At 36, Liz came to me as a patient popping Percocet before breakfast, several ibuprofen before lunch, and another round of narcotics before the kids got home from school. She was tired, constipated, and in chronic pain. A drug addict? No! She's an otherwise well-adjusted suburban soccer mom who has suffered with well over a decade of debilitating chronic endometriosis pain, who has undergone multiple surgical procedures that have only temporarily eased her discomfort, and who is now dependent on strong and potentially addictive and dangerous medications to get her through the day with a manageable pain level.
What is Endometriosis?
Endometriosis is when the type of tissue that normally lines the uterus – called the endometrium – is found in other locations of the body where it’s not supposed to be.The most common place is the abdominal cavity where it can land on the peritoneum, the thin layer that covers the inside of the abdomen, the ovaries, and fallopian tubes.
Like the lining of the uterus, the misplaced endometrial tissue is triggered by the same hormonal changes that trigger your period to come, causing this tissue to shed, or bleed, as well. When this shedding occurs, blood, which is trapped in the abdomen, is irritating to the nerves in the abdomen, causing much of the pain associated with endometriosis.
Over time, this shedding leads to chronic inflammation and the formation of scar tissue. Additionally, the endometrial cells cause abnormal immune responses in that tissue, leading to further chronic inflammation and scarring.
Nobody knows exactly why this happens, and there are many theories. The important thing is that we know that it is an inflammatory condition with an abnormal immune response, and it is triggered by cyclic hormonal changes, environmental hormonal exposures, and other factors that cause inflammation.
Who Gets It?
About 1 in 10 women and girls in the US have endometriosis. Severe pain and cramping is estimated to affect 6.5 million in the United States and Canada, who suffer with the condition. And this is likely a conservative number, given how frequently the diagnosis is missed in teenaged girls, according to a recent New York Time article exploring the horrible pain and miserable experiences of young women who have bounced from one gynecologist to another hoping for an answer or a solution.
Of women undergoing laparoscopy for pelvic pain, here are the numbers of women found to have endometriosis:
- 2 to 32% of women of reproductive age undergoing laparoscopy to determine the cause of pelvic pain
- 9 to 50% of women undergoing laparoscopy for infertility versus 6.7 percent of women undergoing laparoscopy with no past infertility
- 50% of teenagers undergoing laparoscopy for evaluation of chronic pelvic pain or dysmenorrhea
The rates of endometriosis are going up, most likely as a result of chronic exposure to toxin environmental chemicals, so you can use the information in this article now to protect yourself and your daughters later.
What are the Symptoms?
The most common symptoms of endometriosis include killer cramping at the time of the menstrual cycle that sometimes won't even go away with NSAIDS (motrin, ibuprofen, that kind of stuff), periods from hell (long. heavy), often with chronic and sometimes severe pain between periods, constipation and bloating, painful sex, urinary problems, low back ache, and chronic fatigue. Some women also report abnormal vaginal bleeding.
Endometriosis is one of the most common causes of infertility, leading to as many as 50% of cases. Some women may have endometriosis without symptoms, only to discover that they have the problem when they experience difficulty becoming pregnant. As many as 30-40% of women with endometriosis will experience fertility problems.
Endometriosis typically progresses and worsens over time as the chronic inflammation leads to accumulation of scar tissue causing “adhesions” that cause the organs like the intestines and bladder to become fixed in place leading to frequent or even pain with bowel movements and urination, and painful sex.
The percentage of women with endometriosis reporting various symptoms is:
- Painful periods (79%)
- Pelvic pain (69%)
- Pain with sex (45%)
- Bowel upset (e.g., constipation, diarrhea) (36%)
- Bowel pain (29%)
- Infertility (26%)
- Ovarian endometrial mass/tumor (20%)
- Pain with urination (10%)
- Other urinary problems (6%)
Conventional Treatments for Endometriosis – Not Always So Helpful or Healthy!
Conventional medicine has not yet determined what the optimal treatment is for endometriosis, and mostly aims at symptom relief through medications and surgery.
The chronic use of the commonly recommended pain medications like Ibuprofen and other NSAIDS can provide temporary relief, but have risks including long-term damage to the gut lining. Hormonal therapies, such as oral contraceptives, progestins, and GnRH agonists can relieve symptoms of mild to moderate pain but also have potential short and long-term side effects, and don’t get to the root causes of the problem.
While removal of endometrial tissue via a laparoscopy can relieve symptoms for as a long as 2 years, the symptoms do eventually return in most cases, and the procedure itself increases the likelihood of forming scar tissue. Hysterectomy is sometimes recommended, but this is not an option for women who want to become pregnant, and it's important to recognize that this is one of the most over performed unnecessary surgeries in the US – including its use for endometriosis. While it is sometimes helpful when all else fails or if symptoms are unbearable, it is major abdominal surgery – and a major cash cow for doctors and hospitals – so get more than one opinion if you're not sure you want this done!
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The Natural Approach to Endometriosis: Getting to Your Root Causes
We know that endometriosis is an immune and inflammatory problem that is triggered by cyclic hormonal changes and worsened by chronic environmental toxin exposure. Exposure to a class of chemicals called endocrine disruptors (which mimic hormones), as well as other environmental toxins that increase our inflammation and disrupt the normal functioning of the immune system has been implicated in endometriosis. The natural approach supports an optimal immune response, reduces inflammation and pain, promotes natural detoxification of environmental toxins, and helps to balance hormones.
I recommend a comprehensive approach that incorporates an anti-inflammatory diet as well as a selection of the supplements from each of the categories below.
It takes about 6-12 months to see a reduction in the overall number of endometrial implants in your abdomen (these are seen on laparoscopic evaluation). However, it is not necessary to follow up with laparoscopy if you have been getting these done; if your symptoms improve, that can be your guide that you're getting better, so it is ideal to keep a record of how you are feeling on a 1-10 scale during the times your pain is typically at its worst.
You should start to get some pain relief within a few hours of taking the pain supplements.
Anti-inflammatory Diet for Healing Endometriosis
The most important first step is to get onto an anti-inflammatory, low-toxin diet, and check your environment, especially food, for common environmental toxin exposures – especially from food and food packaging – that increase your estrogen load (these are called xenoestrogens).
An anti-inflammatory diet includes up to a pound of combined fresh vegetables, especially leafy greens (kale, collards, broccoli, Brussels’s sprouts) and fresh fruits (especially berries) each day.
The three main triggers to remove for an anti-inflammatory diet are dairy products, gluten-containing products, all corn, and most sugar. Red meat is also pro-inflammatory, so if you are suffering from endometriosis, a plant-based diet with no red meat, and small amounts of poultry and fish is preferable. All meat should be organic to avoid chemicals used in meat production that might be adding to your problem.
While they may seem like no big deal because everyone uses them, plastics are major sources of xenoestrogens that can wreak hormonal havoc and cause or worsen endometriosis. Do your best to avoid foods that come in soft plastic wrap, are stored or microwaved in plastic, are contaminated with pesticides and herbicides (i.e., many fruits and vegetables – and even more so if imported from another country where highly toxic chemicals that have been banned in the US are still used) and plastic water bottles.
Caffeine may exacerbate endometriosis in some women, so if you’re drinking coffee each day, try a couple of months without it. On the other hand, green tea is antioxidant and may be especially beneficial if you have endometriosis.
Keeping your blood sugar steady is also important for keeping inflammation in check, and keeps you from binging on inflammatory sugar and baked goods.
Being overweight increases the likelihood of being estrogen dominant; appropriate weight loss can also be very helpful in reducing general inflammation. The anti-inflammatory diet is a great way to lose weight without having to work too hard to try!
Herbs & Supplements for Healing Endometriosis
Here is my 5 Step Plan for the herbs and supplements to add to your anti-inflammatory diet. These should not be taken during pregnancy, but can be taken up until conception – just discontinue when you try to get pregnant, and resume if you have not conceived, and they can be taken while you are breastfeeding.
Natural anti-inflammatories such as curcumin (from turmeric), bromelain (from pineapple), quercetin (from apples, onions, and other plant sources) ginger root, boswellia, and fish oil are all fabulous anti-inflammatories that I use to treat my patients who have endometriosis. I recommend a combination of these, and use products including Inflammatone from Designs for Health, InflammaResponse from Herb Pharm and Turmeric Supreme: Joint by Gaia Herbs, along with 1-2 tsp. daily of Nordic Naturals Ultimate Omega for a high dose of fish oil (talk with your doctor before taking if you are on blood thinners, though the risks are very small according to medical literature).
Not only will inflammation be reduced, but these herbs also relieve pain over time.
Prevent and Repair Damage with Antioxidants
Antioxidants help to prevent and reverse local tissue damage from inflammation. Some of our best antioxidants come from foods highest in vitamins E, A, and C, which you can also supplement by taking a daily multivitamin. Resveratrol from red grapes, N-acetylcysteine (NAC), pine bark, green tea, and curcumin are powerful antioxidants.
NAC is a powerful antioxidant with some impressive data behind it specifically for endometriosis. In a 2013 study of 92 women in Italy, 47 took NAC and 42 took a placebo. Of those who took 600 mg of NAC three times a day, three consecutive days each week for three months, 24 patients cancelled their scheduled laparoscopy due to a decrease or disappearance of endometriosis, improved pain reduction or because they had gotten pregnant! Fourteen of the women in the NAC group had decreased ovarian cysts, while 8 had a complete disappearance; 21 had pain reduction and 1 became pregnant. In the other group, only 1 patient cancelled surgery. A total of 8 women got pregnant in the NAC group, while 6 did in the placebo-only group.
In yet another study of an antioxidant herb, this time pycnogenol from pine bark, women taking 30 mg twice daily for 48 weeks showed a 33% reduction in pain, including severe pain, and while the pain reduction was not as strong as hormonal treatment, it actually persisted without relapse, unlike the medication group. Further, 5 women in the pycnogenol group became pregnant.
Balance Your Hormones
When estrogen is running wild, it not only increases the size and number of the endometrial tissue, but certain forms of it also contributes to inflammation.
Getting enough dietary or supplemental fiber and having a daily bowel movement are essential for reducing inflammation, overall body toxin load, and eliminating excess estrogen from your system. I recommend taking 1-2 TBS of freshly ground flax seed daily in a smoothie, or mixed into food, and if constipation is a problem, natural treatments are available.
Avoid Environmental Triggers and Support Natural Detoxification
Numerous environmental toxins in our food, food packaging, air, water, homes, and workplaces increase our hormone burden, cause inflammation, and also have the capacity to cause our immune cells to malfunction. Avoiding these chemicals whenever we can, such as in our foods, body products and cosmetics, household cleaners, and flame-retardant treated fabrics can reduce body burden.
Given how common these are, though, if you are suffering from endometriosis, avoiding toxins is not enough – your body can need some extra detoxification support.
Some of the supplements I’ve already mentioned, including NAC, curcumin, resveratrol, and quercetin all support natural detoxification, and so you’re already ahead of the game here! One additional supplement that I haven’t mentioned yet is Indole-3-Carbinol, which is excellent for supporting the detoxification and elimination of excess hormones. One product I love is called Xeno-Pro-Tex by Xymogen, which has many of the detox supplements in the blend, though you may want to add in additional NAC to meet the level I mentioned above. Endocrine Disruptor Relief by Vitanica is also an excellent product.
Ginger root powder (or the equivalent in extract form) at a dose of 500 mg 2-4 times/day has been shown to reduce pain equal to the effects of ibuprofen. Other herbs that are excellent for pain relief include Jamaican dogwood, curcumin, cramp bark, and devil’s claw. I recommend Turmeric Supreme Pain by Gaia Herbs to my patients, along with ginger capsules or extract at the previously mentioned dose.
One study demonstrated that 10 mg of melatonin per day significantly reduces chronic pelvic pain due to endometriosis, pelvic pain during menses and during sex, pain during urination and associated with bowel movements, to the tune of an overall 80% reduction in the need for pain medication in women taking it. At this dose, melatonin supports the body’s natural detoxification processes. In animal studies, melatonin led to regression and shrinkage of endometriosis tissue. I recommend starting at 1-3 mg/day, and build up, and preferably take it in the evening, as it can make you feel tired. It is the natural substance that increases at night in our brains to tell us to get some sleep!
These can be taken with or in place of the herbs mentioned in the above section on inflammation – there will be some crossover, but that’s ok. Acupuncture in one study has been shown to possibly be helpful for endometriosis pain, and I also recommend using alternating hot and cold sitz baths if you can make this happen at home. It stimulates pelvic circulation, getting good blood and lymph flow moving to help wash out inflammation and toxins.
Bonus Tip: Break up Adhesions with Arvigo Massage
In addition to the recommendations above, I suggest working with an Arvigo Massage Therapist or a physical therapist who is skilled in pelvic pain from endometriosis. These therapies are important for helping to break up adhesions. While some of the anti-inflammatory supplements, particularly the enzymes, may help with this to some degree, it really takes the addition of physical manipulation to break down scar tissue.
You can try these natural approaches at home on your own – or work with an integrative, functional medicine doctor, a licensed naturopath, or a midwife who practices comprehensive women’s health, to create a more customized plan for your needs. The evidence is not clear for the long-term benefits of conventional therapies, surgeries are invasive and only provide symptomatic relief, and natural therapies can be safe and effective in the short and long term.
I hope this article allows you to create an endometriosis healing plan that works for you, relieves pain and adhesions, and gives you back your life and hope!