Endometriosis
When we talk about invisible illnesses, this is one of the debilitating female reproductive organ afflicting illnesses.
Did you know that 10-15% of women of reproductive age are affected by Endometriosis (Parasar, Ozcan & Terry, 2017)?
This statistic shows that 1 in 10 women (or 1 in 9 women born in 1973–78 or 1 in 15 born in 1989-1995) are diagnosed with endometriosis (Australian Institute of Health and Welfare, 2019). The average delay in diagnosis is 6.7 years (Parasar, Ozcan & Terry, 2017).
It’s a condition that puts a considerable financial strain on the person, community, and health care system due to the increased hospitalisations and pain.
So what is Endometriosis?
In a nutshell, it is when endometrial-like tissue (endometrial tissue is what lines the uterus and sheds monthly with menstruation) is found outside of the uterus. It is an inflammatory condition. It forms adhesions that can grow, cause scarring, blood-filled cysts on the ovaries (also known as Endometriomas or chocolate cysts), infiltrate organs such as bowel, lungs, or heart, and even stick organs together such as ovaries and bowel.
Whilst genetics have a part to play, there are theories into the causation of this condition, however, there is no definitive pathophysiology known yet. Some known contributing factors include:
The Immune system: White blood cells known as macrophages are responsible for removing debris such as damaged cells and pathogens. Increased numbers are seen in early stages due to an increase in need (increased shedding and attempt to suppress growth), while later stages show a decline in activity and a decreased ability to suppress growth activity resulting in the greater potential to infiltrate other areas of the body. T helper lymphocytes act as regulatory cells within the immune system – signaling for natural killer cell production and macrophage activity. This activity has seen to be suppressed in Endometriosis.
Retrograde menstruation or flow: This is essentially, the reverse flow of menstruation. Instead of flowing out of the cervix, it flows up to the fallopian tubes instead. Whilst this may be normal, the increased volume experienced by those with endometriosis, may contribute to the development of this condition. This is an older out dated belief thought to contribute to the onset of the condition.
Excess oestrogen: increased exposure to oestrogen due to increased frequency of menstruation and younger menarche (beginning of menstruation), contributing to thickening of the endometrium and increased menstrual volume. It also has an impact on the immune system specifically decreasing the natural killer cells which are responsible for “destroying” foreign cells and pathogens such as bacteria and viruses.
Increased Prostaglandins: Prostaglandins are a group of hormone-like substances within our body. Their role is to modulate inflammation, fever, pain, contract/relax muscles, and dilate and constrict blood vessels. This is a normal and necessary function that allows our body to help fight out infections and flood the area with blood and nutrients to repair when necessary. Problems arise when an imbalance within the group arises from allergens, diet, infection or hormone imbalances that create elevated levels of inflammatory prostaglandins leading to increased muscle contraction, inflammation, and pain.
Common medical treatments that may be utilised by doctors to manage this include:
Surgery to remove adhesions and cysts
Anti-inflammatory and pain medication to manage symptoms
Hormonal medication to modify hormones to reduce pain and heavy bleeding
Sounds painful right? – it definitely can be.
Some women don’t discover they have endometriosis until they begin investigations into why they haven’t been able to conceive naturally. Some women endure a range of symptoms for years before being diagnosed. Currently, it takes an average of 7 years to be diagnosed. This is partly due to the limitations around diagnosis. There are no blood tests that can be used, it doesn’t appear on most scans – unless it’s a highly specific scan and even then, it’s only visible if it is deeply infiltrating. For this reason, a laparoscopy is the ‘gold standard’ for diagnosis.
There are various stages/severity of Endometriosis.
Stage 1 – Minimal
Stage 2 – Mild
Stage 3 – Moderate
Stage 4 – Severe
It is important to note that the level of pain is not dependant on the severity of this condition. Stage 4 can experience no period pain, only discomfort when emptying bowels, while stage 1 or 2 may experience constant abdominal pain and vice versa.
Symptoms of Endometriosis
Symptoms of this condition can vary significantly. Due to the adhesions and growth of the tissue, this condition can impact organs in the abdominal cavity such as the gastrointestinal tract and bladder. Symptoms of pain are often worse before and during menstruation, however, they can persist throughout the whole cycle.
Painful periods (dysmenorrhea)
Pain during sexual intercourse
Heavy periods
Chronic pelvic and or abdominal pain
Migraines
IBS like symptoms
Diarrhoea and/or constipation
Pain when emptying bowels (dyschezia)
Pain on urinating
Bloating
Nausea
Impact on health and well being
The impact this condition has can be quite debilitating. Like all chronic pain, it can impact the mental and emotional health of a person. For this reason, it is important to consider a holistic approach to your health care if you have this condition. Below are some ways natural health modalities can improve the management of Endometriosis. This is in no way aimed to replace the need for medical intervention and is designed to complement the medical interventions advised for you. Some find that over time, the need for symptomatic treatment is lessened as the underlying inflammatory nature of the condition is modulated.
Acupuncture has incredible benefits for pain and hormone modulation. Regular treatments can assist with the management of the condition long-term.
There are dietary modifications that can be used, such as identifying inflammatory food triggers and consuming anti-inflammatory foods to help reduce and modify the inflammatory nature of the condition. Dietary modifications are highly beneficial if symptoms of digestive disturbance are experienced also. Different foods and cooking methods can be utilised to assist with reducing bloating, nausea, and normalising bowel motions.
There are various nutrients and herbs that can be utilised to assist with both the underlying inflammatory nature and reduction of symptoms such as pain and digestive disturbances also. Herbs have various medicinal qualities, some qualities that can be useful in the management of Endometriosis include:
Adaptogen – to modulate the body’s ability to adapt to stress (both mental and physical)
Nervine tonic – to improve emotional and mental wellbeing
Sedative – strangely, these herbs don’t actually sedate you, but instead, help calm a busy mind
Anxiolytic – to help reduce symptoms of anxiety that may be associated with chronic pain/illness
Spasmolytic – help reduce uterine spasms and reduce pain, especially spasming pain around menstruation
Carminative – herbs that help reduce bloating and calm the digestive system
Bitter tonic – to optimise digestion to reduce bloating and stimulate digestive signaling to the gallbladder to optimise bile excretion required to improve excretion of excess oestrogen and recycling of hormones
Anti-inflammatory – herbs that modulate prostaglandins to restore balance to the underlying inflammatory state
Immune modulator – to modulate the white blood cells, improving the regulatory nature of the T-helper lymphocytes
Hormone modulators – improving the metabolism of oestrogen and maintaining normal levels to reduce the risk of increased thickening of endometrium and impact on immune function
Every person experiences this condition differently, this is why individualised care and consultations are highly advised. There isn’t a one-size-fits-all when it comes to the management of chronic conditions. If you are interested in discovering how we can work together to facilitate the holistic management of your condition, simply book a 15-minute chat or consultation.
References
Australian Institute of Health and Welfare. (2019). Endometriosis in Australia: prevalence and hospitalisations. Retrieved from https://www.aihw.gov.au/getmedia/a4ba101d-cd6d-4567-a44f-f825047187b8/aihw-phe-247.pdf.aspx?inline=true
Parasar, P., Ozcan, P., & Terry, K. (2017). Endometriosis: Epidemiology, Diagnosis and Clinical Management. Current Obstetrics And Gynecology Reports, 6(1), 34-41. doi: 10.1007/s13669-017-0187-1
