Endometriosis is an oestrogen dependent gynaecological issue that causes pain in the pelvic and abdominal region which affects an estimated 1 in 10 women.
Scroll to the bottom for the 3 secrets to reducing pain from endometriosis.
What parts of the body are affected?
Endometriosis is characterised by endometrial-like cells found throughout the reproductive system and, in some cases, other organs in the upper portion of the body.
The endometrial cells attaches itself primarily to the rectovaginal septum, ovaries, and pelvic peritoneum.
The consequence of endometrial cells sticking to these parts are the binding of organs and pain.
Here are some images of where these parts are located.
Pelvic peritoneum is a sac which encloses the organs in your pelvic region and is part of a larger encasement that extends all the way up to your chest. Its purpose is to support and give some protestion to the encased organs.
Here's a brief look at where the peritoneum is located in a diagram of a person cut in half. Around the bottom of the image where you can see the 'claw' is the pelvic peritoneum.
Endometrial cells attach to the ovaries which can contribute to its adhesion to the surrounding organs.
This is another diagram of a person cut in half. You can see here that the uterus has bound itself to the large intestine.
In rare cases, endometrial cells can also attach to your diaphragm, pleura (the outer layer of your lungs), and pericardium (a membrane which surrounds the heart).
The diaphragm helps push your lungs up to help you breathe. The pleura encases the lungs and cells from the uterus binding there can cause scarring in rare cases which can affect your breathing.
What's the cause?
The most common cause of endometrial-like cells being implanted in unwanted areas of the reproductive system happens mainly from retrograde menstruation.
Retrograde menstruation is when the womb lining (endometrium) does not leave the vagina but flows backwards.
The menstruation contents make their way through the fallopian tubes and into the abdomen. As a result, the cells do not leave the body as a period, instead, they embed on other areas of the reproductive system.
Women affected by endometriosis may have immune dysfunction which interrupts the clearing of the lesions caused by retrograde menstruation. Women who have normal functioning immune systems with retrograde menstruation won't experience the symptoms of endometriosis.
The outcome of retrograde menstruation in endometrial patients is inflammation in your pelvic and abdominal area which leads to the formation of endometrial scars or adhesions.
Your body makes a substance called peritoneal fluid. Peritoneal fluid is liquid made in the cavity of the abdomen which lubricates the surface of organs in the abdomen to allow for the movement with minimal friction.
Endometriosis causes a higher number of white blood cells to take up residence in your peritoneal fluid which causes a hyper-response contributing to excessive amounts of scar tissue
Knowing the causes are genetic and are aggravated by dietary and lifestyle factors, you can take actionable steps to reducing your risk factors. Unfortunately, you can never get rid of or cure endometriosis, but you can reduce the agony it causes.
What aggravates endometriosis?
You can take steps now to reduce the severity of endometriosis by:
- not smoking
- cutting out high carbohydrate foods
- eliminating alcohol and coffee
- having less red meat through the week and
- reducing your stress levels
Numerous people are told they can't have a biological family of their own, perhaps you have been told this devastating news. Fortunately, that isn't the ful story. There are valid reasons why you can still fall preganant
Enhanced immune response
As discussed before, the peritoneal fluid in endometriosis contains a higher amount of white blood cells,
It's suggested that this peritoneal fluid can lead to the killing of sperm through the action of the enhanced immune response by entrance through the fallopian tube.
In your white blood cells, there are different components. Part of the reason for the mass killing of sperm is due to macrophages.
Below is an image of a macrophage killing a pathogen in different stages. Sperm is considered a pathogen as it is recognised as a foreign substance.
Endometriosis has the potential to extend to the ovaries. If this ever happens to you, the ovaries can form cysts called endometriomas.
The most effective surgical option for cysts in the ovaries is still uncertain and recent literature has recognised that any type of additional surgery could cause additional damage to the already compromised ovarian function.
Ovarian endometriosis can cause a decline in fertility, but the quanitity of your ovarian reserve can be counted.
The two most common approaches are measuring the amount of follicle stimulating hormone on day three of your cycle and counting the number of antral ovarian follicles by ultrasound.
Fallopian tube constriction
Structurally, your fallopian tubes can close shut from the scar tissue formation. This can be reversed by surgery. You can see what this looks like below.
All these confounding factors still do not mean you cannot fall pregnant.
The immune response to sperm may not rid of all of them, endometriomas does not mean your eggs are completely wiped out and the constricted structure of the follopian tube does not mean your eggs won't make it to your uterus.
It's still very possible for you to fall pregnant.
Signs and symptoms of endometriosis
Endometriosis symptoms and signs can be glazed over by many as PMS. Have a read below to see if you think you fit into the signs and symptoms of endometriosis.
One of the distinguishing symptoms to look out for is pelvic pain and abdominal pain. You might already experience this, but look out for a gradual increase in pain over the months.
Sex can be painful for you, this is termed dyspareunia
Your bowel movements and urination may cause pain around the time of your period.
You might be going through abnormal bleeding cycles. Some women have experienced going through erratic bleeds which last from anywhere between 4 to 28 days.
Very heavy bleeding can be another trait with some women wearing jumbo size tampons plus pads and still change them 5 times per day.
How is endometriosis diagnosed?
Endometriosis cannot be diagnosed based on the presenting symptoms you have.
Your doctor will check to see if you have the above signs and symptoms discussed above.
Once the signs and symptoms of endometrioses have been established, your doctor may perform a pelvic exam. The purpose of the pelvic exam is to feel for a tender nodule, or a tilted or retroverted uterus.
Your doctor may suspect endometriosis based on the findings, but no diagnosis is made from the exam.
Surgery is needed for diagnosis of endometriosis. Laparoscopy is the preferred procedure which allows viewing of the pelvic organs.
This procedure won't leave a huge scar on your abdomen. It involves a small incision beside the belly button where a thin camera is inserted.
From this position, the camera is able to view the surface of the uterus, fallopian tubes, ovaries and other pelvic organs.
There is a lot of information that can be gathered from the laparoscopy.
The surgeon can view the extent of the endometriosis. The extent of the endometriosis is then staged depending upon the adhesions and endometriomas.
The below image shows the four stages of endometriosis.
The surgeon can then choose to treat the endometriosis by methods like removing scar tissue or vaporising it.
Your fallopian tubes can close from scar tissue so the surgeon can take this opportunity to inject a dye through the cervix into the uterus to determine if your fallopian tubes need re-opening.
What is the doctors treatment for endometriosis?
Hormonal treatment for endometriosis
Gonadotropin-releasing hormone (GnRH) agonists
There is an initial surge of GnRH then a deep suppression of GnRH after the surge has passed.
The purpose of this drug is to trigger the deep suppression of GnRH resulting in the body entering into a state of pseudo-menopause.
The pseudo-menopause state results in the absence of follicular growth, ovulation which means very low circulating oestrogen levels. This action relieves the symptoms of endometriosis but does not cure it.
However, you have to keep in mind that seeing that this is a pseudo-menopausal state you might experience the signs and symptoms of menopause like hot flushes, vaginal dryness, bone loss, headaches and so on.
Here is a more detailed look at GnRH drugs
Progestins are used for the relief of pain. They work by it anti-gonadotropic effect which means it inhibits ovarian function and creates a hypo-oestrogenic environment.
It has another two actions which include acting directly on progesterone receptors located on the lesions which then induces its breakdown, and also by reducing peritoneal inflammation.
Here is a more detailed look at some progestins.
Danazol is a synthetic androgen (so-called male hormone). It works by breaking down scar tissue formed from endometriosis and also works by having an anti-gonadotropic affect.
Here is some more information about danazol
Non-hormonal treatment for endometriosis
Non-steroidal anti-inflammatory drugs (NSAID)
These are drugs which have anti-inflammatory effects. The anti-inflammatory effects reduce endometriosis pain.
Here is some more information on NSAIDS.
You may or may not have realised, but all of the treatment through hormonal therapy suppresses ovarian function.
What does this mean?...
This means that you will experience reduced pain as a trade-off for your fertility.
Ovulation is suppressed with all the current pharmacological treatments available. For this reason, it’s best to discuss your questions about conception with your doctor to find the best course of action for you.
Surgical options for endometriosis?
Surgical therapy to relieve the pain can be initiated either after treatment with pharmaceuticals hasn’t proven effective or if it is needed right away.
Surgical options include excision, fulguration, laser ablation of endometrial tissue on the peritoneum, excision or drainage of the endometriomas, resection of the rectovaginal nodules or interrupting nerve pathways.
What impact does endometriosis have on your quality of life?
Endometriosis can affect your quality of life physically, emotionally, and socially during the most productive years of your life.
Chronic pelvic pain was the symptom which caused the most problems for people.
Pelvic pain can be chronic which affects sufferers in every aspect of their life like moving, eating or sleeping.
Endometriosis pain will affect you differently to another woman.
It’s important to know what stage you are at and how what steps you can take to improve your life.
If you think you have endometriosis but are unsure, go to your doctor for a diagnosis.
Delaying the diagnosis of the condition means it can only get worse resulting in a steady decline in your quality of life.
There are options out there which can improve your quality of life if you are living with endometriosis.
Recognising this disease early will allow for earlier dietary, lifestyle and pharmaceutical management which can slow the progression.
Surgery can relieve painful periods, painful intercourse, pelvic pain and menstrual pain. Laparoscopy is proven to be the preferred method.
3 secrets to reduce pain from endometriosis
1. Decrease inflammation
2. Optimise oestrogen levels
3. Improve lifestyle choices
1. Decreasing inflammation
Inflammation is caused by almost everything around you, but there are some aspects which have a larger influence over others.
All inflammation is not bad.
I don't blame you for being a little confused. There's a lot of things out there being sold as anti-inflammatory which makes you subconsciously think inflammation is the bane of your life.
To clear up any confusion I'll tell you right now why inflammation is needed.
'Normal inflammation' is needed for some functions like:
- functioning of your immune system (you could literally die if your immune system was compromised);
- aids in the delivery of nutrients and oxygen around the body;
- cells and molecules are restored; and
- can increase the temperature of the body to fight infection
"So what's causing my increased inflammatory levels?", you ask...
It's the food you eat, the environment you're in, the stress that is caused by endometriosis which makes you stuck in a cycle of stress.
Foods to decrease or avoid:
- Refined sugars (soft drink, lollies, excess juice, refined grains)
- Oils with high omega 6 content (sunflower, soy, margarine, corn oil and so on)
- Trans fats (deep fried everything, shelf stable cream biscuits, margarine, hydrogenated oils)
- Excess red meat (found to aggravate endometriosis)
- Majority of refined foods
Foods to increase in your diet:
- fruits and vegetables in season
- activated seed and nuts
- beans and lentils
- meat in moderation
Eating the right foods, in opinion is better than searching for those natural remedies for endometriosis. It's about laying the foundation first. You can't expect to progress by taking a natural remedies and staying consistent with the aggravating factors of your condition.
Vitamin E was found to improve the symptoms of everyday pain, pain during their periods and pain during sex.
Vitamin E is found in a variety of quality foods like:
- dark green leafy vegetables
- olive oil
- kiwi fruit
2. Optimise oestrogen levels
Eating more plant-based foods for phyto-oestrogens is a good approach to reducing some symptoms. Phyto-oestrogens mimic the effects of your body's oestrogens and toxic external oestrogens from things like plastic.
It mimics the effects by binding to the same places those oestrogens would if they had a chance. Phyto-oestrogens are less powerful so the effects on endometriosis won't be as great.
You will find phyto-oestrogens in foods like:
- chick peas
- sesame seeds
I mentioned plastics before, and yes they do negatively influence your condition. These are called xeno-oestrogens and are completely foreign to the body.
Xeno-oestrogens are found in items like:
- plastic bottles (replace with glass)
- plastic storage containers (more is released when you heat up food in plastic containers)
- generic shampoos
- generic hand wash
- generic soap
There are many natural products you can choose from nowadays when it comes to your shampoo, hand wash or soap alternatives so I won't list any here.
There are foods you can eat which promote the excretion of excess oestrogens through the liver, sweat, urination and your lungs.
The foods are from the cruciferous family and contain a compound called indole-3-carbinol which drives the oestrogen clearance.
- brussel sprouts
- bok choy
3. Improve lifestyle choices
Some evidence has come out suggesting that vitamin D could be very helpful in endometriosis. It suggests that vitamin D could help balance the immune system and act as an anti-inflammatory.
This means go outside for 5-10 minutes on a sunny day or take a quality vitamin D supplement.
Exercising might not be an option for you depending on what stage you are at with your endometriosis. This is the last thing to consider if the pain you're going through is debilitating.
You will want to modify what you can in your life with the knowledge provided then tackle exercise if you can.
Exercise has a protective effect on against disease which involves inflammatory processes. It has the additional benefit of clearing oestrogen too.
There is no solid evidence that endometriosis is positively impacted by exercise but it is worth incorporating into your life once you can, not only for your endometriosis but also for general heath and well-being.
What's your experience with endometriosis?