Article Summary:
- About 1 in 10 women in the UK suffer with endometriosis
- Endometriosis can be linked with a lot of symptoms such as heavy periods, painful ovulation or infertility; in more severe cases women can undergo hysterectomy.
- Hormones can play a role in endometriosis, usually oestrogen dominance but other factors such as gut health or inflammation can be triggers.
- There are lots of dietary and lifestyle changes that you can do to prevent or manage endometriosis symptoms.
Endometriosis is the growth of cells from the uterine lining, the endometrium, in other areas such as the ovaries or colon. These cells respond to hormone fluctuations in the same way as in the uterus, thickening under the influence of oestrogen and then shedding after the sudden drop of progesterone, in absence of fertilisation. However, unlike the cells in the uterus, these cells have nowhere to escape, making menstruations extremely painful and causing a whole lot of symptoms.
How many women suffer from Endometriosis?
The average woman can spend 10 years, or 3650 days, having a period. For many, these are years of life-affecting symptoms, such as debilitating pain and fatigue. This is especially the case for women with endometriosis. One in ten women in the UK have endometriosis, but diagnosis is tricky and can take up to a staggering 7.5 years.1
Key symptoms of Endometriosis
Hormonal fluctuations are part of a normal female monthly cycle, so experiencing mild abdominal cramps and breast tenderness, can be normal for some individuals. For endometriosis, other symptoms can include:
- Painful and heavy periods
- Back, pelvic, and ovulation pain
- Painful bowel movements, urination, and intercourse
- Bleeding between periods
- Nausea
- Extreme tiredness
Endometriosis can also have a significant impact on fertility and miscarriages. Up to 50% of women can have difficulty conceiving2 as the growth of endometrial-like tissue can block egg release or prevent egg and sperm from meeting. Women experiencing severe endometriosis symptoms such as chronic pain, can choose to undergo a hysterectomy (removal of the uterus). If the ovaries are removed, it will induce early menopause.
What causes Endometriosis?
Hormones can play a role in endometriosis. Oestrogen dominance is often debated when discussing endometriosis.5 Oestrogen is one of the main hormones that regulates the menstrual cycle. It drives the development of the reproductive tract and thickens the endometrium to prepare the uterus for the ovulation and egg implantation. This stems from the ability of oestrogen to promote cell proliferation. However, if oestrogenic activity becomes enhanced, it can drive excessive cell proliferation, possibly contributing to endometriosis.
This can happen when oestrogen synthesis is stimulated by factors such as excessive carbohydrate intake,6 being overweight,7 stress,8 and working night-shifts.9 Shift work has been associated with a 50% increased risk of endometriosis.10 Oestrogenic activity can also be heightened by exposure to environmental chemicals which mimic its activity, for example xenoestrogens from plastics.11,12
Oestrogen is kept within balance thanks to complex detoxification processes performed by your body, mainly methylation, glucuronidation, and sulphation. Unfortunately, many women have a reduced ability to perform these processes and effectively metabolise and eliminate oestrogen. This is exacerbated by high intake of paracetamol13 and smoking,14 coupled with low intake of cruciferous vegetables,15 folate, B12,16 and magnesium.17,18 Disrupted methylation, in particular, has been directly linked with endometriosis.19 To learn about methylation, read our blog Everything you need to know about Methylation
When menstrual blood containing endometrial cells flows back through the fallopian tubes, has long been deemed as the main cause of endometriosis.3,4 However, more recent research highlights many other compounding factors.
Gut health can also play a role. Under normal circumstances, oestrogen metabolites are shunted from the liver into the gut in bile and eliminated through daily bowel movements. Dysbiosis, constipation, and intestinal permeability (‘Leaky Gut’), can increase the risk of oestrogen metabolites being re-absorbed, rather than eliminated, and so, oestrogen dominance. Women with endometriosis can also be prone to irritable bowel syndrome (IBS),20 highlighting the gut-hormone connection.
Elevated inflammation has been identified during, and as a driver of, endometriosis.21 Excess weight,22 disrupted sleep,23 processed food,24 low omega-3 intake,25 and stress,26 can further increase inflammation and may worsen symptoms. Wider immune dysfunction also seems to be involved. Antibodies targeting our own cells have been identified in extra-uterine endometrial tissue,27 indicating an autoimmune component to this condition.28 Low vitamin D is a risk factor for autoimmunity,29 and interestingly, increases endometriosis risk.30
What can you do to manage your Endometriosis?
- If overweight, implement sustainable weight loss. Consider daily exercise, reduced carbohydrate intake, and increased intake of nutrients to support blood glucose regulation, such as chromium.31
- Enjoy daily relaxation and increase intake of calming nutrients, such as magnesium.32
- Reduce xenoestrogen exposure by minimising plastic use and switching to natural cosmetics. We explain about xenoestrogens more in our blog Xenooestrogens and environmental toxins – the hidden hormone disruptors in our daily life.
- Increase phytoestrogen intake from red clover and flaxseeds, which weakly bind to oestrogen receptors, blocking more stimulating oestrogens.33,34
- Support oestrogen detoxification by increasing intake of glucaric acid, sulphoraphane,35 N-acetyl cysteine,36 and glucobrassicin through supplementation or dietary sources, such as cruciferous vegetables, which should be a part of a diet for endometriosis.
- Quit smoking and reduce intake of smoked/charred and non-organic food, caffeine, and alcohol to further take pressure off the liver.
- Test for nutrient deficiencies such as folate, B12, B6, iron, and vitamin D via the GP or privately (Vitamin D test is available here).
- Increase omega-3 intake though through oily fish, hemp and flaxseeds to reduce inflammation and endometriosis risk.37
- Support the gut microbiome and digestion. A diet high in plant foods will help to feed our beneficial gut bacteria, as well as fermented foods such as kombucha, kefir, sauerkraut and kimchi. Consider a live bacteria supplement. Certain strains, such as Lactobacillus gasseri, have been shown to reduce the development of ectopic endometriotic lesions.38
- Minimise pro-inflammatory foods such as processed food, high sugar foods and alcohol, which can promote inflammation and therefore can make symptoms worse.
If you are concerned about your monthly cycle and any symptoms you may be experiencing, or if you have a family history of endometriosis, seek the advice of a registered Nutritional Therapist for targeted, personalised advice and specific diet for endometriosis.
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References
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February 26, 2019
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