Endometriosis is a chronic disease, which is under-diagnosed, under-reported, and under-researched. It is defined as the presence of endometrial tissue outside the uterus and is found in women of all ethnic and social groups . The prevalence has been reported around 10% of the general female population and 20-90% in women with pelvic pain or infertility. It occurs mainly in the pelvic region, (including ovaries, fallopian tubes, vagina and cervix), but may also occur in distant sites, such as lungs, spinal canal, kidneys, stomach and even the nose!
Diagnosis of Endometriosis
Endometriosis is diagnosed via laparoscopy, usually when investigating causes of pelvic pain or infertility. An internal ultrasound and other pathology testing may also be used beforehand, during initial investigations.
Endometriosis is categorised as:
• Mild- small, localised implants
• Moderate- larger, more extensive implants; scar tissue may be present
• Severe- large, widespread implants; extensive scar tissue. When endometriosis is confined to the
muscular wall of the uterus, it is known as adenomyosis
Oestrogen (estrogen) – the main culprit in endometriosis
Endometriosis is an oestrogen-dependent disease. The biologically active oestrogen, estradiol, throught the actions of the enzyme aromatase, aggravates the pathological processes (e.g., inflammation and growth) and the symptoms (e.g., pain) associated with endometriosis.
Estradiol production in endometriosis.
Aromatase is encoded by a single gene and represents the rate-limiting step for estradiol biosynthesis. In a premenopausal woman with endometriosis, estradiol arises from three major tissue sites that express aromatase.
(1) Aromatase is expressed under the influence of follicle-stimulating hormone and accounts for fluctuating serum estradiol levels.
(2) Aromatase is also present in peripheral tissues such as the adipose tissue and is responsible for relatively small but clinically significant quantities of circulating estradiol levels.
(3) Estradiol is produced locally in endometriosis per se via the presence of aromatase and other steroidogenic enzymes in this pathological tissue.
How Do I Know if I have Endometriosis?
Common symptoms of endometriosis, include;
· PMS and/or dysmenorrhoea (painful periods)
· Pelvic Pain – especially pain on urination or defecation
· Joint and muscle aches
· Fatigue and lethargy
Pain from endometriosis may be severe, radiate to the buttocks and perianal region, although it develops gradually and is often asymptomatic for years.
Infertility - the common association.
Endometriosis is strongly associated with infertility. It is considered that up to 50% of infertile women have endometriosis, and 30-40% of endometriosis patients are intertile. Endometriosis is a common cause of infertility, through mechanisms which may include;
· Poor egg development
· Fallopian Tube blockage
· Immune signalling, generating a low level toxicity in the womb, preventing implantation
Endometriosis Risk factors
Major causative factors and risk factors that can contribute to the incidence of endometriosis include the following:
• Obesity, and associated insulin resistance, may contribute to endometriosis.
• Elevated oestrogen levels or oestrogen activity is suspected of causing endometriosis.
• Immunological dysregulation: i.e., inflammation, increased macrophage, prostaglandin, and lymphokine action; decreased T- and NK-cell responsiveness.
• Studies indicate that TCDD (dioxin) and formaldehyde (environmental toxicants), alter the action of oestrogen in reproductive organs and increase the incidence of endometriosis.
• Retrograde (or reflux) menstruation can be due to transtubal dissemination of endometrial cells into pelvic cavity related to anatomical defects and/or lymphatic and vascular transportation to remote areas.
• Genetic predisposition (daughters of mothers having the disorder).
Endometriosis Naturopathic Treatment – Herbs, Nutrients, Diet and lifestyle
Providing liver support is the backbone of naturopathic treatment of endometriosis. Enhancing the liver's ability to metabolize hormones may help restore normal hormone ratios. Endometriosis is best treated early and alternative therapies alone may not be sufficient to eradicate this condition. But it sure beats permanently taking synthetic hormones, (the Pill), which only serve to mask the problem.
Chaste tree (Vitex agnus cactus): helps to normalize pituitary function and balance estrogen/progesterone ratios. This herb may need to be taken long term (12 to 18 months) for maximum effectiveness
Milk thistle (Silybum marianum), dandelion root (Taraxacum officinale), vervain (Verbena officinalis), and/or blue flag (Iris versicolor): support the liver and may help restore hormone ratios
Squaw vine (Mitchella repens), motherwort (Leonurus cardiaca), red root (Ceonothus americanus), red raspberry (Rubus idaeus): can be effective for the relief of pelvic conjestion
Dietary and lifestyle changes may assist in the management of endometriosis:
- Avoid exogenous oestrogens found in oestrogen-fed poultry and pesticide-sprayed fruits and vegetables. Eat only organic poultry and produce.
- As endometriosis is considered to be an oestrogen-dominant condition, ensuring the processes of oestrogen detoxification are optimal through consumption of indole-3-carbinol containing foods, such as cruciferous vegetables (e.g., broccoli, cabbage, cauliflower, and other brassicas) will aid in the management of endometriosis.
- Increase intake of whole grains, fresh vegetables, essential fatty acids (cold-water fish, nuts, and seeds), and vegetable proteins (legumes such as soy). Include liberal amounts of liver-supporting foods such as beets, carrots, onions, garlic, dark leafy greens, artichokes, apples, and lemons.
- Vitamin C: decreases inflammation and supports immune function
- Zinc and beta-carotene: support immune function and enhance healing
- Vitamin E: is necessary for hormone production and is an antioxidant
- Selenium: is needed for fatty acid metabolism
- Iron supplementation: may be necessary if bleeding is severe. Glycinate form is least constipating and 30% better absorbed than ferrous sulfate
- Calcium and magnesium: are needed for hormone metabolism and to modulate inflammation
- Essential fatty acids: to support hormone production and decrease inflammation
- Obesity, and associated insulin resistance, may contribute to endometriosis. A supervised fat loss diet may help to improve insulin sensitivity, correct blood glucose levels, reduce adipose tissue and spare skeletal protein reserves. Fat reduction decreases the peripheral conversion of androgen to oestrone which contributes to endometrial growth
SOUNDS GREAT, NOW HOW CAN I IMPLEMENT THIS?
You can hopefully get some take away points from this information, but if you need further assistance, then we are here to help you. Seeing a qualified practitioner can take the guess work out of the equation for you, saving you time and money in the long run, and get you feeling better much faster.
You will get the benefit of our skills and expertise to correctly identify the best nutritional treatment options for you. You will be prescribed only the best quality herbs and nutrients, which means that you have the piece of mind knowing that you are taking only the nutrients that you really need, and that they are the best quality available.
With guidance from us and these simple tips, you can stand up to endometriosis – rebalancing your hormone detoxification, and living a happy and pain-free life.
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