In this article I hope to give an overview of this mysterious but increasingly common condition, it is the illness of competition, coming about when a women’s emotional needs are competing with how she is operating in the outside world, i.e. they are in conflict.
Endometriosis is defined as the presence of endometrial cell growth outside of the uterus, these cells can appear on the ovaries, fallopian tubes, bowel, bladder, peritoneal tissue, anywhere in the abdominal cavity and in rare cases in the lung and nasal cavity1. Interesting to note is that when pathologists are presented with endometrial cells from the uterus vs cells from endometriosis they are unable to determine it’s origin2. The cells respond to the hormonal changes of the menstrual cycle, growing and shedding in the same way the cells within the uterus do. The bleeding causes inflammation in the surrounding tissue and can lead to scarring. For some women they experience intense pain during menstruation, pain when defecating, or pain during intercourse, yet for others they are asymptomatic. In New Zealand Endometriosis affects 3%, or 1 in 10 women (Ministry of Health), and is more than likely higher as many women go undiagnosed, as endometriosis can only be definitively diagnosed via laparoscopy2.
There is no firm cause for the development of endometriosis, theories include:
- Retrograde flow – In is normal for women to have some menstrual blood flow up from the uterus to the fallopian tubes and into the abdominal cavity, however it is thought that due to either structural anomalies or increase blood flow caused by excess oestrogen, as well as increased prostaglandins which cause the uterus to spasm and the fallopian tubes to widen; those who develop endometriosis have a higher rate of refluxed cells
- Coelomic metaplasia – Undifferentiated cells in the peritoneal lining of the abdominal cavity, change to be differentiated endometrial cells, thought to be due to chemical exposure1,3
- Lymphatic flow – The spread of endometrial tissue through the lymphatic system
It is interesting to note that endometriosis behaves very similar to malignant growths, in that the cells proliferate via local proliferative factors, the cells invade surrounding tissue, they create their own blood supply and avoid detection and destruction. The cells themselves are able to create their own oestrogen through aromatase, they have high levels of an enzyme called 17B-OHSD2 which converts oestrone to the more potent oestadial, and lacks the enzyme 17B-OHSD1 which does the reverse. This increases the local oestrogen resulting in an increase in proliferation. High oestrogen also reduces the activity of natural killer (NK) cells, the immune cells which destroy foreign or malignant cells, and it is thought that the cells also produce other substances which reduce the NK cells. The increase in inflammation increases inflammatory cytokines, interleukins (IL), IL1 and IL6 as well as tumour necrosis factor-alpha (TNF-a), these increase proliferation, adhesion and angiogenesis (meaning that the cells create their own blood supply). These cytokines stimulate nuclear factor kappa B (NF-κB) a DNA transcriptor that turns off apotosis and keeps cells proliferating, it also inhibits macrophage migration2.
Symptoms of Endometriosis
- Pain – although some may not have any pain at all, most would have variable pain in the pelvic region, which can become sharp during menstruation and in some cases cause fainting, vomiting and diarrhoea.
- pain before period and at ovulation
- one-sided pelvic pain
- pain increasing in severity towards the end of the period
- pain associated with sexual activity
- PMS symptoms – due to hormonal imbalance women with endometriosis experience a variety of PMS symptoms such as anxiety, mood swings, bloating, breast soreness, constipation, insomnia, depression, food cravings and headaches
- Infertility – Adhesions or scaring caused by the body in it’s attempts to stop the inflammation and contain it, depending on the site can alter the pelvic anatomy, impairing the path of the egg
Some contributing factors
- Oestrogen excess
- Progesterone deficiency
- Immune system dysfunction
- Magnesium deficiency
- Essential fatty acid deficiency
- High stress and hypoglycaemia
- Other hormonal imbalance
- Excess dietary caffeine
- Excess alcohol
- IUD use
- Family history – a mother or sister with endometriosis
“The intimate interactions between our thoughts, emotions and immunity hold the key to interpreting the message that endometriosis has for the individual women.” Dr Christiane Northrup. It is thought that women with endometriosis are rejecting the feminine aspect of themselves, denying themselves love and they feel ungrounded, unsupported and rejected especially by men.
- Nutrition – balanced whole foods diet, with high quality fats, especially omega 3 fatty acids and plenty of fibre. Remove or reduce alcohol, caffeine, red meat, dairy, and excess carbohydrates. Address hypoglycaemia if this is the case, making sure your blood sugar remains stable. Support the detoxification pathways to reduce excess oestrogens1,2
- Lifestyle management – Counselling or some other therapy to address the psychological issues, stress reduction techniques such as meditation and yoga1,2
- Exercise – Regular exercise such as pilates or yoga to reduce the pelvic tension and improve suppleness, also helps reduce oestrogen excess1,3
- Xenoestrogens – be aware of where to find these, as they increase oestrogen response within the body1,2,3, 4
- Botanicals – There are many herbs that can help with endometriosis from symptom relief to immune support.1,2
In order to treat endometriosis holistically you need to be willing to risk changing the way your see yourself and your role in the world, microscopically analysing how you really feel about being a women and creating a healthy balance between your inner and outer selves.
This has been a very quick overview, if endometriosis is affecting your life come and see us
1. Romm, A. (2010). Botanical medicine for women’s health. St Louis:Churchill Livingstone.
2. Trickey, R. (2011). Women, Hormones & the Menstrual Cycle. Fairfield, VIC: Trickey Enterprises (Victoria) Pty Limited.
3. Macer, M. L., & Taylor, H. S. (2012). Endometriosis and Infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstetrics and Gynecology Clinics of North America, 39(4), 535–549. http://doi.org/10.1016/j.ogc.2012.10.002
4. Cobellis, L., Colacurci, N., Trabucco, E., Carpentiero, C., & Grumetto, L. (2009). Measurement of bisphenol A and bisphenol B levels in human blood sera from healthy and endometriotic women. Biomedical Chromatography: BMC, 23(11), 1186-1190. doi:10.1002/bmc.1241