By Dr. Shawna Darou, ND
Endometriosis is a hormonal condition that appears to be growing in frequency at an alarming rate. I have some theories as to why, and we’ll get to those below. The good news is though that you can balance your hormones, reduce pain and improve fertility with endometriosis, and a lot of this has to do with diet and nutrition.
With endometriosis,there is abnormal growth of uterine lining cells, in places outside of the uterus. These cells outside of the uterus are called ‘endometrial implants’ and they can attach themselves to the fallopian tubes, ovaries, intestines, bladder, outside of the uterus, and sometimes travel farther to the liver and even the lungs. During menstruation, these cells are activated, creating pelvic pain, and pain wherever the implants have attached. The amount of pain experienced is variable – some women with quite severe endometriosis do not have significant pain, and others are incapacitated by it. Due to inflammation, immune imbalance and also structural changes, endometriosis can cause difficulties with fertility.
Signs that you may have endometriosis include:
- Very painful periods (the kind that requires ibuprofen or stronger medications regularly dosed through the day)
- Pain or cramping with intercourse
- Diarrhea at the start of menstruation
- Pain and cramping in the week leading up to menstruation
- Pain from the very first period at puberty
- Pain during bowel movements and /or urination
Endometriosis is often given a speculative diagnosis based on symptoms, as the only accurate way to diagnosis is through laparoscopic surgery.
I also consider endometriosis to be an autoimmune condition, meaning the immune system is dysregulated. It is also one of the ‘estrogen-dominant’ conditions, where estrogen levels are not adequately balanced by progesterone, or estrogen is not detoxified effectively.
There are several steps to take with endometriosis to reduce pain and improve fertility:
- Food intolerances – the presence of food intolerances increases immune system stress and inflammation in the body. This is tested with an IgG food intolerance panel for accuracy;
- Yeast overgrowth – there is a high association with women with chronic yeast infections, frequent antibiotic use and high intestinal yeast and the development of endometriosis. Too much yeast in the body, disruption of the gut microbiome, and subsequent intestinal permeability is one of the causal factors that leads to immune dysregulation;
- Hormone panel, testing for three types of estrogen: estrone, estradiol, estriol and progesterone to show whether there is clear estrogen dominance or poor liver and colon detoxification of hormones;
- Inflammation through diet – a diet that is inflammatory due to high intake of red meat, sugar, white flour, fried foods or alcohol can greatly increase pain and inflammation in the body;
- Weight – carrying extra weight, increases estrogen levels (estrone, one of the stronger stimulating estrogens is produced by fat cells);
- Stress – high stress affects hormone balance, in particular when cortisol levels are high, progesterone drops leading to more estrogen dominance;
- Emotional health – in many cases of endometriosis, there is history of significant emotional stress in childhood and sometimes sexual abuse.
A typical treatment plan for endometriosis is aimed at reducing inflammation, balancing the immune system and correcting estrogen dominance.
Diet can have a profound impact on lowering pain due to endometriosis, and the most effective nutrition plan that I have seen for this condition is adopting a plant-based diet. For some women, going 100% vegan may not be healthy or necessary, but lowering saturated fats from animal products, and greatly increasing the intake of vegetables does make a difference.
Inflammatory foods that should be reduced include: meats (especially pork and beef), eggs, dairy products, all fried foods, alcohol, sugar and peanuts. In addition, and food that you have an intolerance to will also increase inflammation (and pain), and should be eliminated.
Many women with endometriosis also experience a significant reduction in pain with a gluten-free diet, as a way to reduce inflammation. One thing to note is that it can take several months of eating gluten-free to notice a reduction in pain.
Clearing yeast and rebalancing the gut microbiome:
High overgrowth of yeast is extremely common with endometriosis, and clearing out yeast to rebalance the gut microbiome will also reduce pain and inflammation. Clearing yeast has several steps:
- An anti-yeast diet, followed strictly for 1 month, and moderately after. This means avoiding sugar, white flour, yeast and fermented foods;
- Anti-fungal supplements to kill off yeast (for example olive leaf extract, oregano, caprylic acid to name a few);
- Probiotics – taken orally to replenish healthy digestive flora;
- Vaginal treatment if there are yeast infections ranging from probiotic suppositories to boric acid in chronic cases.
Treating estrogen dominance:
An imbalance in estrogen is largely what feeds the growth and spread of endometriosis, so restoring balance is essential. Estrogen is rarely over-produced by the ovaries, so what we are looking at is how well the body is detoxifying and eliminating excess estrogen.
Hormones are detoxified through the liver first, and in the colon second, and treatment for estrogen dominance will be liver support (especially substances like indole-3-carbinol, calcium-d-glucarate, DIM), and fibre to support regular bowel movements and clear hormones (especially an increase in vegetables and ground flax seeds).
The second part of hormone balance has to do with progesterone. Progesterone is a hormone produced by the ovaries after ovulation, and low progesterone leads to more estrogen dominance. Progesterone levels are particularly sensitive to stress, meaning it will be low during periods of prolonged high stress, and progesterone also declines with age which is why estrogen-dominant conditions tend to escalate in the 40’s. Supporting progesterone includes first lowering stress, balancing stress hormones, and next supporting with herbs such as chaste berry extract if needed.
Unfortunately, there is no natural ‘cure’ for endometriosis, but what we can do very effectively is reduce pain, prevent spread and growth and improve fertility through the strategies above.
If you or someone you know if suffering from what sounds like endometriosis, please encourage them to see a naturopathic doctor and begin some of the steps listed above.
And of equal importance, I believe that many cases of endometriosis can be prevented in young girls by addressing food intolerances, inflammation through diet, and especially by clearing out yeast and balancing the gut microbiome if there have been many round of antibiotics before puberty. All of this along with staying active to maintain optimal weight, and being mindful of estrogen mimicking chemicals could greatly reduce the incidence of endometriosis in our children.