How Common is Endometriosis?
Endometriosis is a relatively common but serious gynecological disorder that affects 10 million women worldwide. It most commonly affects females of reproductive age and is a commonly overlooked causative factor in infertility. It occurs when the tissue that normally lines the uterus inside instead forms outside the uterus. The exact cause of Endometriosis remains a mystery, and this has prevented a cure from being developed. When treated properly, the symptoms of Endometriosis are manageable, but what happens if Endometriosis is left untreated?
What Exactly is Endometriosis?
In cases of Endometriosis, the mucous membrane-like tissue that typically lines the inside of the uterus, known as the endometrium, instead forms in an area outside of the uterus. This errant tissue growth most often occurs in the pelvic region, affecting the ovaries, abdomen, and bowel.
Typically, the endometrium thickens during the menstrual cycle and is subsequently shed during your period. When this tissue grows in an area outside of the uterus, it still goes through the same process of thickening and shedding. However, the shed tissue has no way of exiting the body, and with no way of discharging the shed tissue, it becomes trapped inside your body.
This leads to inflammation, swelling, and pain, and it can cause health problems of varying degrees of severity, from minor abdominal pain to infertility. There have been cases of Endometriosis that resulted in death, although it is exceptionally rare. You must understand the health issues or, more appropriately, the symptoms linked to Endometriosis.
Who is at high risk for developing Endometriosis?
There appears to be a strong tie to family history, meaning that if your mother or sister had Endometriosis, you are also more likely to have it (reportedly as high as 7-10X higher risk). There is also a strong link between Endometriosis and autoimmunity. This means that potential drivers of autoimmunity should be considered, such as poor lifestyle/nutrition habits, ongoing exposures, and overall liver/detoxification pathways.
What are the Symptoms of Endometriosis?
A disease that is as serious as Endometriosis brings with it a long list of symptoms. The most common symptom associated with the disorder is a heavy menstrual cycle, and after knowing what Endometriosis entails, this is no surprise. Aside from a heavy menstrual cycle, the other symptoms of Endometriosis are as follows:
- Pain in the abdomen, pelvis, or lower back
- Heavy or irregular periods
- Abdominal bloating
- Lethargy or fatigue
- Constipation or diarrhea
- Severe pain during periods
- Infertility issues
- Painful menstruation
- Nausea or vomiting
- Pain during or after sexual intercourse
- Pain while urinating or passing a bowel movement
If you are experiencing one or more of these symptoms, it could signify that you have Endometriosis. However, many of these symptoms are generic and could be linked to several diseases, bacterial infections, or viruses, so don't rush to conclusions. Instead, schedule an appointment with a trusted health provider and mention all of the symptoms you're experiencing.
How is Endometriosis Diagnosed?
Since there is not much known about the cause of Endometriosis, diagnosing the disease is far more difficult than most other diseases. There is only one method for diagnosing Endometriosis that is reliable and conclusive, and this involves using surgical means to remove tissue from your body and test it.
There are a few other techniques that can be used in diagnosing Endometriosis, even though they are not conclusive:
- Advanced imaging. Over the past decade or so, medical imaging technology has come a long way. By using advanced imaging, your doctor will be able to look for abnormal areas in your body, particularly in the pelvic area. If an abnormality is discovered, the physician should be able to determine if it is Endometriosis.
- Pelvic examination. This method of diagnosis is more of a hands-on experience than other methods. During your exam, the doctor will feel for areas that have been scarred due to Endometriosis.
- Treating with medicine. More of a process of elimination than anything else, this technique involves taking medications that effectively treat Endometriosis. The concept is simple: if the medication causes your symptoms to improve, the condition is the culprit.
How is Endometriosis usually treated?
The treatment of Endometriosis is usually only treated with medications or surgery, or, in some cases, a combination of both. Below we have described 5 common approaches to treatment in conventional medicine and explain 5 ways in which functional medicine approaches Endometriosis. Many women are turning to alternative therapies, as they have proven beneficial in relieving the health issues caused by Endometriosis. Together, you and your doctor will create a treatment plan designed around your symptoms and personal preferences.
Top 5 Conventional Treatments for Pain Caused by Endometriosis.
Please note any treatment approaches mentioned are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment and have not been evaluated by the FDA.
- Pain relievers. These consist of over-the-counter medications, such as paracetamol, acetaminophen, and non-steroidal anti-inflammatories. They provide relief for a broad spectrum of pain-related symptoms caused by Endometriosis. Even though they only offer a temporary respite from the pain, these medications are inexpensive and convenient. Many women consider pain relievers as the first line of defense against endometriosis symptoms.
- Laparoscopy. Also referred to as "keyhole surgery,"laparoscopy utilizes a miniature telescope to locate and identify instances of Endometriosis. Once identified, an excision is used to get a tissue sample for testing. This is the only testing method that can conclusively confirm the presence of Endometriosis. If Endometriosis has been confirmed, ablation is utilized to treat the disorder. Ablation is a medical technique that uses heat energy and electrical currents to relieve pain.
- Hormone pills and injections. An effective alternative to surgery, hormone treatments aid in slowing and, in some cases, altogether stopping the normal menstrual cycle. And since endometrium growth and regrowth are directly correlated with the frequency of a woman's menstrual cycles, when the cycle stops, so does the tissue growth. The same medications used for birth control and hormone treatments come in several forms, such as pills, injections, and implants.
- Hysterectomy. In severe cases of Endometriosis, a hysterectomy may be the only viable treatment option for a woman. A hysterectomy is a surgical procedure that removes the uterus, cervix, fallopian tubes, and ovaries. It prevents any chance of tissue regrowth in the future and eliminates the pain associated with shedding. The surgery is not without risks, and its effects are permanent. Because of this, a hysterectomy is rarely used for treating Endometriosis.
- Bowel surgery. When endometrium growth occurs near your bowel, it can put a lot of pressure on your bowel walls, and this can cause significant pain and eventually damage your bowel walls. If these symptoms become too severe, you may have to go to a colorectal surgeon so they can remove part of your bowel.
Top 5 Functional Medicine Treatments for Pain Caused by Endometriosis.
- Consider the contributors. We can't think of Endometriosis as a single disease with a single cause. We consider and screen for some common things that we screen for, including gut health, inflammation, and hormonal balance. More specifically, we consider if any gut infections are fueling inflammation. We consider what the neighborhood of the gut looks like, looking for "dysbiosis" (imbalance of the neighborhood of the gut), as dysbiosis can interfere with hormone production. We assess for systemic inflammation levels, then create a plan to optimize those levels of inflammation and trend improvement. High levels of inflammation affect aromatase levels, which is a direct tie-in to estrogen production. We need to consider less common contributors, such as chronic infections, heavy metal toxicity, or overall toxic burden.
- Finetune the food strategy. Since Endometriosis is often characterized by high levels of inflammation, hormone imbalances, and/or immune system imbalances, we seek to screen for and address all of these areas. In the first appointment with your physician, we gather your health history and lifestyle aspects and explore details on your current nutritional approach. We aim to correct issues at their root cause source, beginning with personalized nutrition and lifestyle interventions. Working on these "upstream" causes, in turn, has a positive effect on symptom expression and severity. We have a couple of important things to focus on the nutrition side. The first key is the consumption pattern of anti-inflammatory foods.
Eating a rainbow of different colors of fruits and vegetables ensures that you are consuming a good amount of phytonutrients, which often have anti-inflammatory properties. We can achieve fiber goals of at least 25 grams/day in doing so. We also know that herbs and spices can modify your level of inflammation. Many people are familiar with omega 3s and their anti-inflammatory benefits, so we consider screening for omega 3s (omega index) levels, then creating a plan to get us to an optimal range. Lignans can be a powerful tool for their unique benefits. In addition to inflammation, we consider how certain foods can affect glucose and insulin levels. Choosing foods with a lower glycemic index/load is important, but we also find incredible value when using a continuous glucose monitor. This tool allows us to see exactly which foods impact your insulin/glucose levels, specifically for you. While we prioritize all of the nutrition steps above, we also consider whether any foods provide negative effects. High trans-fats, sugar intake, omega 6 fatty acids, and highly processed foods can increase inflammation and drive autoimmunity, so we ensure that we take inventory of those consumers. Each person is unique, so we also consider what unique food sensitivities, allergies, and/or intolerance could play a role. One last area of nutrition that is always part of our initial assessment has to do with hormone detox pathways. This includes how much is being made, how much is being converted (liver pathways, methylation), and how much is being adequately eliminated.
- Address lifestyle elements. We all know the importance of stress and sleep, but they have unique roles in Endometriosis. Stress sets up a vicious cycle by increasing cortisol and adrenaline. Over time chronic stress can result in an inability to manage inflammation properly. This can aggravate symptoms, leading to more pain and a continually heightened stress response, which continues the cycle. Some beneficial options include meditation practices, breathing techniques, or even something as simple as a walk in the park, enjoying your favorite music, or spending some time with loved ones. Sleep deprivation can alter your stress hormones (cortisol, "fight or flight" hormones) but also affects your menses-related hormones (estradiol, progesterone, testosterone, etc.). You can prioritize sleep improvement by keeping a regular sleep schedule. Consider having a "digital detox" before bed to avoid blue light exposure, as it can suppress melatonin production. Some women find a mug of camomile or valerian root tea can be calming in the evening and help to promote sleep. A warm epsom salt bath can relax and ease painful cramps. Lastly, many members find benefits with specific sleep tracking wearable devices to guide specific strategies to improve sleep health.
- Think "outside the box." The value of exercise can't be overstated here. Restorative forms of exercise, such as yoga, tai chi, and walking, can promote various benefits, including cortisol optimization. Any form of exercise is likely also to promote improved bowel habits and, as a result, improved detoxification abilities. We also want to consider if there are any external estrogen sources. We typically want to avoid ongoing exposures, using a toxin screening tool and prioritizing the removal of plastics and styrofoam while limiting pesticide/herbicide exposures. We also want to ensure adequate drinking water filtration and switch to more natural skincare/shampoos/detergents/etc. One other often overlooked therapeutic option to consider is acupuncture. Some research suggests significant benefits for pain symptom severity.
- Consider Targeted Supplements. Once we have identified the key areas we need to address, we then consider if any supplements would be expected to offer benefits. Some commonly used options include resveratrol, grape seed extract, chrysin, and or various detox support (ellagic acid, artichoke leaf extract, watercress, etc.). We often use hormone AND hormone metabolite levels to understand what the "best" option(s) are here. On rare occasions, direct hormone supplementation needs to be considered.
Treatments to Improve Fertility.
The severity of your Endometriosis will affect the likelihood that fertility treatment will be successful. For women with mild cases of Endometriosis, surgery has proven to be very effective in reducing infertility. This appears to be true in some instances involving more severe cases of Endometriosis as well. However, this is up for debate due to a lack of proof. Even still, surgery remains a viable option available for improving fertility, alongside all of the valuable approach considerations listed above.
What Happens if Endometriosis is Left Untreated.
While it's true that there is no cure for Endometriosis, seeking treatment to reduce its symptoms is vital in improving your quality of life. If you decide to forgo treatment, the symptoms will remain, and over time, they may even worsen. There is no sense in dealing with pelvic pain and other symptoms caused by Endometriosis when proven treatment options are available.
Understandably, some women choose to avoid surgery as a treatment option. After all, surgery does involve risks, and the process can be time-consuming. Still, with the availability of hormone treatments and simple pain relievers, there is no excuse to leave Endometriosis completely untreated. At the very least, you should consider trying home remedies if the traditional treatments don't appeal to you.
Aside from reducing the pain-related symptoms of Endometriosis, some treatments have been proven to reduce infertility rates. On the other hand, your chances of becoming infertile only increase over time without treatment. If you plan on getting pregnant or actively trying to get pregnant, you need to consider your treatment options.
The Choice for Treatment is Yours.
There is no doubt that Endometriosis is a serious disease that affects millions of women across the globe. Endometriosis can cause pain in the pelvic area and lead to infertility issues, worsening over time if left untreated. Unfortunately, there isn't a single cause of Endometriosis, so a single "cure" is often ineffective.
Numerous treatment options are available on the conventional medical side, such as medications, hormone injections, and surgeries. For some people, those things can reduce and even eliminate the symptoms of Endometriosis. Our team of functional medicine (root-cause) physicians and nutritionists can help when considering a more comprehensive look at the "why" of Endometriosis. We help you understand the key underlying contributors driving your disease; then, we craft a personalized plan to get you on the path towards healing. Whether or not you decide to seek treatment for Endometriosis is your choice, but it should be an easy choice. You want to consider getting a treatment plan before thick adhesions occur, as it can be difficult to resolve pain at that point. Our team at Index Health would be grateful for the opportunity to serve you and help create a personalized plan for your progress.