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Endometriosis: A Functional Medicine Approach

Updated: May 16


Do you suffer from a chronic pain condition known as endometriosis? Or, maybe you have never been diagnosed (which requires surgery), but you suspect it may be what you have? If yes, you certainly are not alone in your struggle. Endometriosis affects roughly 10% of reproductive age women and girls around the world. That’s 1 in 10 women, or rather 190 million women who have been diagnosed with endometriosis, but with the long time frame it takes to receive an accurate diagnosis (average 6-10 years), it’s likely that number is even higher.


What is Endometriosis?


So what exactly is endometriosis, and what can we do to treat it? Endometriosis is a disease in which the endometrium (the tissue that lines the inside of the uterus) is present outside of the uterus. Endometriosis most commonly occurs in the lower abdomen or pelvis, but in rare instances it can appear elsewhere in the body

It causes a chronic inflammatory reaction that may result in the formation of scar tissue (adhesions, fibrosis) within the pelvis and other parts of the body. Here are several potential lesion types:

  • superficial endometriosis found mainly on the pelvic peritoneum

  • cystic ovarian endometriosis (endometrioma) found in the ovaries

  • deep endometriosis found in the recto-vaginal septum, bladder, and bowel

  • in rare cases, endometriosis has also been found outside the pelvis

Symptoms


Women with endometriosis may experience a wide range of symptoms including:

  • Pelvic pain

  • Lower abdominal or back pain

  • Intense menstrual cramps

  • Pain during intercourse

  • Abnormal or heavy menstrual flow

  • Infertility

  • Fatigue

  • Painful urination during menstrual period

  • Painful bowel movements

  • Gastrointestinal problems (nausea, constipation, diarrhea)

  • And many more


However, it is important to note that the amount of pain a woman experiences is not directly correlated to the severity of the disease. Some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms. Simply put, each individual’s diagnosis is unique to them.


Diagnosis


So why does endometriosis take so long to be diagnosed? It was previously mentioned that women take on average anywhere between 6-10 years to receive a proper diagnosis for endometriosis. Spending year after year going to countless doctor's appointments, leaving each appointment without any clear answers as to what’s going on with her body, and desperately wishing for a sense of clarity and relief. Oftentimes it is misdiagnosed as a GI condition such as IBS, because many of the symptoms resemble a digestive issue: nausea, abdominal pain, fluctuation between constipation and diarrhea. The hormonal component is overlooked.


A diagnosis of endometriosis can only be certain when the doctor performs a laparoscopy, where the doctor biopsies any suspicious tissue, and the diagnosis is then confirmed by examining the tissue beneath a microscope. Laparoscopy is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. This type of procedure is also used to determine the location, extent and size of the endometrial growths. However, this needs to be done in the OR while under anesthesia and is one reason why proper diagnosis is delayed.


Traditional Treatment


As of now there is no found “cure” for endometriosis, but rather methods and treatments to help manage and reduce the pain. The internet and medical professionals have many contradicting opinions and views on the best form of treatment to help women with endometriosis to ease their pain and other complications such as infertility that can occur.

It’s common for women to be given:


  • OTC medication (nonsteroidal anti-inflammatory drugs such as ibuprofen)

  • Hormone therapy (this may include oral contraceptives (such as birth control), progestins, or gonadotropin-releasing hormone agonist)

  • Or surgical techniques:

  • Laparoscopy: As mentioned above, and it’s a way for the surgeon to remove endometrial growths.

  • Laparotomy: A more extensive surgery to remove as much of the displaced endometrium as possible without damaging healthy tissue.

  • Hysterectomy: Surgery to remove the uterus and possibly the ovaries


Functional Medicine Treatment


From a Functional Medicine standpoint, Endometriosis is treated as an inflammatory condition that is resulting from an inflammatory gut health problem as well as an estrogen dominant/hormone imbalance problem.


Focusing on improving gut health and hormone balance may include nutritional changes that are anti-inflammatory. Eating a variety of fruits, leafy greens and other colorful vegetables, nuts, seeds, and fatty fish such as salmon or sardines are encouraged. Herbal teas are another great option to help decrease inflammation, menstrual pain, and other endometriosis symptoms. Avoiding processed and fried foods, refined sugars, sodas, and caffeine including coffee, as these contribute to increased inflammation throughout the body and can cause gut disruption.

Dairy is considered “estrogenic” because the source is a pregnant or lactating cow so the hormone content is high. You can reduce or eliminate dairy for a time to see if this helps your symptoms.


Along with dietary changes, safe detoxification, bioidentical progesterone, herbal or nutrient supplementation, stress management, removing environmental toxins from your home, movement and exercise can be very helpful in management of endometriosis.


Five Actionable Tips You Can Start Today:

  1. 4,000 mg/day High Quality EPA/DHA Omega 3 (make sure the company tests for mercury)

  2. 200 mg a day Vitex or Chasteberry Extract

  3. Start a daily yoga or walking practice

  4. Minimum intake of 4 cups of colorful fruits/veggies a day

  5. Aim to be asleep by 10 pm consistently every night


If you believe you have endometriosis, it’s best to speak to your healthcare provider as soon as possible. Write down a list of your symptoms to take with you to your appointment. Be specific with the symptoms you’ve been experiencing, the various levels of pain and if they correlate with your menstrual cycle. Do you notice specific triggers of your pain (foods, stress, exercise, sexual intercourse etc.)? It is important to discuss the treatment options thoroughly with your healthcare provider and let them know if the suggested treatment doesn’t feel right for you.





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