Exploring Endometriosis

how to take back control of this painful, debilitating condition

If you are struggling with endometriosis, you are not alone. One in 10 women suffer from what can be a debilitating condition. It’s much more than just ‘bad period pain’! Endometriosis is a long-term, debilitating condition that means struggling with pain and other physical and emotional symptoms for up to two weeks out of every four, worrying about fertility, the potential side effects of taking regular painkillers, tissue invasion of the gut and bladder and its complications. 

NHS endometriosis clinics can be very distressing, with patients left feeling that there is no hope of relief, besides hysterectomy. It can feel really unfair, as if your body is deliberately  torturing you and ruining the quality of your life and your relationships… but there is hope!

Although we don’t know the exact mechanisms of why endometriosis affects some women, the root causes lie in inflammation (of our immune system and in our gut health) and hormonal balance. By working on these areas, using the innate mechanisms of the body to stimulate healing, and by listening to ancient traditional medical approaches, many women can find relief.

what is endometriosis?

Endometriosis is a condition where cells from the lining of the womb (endometrium) are found in other places in the body, most commonly in the pelvic area, bowel, bladder and ovaries. However, they have occasionally been found in the genital area, lungs, brain and skin too (this is rare). Usually, these cells are inside our womb, and they grow and are shed monthly as part of our menstrual period. However, if these cells are unable to grow and bleed out naturally, because they are growing outside of our womb, then they can present a number of symptoms and problems. 

Doctors still don’t understand what causes endometriosis and why some people do get it, while others don’t – it can affect all women of any race or ethnicity who have their period, from teenagers to the peri-menopausal. 

endometriosis symptoms and signs

Pre-diagnosis, many sufferers of endometriosis simply believe they are suffering from painful periods, which affect 85% of patients with endometriosis. Other symptoms include:

  • Pain during sex
  • Chronic pain
  • General pain and a feeling of ‘heaviness’ in the lower abdomen
  • Longer and heavier periods than usual, sometimes lasting for weeks
  • Pain and/ or bleeding during ovulation
  • Spotting or bleeding between periods
  • Constipation, diarrhoea, painful bowel movements or other gastrointestinal symptoms which may happen during your period, or be cyclical
  • Urinary symptoms, such as pain passing urine or blood in the urine – these are usually cyclical or occur during your period
  • Fatigue and tiredness
  • Feelings of depression and listlessness
  • Inability to conceive, if trying for a baby 

how do you diagnose endometriosis? 

Being diagnosed with endometriosis is quite often a process of elimination. It takes women an average of between 8-12 years1 to be diagnosed. This can be truly disheartening if you are only just beginning to suspect that you may have endometriosis, but because so many symptoms of the condition occur as a result of other causes too, these all have to be ruled out, which takes time and a lot of visits to the doctor. Keeping a symptom diary can be really useful, to help to enable your GP to consider endometriosis as the cause. 

 Some doctors will begin by doing a pelvic exam which may show pain or tenderness internally. Doctors may order a blood test to check for a protein called CA 125, which if raised over 35 IU/ml, can suggest inflammation or endometriosis. However, those raised levels could also indicate other conditions, such as ovarian cysts or a pelvic infection and a negative test does not rule out endometriosis. The most likely initial test will be an ultrasound scan, including transvaginal ultrasonography, which can rule out other causes of your symptoms but again may not pick up endometriosis lesions. 

The most accurate form of diagnosis is laparoscopy, where a camera is inserted into the pelvis and signs of endometriosis are shown to be present. This is done under general anaesthetic and a biopsy of the growth is often taken, which can be analysed to confirm the diagnosis.

 

how is endometriosis usually treated?

If endometriosis is found during the laparoscopy, surgeons will usually elect to remove any excess cells during the investigation. In some cases, full removal may not be possible, but the good news is that in 62.5% of cases, women who had laparoscopic surgery found their symptoms to be improved or resolved six months after treatment.2 

In more severe cases, a hysterectomy may be advised, but this will be fully discussed with you and only suggested when other treatment methods have not helped to improve things. 

Usually, following a laparoscopy, or as an attempt to resolve resorting to invasive surgery, a progesterone therapy, such as the contraceptive pill or Mirena coil may be advised to help regulate hormonal balance, to prevent or delay symptoms from returning. Unfortunately, many women gain little or only temporary relief from these treatments.3

other approaches to endometriosis

Endometriosis is a condition of chronic inflammation4 (pain, swelling and the abnormal growth of tissue) and a failure of our immune system5 to remove and heal the tissue. A logical part of your health journey is to work on reducing inflammation to support immune health for your reproductive system.

As 80% of our immune system is in our gut and your large intestine is right next to your womb, many women with endometriosis also experience digestive symptoms. We would strongly suggest working on your gut health & digestion. Constipation has a strong relationship with endometriosis and can cause increased pain during your period. Regular bowel movements are very important in the fight to reduce symptoms. There are many ways to help relieve the symptoms of constipation naturally. Consider resetting your gut with our refresh programme, to help balance out any nutritional deficiencies and reduce naturally occurring inflammation. 

Reducing oestrogen levels and increasing progesterone levels can be beneficial. Most doctors advise taking the contraceptive pill or using hormonal implants or coils after a laparoscopy, however, natural ways to stabilise your hormonal balance can also be helpful. Endometriosis is a condition driven by oestrogen, so it becomes extremely important to look at endocrine-disrupting chemicals found commonly in our environment.

It may be that your contraception contains too much synthetic oestrogen for your body to handle. It is also worth knowing that many household and personal care products contain chemicals that can disrupt your hormones and endocrines. Avoiding these can be a positive step to reducing symptoms. Stress and the long-term production of cortisol should also be considered one of the most important factors in stabilising hormonal balance, as stress can disrupt the sex hormone pathways. 

More recent medical research has shown that individual genetic variations, called SNP’s, can make it more difficult to regulate our hormones – COMT, CYP1A1, CYP1B1 and GST genes can all affect oestrogen balance. Simple mouth swab DNA tests for these cost around £100-£200, (we like Nordic VMS). If you have these gene variations, nutritional, diet and lifestyle measures can help you better manage your endometriosis symptoms and regulate your hormonal balance.

 

tcm & acupuncture

In traditional Chinese medicine (TCM), endometriosis is nearly always seen to be a condition of ‘blood stasis’ which is related to blocked circulation and pain. Chinese medicine uses herbs to promote circulation and to warm the body, when treating this condition. Jess finds these herbs very helpful in practice with her patients for both endometriosis and also for period pain (dysmenorrhea). 

Blood stasis in TCM is seen to be caused by many factors, including injury, long-term stress and trauma. Trauma and adverse childhood events (ACE’s), such as childhood abuse are both triggers that Jess has seen many times in practice and has also been shown in research6 to be a trigger for conditions in the pelvic area in women.   

Well-known herbs in Chinese blood stasis combinations include Dang Gui (Angelica sinensis), Hong Hua (Carthamus tinctorius, Safflower), Chi Shao (Paeonia lactiflora,peony) and Tao Ren (Prunus persica, peach kernel seed). There have been some small-scale studies to show that Chinese medicine can be helpful for endometriosis.7 

Acupuncture, electroacupuncture and moxibustion (warming the area of acupuncture points by burning herbs) have some trial evidence of benefit7 and many patients find these therapies useful. Home acupressure of the following acupuncture points (massaging them for 2 minutes) may bring some relief during symptoms: 

  • Spleen 10

  • Pericardium 6

  • Gallbladder 26

  • Spleen 12

  • Stomach 29

  • Triple Energiser 6

  • Liver 3 

  • Large Intestine 4 

  • Kidney 8 

 A western herbal approach to endometriosis includes herbs that are traditionally used to relieve cramping, including: 

  •     Crampbarks, Guelder Rose (Viburnum opulus) and
  •     Blackhaw (Viburnum prunifolium), and herbs that aid circulation, such as 
  •     Yarrow (Achillea millefolium), plus warming spices, such as
  •     Ginger (Zingiber officinale)

A herbal tincture of Viburnum and Achillea, with a small amount of ginger, is one that Jess has found helpful with many of her patients for helping during the period itself. Yarrow (Achillea millefolium) was shown in a clinical trial to significantly reduce period pain when drunk as a tea three times a day during the period.9  

Homoeopathic remedies include Mag phos 30c, which is used for cramping and can be taken hourly when needed. A double-blind, randomised controlled trial of 50 women with endometriosis showed significant improvement in pain with homoeopathic treatment.10 Treatment from a qualified homoeopath is recommended, your homoeopath will likely use female-centric remedies such as; Pulsatilla, Sepia, Lachesis and Folliculinum. To find a good homoeopath, click here.

natural supports for endometriosis

vitamin d supplement

nutrients

Omega 3  from S.M.A.S.H fish (Sardines, Mackerel, Anchovies, Salmon or Herring), or taken as a supplement of 1000mg daily. Omega 3 helps to activate anti-inflammatory pathways. Reducing consumption of Omega 6 can also improve inflammation in the body. 

Magnesium can often aid pain and muscle cramps, and has been shown to reduce period pain and also help bowels to stay regular.11

Methylated B vitamins can support healthy oestrogen metabolism. 

Spatone (a natural iron supplement). Iron deficiency is often seen in women suffering from endometriosis symptoms. If you are feeling weak and drained by your periods, it is worth having your GP check your iron levels with a blood test. Spatone is a gentle natural iron supplement that can be taken daily. (We prefer the apple flavoured one!)

Probiotics and prebiotic fibre. 80% of our immune system lives in our gut and inflammation is heavily influenced by our gut microbiome (the conditions in our gut). 

herbal supports

Shepherd’s purse  (Capsella bursa pastoris) tea or tincture – a gentle herb, used in traditional herbal folklore to reduce bleeding during periods and lessen discomfort. This is a commonly used herb, considered to be safe.

Yarrow (Achillea millefolium) traditionally aids circulation, anti-inflammatory and to lessen period pain. Drink three cups daily during your period. Floradix Salus House is a good brand of organic yarrow teabags.

Vitex agnus castus. This herb is traditionally used to help hormonal balance. It needs to be taken for several months, but can provide wonderful relief. 

Chinese Angelica (Angelica sinensis, Dong Gui). This is a well-known traditional Chinese women’s support, used for period problems and blood stasis. 

other

Natural progesterone cream. Endometriosis is a condition that is thought to be oestrogen-driven. Consider supporting healthy hormone balance with natural progesterone. (You may wish to work with a natural practitioner, with experience of using natural hormones.)

Stress management. Breathwork, meditation and mindfulness are all proven to reduce pain, following the traditional philosophies of blocked circulation. Exercise like yoga and Tai chi would also be a good choice, to help improve circulation and increase energy. 

To find a functional medicine practitioner who can support diet, nutrition, hormonal balance and gut health and help you consider further testing and genetic factors, click here. To find a registered Traditional Chinese herbalist, click here. To find a registered acupuncturist, click here.

q&a with dr jess 

You mentioned supplements like Omega 3 and magnesium, is there somewhere you recommend getting high-quality supplements?

There are many good brands including Cytoplan, we would encourage you to consider an ethical krill oil (like Healthspan or Cytoplan) as an excellent source of omega 3 or a fish oil-based omega 3, rather than plant-based. Magnesium citrate can help with constipation – Cytoplan do a good Biofood version, but for pain and cramping we have found people seem to benefit more from ionic Magnesium. Good State is a brand we like (ionic magnesium tastes bitter, so dilute with water or juice before drinking).

You mentioned probiotics and prebiotics, is there somewhere you recommend getting them?

Probiotics are beneficial bacterial cultures that we can take as powders, supplements or ideally in fermented foods (live cultures like yoghurts, sauerkraut and kimchi) to improve the balance of ‘good bacteria in the gut microbiome. 

Fermented foods have been consumed historically as a method of food preservation, but are also shown to contain many bacterial strains similar to probiotics. Many fermented foods, like kefir, contain higher live good bacterial loads than probiotic supplements. 

Probiotic supplements that we recommend are Natren Healthy Trinity and Klaire Labs Therbiotic Complete for general support. Visit our gut health & digestion Toolkit for more information.

Will endometriosis affect my ability to get pregnant? 

Although endometriosis can have an effect on your chances of getting pregnant, most women who have mild endometriosis are not infertile. The exact nature of the link between infertility and endometriosis is unclear, but the severity of the condition and location of the tissue appears to have an effect. For example, it is not fully known how a few spots of endometriosis may affect your chances of getting pregnant, but if you have severe endometriosis with lots of inflammation and scarring your fertility is likely to be affected. However, even with severe endometriosis, natural conception is possible.

Sex is painful, is it making endometriosis worse?

Pain during or after intercourse is one of the symptoms of endometriosis. Having sex shouldn’t make the condition worse – but it could increase your pain temporarily. 

Consider using a natural lubricant like Yes organic lubricant to help with any dryness (which can be worse with anxiety about pain) – their oil-based lubricant is excellent. Many women find avoiding sex just before and after your period is helpful.

What should I do if I think I have endometriosis?

Always seek advice from your GP, gynaecologist or medical provider in order to make sure endometriosis is the right diagnosis and to avoid complications. 

Once you have been diagnosed, the best approach will differ from person to person and it’s important to individualise treatment depending on various factors such as your history, age, symptoms and severity of endometriosis. To find a functional medicine practitioner who can support diet, nutrition, hormonal balance and gut health and help you consider further hormone testing, nutritional testing and genetic factors click here. 

To find an experienced and qualified Traditional Chinese Herbalist, Medical Herbalist or Acupuncturist click on the links 

references

  1. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis Br J Gen Pract. 2007;57(539):470-476.
  2. Endometriosis-uk.org: Event information / materials
  3. Becker CM, Gattrell WT, Gude K, Singh SS. Reevaluating response and failure of medical treatment of endometriosis: a systematic review Fertil Steril. 2017 Jul;108(1):125-136. doi: 10.1016/j.fertnstert.2017.05.004. PMID: 28668150; PMCID: PMC5494290.
  4. Mehedintu C, Plotogea MN, Ionescu S, Antonovici M. Endometriosis still a challenge J Med Life. 2014 Sep 15;7(3):349-57. Epub 2014 Sep 25. PMID: 25408753; PMCID: PMC4233437.
  5. Vallvé-Juanico J, Houshdaran S, Giudice LC. The endometrial immune environment of women with endometriosis Hum Reprod Update. 2019 Sep 11;25(5):564-591. doi: 10.1093/humupd/dmz018. PMID: 31424502; PMCID: PMC6737540
  6. Walling MK, Reiter RC, O’Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse Obstet Gynecol. 1994 Aug;84(2):193-9. PMID: 8041529.
  7. Flower A, Liu JP, Chen S, Lewith G, Little P. Chinese herbal medicine for endometriosis Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006568. doi: 10.1002/14651858.CD006568.pub2. Update in: Cochrane Database Syst Rev. 2012;5:CD006568. PMID: 19588398.
  8. Xi J, Cao XX, Gao YL, Cheng J, Xia YB. [Research progress on the mechanism of acupuncture and moxibustion in treatment of endometriosis] Zhen Ci Yan Jiu. 2019 Oct 25;44(10):772-6. Chinese. doi: 10.13702/j.1000-0607.190023. PMID: 31657170.
  9. Jenabi E, Fereidoony B. Effect of Achillea Millefolium on Relief of Primary Dysmenorrhea: A Double-Blind Randomized Clinical Trial. J Pediatr Adolesc Gynecol. 2015 Oct;28(5):402-4. doi: 10.1016/j.jpag.2014.12.008. Epub 2014 Dec 23. PMID: 26238568.
  10. Teixeira MZ, Podgaec S, Baracat EC. Potentized estrogen in homeopathic treatment of endometriosis-associated pelvic pain: A 24-week, randomized, double-blind, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:48-55. doi: 10.1016/j.ejogrb.2017.01.052. Epub 2017 Jan 25. PMID: 28187404.
  11. Guerrera MP, Volpe SL, Mao JJ..Therapeutic uses of magnesium Am Fam Physician. 2009 Jul 15;80(2):157-62. PMID: 19621856

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