Over the years, I am seeing more and more women who have been told they have endometriosis at younger and younger ages.  Endometriosis occurs when uterine tissue basically grows where it shouldn’t be. It can be anywhere outside of the uterus in the pelvic cavity attached to other organs and I have even heard of cases on the skin.

Symptoms can range from painful cramps in the pelvic area that can occur anytime during the cycle but more commonly around ovulation and menses.  Heavier cycles, spotting, significant bloating, pain during intercourse and chronic pelvic pain may occur.  If you have these symptoms, it does not mean you have endometriosis it is just something that needs to be considered.  Unfortunately, there is not a quick blood test we can do to diagnose this which is one of the reasons it is often missed until symptoms are bad enough to go in and do a surgical exploration.

While some cases require surgical removal of the tissue, I want to give you some tips on how to hopefully slow down the progression or even better help improve not only the symptoms but the underlying cause.

First, you need to understand that endometriosis is fed hormonally so anything that raises hormones or can act like an estrogen will stimulate growth.  Some people are genetically predisposed and when doing gene testing, they will show difficulty handling their estrogen!

With that understanding, let’s look at 6 key areas to consider and address…. READ ON…

*if you have not been diagnosed with endometriosis but still have a lot of similar symptoms then it won’t hurt to look at all these areas while you are working with your ob/gyn on a diagnosis

  1. Hormone balance. When I see someone who has endometriosis, I know they are estrogen dominant almost always.  However, testing your hormones will help you see how much of this is due to the estrogen/progesterone imbalance.  Typically, when I measure hormones, I typically look at one lab test on a specific day in your cycle but with endometriosis I want two different dates of measurements of estradiol and progesterone.  The first test is on day 7-10 and the second test about 7 days prior to your next cycle.  You calculate when to test by looking at the typical length of your cycle.  Day one is the day you start your period.  If you have a 28 day cycle, your first hormone test will be around day 8 and your second test would be day 21.  If your cycle is 31 days then you would do the labs on day 10 and again on day 24.  On the first lab test, I am looking at just the estrogen level as progesterone should be very low.  The second test we focus more on the amount of progesterone relative to how much estrogen you have at this point.  The higher the estrogen and the lower the progesterone both point to a hormone imbalance.  Marked increases in estrogen levels on either test will be important to address.
  • If you are on birth control, then hormone testing will not be accurate so skip this step. You would need to be off for 3-6 months to get accurate readings so don’t just stop your birth control thinking you can test in a few weeks.
    1. Treatment options are geared toward restoring the hormone balance
      1. Progesterone: in mild to moderate cases, boosting progesterone will help. Depending on your levels, we often dose progesterone only in the latter half of your cycle.
      2. Hormone suppression options: Birth control results in a reduction of estrogen. In severe cases, stronger medications may be offered all geared toward decreasing the estrogen dominance and should be considered.
  • Natural products that may help in addition to hormones and hormone suppression include products that target both the higher estrogen and lower progesterone. Estrogen byproducts will recycle rather than being deposited in our trash cans so products that help tag the estrogen for the trash may help and include DIM, I3C, calcium D-glucarate, inositol and ECGC (green tea extract). Chaste tree vitex will naturally help boost progesterone.  You can layer in inositol with the Dim/I3C and chaste tree if symptoms are significant.  Inositol is a great product that also has a really nice calming effect so should be taken at bedtime.  Ovarian care by Thorne is an example.  An example of a product containing DIM coupled with Chaste tree , calcium D glucarate and ECGC include Femquil by Xymogen.
  1. The saying you are what you eat applies here, too.  Foods higher in hormones can feed endometriosis.  Dairy and red meat would be two examples so reducing these may help.  However, high inflammatory foods will also create a response that may aggravate endometriosis.  Figuring out which foods are inflammatory for you are key.  Often gluten and sugar are culprits but if you have any of the following symptoms you may have a food sensitivity:  swelling in the hands especially when you wake up or by the end of the day, feet are tender when you take your first step in the morning, headaches, any type of gut issues especially IBS plus many other symptoms. Work on eliminating those foods and notice how all of those symptoms respond.  Don’t focus on the endometriosis part when doing a food elimination because these foods will need to be removed for at least 6 months before noticing improvement.  There are several good diets available to follow that will help you do this.  In general, a healthy eating program like a Mediterranean diet is important and eliminating as much processed foods as possible helps.  The Virgin diet by JJ Virgin is a simple elimination diet or you can go hard core and do the AIP (autoimmune protocol) diet which is an anti-inflammatory diet.  If you know you have some food issues then consider food sensitivity testing like the ALCAT.
  2. Fat cells are full of estrogen.  If you have any excess weight, you are providing a constant supply of estrogen. In addition, fat cells are inflammatory adding another layer of issues.  Making the necessary diet changes and adding exercise will all help you lose the weight therefore decreasing the volume of circulating estrogens in your body.  All of this potentially decreasing some of the driving forces for endometriosis.
  3. Immune activation. You may see some articles that say endometriosis is an autoimmune condition.  I don’t often see an elevated ANA (autoimmune test) with just endometriosis but even without a positive test, I do think an activated immune response is a culprit so evaluating things that can trigger the immune system become important.
    1. Like I already mentioned above this really is very important to address.  When I see a low autoimmune titer (ANA), I always start with food sensitivities first and will often see this test go from positive to negative just with eliminating the food triggers.
    2. I know, you didn’t see this one coming.  There are many different types of mold toxins but one in particular will act like an estrogen.  If you have had any exposure to water damage in your home or office regardless of how long ago (exposures that occurred years ago may still be a problem) then this needs to be addressed.  My favorite mold test is a urine test by Real Time Labs.  Any mold toxin that turns up on testing needs to be addressed but when I am looking for estrogen fed issues, I pay close attention to the Zearalenone toxin.  You can address this by making sure you aren’t actively living/working in a moldy environment and a binder protocol specific for the types of mold toxins found on your test.
    3. Yeast lives in our gut but when it starts to overgrow it can create many issues.  Perhaps this is one reason limiting sugar helps decrease the symptoms associated with endometriosis.  The ultimate goal is to decrease the yeast burden.  Limiting sugar, healing the gut microbiome and doing yeast/candida cleanses may all help.  I find in most cases, prescription anti-fungal medication (fluconazole) for several weeks followed by an herbal product containing ingredients like olive leaf extract, curcumin, garlic, oregano or caprylic acid will help decrease the yeast burden.  The more herbal ingredients together the better!  Examples include Yeast Cleanse by VitruviaMD or Candibactin BR by Metagenics.  Often yeast treatment needs to continue for many months.  I test for candida antibodies and will keep pulsing in the treatment until these are gone.  If you test for these antibodies and they are negative you can still have yeast and doing a 6-8 week protocol may still be useful.
  4. Stress is the culprit for so many ailments and can be a part of endometriosis, also.  Cortisol is a hormone that stimulates so many hormonally driven pathways so it just makes sense that the higher the cortisol the more issues you may have. Chronic pain associated with endometriosis is a trigger for higher cortisol, too.   Lifestyle changes to help mediate stress are always important and can make a dramatic difference in the severity of symptoms. Stress reduction techniques that have been shown to help with quality of life and improvement of pain associated with endometriosis includes yoga, meditation, acupuncture and cognitive behavioral therapy.  We all need stress reduction so don’t forget how important this is and start building your stress toolbox.
  5. A xenoestrogen is anything that acts like an estrogen and is known as an endocrine disruptor.  Environmental exposures are often overlooked.  While you can go down a huge rabbit hole in this category key culprits include:
    1. Plastics: Storing your food in glass containers, avoiding microwaving your food in plastic containers and drinking out of glass or stainless steel containers are simple ways to cut down on xenoestrogens.
    2. Heavy metals. Examples that may act like an estrogen include cadmium found in cigarette smoke and mercury found in your teeth filling and certain fish.   Heavy metals are found in more than smoke, fillings and fish though so paying attention to your environmental exposures are part of the equation.
    3. Pesticides
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Keep in mind that once endometriosis starts you should address ALL of these areas for optimal improvement.  The hormone piece is very important and the other areas just contribute and add insult to injury.  Consistency is key as it may take months or more to see progress.

To your health,

 

Laura