March 2020. Just because you can’t see it. Doesn’t mean it doesn’t exist.
The month of March is Endometriosis Awareness Month. It is really important that we bring awareness to this disease that affects millions of women worldwide.
Statistics show that 1 in 10 women have endometriosis. These stats are just of the women diagnosed. A significant portion of women with endometriosis (often referred to as ‘endo’) are asymptomatic and many women do not realise they have endometriosis, or have been dismissed along the way throughout their medical journey. This means the 1 in 10 women with endometriosis is very much understated.
Due to so many women being dismissed from various medical practitioners before finally having a diagnosis the national average timeframe to diagnose endometriosis is often up to 10 years or more (the only way to definitively diagnose endometriosis is via surgical intervention, a laparoscopy). Ultrasounds and blood tests can provide more information to create a better picture but not a definite.
Here are Darling Health, many of our practitioners see symptoms of endometriosis regularly. The one message that all of us want everyone to know is that painful periods are not normal. It can be a symptom of endometriosis, amongst several other symptoms. We are involved in the education and awareness of endometriosis and the month of March reiterates the importance of creating such an awareness amongst our society.
Symptoms of Endometriosis
Period pain is a common symptom discussed with endometriosis, but as mentioned, several other symptoms can present. There is a large variety and cases exhibit very differently. The common signs include:
- Period pain (dysmenorrhea)
- Pain with intercourse (dyspareunia)
- Pain on bowel movement/evacuation
- Urination pain
- Ovulation pain
- Nausea and vomiting
- Heavy menstruation or irregular bleeding
- Bleeding from the bowel
- Pelvic or lower back pain and/or rectal pressure
- Anxiety and mood disorders
- IBS-like symptoms, from diarrhoea to constipation
- UTI-like symptoms
- Abdominal pain
- Musculoskeletal pain
- Iron deficiency resulting from heavy blood loss
What exactly is Endometriosis?
Endometriosis has hereditary links and is multifactorial. Part of the picture is driven by oestrogen, so even small amounts of exogenous oestrogen’s will drive the growth of the disease. To describe the pathology it involves normal uterine tissue growing in abnormal area. Very much like how cancer grows without being cancerous. These lesions induce a chronic activation of the immune system, releasing inflammatory cytokines and triggering pain responses. It can damage multiple organs and has even been found in the brain and even astonishingly in men, although this is very rare.
There are however various contributing pathways that perpetuate the condition. Peritoneal fluid is complex and links the reproductive and immune systems. This influences the endometriotic tissue and vice versa, hence the need for immune modulation and anti-inflammatories. The gut and its microbiome also play a role in immune health and the histamine involvement.
The gut-immune connection
Endometriosis, like a growing number of other conditions shows changes in the gut microbiome. Even raised levels of depression in endometriosis may be linked due to the microbiome’s gut-brain axis role in depression. In endometriosis, certain immune cytokines are heightened due to inflammatory activity. A number of immune cells are altered in the peritoneal fluid and blood, often correlating with levels of severity. The dynamic interaction of immune cells with other systems indicates stress and inflammation can increase gut permeability, which hence drives further immune cell changes. Vaginal microbiota is also associated, perhaps due to hormonal changes that modulate the pH. Gut dysregulation is strongly linked to a decrease in gut barrier maintenance and various immune dampening, including mitochondria function.
To note, is the inflammatory response of endometriosis and the pathway of melatonin synthesis. Raised inflammatory cytokine levels inhibits the circadian production of melatonin. Circadian dysregulation caused by shift work hence further decreases melatonin production and increases the risk of endometriosis. Further to this studies show that women with endometriosis have a high level of gram-negative bacteria in the pelvic microbiome. This type of bacteria produces a toxin called lipopolysaccharide (LPS) that stimulates inflammatory chemicals within a immune response.
Handy Hints for Women with Endometriosis
- Remove immune-triggering or inflammatory foods – gluten and cow’s milk dairy are the common culprits, but there are others depending on the person
- Anti-inflammatory or Mediterranean diet that is abundant in plant foods, quality proteins (lots of oily fish, plant-based proteins), healthy fats and lots of fibre. Avoid trans fats, processed and fried food.
- Limit caffeine and alcohol intake – both inflammatory
- Address gut concerns and overall improving gut health with your Naturopath. Gut dysbiosis is extremely common, often with higher amounts of gram negative bacteria
- Consider natural anti-inflammatories – this could include anything from herbs from your Naturopath, to turmeric or ginger herbal teas
- Stay hydrated and warm – take calming, warm baths with essential oils (suggestions include cinnamon, clove, lavender, rose), drink warm herbal teas. Ginger or raspberry leaf are good for blood moving and nourishing the uterus
- Reduce stress response. If meditation or yoga isn’t for you then perhaps spend some time reflecting on how you can manage your stress better, whether it be journalling, going for a walk, aiming to remove the stress trigger in your life, deeper breathing techniques.
These are all very beneficial lifestyle changes you can make day to day. There are also, however, many, many, many other things a Naturopath can do to assist with Endometriosis symptoms. Every person has a unique health picture and requires different relief or treatment after determining their underlying cause and contributing factors. Herbal medicine, amino acids and supplementation may be required for this chronic illness.
If you have unmanaged endometriosis, have painful periods or know someone who does please consider seeking help for this. You are definitely not alone and don’t let anyone suggest what you have is normal. Our clinic can provide the support you may need.
If you do have queries or require support please contact our friendly reception team by calling 02 9555 8806 or emailing firstname.lastname@example.org and find out how we can assist you including phone, Skype and in-person consultations.
For more information on Endometriosis Awareness Month, or Endo March, please see the following websites