JOURNAL 38: Endometriosis
More and more women are presenting with endometriosis in clinic. Statistically, endometriosis is thought to affect 1 in 10 women, however many of those women remain undiagnosed (refer recent blog on Living With an Invisible Illness).
Diagnosing endometriosis can be challenging, firstly because doctors don’t always understand the degree of pain that women experience. Sadly, many of my patients have been dismissed from the doctor’s office, leaving them feeling deflated, misunderstood and unheard. A diagnosis can only be made by a gynaecologist via laparoscopy so, if these words resonate with you, please persist with your general practitioner—or find another one who will listen to you and get a referral.
Historically, the condition was never recognised. It is now thought that women diagnosed with ‘hysteria’ may have actually had endometriosis due to their chronic unexplained pain. Treatment at the time was confinement to a dark room until the hysteria passed. I’m pleased to report there is a lot more that can be done to support women with endometriosis today!
So, what is endometriosis?
Endometriosis is a condition involving the abnormal growth of uterine endothelial tissue outside of the uterus. For many women, this abnormal tissue growth occurs in other areas of the pelvic cavity such as the ovary, rectum, outside the uterus and the bladder, but it is possible for it to occur in other areas of the body. I have read of women with tissue growth in the brain and have seen women in clinic with it outside of the pelvic cavity that has resulted in referred pain into their back and shoulders.
Stage 1 is minimal tissue growth, stage 2 is mild, stage 3 moderate and stage 4 is severe and where the endometrial tissue has become fibrotic and fused to organs such as the ovary.
Some women with endometriosis go on to develop adenomyosis, where the uterine endothelial tissue grows into the uterine muscle. Often women are told they have a ‘bulky’ uterus when, in fact, they have endometriosis/adenomyosis.
What are the symptoms?
The main symptom of endometriosis is PAIN. The site of pain can vary and so can the timing – it is not always associated with period onset.
Interestingly though, the degree of tissue growth isn’t always related to the pain severity. Often those with the most extensive tissue growth have less pain than those with less abnormal tissue growth.
Other symptoms include:
bladder and/or bowel issues
abdominal bloating
nausea and vomiting
headaches
low-grade fever
bleeding/spotting between periods
heavy, long and painful periods
infertility or recurrent miscarriage
pain during sex.
Did you know that 70% of teens reporting chronic pelvic pain will eventually go on to be diagnosed with endometriosis?
What causes endometriosis?
Sadly, there hasn’t been much research into endometriosis so less is known about it compared to other conditions. However, with the fantastic work of scientists and naturopaths such as Leah Hechtman, more information is being discovered, with some really exciting research coming out in the last few years.
Historically, there were three theories regarding the cause of endometriosis. These are:
Metaplastic theory – similar to cancer, it was thought that the abnormal tissue in distal sites developed from local stem cells
Retrograde menstruation – this actually occurs in most women, but it was theorised that this, combined with metaplastic theory, led to tissue growth outside of the uterus
Relative oestrogen excess – perhaps the most popular theory, this is thought to promote proliferation of endometrial tissue.
I believe that all three theories play a role, but this does not complete the entire picture. For example, high levels of oestrogen are common, but there are many women with high oestrogen who don’t have endometriosis. There is definitely more to the story.
More recent evidence from clinical research suggests a significant immune involvement, which makes sense because we know that endometriosis is a whole body inflammatory disorder. Some researchers have theorised that it may be an autoimmune disease however, to date, no specific antibodies have been identified. What we do know is that there is a notable immune derangement resulting in systemic inflammation.
Furthermore, 80 per cent of women with endometriosis also have symptoms of irritable bowel syndrome. Having had the opportunity to use functional gut testing with endometriosis patients has enabled us to identify specific bacteria and triggers and understand the impact gut integrity and function, as well as the microbiota, are having on overall health. There are numerous strains of pathogenic bacteria that produce lipopolysaccharides that are known to create massive amounts of inflammation, so addressing this is a key component of treatment.
Addressing and correcting the gut-immune interface is key in treating women with endometriosis.
If you have endometriosis, or you suspect you do, there are so many more options available to you today in terms of treatment. Standard medical care usually involves contraceptives and medication for pain, then a dilation and curette, followed by a recommendation for a full hysterectomy. These should all be a last resort in my opinion. As we learn more about the underlying drivers and pathophysiology of this condition, we increase the specificity and success of natural treatment options available to you.
If you would like to explore your options regarding treatment for endometriosis, we’d love to work with you. Book an appointment with one of our naturopaths and together we will find the most suitable treatment for you.
Written by Denise Berry BHSc
Naturopath
