The discourse surrounding endometriosis is growing more prominent. As one in seven people assigned female at birth experiences the severe impacts of this condition, a growing number of individuals are seeking to understand what endometriosis is.
What is endometriosis?
Endometriosis refers to the presence of endometrial like tissue in places outside the uterus. This is commonly found on the outside of the uterus, on the ovaries, the abdominal wall, around the bowels and urinary structures (bladder, and kidneys).
Anyone with a uterus can develop endometriosis, and it is still largely misunderstood as to why it develops despite there being some theories around early menarche, retrograde menstruation and an autoimmune link. What is known, is that those who have a close relative (mother or sister) with endometriosis are 7 to 10 times more likely to develop it.
Rates of endometriosis diagnosis have increased in recent years with one in seven uterus owners being diagnosed. This number is estimated to be higher, with many people continuing to fight for diagnosis and adequate treatment. Those who breastfeed, are on progesterone only contraception and have irregular periods are thought to be less likely to develop endometriosis.
Some of the most common symptoms of endometriosis include:
– Pain with periods
– Pelvic pain through the cycle
– Pain with sexual intercourse
– Heavy and prolonged bleeding
– Bladder and bowel symptoms (urgency or constipation)
– Fatigue
Diagnosis of endometriosis
Endometriosis is best diagnosed with via laparoscopy. Whilst there is the option of an internal pelvic ultrasound, and MRI (Magnetic resonance imaging), laparoscopy is the most specific and “gold standard” way of diagnosis endometriosis.
Once endometriosis has been diagnosed, is it given a classification. The most used classification comes from the American Society for Reproductive Medicine (ASRM). In this system, endometriosis is given a ‘stage’ ranked from 1-4 depending on severity. This includes where the endometriosis is found, in how many places it is found, and how deeply the tissue / endometriosis extends.
– Stage I (minimal) refers to minimal or smaller spots of endometriosis, smaller adhesions, and inflammation around the uterus.
– Stage II (mild) refers to more endometriosis adhesions, and areas where it occurs. however, includes some scarring from endometriosis, and might involve endometriosis around the bowel.
– Stage III (moderate) includes the same as stage II however there is more extensive involvement of endometriosis around other reproductive organs such as the ovaries and/or fallopian tubes.
– Stage IIII is the most severe stage of endometriosis, and this is typically characterized by extensive scarring, adhesions of organs and endometriosis, and changes in the shape and potentially function of reproductive organs. It is important to note that stage of endometriosis does not necessarily equal severity of symptoms experienced.
What about other uterine conditions?
Other uterine conditions can often co-exist in people who have endometriosis. Two of the most common conditions to co-exist include uterine fibroids and adenomyosis. Adenomyosis is colloquially known as the “sister or cousin to endometriosis” and refers to a condition where uterine tissue that lines the uterus, grows into the muscle wall of the uterus causing similar symptoms to endometriosis. Those who live with endometriosis may also be at an increased risk of autoimmune illnesses, early menopause, some cancers (thyroid, ovarian, and breast cancer) and heart disease.
It is important to acknowledge the major impact endometriosis and chronic pelvic pain has on every area of a person’s life. Work, social life, relationships, and mental health are all significantly impacted. Endometriosis is a whole body and “all encompassing” disease.
Read more about adenomyosis here
Treatment of endometriosis
Treatment options for endometriosis can be categorized into a few different approaches. Hormonal therapy or medication, surgery, and natural therapies.
Hormonal therapy or medication
Hormone therapy is designed to minimize the progression of endometriosis and halt bleeding, encompassing menstrual flow. The primary objectives of these treatments are to alleviate distressing symptoms such as pain and excessive bleeding. Frequently utilized hormonal treatments encompass:
– The combined oral contraceptive pill,
– Progestogens, available in oral form, as an injection, or through the Mirena IUD (intrauterine device),
– GnRH (gonadotrophin-releasing hormone) agonists and antagonists, which cease the menstrual cycle and may induce a temporary chemical menopause.
The most disruptive symptom for those suffering from endometriosis is often the severe chronic pelvic pain.
Several medicinal strategies for managing this pain can be beneficial, including:
– Over-the-counter pain relievers, like paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs, for example, ibuprofen),
– Prescription pain medications such as Ponstan and Naproxen,
– More potent pain relievers like Panadeine or Tramadol,
Medications designed for chronic pain that target nerve pain and function as nerve/muscle relaxants, such as:
– Amitriptyline
– Pregabalin
Surgery
Surgical excision, which involves the removal of endometriosis tissue, stands as a principal treatment method for endometriosis. Achieving thorough and optimal removal of the endometriosis tissue is crucial. Inadequate removal can cause scarring and can lead to the recurrence of endometriosis growth.
Natural therapies
The plethora of appointments and medications for endometriosis management can be daunting, prompting some to explore alternative management options. These alternatives, often called non-pharmacological strategies, can complement traditional treatments.
Options include:
– Heat packs
– Activities such as stretching, yoga, pilates, or taking gentle walks
– Use of a TENS machine (for example, Ovira)
– Expanding your healthcare team to include specialists beyond a GP and gynecologist, such as a pelvic floor physiotherapist, dietitian or naturopath, and a psychologist or pain psychologist.
Nutrition for endometriosis
Incorporating lifestyle adjustments alongside medical treatments can significantly enhance the quality of life for those living with endometriosis.
One of these natural treatments that people often look to improve symptoms is diet. Endometriosis, a condition characterized by inflammation, can be managed in part through dietary adjustments aimed at mitigating inflammation through anti-inflammatory eating habits.
What does this include?
Incorporating antioxidants into your diet is a key aspect of managing endometriosis. Antioxidants safeguard our cells from damage and possess anti-inflammatory properties, promoting a focus on enriching your diet rather than eliminating entire food groups and nutrients. As endometriosis is an inflammatory condition we can really harness this power of antioxidants.
It’s important to note that there isn’t a singular “endometriosis diet” suitable for everyone; what benefits one individual may not have the same effect on another. However, research indicates that consuming specific nutrients can alleviate endometriosis symptoms, such as the development, severity, and frequency of pain throughout the menstrual cycle.
My top 5 key foods to include in an endometriosis friendly diet include:
Salmon
Salmon is rich in omega-3 fatty acids. Omega-3 fatty acids, particularly EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), have potent anti-inflammatory properties that can help reduce the inflammatory response associated with endometriosis. This can lead to a reduction in pain and discomfort.
Extra virgin olive oil
Extra virgin olive oil contains a high concentration of antioxidants and omega-3 fatty acids. Specifically, oleocanthal, an antioxidant found in extra virgin olive oil, has been researched for its properties that closely mimic ibuprofen, offering anti-inflammatory and pain-relieving benefits (Parkinson & Keast, 2014)
Berries
Berries are packed with antioxidants, such as vitamin C, vitamin E, and flavonoids, which protect cells from oxidative stress and damage. Oxidative stress is implicated in the pathogenesis and progression of endometriosis. The antioxidants in berries can help neutralize free radicals, reducing oxidative stress and potentially slowing the progression of endometriosis.
Leafy green vegetables (kale, spinach, rocket, bok choy, romaine lettuce, swiss chard)
Women with endometriosis often experience heavy menstrual bleeding, leading to iron deficiency or anaemia. Including iron-rich leafy greens in the diet can help mitigate this risk. The consumption of green leafy vegetables can contribute to maintaining a hormonal balance. Certain compounds found in these vegetables, such as indole-3-carbinol, can help in managing estrogen levels, potentially reducing the estrogen dominance that is often linked with endometriosis progression.
Wholegrains
Wholegrains are grains that contain all essential parts and naturally occurring nutrients of the entire grain seed; this includes the bran, germ, and endosperm. Wholegrains have been shown to have anti-inflammatory effects, which is crucial for managing endometriosis as we already know! They are also a great source of dietary fibre. Fibre helps in the regulation of hormone levels by aiding in the elimination of excess estrogen from the body through the digestive tract. The fibre in wholegrains can also support a healthy gut microbiome, which can be helpful for those who also suffer from IBS (irritable bowel syndrome) which can often co-exist with endometriosis.
