Endometriosis: Your Naturopathic Handbook

Have you been diagnosed with endometriosis, or are you suspecting you might have it? In this series, we’re starting with the basics and working our way to a deeper knowledge of the potential causes beyond this condition. When we start to understand the causes, we gain clarity on the path to treatment and pain reduction – and that's root cause medicine!

What’s endometriosis?

You’ve surely met someone with it, even if you don’t have it yourself – it’s thought to affect over 10% of women. Endometriosis describes endometrial tissue outside of the uterus, when normally it should only be inside the uterus and shed during periods. Typically, endometriosis patches are in other areas of the pelvis, but could be anywhere including the central nervous system (yes, there’s a published case of psychiatric symptoms caused by brain endometriosis, referenced below). These cells release hormones and inflammatory messenger molecules differently compared to cells in the uterus, and during periods, they bleed into the pelvis and abdomen. This causes nerves in our abdomen to sense blood where it shouldn’t be, which can cause a lot of pain, as well as drive local inflammation and scarring. Over the years, whether from endometriosis itself or from surgery, it’s common to form bands of scar tissue called adhesions, and these bands can limit the proper movement of organs and contribute to the chronic pain that many women with endometriosis know too well.

What are the common symptoms?

• Period pain that may even start before the period and extend for multiple days

• Abdominal and/or pelvic pain may be seen chronically or at other points in the cycle

• Heavy / clotted periods (depending on the patient)

• Pain or symptoms around bowel movements, urination or intimacy

• Lowered fertility

• Fatigue!

• Digestive symptoms like constipation / diarrhea, bloating, nausea, heartburn or reflux

What else may be causing my symptoms?

Many conditions have overlapping symptoms with endometriosis, so a thorough workup is vital! Here’s a non-exhaustive list:

• Ectopic pregnancy

• Polycystic ovarian syndrome

• Primary dysmenorrhea (or “just” painful periods without an obvious cause – a naturopathic doctor can help you investigate this further)

• Post-surgical adhesions (scarring in the abdomen or pelvis after surgery)

• Inflammatory bowel disease

• Appendicitis

• Diverticulitis

• Malformed uterus

• Various types of ovarian cysts

• Pelvic inflammatory disease (PID): inflammation in the upper genital tract caused by sexually transmitted infections like Chlamydia or Gonorrhea – they can reach the uterus and wreak havoc there

• Urinary tract infections

• Certain cancers (colon, ovarian, cervical, uterine)

Have you heard of endometriomas?

An endometrioma is endometrial tissue forming a cyst(s) on one or both ovaries. Some doctors call them “chocolate cysts” because they contain old blood (a little gross, but good to know). The number and size of endometriomas can affect our decisions around medication, surgery and optimizing naturopathic treatments. No matter how you choose to approach endometriosis, I’m here to support you!

Endometriosis is a hormonal condition… right?

Oh, the good old “estrogen dominance”! I remember when I was looking for options to treat my endometriosis several years ago, both the conventional and alternative health worlds focused on hormones – the standard medications to treat endometriosis, like contraceptives and GnRH blockers, are generally hormone-suppressive, while the endometriosis blogs of the time focused on balancing estrogen and progesterone with diet, lifestyle and supplements. While hormonal treatment has its role to play, there’s much more to the story. Leading doctors now understand that endometriosis is responsive to hormones, not fully caused by hormones. Some women with higher estrogen will never develop endometriosis, and not all women with endometriosis symptoms necessarily have high estrogen! We need to think about inflammatory pathways, immune system imbalances and gut microbes that all feed into the development and severity of endometriosis. This is where naturopathic medicine plays a massive role and has changed the game in endometriosis care.

How is endometriosis diagnosed?

The gold standard is to see it on laparoscopic surgery, BUT certain lab tests and pelvic ultrasounds can be used to help assess whether you're more or less likely to have endometriosis and to tailor your treatment plan accordingly. In this blog series, I’ll share information on lab tests that you should consider if you have endometriosis.

Stay tuned!

References

1. U.S. Department of Health & Human Services Office on Women’s Health Endometriosis Fact Sheet. Last updated 2021. Retrieved from: https://www.womenshealth.gov/a-z-topics/endometriosis

2. Elefante C, Brancati GE, Oragvelidze E, Lattanzi L, Maremmani I, Perugi G. Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review. J Clin Med. 2022 Dec 4;11(23):7212. doi: 10.3390/jcm11237212. PMID: 36498786; PMCID: PMC9738496

3. Zhang, H., Sheng, S., Pan, Z., Zhao, L., Yang, C., Li, C., & Wang, F. (2023). Immune and endocrine regulation in endometriosis: what we know. Journal of Endometriosis and Uterine Disorders, 4, 100049. https://doi.org/10.1016/j.jeud.2023.100049