Endometriosis is a reproductive disorder in which endometrial cells, usually found in the lining of the uterus, implant elsewhere in the body. During your period, your hormones fluctuate, which stimulates these endometrial cells to grow, then break down and bleed like they would in the lining of the uterus. This blood has nowhere to escape, leading to inflammation, pain and the formation of scar tissue.
Approximately 10-15% of all premenopausal women have endometriosis, but despite this, the topic of how endometriosis progresses remains controversial. It is clear that endometriosis is fueled by a dominance of the hormone estrogen, but growing research suggests that there is an autoimmune aspect to the disease.
Because endometriosis manifests in a variety of ways and shares symptoms with other conditions, diagnosis can be difficult and often delayed. Recent research shows that it now takes an average of 7.5 years between first seeing a doctor about your symptoms and receiving a definitive diagnosis. The only definitive way to diagnose endometriosis is with laparoscopy – an operation in which a camera (a laparoscope) is inserted into the pelvis through a small incision near the belly button. The surgeon uses the camera to view the pelvic organs and look for any signs of endometriosis.
What causes endometriosis?
Science still can’t give us a definitive answer. There are several theories about the cause of endometriosis, but none completely explains why this condition occurs. It is likely that a combination of the following factors is involved:
Retrograde menstruation:
Normally, your menstrual blood passes through the cervix and vagina when you have your period, but with retrograde periods, it flows back through the fallopian tubes and into the pelvic cavity. Endometrial cells are carried in the blood and can adhere to the pelvic walls and surfaces of the pelvic organs. These cells grow with each menstrual cycle but cannot leave the body during your period. This blood builds up causing inflammation and pain(5). Although retrograde menstruation occurs to some extent in almost all women, not all women develop endometriosis. So, could the immune system of certain women, which should normally fight against these unwanted cells, malfunction and allow lesions to form?(2) Many women with endometriosis appear to have reduced immunity to other conditions, but it is unclear whether this contributes to the endometriosis or is due to the endometriosis.
Estrogen dominance:
I think it would be more accurate to say that hormonal imbalances make endometriosis worse rather than causing it. One of the functions of estrogen is to increase the reproduction of endometrial cells(6) which would make sense given that a robust endometrium is essential for pregnancy. If estrogen-containing menstrual blood is in the wrong place, the cells increase in number, creating endometriosis-related lesions. We must therefore think about balancing our estrogen levels… enough for a healthy reproductive cycle but without excess circulating in our body. More on this approach in my next article “Nutritional Approaches to Managing Endometriosis”.
Unbalanced gut bacteria:
A new study suggests that an imbalance of bacteria in the gut and genitals is associated with endometriosis. Researchers found a complete absence of one bacterial family, Atopobium, in people with moderate to severe endometriosis, while levels of Gardnerella, Streptococcus, Escherichia, Shigella and Ureoplasma, all of which contain potentially pathogenic species, were increased.(12). It is possible that bacteria can influence the immune system, creating inflammation. So it can be very important to take care of your gut bacteria.
Linking your gut bacteria to estrogen levels and endometriosis, research has shown that an imbalance in gut bacteria leads to increased estrogen levels, which may be a driver of endometriosis by stimulating growth endometriotic cells and their inflammatory activity.
Good escape:
New research has found a strong correlation between intestinal permeability (leaky gut) – a condition in which bacteria and toxins pass through the intestinal wall and enter the bloodstream – and the presence of endometriosis. The reality is that all autoimmune diseases have their roots in bacterial dysbiosis and leaky gut. In my experience as a practitioner, I always start by working on gut health, because you can never ignore the role of digestion when trying to balance hormones. The reality is that you can take all the hormone balancing supplements you want, but if your digestion is struggling, trying to get back into balance will be a challenge.
If in doubt about the diagnosis, contact your GP, as 30-50% of women with endometriosis will also experience it. infertility.(7)
How is it? endometriosis treated?
Unfortunately, there is no cure and medical interventions do not always solve the problem. Your GP may consider offering you painkillers, the oral contraceptive pill or a laparoscopic procedure (keyhole surgery) to remove the lesions.(5). In my opinion, the most effective approach to managing chronic pain associated with endometriosis combines traditional medical and surgical treatments with complementary therapies delivered by a multidisciplinary team. This will likely include acupuncture, massage, physiotherapy and of course nutritional therapy.
In my next article Nutritional Approaches to Managing Endometriosis We explore simple dietary adjustments that can make a big difference to your quality of life as a person with endometriosis.
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