Endometriosis

Endometriosis is a very common gynaecological condition which can affect up to 15 percent of all women. Half of all women with endometriosis will have fertility issues. After fibroids, endometriosis is the most common gynaecological problem. While Irish figures are not available, the National Endometriosis Society in the UK estimates that between 1.5 and 2 million women in Britain have endometriosis. Endometriosis is more common in childless women over the age of 30.

What is endometriosis?

Endometriosis is a condition in which the lining of the womb (the endometrium) implants and grows outside the womb itself. These endometrial implants can grow in the pelvis, fallopian tubes, ovaries, bowel and bladder. More uncommonly, they can also crop up in the lung, heart, eye, armpit or knee.

Wherever it grows, the womb lining responds to the natural hormone cycle and bleeds every time a period occurs. When women bleed normally throughout menstruation, blood leaves the body through the vagina. However, in the case of endometriosis, the blood has no outlet and becomes trapped in the tissue, causing pain, inflammation, cysts and scar tissue. You may find blood in your stools or urine during your period, or experience pain in diverse areas of your body. Some of my patients experience nosebleeds during their periods because they have endometrial patches in the nasal passages.

What are the symptoms?

The symptoms vary between women. In some women, endometriosis can cause extremely painful periods and painful sex, but some women experience no symptoms whatsoever.

Symptoms can occur at any time of the month – during a bowel movement, or when urinating, for example. The most severe pain can start between five and seven days before a period and last for two to three days during the period itself. Painful sex (called dyspareunia) is a feature of the condition in up to 59 percent of all women with endometriosis, and acts as a keynote symptom – something that alerts doctors to a possible diagnosis.

Symptoms often improve dramatically after pregnancy, and it is believed that having a break from the monthly cycle actually ‘quietens down’ the disease in some sufferers.

Women have talked about how the endometriosis takes over their lives. Holidays are planned to avoid periods and social arrangements are cancelled at the last minute when the pain becomes intense. Many women are forced to take days off work each month in order to cope with the condition and some women have had to give up work because their employers cannot cope with their frequent absences.

Common symptoms

• painful periods (dysmenorrhoea)
• heavy or irregular periods
• painful sex (dyspareunia)
• back pain
• nausea
• fatigue
• gastrointestinal problems including diarrhoea, bloating and painful defecation
• infertility
• general pain in the pelvic area

The B vitamins

The B vitamins are particularly important for endometriosis sufferers for a number of reasons. First and foremost, they are needed by the liver to convert excess oestrogen into weaker and less dangerous forms. One of the B vitamins, B6, has been shown to significantly reduce the intensity and duration of period pains, which will help many sufferers.

The B vitamins, along with zinc, are also crucial for the conversion of essential fatty acids into beneficial prostaglandins (hormone-like substances that have a relaxing effect on the womb muscles and anti-inflammatory properties). Essential fatty acids (EFAs) are found in oily fish, nuts and seeds. The B vitamins are required to convert these essential fats into a form that can be used by the body to produce a ‘good’ type of prostaglandins. Without this conversion, your body will produce more of the ‘bad’ prostaglandins, which can increase period pains and set up inflammation from the endometrial patches.

B vitamins are found in a diverse range of foods but include wholegrains, pulses and leafy green.  B6 is found in cauliflower, cabbage, peppers, bananas, squash, broccoli, asparagus, lentils, kidney beans, onions, nuts and seeds.

Vitamin E

This is an important vitamin in endometriosis which has been shown to relieve menstrual cramps in 70 percent of women within two menstrual cycles.  Dietary sources include avocado, salmon, sardines, sweet potato, almonds, cashew nuts, sunflower seeds, olives and olive oil.

Magnesium

Magnesium acts as a muscle relaxant and has been shown to have a beneficial effect on painful periods and lower back pain. In addition to food, it can be taken as a supplement and can also be used on the skin which is a good way to absorb magnesium.  It is available as lotions or sprays or you can have a relaxing Epsom salt bath.

Approximately 60% of patients tested in our clinic are deficient in magnesium.  It is necessary to test the magnesium in your red cells (blood test) as a more accurate way of determining deficiency.  Read our paper here on how and why to test magnesium and its important role in pregnancy.

Omega-3

Omega-3 is one of the most powerful food source anti-inflammatory agents. A ‘Western Diet’ does not usually provide enough omega-3.  Eating at least two portions of oily fish per week is recommended.  If you do not eat fish, a supplement containing over 500mg of each of EPA and DHA is useful.

Many women attending our clinic have been taking evening primrose oil supplements, an omega-6 fatty acid, for years and have not been eating enough omega-3 oils, or taking them in supplement form, to counterbalance this. Some women are also taking combinations such as omega-3, -6, and -9 in supplement form because they have heard that we need a good balance of all the Omega fatty acids. This is true, but you have to take into account what your own levels may be in the first place. It is much more common that we already have high levels of omega-6 which is found in processed foods, ready meals but also other foods like meats, breads, spreads and anything that contains or is cooked in oil. While evening primrose oil can be useful for hormonally driven breast tenderness, omega-6 oils have the potential to produce pro-inflammatory signals and should be balanced with omega-3.

Liver Support

Your liver has the important job of removing excess oestrogens from your body.  You can support this function by including foods from the Brassica family such as cabbages, kale, broccoli and Brussel sprouts.  Give your liver a break by reducing or avoiding alcohol and caffeine. The are also a wide number of liver supporting supplements and apparent ‘detox’ protocols available online which include juices and severely restrictive diets.  Many of these protocols are not based in science and some could be considered dangerous. Liver supporting supplements and herbs can be quite potent in our experience so best to get personalised advice from your nutritionist.

Environmental oestrogen

One of the key ways to control excess oestrogen in your body is to avoid environmental oestrogens, also known as ‘xenoestrogens’. Researchers have found a connection between dioxins (a class of xenoestrogens from pesticides) and the development of endometriosis. Choose organic food where you can and opt for natural cosmetics and personal hygiene products if possible.

Exercise

Exercise is highly beneficial for endometriosis sufferers as it can help to alleviate period pains by increasing circulation to the pelvic region. Exercise can also reduce stress which can exacerbate the problem in some women. Finally, exercise releases brain chemicals called endorphins (the body’s natural painkillers) into the body and they also help us to feel happier, more alert and calmer.

Tests

Where to start?

Start making improvements to your diet as you can.  If you need further support or tailored advice, particularly in the area of liver support, it would be helpful to request an appointment with one of our qualified team.