19 Jan Endometriosis
Endometriosis is finally getting more recognition as a significant disease impacting many women’s lives, and is at last, getting more funding for treatment. Perth Naturopath Jacky Dixon discusses the cause and treatment of endometriosis from an integrated medicine perspective.
What is Endometriosis and How does it affect patient’s day to day life?
Endometriosis is an inflammatory disease that is affected by hormones but is not caused by hormones. Recent research has discovered that it is more of a disease of immune dysfunction.
Endometriosis is a disease in which tissue that is like endometrial tissue grows outside the uterus. It can cause pain and other unpleasant symptoms.
The endometrial lesions are either laid down before birth or occur via retrograde menstruation.
The diagnosis cannot generally be determined by standard imaging (i.e., ultrasound) as the lesions are often very deep; infiltration can be determined by a Gynaecological sonographer, of which there are only 20-30 in Australia.
Laparoscopy is the gold standard for the diagnosis of endometriosis. It is a type of keyhole surgery used to inspect and operate on the organs inside the abdominal and pelvic area. Laparoscopy views internal organs and takes tissue samples during the procedure. It is often used to remove endometrial lesions at the same time.
Common Signs and Symptoms of Endometriosis
- Pain around your period
- Pain on or around ovulation
- Pain during or after sex
- Pain with bowel movements
- Pain with urination
- Pain in your pelvic region, lower back, or legs
- Frequent urination, trouble holding on when you have a full bladder
- Heavy bleeding or irregular bleeding
- Very dark blood with clotting
Origins of Endometriosis and Research
Endometriosis is a complex medical condition which is thought to be multifactorial. Several hypotheses and research have been proposed to explain potential contributing factors including;
Endometrial lesions are resistant to progesterone, which is generally anti-inflammatory while oestrogen stimulates endometriosis lesions which can be even made by endometriosis lesions. (The main female hormones of progesterone and oestrogen are not the cause of endometriosis but do influence the symptoms.)
High Iron levels:
This could possibly be from damaged cells and hypoxia (i.e., low oxygen) at the site of the endometriosis lesions.
Low androgen exposure in utero due to environmental toxins:
This may cause epigenetic changes to hormone production, hormone-sensitive tissue, and the immune system.
Environmental toxins can cause other epigenetic changes:
Some of which may be transgenerational, which means your endometriosis today could be the result of an environmental toxin, such as a dioxin, that your grandmother was exposed to.
Microbiome and the “bacterial contamination theory” of endometriosis:
This states that the presence of a bacterial toxin called lipopolysaccharide (LPS) in the pelvis could be an initiating factor in the immune dysfunction of endometriosis
LPS upsets macrophages. Macrophages are involved in the immune system that plays a critical role in the body’s inflammatory response. Macrophages are also activated by tissue hypoxia.
LPS could be coming from either dysbiosis of the vaginal microbiome moving upwards into the uterine lining and out via retrograde menstruation and/or from the gut via intestinal permeability – gut microbiota – derived extracellular vesicles, meaning that an exposure to LPS from the gut can drive endometriosis in women who are vulnerable due to their genetics and epigenetics.
Certainly, there’s a strong link between endometriosis and gut problems.
Women with endometriosis are more likely to suffer from IBS (irritable bowel syndrome) or SIBO (small intestinal bacterial overgrowth). However, it could be in the other direction with intestinal permeability and LPS from SIBO driving endometriosis. One study found that women with endometriosis are more likely to have intestinal permeability.
The nervous system is also a driver of the growth of the endometriosis lesions which have an increased supply of nerves, and this promotes neurogenic inflammation – inflammation activated by the nervous system.
Endometriosis pain can involve the entire Nervous System
Endometriosis pain is particularly complex because your brain places high importance on looking for threat or danger in your pelvic area, which houses essential reproductive and sexual organs and the bladder and bowel.
The nerves that supply your bladder, bowel and reproductive tract are all connected and share common pathways which allow these organs to ‘talk’ to each other, which can also contribute to endometriosis-related pain.
The presence of endometrial lesions may cause inflammation of the pelvic nerves. Over time, if this persists, the nerves in both your pelvis and your entire nervous system (the brain, spinal cord, and other nerves) may become extra sensitive.
For someone with endometriosis and an extra sensitive nervous system, doing something that is safe, like going for a walk, can result in increased pain.
Thoughts, emotions, and the world around us also contribute to the experience of pain. When we are tired, burnt out, anxious, depressed, have work stress, family stress, relationship stress, or are living through something like a global pandemic our tolerance for threat reduces, meaning pain is more easily experienced.
It is also common for women with endometriosis to experience other conditions commonly linked with sensitisation. These include irritable bowel syndrome, painful bladder syndrome, chronic fatigue syndrome, fibromyalgia, migraines or tension headaches, anxiety or panic attacks and depression.
Targets for Natural Treatment
- Target Immune Dysfunction & Autoimmune Genotype
- An antimicrobial approach to knock back LPS toxins and SIBO. It is crucial to target the digestive system first before we can target the endo.
- Following the autoimmune dietary guidelines to reduce inflammation and modulate the immune system.
- Practitioner Grade Supplements, Herbal Medicines, and anti-inflammatory nutrients to modulate oestrogen levels which has a role in promotion of endometrial lesions, using foods, herbal medicines, and nutrients.
- Natural anti-inflammatory supplements which reduce pain and reduce the symptoms of flare up.
Surgery is a treatment but not a cure
The best surgery is carried out by “Advanced trained surgeons” who train for an extra 5 years and are exports in their fields. The Royal College of surgeons and Endometriosis Australia can inform you if they are available in your area. The best treatment is creating a team of support, this may come from Family and friends, plus Pain Psychologists, Pelvic physiotherapists, GPS, Naturopaths, and an experienced Gynaecologist.