Endometriosis Explained

Endometriosis is believed to affect 1 in 10 women globally.

What exactly is endometriosis?

Endometriosis is a complex and multifactorial condition. It’s an inflammatory condition that is dependent on the hormone oestrogen.

The Jean Hailes Institute defines it as this: “Endometriosis, pronounced end-o-me-tree-oh-sis (or just endo) is a progressive, chronic condition where cells similar to those that line the uterus (the endometrium) are found in other parts of the body. These cells are often found on organs in the pelvis, may start to grow and form patches or nodules on pelvic organs or on the peritoneum (the inside lining of the abdomen and pelvis), and can have the same cyclical/menstrual changes outside the uterus as inside the uterus, meaning they may bleed at the same time as your period (menstruation)”

Common symptoms that present are pain within the abdomen, lower back, pelvis and rectum (this pain can be debilitating and may also occur during sexual intercourse or when defecating), irregular periods, spotting, blood clots, constipation and nausea. The severity of the pain itself is not an indication of the severity of the condition with some women with severe endometriosis experiencing minimal pain, to women with minor endometriosis with severe pain. 

The endometrium is the lining of the uterine cavity within the woman that thickens prior to conception but will then shed and bleed without fertilisation – this is the woman’s period. The thickening of the lining is stimulated by oestrogen, making oestrogen a focal point in terms of treatments, however, with endometriosis, it is mainly a condition that is inflammatory and this is key when seeking therapies to support you with your diagnosis. Targeting inflammation is an area where nutritional medicine really shines. Many women don’t often consider nutritional medicine as a treatment for endometriosis but it’s a major player in terms of managing and reducing the pain and symptoms present.

The cause of endometriosis is still unknown, with multiple theories considered. Endometriosis is now thought of more as an autoimmune condition rather than a hormonal one, with immune dysregulation at its core. As natural therapists, immune support is something that can be helped – there are many interventions, nutritionals and foods that can be incorporated in the client’s diet that can modulate immune function and reduce the inflammation.

Lara Briden, a naturopathic doctor based in Sydney explains the immune dysfunction brilliantly – “How the immune system responds: in a normal situation, the immune system stays calm, and does not react to the endometrial tissue. In the case of endometriosis, something different happens. The immune system makes inflammatory cyotkines and auto-antibodies that inflame the lesions and promote their growth. Known reasons for the aberrant immune response include exposure to environmental toxins such as dioxins and bacterial endotoxins (lipopolysaccharides) such as those from intestinal bacteria”.

How Nutrition Can Support You

In terms of treatment, nutritionally there is much that can be done, giving hope to many suffering with endometriosis:

·      Turmeric for one, is immune-supporting, anti-inflammatory and analgesic, with studies now finding that turmeric acts specifically on endometrial tissue itself.

·      Zinc is a key nutrient to consider in terms of endometriosis treatment. Zinc has multiple functions that are of benefit; zinc acts as an antioxidant, reducing oxidative stress within the body, it reduces inflammation and supports the immune system and aids in wound repair – both ideal in terms of the endometrial lesions present with an endometriosis diagnosis.

·      Probiotics maintain a healthy microbiome and support digestive function as well as intestinal lining integrity. Abdominal discomfort is common with endometriosis, so probiotic supplementation may help to rectify and reduce gastrointestinal complaints. Specific strains of probiotics are involved in metabolising and clearing oestrogen, thereby balancing levels of endometriosis and reducing its effect on stimulating the endometrial lining. As mentioned previously, bacterial endotoxins from pathogenic intestinal bacteria can elicit an aberrant immune response, further promoting the progression of the condition. Probiotics heal and protect the intestinal lining, reducing permeability that is a common driver of autoimmune conditions like endometriosis.

·      Anti-inflammatory diet is to be followed to further support the person suffering. Diet is key to controlling inflammation within the body, common culprits like gluten, dairy, sugar and vegetable oils are to be removed and replaced with anti-inflammatory fats, antioxidant rich vegetables and healing herbs and spices.

The Gut-Endocrine Connection

The body is not simply a collection of separate tissues or organ systems living together encased within our skin, rather its one whole intricate system that’s functioning together and ultimately impacting on one another – when in a state of desired balance (aka homeostasis) and also when we are out of balance, which may manifest as disease. This is certainly true when considering our gut health as its shown to have a direct link to our immune system, brain function, metabolism, energy and hormonal health.

“All disease begins in the gut” – Hippocrates 400BC

Imbalances within our gut not only influences our digestion which may lead to bloating, cramping, changes to bowels, pain, and nausea but also can disrupt the intricate hormonal dance within our body. This can lead to menstrual irregularities, conditions like endometriosis and PMS. But for many of us, we might not consider the impact that the state of our gut can have on our endocrine or hormonal system. For many women who are struggling with hormonal imbalances, or conditions like PCOS or endometriosis it’s not a common consideration to treat the gut to get things back into balance. Yet, the key to balanced, humming hormones is, in fact, a healthy gut as they are so closely connected.

Our gut is responsible for digesting and absorbing nutrients from our foods, it’s also where the majority of our immune system resides. It is also involved in neurotransmitter synthesis and energy production. Hormone production, detoxification, and elimination also take place here, highlighting even more just how closely connected these systems are.

What is Leaky Gut

Have you heard of leaky gut? This is basically when there is inflammation within the gut lining that results in large openings of our tight junctions that lie between our intestinal cells. These tight junctions are normally held together like Lego pieces to prevent toxins, food, and microbes from passing through and ‘leaking’ into our system. Normally, food and its nutrients are filtered through the cells and do not go between them, which is important considering that 60% of our immune system is right under the one-cell-thick lining of our intestinal tract. If foreign foods, toxins, and microbes are able to get through these large inflamed gaps they can trigger an immune response and activate a whole host of inflammatory cytokines, which can be the beginning of disease. Not to mention anything that is able to then enter our system can then get into our bloodstreams and travel around the body, even to the brain, causing neuroinflammation – more bad news. 

With a leaky gut, excess estrogen is not excreted as it should be and the residual hormone can re-enter the system, back into circulation which can create estrogen dominance. This can result in higher levels of estrogen and lower levels of progesterone. Estrogen dominance is linked with breast cancer, endometriosis and symptoms of PMS like irritability, breast tenderness, constipation and fluid retention.

Introducing the Estrobolome

Within our colon, a section of our intestines is where we find a large number of microbes, yeast, parasites, fungi, and bacteria living. This is known as our microbiome and it’s a crucial element to having vitality and health. What we have recently learned is that within the microbiome we also have an estrobolome. This is a subset of bacteria within the microbiome that help to metabolise estrogens and reduce the levels of harmful estrogen, the ones that are responsible for thyroid cancer, breast cancer, ovarian cancer and uterine cancer. People with a leaky gut more often than not have a poorly functioning estrobolome.

Effects on Thyroid Hormones

Also happening within the gut is the conversion of thyroid hormones T4 (inactive) into T3 (active form). This action can be compromised with cases of poor gut function, thus impacting on thyroid health which can then manifest with a whole host of symptoms from fatigue, depression, weight gain, dry skin or the opposite with excessive heat, weight loss, heart palpitations and anxiety.

Effects on Neurotransmitters

As we know, neurotransmitter synthesis occurs within the gut with up to 97% of our serotonin being produced in the gut. Serotonin is often referred to as our happy hormone, but that statement alone is quite limiting in terms of what this chemical is responsible for. Serotonin is also needed to promote bowel motility. With low levels of serotonin, constipation can occur, meaning that estrogens that are to be passed through and eliminated remain within our system, stagnated and contributing to estrogen dominance.

Effects on Hunger Hormones

Imbalances with gut flora can also influence insulin levels, with new research showing us that imbalances within the microbiome and/or leaky gut can drive up insulin levels and lead to increased production of androgens. Not to mention that with inflammation present in the gut, the bacteria that thrive in this environment are also those that can influence levels of ghrelin (hunger hormone) and leptin (satiety hormone). This can result in an increased appetite, overeating, influence what foods you crave and even change your taste receptors.

Effects on Stress Hormones

With leaky gut, cortisol levels can also be increased meaning that your stress response is impaired. High cortisol can lead to increased visceral fat and predispose you to chronic metabolic conditions like type 2 diabetes and metabolic syndrome.  

What You Can Do

Supporting your gut can be done easily through dietary applications and some simple lifestyle changes. 

•    Fibre is a crucial element in supporting the health of the microbiome. Be sure to get adequate and varied forms of fibre in the diet from plant sources (think vegetables, nuts, seeds and pseudo-grains like quinoa, buckwheat, and millet). Certain fibres act as prebiotics and are a food source for the gut bugs living within the colon. Fibre also helps to keep bowels moving regularly, to ensure that excess hormones are being eliminated.

•    Keep inflammation down by avoiding gluten-containing grains, sugar and any other foods that you may have an intolerance or allergy to. Including spices like turmeric and drinking bone broth can also help to heal damage to your stomach lining.

•    Include fermented foods and drinks to further support your microbial population, things like kombucha, sauerkraut, kimchi, kefir, and yoghurt.

•    Support the liver to detoxify excess hormones by including cruciferous vegetables in the diet. These include broccoli, cauliflower, cabbage, brussel sprouts, asparagus, and kale. Other foods and herbs like parsley, turmeric, green tea, garlic, and onions also support the liver to detoxify.

For further support of your gut, your hormones & your health it's always best to work with a qualified practitioner that can give you the appropriate and individualised treatment that you may need. To learn more about how I can support you, get in touch