Endometriosis: What you NEED to know.

Could you be living with endometriosis and not know? The probability is worth being considered as 1 in 10 women are sufferers (1). Endometriosis can take up to 10 years before it is diagnosed, and sometimes longer. This is due to women believing their pain is normal, or for medical professionals telling them their pain is normal. It is NOT normal, and leaves certain woman suffering for numerous years without care or management. A lot of awareness is coming to light nowadays, and I'm glad to see so many worthy articles circulating. Some women I have spoken to with endometriosis, appear to be vague in regards to knowledge, treatment and management of the condition. Education is valuable in taking steps forward to improving your health, and taking control of your current situation. If you are a sufferer, then you know how it can affect your daily life in unpleasant ways. So here’s an overview on endometriosis, and ways to work through it in order to improve your quality of life.

What it is: Tissue within the womb are known as endometrium. This grows during the menstrual cycle, and is shed when there is no pregnancy, as menstruation. Endometriosis is a condition where similar endometrium is growing in other parts within the body, including female reproductive organs. Behaving in the same manner in response to estrogen, it follows a similar cycle yet has no where to shed and is trapped within the body. Endometriosis is known as an inflammatory condition. It can occur at any age starting from menses, and with a possible reduction in symptoms with menopause (2). Symptoms: Pain is common and can vary from extreme to no pain at all, which is known as silent endometriosis. Having no symptoms does not mean that you no longer have the condition. Furthermore, endometriosis can lead to other conditions and symptoms within the body. Due to its inflammatory nature, it can affect hormones, sleep, energy levels, mood, bowel movements, ovulation pain, and pain during intercourse. It can cause muscular and skeletal pain, joint pain, IBS, and UTI’s. The upside is that endometriosis can be managed and one can live symptom free with proper management. Diagnosing: This can only be done through surgical intervention. Yet surgical intervention will not cure endometriosis. It can only be managed with the correct care. Blood tests and scans can not diagnose endometriosis. The only way to diagnose is via a laparoscopy / laparotomy, followed by a biopsy (3). For this to be performed correctly, the surgery needs to be done by a well advanced surgeon who specializes in excision of endometriosis.

The cure: There is no cure for endometriosis. Even if you no longer express the symptoms, you still have the condition. It can be a manageable condition but not curable. It should be noted that the extent of the symptoms do not express the severity of the condition. You can live pain free and still have endometriosis. Although commonly prescribed, the oral contraceptive pill is not the answer. It can mask it, so when a woman comes off the oral contraceptive pill in an attempt to fall pregnant she faces infertility struggles and a chronic condition to treat (4). Please think twice and seek the advice of well informed practitioners before getting a hysterectomy. I recently spoke to a woman who was advised to do this. Yet what no one explained to her is that a hysterectomy - removing ones uterus- is not a cure for endometriosis. Endometriosis can be anywhere in the body. Places it expresses itself include the bowel area, joints, and even around the heart. Just to name a few places. It is not only in the uterus. The following was stated by Dr Jason Abbott, Medical Director at Endometriosis Australia and Professor of gynaecological surgery at UNSW:

“Women with endometriosis, by definition, have disease outside the uterus with these areas of inflamed tissue being the cause of pain and/or infertility. Hence, the uterus in women with endometriosis is often normal. Having a hysterectomy (removal of the uterus and/or cervix) without removal of the additional endometriosis will cause ongoing symptoms in a woman with pain. So, hysterectomy is not a cure for endometriosis but it is beneficial that endometriosis is removed” (5). Infertility & pregnancy:

There is a misconception around believing that having children will cure endometriosis, this is not true (4). What is true, is that a full term pregnancy can decrease the risk of having endometriosis. Also, during pregnancy and after pregnancy, hormonal changes occur naturally within the mothers’ body. These changes may improve the symptoms of endometriosis but only temporarily. Therefore, having a baby is not an ideal treatment option for endometriosis sufferers.

While some women with endometriosis find it difficult to fall pregnant, others have had no issues at all.

Genetics: There seems to be a genetic link with endometriosis in families (2). It presents itself as an autoimmune condition due to its inflammatory nature. This is not to say that it is an autoimmune condition. More research is being conducted in this area. Estrogen misconception: Having excess estrogen will not cause endometriosis. Yet the condition itself is driven by estrogen (4). This could be estrogen's from the environment, drugs, body fat, food, plastics, hormones, or circulating estrogen's that are within the body. Management: Once correctly diagnosed, a multi disciplinary approach should be implemented for successful management. This should include proper nutrition, lifestyle changes, possibly counseling, herbal medicine, acupuncture, exercise, pain management, and supplements. Ideally seek a well informed Naturopath to manage the treatment plan, and dispense practitioner quality herbs and supplements.

Nutrition & Supplements: 1. An antioxidant rich diet will address oxidation within the body occurring as a result of the inflammation. Include more fresh fruits and vegetables, preferably organic when possible. Vitamin C rich foods such as guava, pineapple and oranges are a great source of antioxidants. Vitamin A rich foods such as carrots, and broccoli are also beneficial (3).

2. Wash your fresh produce well to remove the residue of chemicals and pesticides. These are hormonal disruptors.

3. Increase intake of omega-3 fatty acids for their anti-inflammatory benefits, pain management, and positive affects on the hormonal system (2). Omega-3 fatty acids also assist with mood and brain function.

4. Supplementing with the anti-inflammatory N-Acetyl Cysteine assists pain reduction. Studies have shown this to be an optimally functioning supplement for endometriosis sufferers (6).

5. Include foods from the brassica family of vegetables, such as cabbage, cauliflower, and brussel sprouts. They have an ability to assist in the clearance of estrogen's not required from the body.

6. Turmeric is another great anti-inflammatory. It has also been shown to reduce the size of endometriosis lesions, and it's activity (6). Turmeric is also a beneficial liver herb, and assists the liver with hormonal clearance (2).

7. Exclusion of red meat, processed meats, caffeine, sugar, deep fried foods, saturated fats, smoking cigarettes and alcohol. These increase inflammation in the body. Alternatively include more ginger, nuts, seeds, and cold pressed oils.

8. Fibre eliminates excess estrogen via the bowels by binding to it. Increase fibre intake from sources such as oats, chia seeds, brown rice, avocados, berries, psyllium husk, lentils and legumes.

9. Excluding soy as it may aggravate estrogen receptor sites (3). Many products contain hidden soy ingredients such as energy bars, muesli bars, packaged foods, and processed meats.

10. Studies have shown that the microflora can be disrupted in inflammatory conditions as in endometriosis. Lactobacilli probiotics have shown to improve such situations (7).

11. Supplementing with Zinc as it has been found that most endometriosis sufferers are low in Zinc levels. It will also help reduce pain and prostaglandins (6).

12. Avoidance of dairy, gluten, and eggs. These foods disrupt immune function. They may also release inflammatory cytokines (6).

Other Considerations: 1. The use of custom made herbal formulas and supplements will dramatically drive the management of endometriosis. Seek the advice of an experienced naturopath for such prescriptions.

2. Avoid the use of tampons due to the synthetics, fragrances, and hormonal disrupting chemicals they contain. The use of pure cotton sanitary pads is recommended.

3. Meditation has such a calming effect on the entire system. It is effective in pain management, improving quality of sleep, regaining a sense of inner peace, and releases happy hormones throughout the body making it a natural medicine wonder.

4. Allow yourself to explore, ask, investigate, and not stop until you are satisfied with the answers. I know women who were told that their pain is “normal” by their health care professionals, and so accepted it as a part of who they are in a women’s body for 20 years on. It is not normal. It is an indication of an imbalance that should be addressed. This applies to all menstrual conditions. Proper management improves quality of life. I believe in the power of nature and the innate intelligence within our bodies that has an ability to manage, treat, resolve, and transform. It takes a change in perspective, lifestyle alterations, and compliancy to a professionally tailored treatment plan. Stay informed, empowered, and in control. If you don’t feel quite right, ask a health professional you trust to go deeper into that with you. Be selective, you don’t want to see a health professional who will be quick to prescribe or quick to dismiss your situation. Most importantly, spread the awareness! A possible 10 year time frame for a diagnosis is way too long. With the correct knowledge, women will be able to detect signs and symptoms and seek professional advice earlier. Most importantly, don't take "your pain is normal" as an answer.

Dianna Bedran

Naturopathic Practitioner

Women's Health & Hormones

Health & Wellness Writer

References 1. Endometriosis Australia (2016). Endometriosis Research. Retrieved from https://www.endometriosisaustralia.org/research.

2. Trickey, R. (2011). Women, Hormones, & the Menstrual Cycle. Melbourne, Australia: Holistic Health Group, p. 250, 253, 260, 261.

3. Hechtman, L. (2012). Clinical Naturopathic Medicine. Sydney, Australia: Churchill Livingstone Elsevier, p. 816-817, 820. 4. Orr, A., (2017). The Facts About Period Pain & Endometriosis- “What Women Need To Know”. Retrieved from http://drandreworr.com.au/the-facts-about-period-pain-endometriosis-what-women-need-to-know/ 5. Price, L. (2018). Here’s What You Need To Know About Hysterectomies As An Endo ‘Cure’. Retrieved from https://www.pedestrian.tv/health/lena-denham-hysterectomy-endometriosis-australia/ 6. Briden, L., (2016). Endometriosis: 5 Natural Treatments That Really Work. Retrieved from http://www.larabriden.com/endometriosis-natural-treatments-really-work/

7. Bailey, M.T., and Coe, C.L. (2002). Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction Journal 17(7):1704-8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/120938272.

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