Endometriosis Awareness, Root Causes, and Fertility

March is Endometriosis Awareness Month and the perfect time to dive into endometriosis, which affects 10% of women in their reproductive years. It’s the most common cause of pelvic pain.

Endometriosis is mysterious, painful, and affects quality of life and reproductive health. It’s often overlooked, brushed aside, or misunderstood by doctors. It can take ten years to get an accurate diagnosis.

If you or a loved one has endometriosis, you know how overwhelming and scary it can be to find effective solutions. Where surgeries and medications may be necessary and helpful, integrative medicine also has a lot to offer by way of complementary and alternative therapies.

I’ve written about an integrative approach to endometriosis before, and today’s article will dive deeper.

Keep reading to learn more about:

• What is endometriosis and symptoms?
• A conventional vs. root cause perspective
• Endometriosis and fertility
• An integrative endometriosis plan

Endometriosis Basics

Endometriosis is a complex, estrogen-dependent inflammatory syndrome.  Symptoms can begin shortly after puberty and can last until menopause. Estrogen promotes inflammation and immune dysregulation, contributing to symptoms, which is why it affects women during the reproductive years when estrogen levels are robust.

Many women with endometriosis experience cyclical symptoms with debilitating pain during the menstrual cycle, others experience constant pelvic pain, and some don’t experience pain but have other symptoms or infertility.

Symptoms of endometriosis may include:

• Chronic pelvic pain
• Painful periods
• Abdominal or back pain
• Painful intercourse
• Heavy periods
• Bladder problems (increased urinary frequency and urgency)
• Digestive issues (diarrhea, constipation, bloating, nausea, vomiting)
• Headaches
• Bleeding between periods
• Infertility
• Miscarriages

Because endometriosis includes immune dysregulation, it shares features with autoimmune diseases. Women with endometriosis may be more likely to have other conditions, like autoimmune disease, allergies, asthma, and various cancers, including ovarian and breast cancer.

It’s an inflammatory disease that affects the whole body; endometriosis dramatically impacts quality of life.

Understanding Endometriosis from a Root Cause Perspective

The conventional approach to endometriosis is to manage pain with medication and surgery. Birth control pills suppress ovulation and estrogen. Other medications include pain medications (NSAIDs and opiates), gnrh agonists, gnrh antagonists, progestin IUDs and other hormonal contraceptive medications. Surgery removes lesions, and women may require multiple surgeries over time.

Endometriosis has a genetic component, and while we can’t change genetics, we can support healthy gene expression and some of the underlying drivers of the condition, like inflammation, hormone balance, and environmental factors, including diet and toxins.

With an integrative approach, we use conventional tools and employ additional strategies to treat the underlying causes and contributors. We might be able to decrease medications and avoid unwanted side effects. This approach indeed marries the best of both worlds.

Here are some root cause areas to support:

• Endocrine-disrupting chemicals are all around us in plastics, personal care products, clothing, and more. These chemicals disrupt hormones in the body. Estrogen mimics, or xenoestrogens, account for a significant portion of these chemicals, with the ability to act like estrogen in the body. Estrogen mimics can intensify endometriosis symptoms.

In a review of 23 studies, researchers found chemical exposures linked to the development of endometriosis, including pesticides, chlorinated chemicals, brominated chemicals, fluorinated chemicals (PFAS), lead, and others.

• Gut health also plays a role in endometriosis as some gut bacteria in the microbiome produce LPS (lipopolysaccharide), a compound that triggers chronic inflammation. LPS is found in pelvic fluids and the vaginal microbiome in those with endometriosis.

Additionally, part of the gut microbiome called the Estrobolome is critical for estrogen detoxification and clearance from the body. Gut imbalances could mean more circulating estrogens, which can worsen endometriosis symptoms.

• Genetic coagulation factors may be involved in the development of endometriosis, according to recent research. Women with endometriosis are more likely to have a blood clotting disorder. Screening and treating blood clotting disorders may be supportive.

• Estrogen and progesterone balance each other out. While estrogen promotes endometrial growth, progesterone opposes estrogen and helps maintain the uterine lining for pregnancy. High estrogen doesn’t cause endometriosis, but it can exacerbate the condition. Working to achieve estrogen and progesterone balance with integrative tools like herbal medicine, liver support, gut support, and bioidentical progesterone supports immune regulation.

There are likely other underlying causes and contributors to consider. Your TārāMD healthcare team can take a comprehensive deep dive into your health and help you connect the dots and optimize contributing health factors.

Endometriosis and Fertility

Endometriosis can damage the ovaries or fallopian tubes, contributing to fertility issues, especially in more severe endometriosis cases. In these cases, women may turn to fertility support like IVF (in-vitro fertilization) to assist in pregnancy. However, many women with endometriosis can get pregnant naturally and have healthy babies.

Teenagers and young women may not be thinking about family planning when they experience pelvic pain or receive an endometriosis diagnosis, yet preserving fertility is an important clinical goal. Integrative approaches, along with surgery as needed, can help prevent damage to the reproductive organs and hysterectomies. Early diagnosis and interventions are critical.

An Integrative Endometriosis Plan

Each woman needs a personalized, specific endometriosis plan to address her unique needs.

Here are some pieces of an integrative endometriosis plan to consider:

• Work with a gynecologist who understands endometriosis. Don’t try to go at it alone; you’ll need support and guidance. If you need surgery or other specialists, your gynecologist can refer you to the best doctors for treatment. At TārāMD, we support women with endometriosis with personalized, high-level care.

• Experiment with a gluten and diary-free diet. Avoiding these common food sensitivities can help reduce period pain by decreasing inflammation for those who are sensitive. Experiment with avoiding gluten and dairy for a couple of menstrual cycles to observe any shifts in symptoms.

One study found 75% of women following a gluten-free diet experienced a significant reduction in endometriosis symptoms after one year. In another study, total dairy intake correlates with an increased risk of endometriosis.

• Support gut health. Understand your microbiome with functional stool testing and work to create balance. A balanced gut is helpful for hormone balance, reducing inflammation, reducing LPS, and other aspects that affect endometriosis symptoms. Read my recent blog on the microbiome for details about diet and lifestyle strategies.

• Adopt an anti-inflammatory diet. A diet rich in colorful plant foods, like berries, citrus fruits, leafy green vegetables, beets, purple cabbage, herbs, spices, nuts, seeds, etc., provides numerous anti-inflammatory compounds, supports gut health, and can be a foundational approach to managing endometriosis. Additionally, include anti-inflammatory omega-3 fats from cold water fish or high-quality fish oil.

• Work with a registered dietitian. Diet change can be challenging, and dialing in the right strategy for you can feel overwhelming and confusing as you hear conflicting information from doctors, books, and other sources. Working with a nutritionist who understands endometriosis, like our nutritionists at TārāMD, can help you reach your goals more quickly and efficiently. We’ll help you home in on the nutrition strategies and specific foods to help your body heal and restore balance.

• Use supplements. Many supplements can help reduce inflammation, support the immune system, correct nutrient deficiencies, and help you address endometriosis’s root causes. Supplements to consider may include:

• • Turmeric
  • Ginger
  • Omega-3s
  • NAC
  • Zinc
  • Selenium
  • Glutathione
  • Magnesium
  • B vitamins

• Consider progesterone therapy. Bioidentical progesterone may help oppose the proliferative effects of estrogen and reduce pain and other endometrial symptoms. Work with a knowledgeable gynecologist to see if you’d be a good candidate.

Be sure to choose bioidentical progesterone (instead of synthetic progestins) because of fewer side effects and more health benefits.

• Add bodywork to your routine. Acupuncture, abdominal massage, pelvic floor physical therapy, and SoLā pelvic therapy are supportive therapies that can improve blood flow, pelvic health, and break up adhesions. Regular pelvic bodywork and care is a helpful adjunct therapy for endometriosis.

• Reduce plastics, pesticides, and other endocrine disruptors. The environment around you influences your health in unexpected ways. You can’t protect yourself from every toxin, but making conscious choices to reduce exposure makes a big difference in your health and symptoms.

Choosing organic food, never heating food in plastic containers, and investing in a quality water filter are some of the ways to reduce endocrine disruptors in your body. For more tips, read Endocrine Disruptors – Hidden Causes of Hormonal Imbalance.

Endometriosis is a painful, awful condition, but you don’t need to continue to suffer. There are many tools, including conventional treatments and holistic approaches, to help you find relief and preserve fertility. Working with a healthcare team specializing in endometriosis is critical for finding solutions. If you’re ready for this type of care, please reach out. TārāMD is here for you.

References:

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7. Marziali, M., Venza, M., Lazzaro, S., Lazzaro, A., Micossi, C., & Stolfi, V. M. (2012). Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?. Minerva chirurgica,67(6), 499–504.
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