Endometriosis; The Symptoms and Management

Endometriosis is a condition where the endometrial tissue (lining of the womb) can be found outside the womb, most often on the ovaries fallopian tubes, lining of the abdomen and on the bladder or bowel. It affects roughly 1.5milion women in the UK mostly in the 24-40 years age group.

We spoke to Dr Haleema, a specialist in integrative women's health and bioidentical hormone balancing for the Marion Gluck Clinic who explains more about the symptoms and how to manage them

The endometrial tissue is hormone sensitive and responds to the cyclic hormones of the female menstrual cycle and so will thicken and breakdown every month. However unlike the uterine cavity the blood cannot be expelled from the body and gets trapped causing internal inflammation, swelling and significant pain which can become chronic.

Symptoms include:

• painful menstruation

• heavy/irregular periods and spotting/bleeding between periods

• pain in the lower abdomen, pelvis or lower back

• bloating/constipation

• nausea/fainting

•. lethargy/chronic fatigue

• painful sex

• problems conceiving/ infertility

Other symptoms are related to the location of the endometrial growths such as painful urination or bowel movements, joint pain, and sometimes includes coughing up blood. However, other women may be completely asymptomatic and only discover they have the condition when they experience problems getting pregnant.

We still don’t know exactly what causes the development of endometriosis but there appears to be dysregulation of the immune system coupled with inflammation and unbalanced hormones with oestrogen hormone dominance.

The gold standard for diagnosis of endometriosis is laparoscopy which can also be therapeutic as if endometrial deposits are seen in the abdominal/pelvic cavity they can be surgically removed or destroyed with ablation (diathermy heat).

Currently, there is no absolute ‘cure’ for endometriosis and the conventional approach is centred around pain relief and blocking the hormonal fluctuation of the cycle which leads to monthly shedding of the endometrial tissue. This can be done by putting the ovaries to sleep using the contraceptive pill and GnRH analogue drugs which put the body into a pharmaceutical-induced menopause with low hormones which reduces the hormonal drive to the endometriosis deposits. However, it is not without side effects and does not look at the other root causes of the condition. The functional medicine approach to endometriosis looks upstream at what is driving the development of endometriosis which is related to high levels of inflammation and oestrogen activity coupled with an unbalanced immune system.

Lifestyle and nutritional interventions can work on these root cause drivers and help manage the condition effectively: www.mariongluckclinic.com

1. Eat an anti-inflammatory diet with the rainbow of different coloured vegetables and add herbs and spices which have an anti-inflammatory effect such as cinnamon/ginger/cloves. Ensure good intake of omega 3 fatty acids from oily fish/flaxseed which improves cell membranes and hormonal health. Prioritising cruciferous vegetables like broccoli/rocket/sprouts ensure healthy oestrogen detoxification.

2. Gentle exercise promotes healthy oestrogen detoxification and has been shown in studies to improve outcomes.

3. Prioritize sleep which is when the body does detoxification work and lack of quality sleep increases pain perception and is also a driver of inflammation.

4. Managing stress leads to a more balanced cortisol pattern (stress response hormone) which if chronically elevated can be a driver of inflammation in the body.

5. .Avoid xenoestrogens which are chemical/synthetic substances in our environment which mimic our natural oestrogens and can bind to receptors causing disrupted oestrogen signalling pathways. This can lead to oestrogen dominance which is one of the drivers of endometriosis. These xenoestrogens can be found in plastic bottles/containers and in many skin care products/makeup which get absorbed through the skin and disrupt oestrogen metabolism and detoxification.

Acupuncture has been shown to be a useful drug-free therapy in managing endometriosis-associated pain and would be worth considering to manage symptoms better.

There are nutritional supplements which can also help with inflammation/ immune dysfunction and hormonal balance and seeing a functional medicine provider would be useful to look at this in more detail and develop a personalised approach.

Although there is no cure for endometriosis women can be supported by their healthcare practitioner to look at personalizing diet and lifestyle habits into their daily routine to balance the drivers of the condition. Each woman is unique and will respond differently to treatment, so improving our lifestyle toolbox and finding what works for each of us is key.