Endometriosis is amongst us

What is Endometriosis?

Endometriosis is a medical condition that occurs when tissue like the lining of the uterus (endometrium) grows outside of the uterus. This tissue can grow on other organs in the pelvic area, such as the ovaries, fallopian tubes, and the tissue lining the pelvis.

In rare cases, it can also grow outside of the pelvic area in places such as the lungs, bladder, bowel, and even in surgical scars.

The symptoms associated with it are many. To note, this can include severe and debilitating pelvic pain, heavy and irregular periods, fatigue, and bowel problems.

Endometriosis UK estimates that:

  • The condition affects 1 in 10 women of reproductive age in the UK and worldwide.
  • It is the second most common gynaecological condition in the UK, linked to a 30-50% prevalence of infertility.
  • It can take an average of 8 years from onset of symptoms to be diagnosed.
  • It costs the UK economy around £8.2bn a year in treatment, loss of work and healthcare costs.

What causes endometriosis?

It is not yet clear what the direct cause of endometriosis is, and it will vary from person to person, however the following are all potential influences, resulting in the condition:

  • Retrograde menstruation; when blood flows backwards into the pelvis.
  • Lymphatic and immune dysfunction; when endometrial tissues travel to other areas through the lymphatic system or bloodstream.
  • Coelomic metaplasia: based on the fact that endometrial and peritoneal cells both arise from the same embryologic precursor.

And more generically speaking…

  • Oestrogen excess & impaired detoxification pathways
  • An unhealthy microbiome
  • Environmental toxin exposure
  • Inflammation
  • Genetic predisposition

Let’s have a closer look at some of those factors:

Is Oestrogen to blame?

As we know, oestrogen is one of the main female hormones, playing a critical role in the menstrual cycle and in the development and maintenance of female reproductive organs, including the endometrium (uterus).

Studies have shown that women with endometriosis have higher levels of oestrogen in their blood and tissues compared to women without endometriosis.

This might be due to several reasons including increase aromatase activity, altered oestrogen metabolism and local oestrogen production.

Let’s expand on this last point, local oestrogen production: why is this a problem?

Ectopic endometrial tissues can actually produce oestrogen, and they can also respond to changes in oestrogen levels in the same way that the tissue inside the uterus does, leading to growth, inflammation, and pain.

Excessive exposure to oestrogen can also lead to a range of immune and inflammatory changes. For example, oestrogen can increase the production of inflammatory cytokines and prostaglandins, which can promote the growth of the ectopic tissue and contribute to pain, adhesions and inflammation.

But is it just about the level of oestrogen?

No, which metabolites oestrogen is converted into during Phase 1 of liver detoxification, is also important.

For example, a metabolite like the 16-OH (16-hydroxyestrone) is more proliferative and binds most strongly to oestrogen receptor.

Understanding the levels and ensuring efficient liver detoxification process and excretion is key.

And let’s not forget that xenoestrogens can also disrupt our body’s hormonal balance, leading to oestrogen dominance.

So, filtering our water, buying organic, limiting plastic container and canned food, using natural cleaning and body care products is key.

What about our gut health?

Ever heard of estrobolome? This is a collection of bacteria in the gut that plays a critical role in metabolizing oestrogen.

Yes, certain bacteria in our gut are indeed involved in breaking down oestrogen into metabolites that can then be excreted from the body.

But what if the gut is imbalanced, so called dysbiosis?

Studies have in fact shown that women with endometriosis can present with a higher level of bacteria that can interfere with oestrogen metabolism, such as beta-glucuronidase-producing bacteria.

Beta-glucuronidase is an enzyme that plays an important role in the metabolism of oestrogen.

As we know, oestrogen is metabolized during liver detoxification, it is typically converted into a form called oestrogen glucuronide, which is then excreted in the urine or stools.

Beta-glucuronidase can however reactivate oestrogen glucuronide and convert it back into its active form therefore increasing the amount of active oestrogen in the body.

This is not ideal, hence why working on ensuring a healthy microbiome is just as important as liver detoxification and excretion.

Are you eating gut loving foods like probiotic and prebiotic?

If not, you might want to consider adding probiotic (fermented) foods like sauerkrauts, kimchi, miso, kombucha AND prebiotics foods (think of them as the compost feeding your good bacteria) like leak, garlic, onions.

And inflammation?

Yes, inflammation in its chronic form is thought to play a key role in the development and progression of the endometriosis.

The presence of ectopic endometrial tissue in the pelvic cavity can trigger an inflammatory response, which can cause pain, adhesions, and other symptoms.

But aside from local effects, inflammation can also fuel the growth and survival of the ectopic tissue in several ways:

  • Increasing blood vessel formation and allowing tissues to grow and survive even in areas where there is limited blood supply.
  • Disrupting the immune system leading to the production of cytokines and other signaling molecules that promote the growth and survival of the ectopic tissue.
  • Effecting hormonal balance by creating a positive feedback loop, whereby inflammation promote the production of oestrogen, which in tun will lead to more inflammation.

Do you have enough antioxidants in your diet?

Think about colourful fruit and vegetables (aim for a 30% – 70% split). They are natural multivitamins and rich of compounds which will help fighting free radical reducing oxidative stress and inflammation.

How does stress and exposure to environmental toxins fit in?

When it comes to endometriosis chronic stress can be an aggravating factor. It impacts:

  • Inflammation: triggering the release of pro-inflammatory cytokines, which can further exacerbate inflammation.
  • Hormonal balance: disrupting the balance between oestrogen and progesterone, increasing the production of cortisol, exacerbating glycaemic fluctuations.
  • Gut health: slowing down digestion due to lower enzyme secretion and hydrochloric acid production, and disrupting the microbiome.

And when it comes to environmental toxins, studies have now shown that these may indeed increase the risk of endometriosis. Toxins like dioxins and PCBs can disrupt the body’s hormonal balance, leading to increased levels of oestrogen and inflammation. Others like phthalates, BPA, and flame retardants can interfere with the body’s natural hormone production and function, leading to hormonal imbalances.

A holistic intervention…

It’s not just the food we eat then, is it?

Let’s aim to reduce stress by introducing mindful practices into our days and minimising toxin exposure by buying local, organic and natural products.

There can be many contributing factors resulting in endometriosis, so ensuring our diet and lifestyle cater for a reduction of any possible triggers is really important.

What are the dos and don’ts?

  1. Aim for a diet rich in plant food (allowing for plenty of antioxidants), high in fibre, especially cruciferous vegetables  which are great for oestrogen metabolism and support the liver detoxification process. Include Omega 3 rich foods like oily fish, flaxseeds, chia seeds and other good quality fats like avocado and olive oil. Fats are essential for cellular repair, hormone production, immunity and to control inflammation. Where possible, choose a diet high in organic foods to limit exposure to chemicals.
  2. Ensure adequate hydrationsleep, and restorative daily practices to limit stress.
  3. Try avoiding (or reducing) sugar (watch out for the hidden ones!), alcohol, gluten, dairy, excessive caffeine, and red meat, as these can contribute to bodily inflammation.

Those are some of the recommendations that I use for my clients, alongside tailored and more personalised measures, supplementations and testing. Testing is key, as it helps identify root causes and provide a tailored approach for the individual.

Understanding how our body is set to work, alongside what it is experiencing is so important to guide us to define the right protocols.

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