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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
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.
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:
What Are The Main Drivers?
Retrograde menstruation, when menstrual blood containing endometrial cells flows back through the fallopian tubes, has long been deemed as the main cause of endometriosis.2,3 However, more recent research highlights many other compounding factors.
Oestrogen dominance, is often debated when discussing endometriosis.4 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,5 being overweight,6 stress,7 and working night-shifts.8 Shift work has been associated with a 50% increased risk of endometriosis.9 Oestrogenic activity can also be heightened by exposure to environmental chemicals which mimic its activity, for example xenoestrogens from plastics.10,11
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 paracetamol12 and smoking,13 coupled with low intake of cruciferous vegetables,14 folate, B12,15 and magnesium.16,17 Disrupted methylation, in particular, has been directly linked with endometriosis.18
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),19 highlighting the gut-hormone connection.
Elevated inflammation has been identified during, and as a driver of, endometriosis.20 Excess weight,21 disrupted sleep,22 processed food,23 low omega-3 intake,24 and stress,25 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,26 indicating an autoimmune component to this condition.27 Low vitamin D is a risk factor for autoimmunity,28 and interestingly, increases endometriosis risk.29
What You Can Do?
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.
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