Menstrual cramps are part of life for many women, but extreme, debilitating pain during the menstrual cycle and beyond can be a sign of an underlying condition called endometriosis. This condition has mystified doctors and deeply affected the lives of millions of women. There have been breakthroughs in the understanding of the mechanisms that drive this painful condition. Treatment options designed to target the underlying cause of this condition are helping women to reduce pain and improve fertility.
Endometriosis is a condition where uterine tissue flows in the wrong direction, up the fallopian tubes, and ends up in the abdominal cavity. That wayward tissue should be detected and destroyed by the immune system, and in fact, that process regularly occurs for many women. But for women with endometriosis, the immune system turns a blind eye to the uterine tissue that has gone astray. These small bits of uterine tissue can adhere to the bowel, the ovary, and other organs. They are sensitive to the same hormones as the regular uterine tissue, so they fill with fluid and blood, which is released during menstruation. The lesions can cause pain throughout the cycle, but when the fluid is released into the abdominal cavity, the pain can be debilitating.
The real question isn’t how come the uterine tissue flows backward, as that seems to be common. The question is, why doesn’t the immune system recognize and destroy the lesions; why are they left to grow unchecked? There is a complex interaction between the hormones and the immune system that is to blame for this problem. It turns out that for people with endometriosis, the immune cells that usually prevent us from attacking our own tissues are working overtime. These T-regulator cells tell the immune system to back off, causing the endometrial lesions to evade surveillance and destruction. But T-regulator cells are just taking instruction from certain immune-suppressing chemicals called cytokines. And those cytokines are influenced by a common hormone imbalance where there is too much estrogen and not enough progesterone. This “estrogen dominance” at the heart of endometriosis can be influenced by a number of genetic, lifestyle and environmental factors.
The other mechanism that drives the growth of endometrial lesions is the presence of naturally occurring chemicals that encourage growth of this specific type of tissue. People with endometriosis have more Vascular Endothelial Growth Factors (VEGT) in their abdominal cavity. VEGT stimulates the uterine cells to proliferate, helps the tissue to grow more blood vessels and ultimately makes the endometriosis lesions grow. People with endometriosis are also found to have more oxidative stress markers in their abdominal cavity as well as increased inflammation. These three factors create a favorable growth environment for the painful lesions.
Treatment is designed to reduce pain but also to try to reduce the size of the lesions or eliminate them. Some treatments provide immediate pain control while others try to address the underlying cause by balancing the hormones and promoting a proper immune response to the lesions. Surgery can be done through a minimally invasive procedure that basically zaps the lesions. While this treatment can provide some relief, I’ve seen patients who just keep developing more lesions. Hormone therapy should be aimed at correcting the estrogen dominance. Oral contraceptives contain estrogen, and while they can help to some degree, progesterone only pills and uterine implants are preferable. The later can help reduce the amount of blood build up in the lesions and reduce pain. However, they prevent ovulation and therefore pregnancy, which may not be suitable for a patient trying to have a family.
The naturopathic treatment strategy can be used alone or in combination with conventional medical approaches. It endeavors to address the mechanisms that drive endometriosis. Firstly, we target the immune dysfunction that allows the lesions to evade detection. Herbal medicine and antioxidant nutrients can target the hormonal imbalance, oxidative stress, immune imbalance and pro-inflammatory state that typifies this condition. Secondly, hormones and immune system are affected by the intestinal microbiome; the trillions of bacteria that live primarily in the intestine. Our diet influences the microbiome so naturopathic physicians encourage a diet that is low in sugar and refined flour and may give probiotics and other treatments to bolster the microbiome. Thirdly, healthy fats, like omega 3’s have been shown to help prevent and treat endometriosis lesions and reduce pain.
Finally, hormone balance plays a critical role in the naturopathic treatment of endometriosis. To balance the estrogen dominance typical of this condition, there are nutrients that help the body to eliminate old estrogen and herbs that assist the body produce more progesterone. It is also important to support the liver during this process, as it plays a major role in the elimination of old estrogen. The role of environmental toxins in endometriosis is an area of significant concern. Many environmental toxins, like pesticides and plastics, can actually act like super-estrogens once inside the body and have long term effects. Hormones in red meat and dairy may also tip the delicate balance of hormones for women. Reducing exposure to these external sources of estrogen is critical to the prevention and treatment of endometriosis.
With proper guidance, many women with endometriosis can have less pain, better quality of life and preserve their fertility.