with it and have none. Many women don’t even know they have it until the time comes to get pregnant and they have trouble conceiving. You can not formally diagnose Endometriosis without a laparoscopy. However there are a few other tests that may be used to potentially indicate the disease. These include:

1. Blood tests

Often those with late stage Endometriosis with have increased inflammatory markers in their blood work. Markers that tend to be increased with general inflammation are ESR and CRP.  It is also wise to have your GP test for the marker CA125, which can be elevated in later, more developed stages of endometriosis. Lastly testing for ANA will give you an idea if their is an autoimmune picture going on or not.

2. Ultrasound

When Endometriosis is advanced far enough, you can sometimes see the bigger endometrial cysts (not implants) on an ultrasound. During the scan you can also sometimes see Endometriosis sticking your organs together.  In saying that, you need to make sure you are getting the ultrasound done at a specialist female repro ultrasound clinic (where clinicians are trained to see it) because many normal radiologists (in my experience) can miss it. Ultrasounds are useful if you can actually see anything on them but in most cases, even when the ultrasound has revealed no Endometriosis the Doctor can then open you up to find that you’re riddled with it. So it’s isn’t the most reliable of tests.

At the end of the day, if you truly want to find out if you have Endometriosis (and if you do have it taken out), you will need to undergo a laparoscopy with a specialised physician. More on that  below.

The conventional medicine approach to Endometriosis

Conventional medicine definitely has it’s place. When it comes to Endometriosis, most gynaecologists like to offer the Pill or progesterone based medications such as the new Vissane to suppress the cycle and more importantly the proliferation of more foreign, endometrial tissue. This suppresses symptoms for many people, but it certainly does not address the cause and it may even contribute to it (synthetic hormones, particularly those with estrogen like in the combined Pill only work to increase estrogen dominance and liver congestion). Many gynaecologists also like to fit Endo patients with Marina’s, which are progesterone secreting IUDs. This form of progesterone (progestin) will help suppress the Endometriosis, but at the end of the dat it’s another synthetic hormone that will ultimately load up your liver. Also, IUDs are also famous for increasing menstrual bleeding and period pain, so I’m unsure why they’re even considered in treatment.

The Functional Medicine approach

Naturopathic and functional medicine’s approach to Endometriosis works by addressing the potential cause of the disease and as a result symptoms lessen naturally.

It is a 5 step, multi-modality approach:

1. Treat inflammation by restoring a leaky gut and eliminate toxic foods, substances and excess insulin levels that could be fuelling the Endometriosis:

  • Avoid all gluten-based foods that create inflammation by destroying the lining of the gut wall.
  • Avoid ALL dairy foods. They are mucous forming but more importantly they contain A1 casein protein which can be HIGHLY inflammatory in sensitive individuals. Dairy foods from cows in Australia, Europe and North America are particularly bad. A1 casein has also been associated with autoimmune disease in studies (see more on that below). So it’s important to avoid milk, cheese, yogurt, cream, ice cream and anything including these ingredients. Butter however is fine as it is mostly fat (it also has many other health benefits, so eat up).
  • Limit/ avoid caffeinated beverages, particularly if you already have an issue with fatigue. If you do still want your morning cuppa, opt for the healthier options: always organic, preferably decaf, never with dairy milks and if you have to only stevia or honey as a sweetener.
  • Avoid any ingredient that sounds like a chemical or any that you can’t pronounce. Particularly artificial sweeteners found in “diet” products, such as aspartame.
  • Avoid hydrogenated oils and trans fatty acids found in margarine, fried foods, processed and packaged foods create inflammation in the body. Opt for Avocado/Linseed /Extra Virgin Olive Oil instead.
  • Generally avoid eating out of a packet, especially refined grains and sugars, baked goods, lollies, chips, chocolate, ice cream etc. You get the idea.
  • Include as many things in your diet that may work to reduce pain and inflammation. My favourite natural anti-inflammatories include turmeric (in your cooking but preferably in a medicinal form which is much stronger), ginger, protealytic enzymes (such as papain, rutin and quercetin), a good quality EPA/ DHA extract, Vitamin E and very colourful vegetables (particularly anything green!).

2. Reduce estrogen excess (dominance) by taking away environmental estrogen’s and by detoxing the liver with some of the natural medicines listed below.

Estrogen is the fuel that lights the endometrial fire. It is not the root cause but definitely worsens the condition. Women with endometriosis are generally ‘estrogen dominant’ – which is a term to describe there an excess of estrogen and a deficiency of progesterone. This excess estrogen builds up in the body, often in the tissues and always in the liver.

This is also why taking the combined Pill that your GP may prescribe to manage symptoms and your cycle can be a bad idea when you have Endo (unless you have taken all the steps described in this article and still desperately need something to control symptoms). With the Pill you may temporarily suppress the pain, but ultimately you are increasing your estrogen load. It is better to address the root cause of the Endometriosis (by addressing autoimmunity) and clear the body of any excess estrogen rather than adding to the problem.

The only catch I want to mention is that you usually don’t see “estrogen dominance” on a blood test (which only indicates levels of circulating levels of estrogen and progesterone). With Endometriosis, it’s the hormone level at site of tissue and receptor sensitivity that is more of a concern (women with Endometriosis have increased cell receptor sensitivity to estrogen). The absolute best way to measure your true estrogen levels (and to see how easily you accumulate/ eliminate it) is through an estrogen metabolites test which needs to be ordered by a qualified nutritionist, naturopath or integrative GP.

Outside of specialised testing, doing the estrogen clearance work under the supervision of a practitioner is more beneficial as you gain access to high quality, natural medicines that can only be obtained on script. These include:

  • Formulations comprising of nutrients such as Indole 3 Carbinole, Calcium DeGlurate, Green tea, St Mary’s Thistle, N-Acetyl Cysteine, DIM and Brocolli sprout powders.
  • Liver cleansing herbs, particularly Dandelion and St Mary’s thistle.
  • The herb Vitex which has been shown decrease estrogen effects & promote progesterone via the anterior pituitary regulation.
  • Progesterone cream, which works for some people but is not suitable for the hormone sensitive (if you haven’t tolerated the Pill very well in the past you are likely one of these people). The cream can also build up in the tissues taking 6 months to clear, potentially causing a myriad of side effects. If you do not consider yourself sensitive, some Wild Yam cream is a good option to help boost your progesterone levels. Start with a 1/4 teaspoon and use only after ovulating and before getting your period.
  • Homeopathic progesterone drops, which don’t have a huge amount of science behind them I admit but I do get good results with patients.

Outside of prescribed natural medicines, there is plenty you can you at home to reduce your estrogen load (and to increase progesterone, which will help suppress the proliferation of endometrial tissue altogether):

  • Maintain a health weight to help reduce your overall estrone load.
  • Avoid antibiotics and the Pill.
  • Avoid inflammatory foods (as described above) as they increase estrogen receptor sensitivity.
  • Support the liver by avoiding toxins such as smoking and alcohol.
  • Generally eat a diet high in natural fibres. Aim for 3 cups of colourful vegetables a day. Starchy vegetables are also great (except potato) as well as non-glutinous grains such as buckwheat, brown rice and quinoa. These fibres help feed healthy intestinal bacteria and boost the immune system.
  • Include flaxseeds/ ground flax or flaxseed oil in your diet as they are rich in weak phytoestrogens which help decrease the effect of estrogen in the body.
  • Replace high intakes of saturated fats with foods rich in high quality essential fatty acids. These include fatty fish (salmon, sardines, etc), flaxseed oil and seeds, almonds, walnuts, olive + coconut oil and a good evening primrose oil supplement.
  • Turmeric, onions, garlic, rosemary, leek, ginger and dandelion (think dandelion tea) stimulate liver detoxification of estrogen.
  • Unless you suffer from hypothyroidism, eat as many cruciferous vegetables as you can. When you chew on veges like brocolli, cabbage or brussel sprouts, the estrogen-clearing compound Indole 3 carbinole is released.
  • If you are able to tolerate it (and don’t have an issue with SIBO), eat fermented foods daily as they are rich in natural probiotics which help prevent estrogen reabsobrtion.
  • Avoid all plastics as they are a source of xenoestrogens which build up in your system. Replace your plastic water bottle with a glass or stainless steel one; use baking paper instead of glad wrap and change your plastic tupperware containers to glass ones (IKEA have great, super cheap ones to offer). And never ever microwave in plastic.
  • Avoid tap water. It is rich in the hormone-disruptor fluoride and synthetic hormones derived from things like the Pill. My first preference for a water filter is Reverse Osmosis.

3. Address potential autoimmunity by treating a leaky gut and modulating the immune system.

There is a growing amount of scientific evidence that Endometriosis is actually an autoimmune disease. It’s thought that the immune system responds in a dysfunctional way to the foreign endometrial tissue, launching inflammatory cytokines and autoantibodies that increase inflammation and fuel its growth. These are the sort of inflammatory markers you see on the blood test of anyone with an autoimmune disease. Triggers may include a leaky gut, toxic overload (environmental and bacterial), a genetic predisposition and stress.

So how do you address potential autoimmunity? Again, this is something you would look at under the supervision of a trained practitioner. In short though you can reduce any autoimmune response and the chance of developing an autoimmune disease by:

  • Restoring the lining of a leaky gut.  A permeable, “leaky” gut lining drives inflammation, activating the immune system in a dysfunctional way as it does so (NB: 80% of your antibodies are created in the GALT tissue of your gut). This repair of intestinal permeability is done by both removing things that destroy it (gluten, dairy products, stress, toxins, etc) and replenishing it with an individualised supplement protocol (including glutamine, berberine, HCL, enzymes, probiotics and slippery elm).
  • Cleansing the body from heavy metals and environmental toxins that may trigger autoimmunity.
  • Boosting general nutrient status by optimising the diet and lifestyle, taking supplements and increasing absorption levels. Vitamin D is essential in regulating the immune system and inflammation; Omega 3 fatty acids suppress inflammation by reducing elevated levels of cytokines; modulating the immune system with anti-infammatory herbs and natural medicines (turmeric especially); increasing general antioxidant status to reduce inflammation (Endometriosis patients are often deficient in Zinc and Selenium).

There is also growing support in the medical community for Low Dose Naltrexone (LDN) as an effective treatment for chronic pain and autoimmune disease. It works by blocking “your opioid receptors for a few hours in the middle of the night — it is believed to up-regulate vital elements of your immune system by increasing your body’s production of metenkephalin and endorphins (your natural opioids), hence improving immune function”.

Whilst there haven’t been any specific scientific studies carried out (to date) regarding LDNs effectiveness with Endometriosis, the research of LDN with other autoimmune diseases does look very, very promising.

NB: LDN is a pharmaceutical grade drug and can only be prescribed by a medical Doctor.

4. Stress feeds Endometriosis, Endometriosis feeds stress and chronic stress as it is a driving force of inflammation. So stress needs to be reduced for true healing to take place.

Endometriosis causes significant stress and stress impacts the severity of the Endometriosis. Emotional stress in particular impacts the severity of the disease, causing increased uterine tension & toxicity, poor lifestyle choices and potential magnesium deficiencies. Stress can be a never ending cycle unless you choose to do something about it.

I am a particular stress bunny so have refined the artform of (trying) to manage my stress levels which I can vouch do lessen Endo pain. Here are a few of my favourite techniques you can consider:

Meditation

Meditation helps to reduce stress, boost the immune system and gives the body a break from the mind which it is often slave to. It also gives you the space to watch your thoughts (sometimes you can be so identified with the disease in your thoughts you can create it). The practice of meditation also creates a slowed space between your thoughts that you can take out into your day, lessening your reactivity to events you may have considered stressful previously. It also gets your breathing. My osteopath once told me Endometriosis is caused by a lack of deep belly breaths, where the pelvis is deprived from oxygen and blood flow. Even 5 minutes of meditation a day will help you. If you can make it a habit you will naturally want to increase it to be longer. Just breathe into your belly and try to count from one to ten without losing track… if you do, just calmly take your mind back to 1 and start again.

Visualisation

Visualising and focussing on what you want generally out of life is important and super effective if you are consistent in your practice. It’s quantum physics – what you focus on is what you will get. For 5 minutes a day (I often do this before getting out of bed or after meditation), imagine your life without the pain of Endometriosis. See how well you are. You could also draw a symbol of your healed body/ uterus on a piece of paper and stick it by your bed to glance at every morning. You don’t have to think about it, you just have to look at it. The subconscious mind will observe the new reality you want and help you unconsciously create it. This 100% works. I have personally been diligent with it for over a month and my period this week consisted of 2 hours of pain, tops (which is a huge improvement).

Exercise

Regular exercise is imperative for Endometriosis patients. It helps to build the immune system, releases natural pain-killing endorphins, improves insulin resistance, grounds the spirit in the body and burns fat. Anything cardiovascular is ideal, but the idea is not to push it. If you’re fatigued with the pain or have a pre-existing thyroid or adrenal issue. 30 minutes a day 4-5x/week is tonnes. You could run, walk, swim, cycle, whatever gets you going. Yoga is my favourite for pain relief. I have found it helps me “stretch out” (and potentially break down) old, internal endometrial scar tissue (post surgery) and also get my pelvis bloodflow going. I also love ocean swimming as ionising salt water calms my mind and wipes away any negative energy I might be carrying on the day.

Psychotherapy

Psychotherapy has been life changing for me, even physically. A quality psychotherapist will help you to cope with the chronic pain, low energy levels, delays in diagnosis and side-effects from treatment methods. It also helps you deal with relationship/ family issues caused by the Endo (e.g. not being able to have sex with your partner or being too tired to ever go out and do anything with them). For me though most importantly, it helps bring to light emotional issues you may not be consciously aware of; ones you may be suppressing. Many of the renowned naturopaths I have met have said that Endometriosis is an issue of suppressed emotions in women, particular issues surrounding relationships with men. Therapy also helps you reconnect to how you feel in your body (Endometriosis sufferers also tend to disconnect from how they due to the level of pain they experience). Somatic psychotherapy is my first choice in the specific type of psychotherapy thats most beneficial (as it gets you back into your body). 

5. Do the surgery. Sometimes it is necessary to cut out all the dead endometrial tissue that is causing problems. A laparoscopy can help reduce symptoms quickly, reducing inflammation, giving you a clean slate to work from.

Systemic inflammation may cause Endometriosis but Endometriosis in itself causes extensive inflammation. By removing the old, inflammatory endometrial tissue you give your body the chance to recuperate, and the opportunity to start with all the treatments described in this post that work to prevent it from growing back. My only advice is to find a surgeon who is experienced, specialised, conservative when it comes to surgical procedures but open minded when it comes to prevention and complimentary treatments. I have a great gyny in Sydney who only after 10 yrs of pain has suggested medication as a last option to me – and that’s what it should always be, the very last option. If you are looking for a good gynaecologist in NSW or QLD let me know and I can send some good suggestions to you.

6. Do some sort of body work to help with the manual break down of scar tissue and/or adhesions, to increase pelvic blood flow and general vital energy.

Osteopathy

Osteopathic techniques are really useful as thru the body work they help break down adhesions, and stimulate various drainage points of the pelvis thus reducing uterine congestion and relieving period pain. It is also a great modality that works on stimulating the vagus nerve – a major nerve that activates mechanisms in the body that reduce inflammation.

TCM & Acupuncture

Acupucnture helps address both the cause and symptoms of endometriosis. It improves pelvic blood circulation, energy (qi) stagnation and general stress levels. Chinese herbs are also great for improving blood flow and decongesting the liver (the most beneficial time to take them is for the week before your period is due). Like Osteopathy Acupuncture also carries the benefit of stimulating the vagus nerve.

Castor oil packs

Castor oil packs can be annoying and messy to prepare, but regular use definitely improves symptoms. The packs can help stimulate the lymphatic system, liver and general circulation, as well as helping to break down old, internal scar tissue (often int he form of adhesions). This little pack I ordered a while ago has been great. If castor oil packs aren’t for you, you may prefer to try a ginger compress instead which also work on reducing inflammation.

Transcutaneous Electrical Nerve Stimulation (TENS) device

I haven’t used one of these personally, but I’ve heard good anecdotal feedback on TENS machines to help ease the pain on Endometriosis. They work by blocking the pain messages from reaching the brain via the nerves, and also help to stimulate the production of the body’s natural healing endorphins. I haven’t seen any science on this machine, but I have come across TENSAUSTRALIA online selling Freelady, a TENS machine specifically for those with bad period pain and endo. If anyone else has feedback on this I would love to hear it.

So that is the very basic summary of what I consider the best possible treatment for Endometriosis. I would love to hear from you if you have any thoughts, suggestions and or recent scientific studies that I may not have included in this piece.

 

 

 

 

 

 

 

 

Leave a comment