Endometriosis is a condition that affects approximately 1 in 10 women and takes an average of 7 years to diagnose, meaning many women experience life altering symptoms unnecessarily . Endometriosis occurs when endometrial-like tissue (the endometrium lines the uterus and sheds monthly), grows outside of the uterus. It can grow in the pelvic cavity, pelvic wall, on the ovaries, bowel, bladder and many other sites.
The primary symptoms of endometriosis are pain; painful - sex, ovulation, bowel or bladder motions, lower back or chronic persistent pain. It is important to note that the stage of endometriosis, graded 1-4, does not directly correlate to symptom severity. Many woman may be asymptomatic or are not diagnosed until facing fertility issues.
Whilst the cause is unknown and many theories exist, we do know that endometriosis is a chronic multifactorial condition with many aggravating and predisposing factors. One theory suggests that the endometrial cells are spread throughout the pelvis via retrograde menstruation, meaning menstruation occurs in the opposite direction to what it should. Endometriosis responds to the menstrual cycle causing the deposits to proliferate in response to specific sex hormones. Genetics, diet, lifestyle, hormones, stress, the gut and vaginal microbiome aggravate and predispose a person to endometriosis.
Endometriosis exhibits a similar pathophysiology to autoimmune disease with systemic inflammation and an altered immune system. When women menstruate prostaglandins are released, this is an inflammatory response that can cause acute pain in conjunction with the pre-existing chronic inflammation.
Endometriosis deposits throughout the pelvic cavity swell, grow and irritate the surrounding structures and those it has adhered too, causing adhesions and scarring. This may cause pelvic congestion and IBS, hallmark symptoms of the condition. The vagus nerve supplies all of our digestive tract, lungs and pelvic organs and is essential for rest, digest and repair which is controlled by our parasympathetic nervous system. Increased stress will cause the sympathetic nervous system, our fight or flight response, to dominate; increasing pain, IBS and hormonal fluctuations.
Nutrition and lifestyle choices can help decrease inflammation, manage symptoms and support quality of life. Major dietary recommendations include adopting an anti-inflammatory/autoimmune protocol diet which involves eliminating gluten, dairy and alcohol whilst consuming adequate fibre. Eating this way decreases prostaglandin production, supports a diverse healthy gut microbiome and the livers ability to detoxify hormones and toxins. Enabling the liver to function optimally prevents the recirculation of ‘bad’ oestrogen back into the blood stream. This type of oestrogen is responsible for the nasty symptoms associated with PMS.
Eating a varied diet rich in fresh seasonal produce and small amounts of quality meat helps supply the body with much needed nutrients, particularly zinc and magnesium, both are important minerals for hormone production and balance; magnesium also supports pain relief, sleep and the stress response.
Certain supplements such as n-acetylcysteine, alpha-lipoic acid, bromelain and calcium-d-glucurate have shown promising results in clinical trials to manage pain, decrease inflammation and increase chances of conception, however prescription should only be used under the guidance of a qualified nutritionist.
Lifestyle changes are almost always essential in endometriosis treatment. In order to downregulate the sympathetic nervous system, it’s important to manage stress and have deep, restorative sleep. Exercise and movement nourish your body. Stress management and exercise are individualistic and should be realistic and enjoyable. Simple things such as a gratitude journal, mindful eating, night-time routine, walking, yoga and forest bathing are all proven to minimise stress and enhance the parasympathetic nervous system. Endometriosis truly requires a holistic and individual approach to treatment incorporating lifestyle, diet, mental and emotional health. With a multifaceted approach the symptoms that plague so many women may be subsided