As a physician, I am humbled when faced with the chronic pain of patients with endometriosis. Researchers estimate that endometriosis affects 10 to 35 percent of women during their reproductive years-500,000 in Canada alone. Its social burden is enormous.
The good news is that cultural studies and clinical research show that there are a variety of dietary, lifestyle and powerful nutritional measures for women to take to manage their risk of developing endometriosis and remain in control of their lives.
Endometriosis is derived from the word endometrium, or uterine lining. Normally the tissue lining of the uterus grows each month; if a woman is not pregnant, this lining disintegrates and sheds as menstrual flow at the end of the cycle. In endometriosis, pieces of this normal lining are found outside the uterus. Unlike the menstrual fluid from the uterus, endometrial tissue bleeds onto surrounding organs, causing swelling and inflammation. This repeated occurrence over time leads to the build-up of destructive scar tissue, cysts and adhesions.
Symptoms of endometriosis vary widely. The most common symptom is pain. Usually described as excessive menstrual cramps, the pain is dull and achy and persists throughout the month. It’s especially worse before or during menstruation. There does not seem to be any correlation between the intensity of the pain and the severity of the endometriosis. Other common symptoms include painful intercourse, abnormal bleeding, infertility and painful bowel movements or urination.
Theories abound as to the causes of endometriosis, but its origin is yet to be determined. The “retrograde theory” maintains that some of the menstrual blood backs up through the fallopian tubes during menses, where it lodges in the pelvic cavity and continues to grow. Most recently, exposure to environmental pollutants and toxins found in many herbicides and pesticides has been connected to a rise in endometriosis rates. These chemicals may mimic estrogen, contributing to a hormonal imbalance and a disruption of the immune system.
While various imaging methods including ultrasound, magnetic resonance imaging (MRI) and computered tomography (CT) scan may offer diagnostic clues, the only way to truly diagnose endometriosis is with a laparoscopy. This is a surgical procedure done under general anesthesia during which a slender, wand-like instrument with a light (laparoscope) is inserted into the lower abdomen through a small incision to explore for the location, depth and size of endometrial tissue implants.
The aggressiveness of a conventional treatment protocol depends on the severity of a woman’s symptoms, the location and degree of endometriosis, her age, her circumstances and personal preferences, including her plans to have children.
Mainstream practitioners normally recommend over-the-counter, prescription-strength pain relievers or oral contraceptives to quell mild cramping and menstrual pain. In cases of severe pain, they prescribe narcotic medications. The problem with these solutions is two-fold–they have side effects and they address the symptoms, not the condition itself.
Conventional medicine falls back on laparoscopic surgery when drug therapy fails to treat endometriosis or control pain. Most experts agree that the more extreme removal of the uterus, ovaries and fallopian tubes (hysterectomy or oophorectomy) should be reserved only as a last resort.
There is mounting evidence that endometriosis warrants a multifaceted approach that includes a balanced diet, appropriate nutritional supplementation, healthy lifestyle choices and regular exercise.
Population studies have consistently linked plant-based diets, emphasizing vegetables, whole grains, fruits, legumes, nuts and seeds to lower disease risk. The uterine lining is particularly prone to rapid division when triggered by estrogen. Therefore phytoestrogens, healthy nutrients with a weak estrogenic effect found in foods, can help crowd out the body’s strong estrogens and lower our disease potential. The major types of phytoestrogens are thought to be isoflavones, nutrients found in soy, and lignans, found in flax seeds. Fermented soy products such as natto, miso and tempeh are the best choice for highly biologically-available isoflavones.
Replacing animal fats with omega-3 essential fatty acids can provide additional protection by inhibiting the growth of endometrial cells and reducing inflammation. Rich sources include flax seeds, salmon, mackerel, tuna and bluefish.
Natural (bioidentical) progesterone supplementation as a cream or a compounded oral preparation is a key factor in opposing the estrogen dominance that contributes to the hormonal imbalance in endometriosis. Natural progesterone can help regulate irregular menstrual cycles and prevent endometrial growth, with fewer side effects than synthetic progestins. In Canada, natural progesterone is available by prescription from a doctor. It can be purchased over the counter as a cosmetic cream in the United States.
Herbs are commonly prescribed along with natural progesterone. Some notable pain-relieving herbs include meadowsweet, willow bark, valerian, crampbark, wild yam, black and blue cohosh. Yellow dock, Jerusalem artichoke, pau d’arco, dandelion root and milk thistle are particularly effective for enhancing liver function, necessary for proper hormone balance.
Nutritional supplements are frequently an integral part of any treatment protocol. Beta-carotene (the precursor to vitamin A), vitamin C and bioflavonoids can all help to reduce excessive menstrual bleeding and bolster immune function. Vitamin E has long been recognized as a potent antioxidant with anti-inflammatory actions. It has also been shown to enhance estrogen/progesterone balance in the body. B vitamins enhance the liver’s efficient removal of excess estrogen from the body. Studies of indole-3-carbinol, found in cruciferous vegetables, have shown that it strengthens immune function and helps detoxify the liver. Fructo-oligosaccharides (FOS) and other beneficial intestinal bacteria such as lactobaccilus and bifidobacteria have been successfully used to ensure the growth of healthy gut flora necessary for reducing the toxic load of the body.
Women have reported pain relief from acupuncture, possibly due to its ability to stimulate the release of endorphins and enkephalins (pain-relieving hormones). Hydrotherapy or hot castor oil packs applied to the abdomen can help with pain relief and poor blood circulation. Also, soaking in a warm bath with Epsom salts can help release stress and relax painful, contracted muscles.
Of all the controllable lifestyle factors, quitting smoking may have the greatest impact on disease prevention. Stress management and relaxation techniques can also help manage endometriosis. Still another preventable risk factor is physical inactivity, since exercise has been shown to improve immune function, increase lymphatic flow and aid in detoxification.
Women can do plenty to keep their bodies disease-free. I recommend working with a health practitioner such as a naturopath to rule out other causes of pain and to establish a personalized formula for the management and treatment of this common condition.