Endo What?

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Have you ever heard of endometriosis? Do you have pelvic pain, abdominal pain, pain with your period or pain during sex? [1] Then you may have a condition known as endometriosis. Unfortunately, if you are experiencing these symptoms, it may take 8–10 years for you to receive the proper diagnosis. It also may require up to 8 different doctors to finally obtain the correct diagnosis. [2]

Why is this? The symptoms of endometriosis are varied and differ with each woman. The symptoms also mimic many other conditions. However, pain is often the main symptom and it is often severe! The other issue is that endometriosis can only be diagnosed with laparoscopic (surgical) removal of a suspected endometrial lesion. [1]

What Is Endometriosis? How Common Is It?

Endometriosis affects approximately 1 in 10 women in the United States and over 176 million women around the world. Endometriosis occurs when the tissue that normally lines the endometrium, i.e. uterus, begins to grow outside of the endometrium. [1] The most common sites for endometrial lesions are around the uterus, ovaries and fallopian tubes. [3] These lesions can also be found on your bowels, other tissue in the pelvic cavity and they can even be found in tissue beyond the pelvic cavity, but this is rare. [4]

What Is The Cause?

Short answer…no one knows! There are several different theories on what causes the endometrial tissue to grow outside of the uterus. The oldest theory is retrograde menstruation where menstrual fluid refluxes into the pelvic cavity leading to the implantation of endometrial tissue from this fluid onto tissues in the pelvic cavity. [1]

Some believe that it may be related to autoimmune disease. At the very least, there are some similarities between autoimmune disease and endometriosis. These similarities include increased inflammation and the production of autoantibodies. There are also increased cytokines, decreased cell apoptosis (programmed cell death; the death of cells that occurs as a normal and controlled part of an organism’s growth or development), and cell-mediated abnormalities in both conditions. [5] Other theories revolve around environmental factors, genetics, abdominal cells mistakenly turning into endometrial cells and/or abnormalities with the endometrium itself. [6]

Photos from Anemone123 at pixabay.com

As you can see, no one knows exactly what is causing this painful condition for women. That may have you feeling discouraged and hopeless. To change that, let’s focus on what we do know. Endometriosis is a chronic inflammatory condition that involves the immune system and the endocrine (hormonal) system. [7] For example, it has been found that women with endometriosis have decreased activated T-reg cells, one type of immune cell, in the endometrial lesions and endometrium versus women without endometriosis. This deficiency can increase local inflammation and angiogenesis, the formation of new blood vessels, to the endometrial lesion. [7] Women with endometriosis also have decreased Natural Killer cells, another type of immune cell, and increased levels of E. coli colonization and endotoxin/Lipopolysaccharide (LPS) levels in their menstrual blood. [8] LPS is part of the cell wall of gram negative bacteria like E. coli. LPS is also a potent stimulator of the immune system and can lead to increased inflammation and immune dysfunction. [9]

Original image from https://edc2.healthtap.com/ht-staging/user_answer/reference_image/7081/large/Uterus.jpeg?1386669522. This image from https://endo-update.blogspot.com/2015/03/endometriosis-awareness-month-part-iii.html [10]

But I Thought Estrogen Was The Problem!

Estrogen is ‘a’ problem but it is not ‘THE’ problem. ‘THE’ problem is inflammation, but estrogen can worsen the pain and the symptoms a woman experiences. How does it do so? Estrogen causes the endometrium lining to thicken and grow. It also does the same for the tissue in the endometrial lesions. The lesions will then go through their own “period” in conjunction with your usual period. This can lead to more pain, more scarring and more lesions. [1] It also appears that estrogen combined with LPS may promote pelvic inflammation and growth of endometrial lesions. [11] This shows that estrogen can have direct effects on the endometrial lesions. However, steroid hormones like estrogen also have effects on the immune system. Therefore, estrogen can also indirectly affect endometriosis via its effects on the immune system. [12] Progesterone, the other key hormone for a healthy menstrual cycle, also plays a role in endometriosis. We will cover it in more detail in a future article on menstrual health and tie it back into endometriosis at that time.

What Options Do I Have?

Photo by geudki from pixabay.com

Conventional treatment often consists of medications to address the inflammation and pain that is present. The other most common forms of conventional treatment include the use of medications to suppress estrogen or the surgical removal of the endometrial lesions. Surgery does have the best outcomes but the success rate is highly dependent on the expertise of the surgeon performing the procedure. There is also a risk of more scarring due to the surgery that could result in the continuation of pain and other symptoms. There are some new areas of treatment that are beginning to be researched and used. These include the use of medications to address and modulate the immune system and medications to inhibit angiogenesis.

Functional Medicine has some different treatment options to offer. As we discussed earlier, there is an immune component involved in endometriosis and we have discussed the role of the gut and the microbiome in immunity and inflammation in other articles. It should also be noted that the gut microbiome affects estrogen metabolism and stem-cell balance. [13] One way to help our gut and our immune system is to decrease the load on these systems by not eating foods that don’t agree with your body. A common food that is problematic for people is gluten. Research has shown that a gluten-free diet can help to decrease the pain women with endometriosis experience. [14]

Zinc has also been shown to be beneficial for women with endometriosis. Zinc helps to regulate pain and is found in the nervous system. [15] Zinc is also crucial for the integrity of our gut. Decreased levels of zinc are associated with increased intestinal permeability and an increase in some inflammatory chemicals. [16] Increased intestinal permeability could allow for more gram negative bacteria, like E. coli, and LPS to circulate around the body which, as we discovered earlier, is often found in women with endometriosis. Zinc levels are often deficient in women with endometriosis. This deficiency can result in disruption of normal inflammation and immunity. [17]

N-acetyl-cysteine (NAC) and curcumin have also shown promise in the treatment of endometriosis. Curcumin is found in the spice turmeric and has anti-inflammatory properties. It also appears to induce apoptosis in the cells in endometrial lesions. [18] Curcumin may also be capable of reducing estrogen and thereby reducing the proliferation of endometrial cells. [19]

Now What?

Endometriosis is a complex condition that involves multiple body systems. There is no definitive, cookie-cutter treatment, but there are treatments available that can be customized to you and your unique needs. You do not have to suffer with the severe pain of endometriosis or even severe period pain which many women think is normal. If you are having these issues or other issues related to your menstrual cycle, please see your Primary Care Doctor or your Gynecologist and also seek out a Functional Medicine Practitioner . By doing so, you will be able to address the issue and your health from all angles leading to the best outcomes possible!

If you would like to get started on your own personal health journey, please go to my website, healthydesignfxmed.com, and sign up for a free 15 minute consultation to ask questions and see if we would work well together or dive right in and schedule your 60 minute Initial Evaluation. The Initial Evaluation and the free consultation can be performed in person or via phone/skype. I look forward to hearing from you and working together to accomplish your goals.

Disclaimer:

This article is for educational use only. Nothing contained in this article should be considered, or used as a substitute for, medical advice, diagnosis or treatment. This article does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. Always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay in obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this article. If you have or suspect that you have a medical problem or condition, you should contact a qualified health care professional immediately. If you are in the United States and are experiencing a medical emergency, you should dial 911 or call for emergency medical help on the nearest telephone.

Citations/References:

1. https://www.endonews.com/endometriosis
2. https://www.self.com/story/when-doctors-miss-your-endometriosis-diagnosis
3. Briden, Lara. (2017) Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. Retrieved from https://www.amazon.com/.
4. Briden ND, Lara. Period Repair Manual, Second Edition: Natural Treatment for Better Hormones and Better Periods . Lara Briden ND. Kindle Edition..
5. https://www.healthline.com/health/endometriosis#causes
6. Eisenberg VH, Zolti M, and Soriano D. (2012) Is there an association between autoimmunity and endometriosis? Autoimmun Rev. 2012 Sep;11(11):806–14. doi: 10.1016/j.autrev.2012.01.005. Epub 2012 Feb 4.
7. https://www.healthywomen.org/condition/endometriosis
8. Yukiko Tanaka, Taisuke Mori, Fumitake Ito, Akemi Koshiba, Osamu Takaoka, Hisashi Kataoka, Eiko Maeda, Hiroyuki Okimura, Takahide Mori, Jo Kitawaki; Exacerbation of Endometriosis Due To Regulatory T-Cell Dysfunction, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 9, 1 September 2017, Pages 3206–3217, https://doi.org/10.1210/jc.2017-00052.
9. Khan KN, Kitajima M, Hiraki K, Yamaguchi N, Katamine S, Matsuyama T, Nakashima M, Fujishita A, Ishimaru T, Masuzaki H. (2010) Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis. Fertil Steril. 2010 Dec;94(7):2860–3.e1–3. doi: 10.1016/j.fertnstert.2010.04.053.
10. https://www.larabriden.com/endometriosis-and-the-microbiome/
11. https://endo-update.blogspot.com/2015/03/endometriosis-awareness-month-part-iii.html
12. Khan, K. N., Kitajima, M., Inoue, T., Fujishita, A., Nakashima, M., & Masuzaki, H. (2015). 17β-Estradiol and Lipopolysaccharide Additively Promote Pelvic Inflammation and Growth of Endometriosis. Reproductive Sciences, 22(5), 585–594. http://doi.org/10.1177/1933719114556487.
13. Herington, J. L., Bruner-Tran, K. L., Lucas, J. A., & Osteen, K. G. (2011). Immune interactions in endometriosis. Expert Review of Clinical Immunology, 7(5), 611–626. http://doi.org/10.1586/eci.11.53
14. Laschke MW and Menger MD. (2016) The gut microbiota: a puppet master in the pathogenesis of endometriosis? Am J Obstet Gynecol. 2016 Jul;215(1):68.e1–4. doi: 10.1016/j.ajog.2016.02.036. Epub 2016 Feb 18.
15. Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, and Stolfi VM. (2012) Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012 Dec;67(6):499–504.
16. Nozaki, C., Vergnano, A. M., Filliol, D., Ouagazzal, A.-M., Le Goff, A., Carvalho, S., … Kieffer, B. L. (2011). Zinc alleviates pain through high-affinity binding to the NMDA receptor NR2A subunit. Nature Neuroscience, 14(8), 1017–1022. http://doi.org/10.1038/nn.2844.
17. Finamore A, Massimi M, Conti Devirgiliis L, and Mengheri E. (2008) Zinc deficiency induces membrane barrier damage and increases neutrophil transmigration in Caco-2 cells. J Nutr. 2008 Sep;138(9):1664–70.
18. Messalli EM, Schettino MT, Mainini G, Ercolano S, Fuschillo G, Falcone F, Esposito E, Di Donna MC, De Franciscis P, and Torella M. (2014) The possible role of zinc in the etiopathogenesis of endometriosis. Clin Exp Obstet Gynecol. 2014;41(5):541–6.
19. Jana S, Paul S, and Swarnakar S. (2012) Curcumin as anti-endometriotic agent: implication of MMP-3 and intrinsic apoptotic pathway. Biochem Pharmacol. 2012 Mar 15;83(6):797–804. doi: 10.1016/j.bcp.2011.12.030. Epub 2011 Dec 29.
20. Zhang, Y., Cao, H., Yu, Z., Peng, H.-Y., & Zhang, C. (2013). Curcumin inhibits endometriosis endometrial cells by reducing estradiol production . Iranian Journal of Reproductive Medicine, 11(5), 415–422.