How to live well with Endometriosis

Endometriosis is a painful condition that affects millions of women and can have a profound effect on their lives. It is complicated to diagnose and often women can suffer for decades even if they have had help or advice. Here, I have taken a deep dive into this debilitating condition. And below, you can find my tips on what could be driving your endometriosis, as well as ideas to ease the symptoms with diet and lifestyle changes.

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What is Endometriosis?

Endometriosis is when tissue similar to womb-tissue grows outside the uterus and it usually settles on or around the reproductive organs in the pelvis or abdomen such as the fallopian tubes or ovaries. It can lead to excess fibrous tissue forming between the reproductive organs which can cause them to stick together.

The tissue can also sometimes be found in the pelvis, intestines and bladder. This endometrial tissue does not shed blood but the build-up of abnormal tissue outside the uterus can lead to painful inflammation, scarring and cysts. This means the pain may not just happen during menstruation but may flare up at other times of the month.

Symptoms include painful menstruation, heavy and irregular periods, spotting or bleeding between periods as well as bloating, constipation, pain in the lower abdomen, nausea, chronic fatigue, lethargy, painful intercourse and sometimes reduced fertility.

If you are unsure whether you have endometriosis, you should get in touch with your doctor. Sadly there is no cure, but there are medical and surgical options.

Why do women get Endometriosis?

We don’t know precisely how or why it occurs, but some research suggests that endometriosis is an oestrogen-dependent gynaecological condition. Other research also suggests that it could be due to a misdirected immune system. There are multiple theories regarding what drives endometriosis and most people agree that it can be influenced by a combination of your genes, immune system, inflammation, nervous system, hormones and the environment.

What we do know is that women who suffer from endometriosis may also have higher levels of inflammation and oxidative stress. They may also experience digestive problems or an autoimmune skew to their immune system, have a high toxic load or poor oestrogen metabolism. Collectively or individually, these conditions can be underlying drivers or exacerbators of the disease. To be able to unpick your endometriosis, it’s important to understand what could be contributing to your symptoms, and what targeted interventions you can implement to start reducing or supporting biochemical pathways.

Here is more information about each driver which might be part of the picture, and this may help you work out the most important area to support first.

Psychological stress
One of the first things to consider is the amount of emotional stress a women experiences when she suffers with endometriosis and this in turn can compound things further. Living in a state of trauma due to the painful or heavy periods, feeling exhausted and the potential worry about infertility or need for surgery should not be underestimated. Your body can be in a state of “fight or flight” when symptoms are flaring, and over time this takes its toll. Very often women find themselves in a vicious loop as endometriosis causes stress, but stress also exacerbates the condition. So, breaking the stress cycle is really important.

Oxidative stress
Oxidative stress is essentially cell damage, and is associated with many chronic health conditions as well as infection, inflammation and psychological stress. Research shows that endometriosis sufferers have higher levels of oxidative stress due to difficulty producing a naturally occurring master antioxidant called glutathione which is also partly diet and lifestyle dependent.

Circadian rhythm and sleep
Many of us underestimate the importance of our circadian rhythm and sleep patterns. Poor quality sleep is associated with depressive symptoms, worse quality of life and increased bladder pain in women with endometriosis.

When our circadian patterns are disrupted (e.g. by using mobile phones or laptops late into the evening), our levels of melatonin are lowered. Melatonin is a hormone that helps control the sleep/wake cycle. It is also a potent antioxidant and is also thought to have some anti-inflammatory properties. Preliminary research indicates that melatonin maybe helpful for the treatment of endometriosis and its associated symptoms. This needs to be prescribed by a medical doctor in the UK.

Gut microbiome and intestinal permeability
When we think of gut support for endometriosis research is increasingly showing a link between certain types of gut bacteria that promote endometriosis, and others that protect against it.

Fibre-fermenting gut bacteria produce the short chain fatty acid butyrate shown to be helpful with endometriosis sufferers. This is because butyrate helps to support a healthy gut microbiome and gut lining, whilst also dampening down immune inflammatory activity.

Research also shows that intestinal permeability (leaky gut) plays a role in this chronic disease, so the integrity of the gut lining is of utmost importance, and this can be supported by optimising levels of zinc, Vitamin A and D as well as encouraging a healthy balance of gut microbes in the colon. A diverse gut microbiome really counts, and increasing the consumption of plant-based foods can help to set up the right intestinal environment.

Autoimmunity
Although doctors do not consider endometriosis to be an autoimmune disease, it is suggested that your risk of developing an autoimmune condition may be increased if you have endometriosis. With endometriosis, many systems within the body are often involved and research suggests that an existing autoimmune skew may be present.

For example, there is an intimate connection between sex hormone imbalance and our thyroid, so it’s entirely possible that sex hormones may be impacting the thyroid and vice versa. Thyroid autoimmunity is seen amongst endometriosis sufferers, so it’s worth getting thyroid antibodies checked to rule out Hashimoto’s disease.

Hormone metabolism
When endometrial tissue grows outside the uterine cavity, the signalling of oestrogen and progesterone can become disrupted, very often resulting in oestrogen dominance and progesterone resistance. At this stage, we really need our bodies to be able to clear the excessive oestrogen, and this is down to our genetics, but can also be influenced with nutrition and lifestyle. It’s easy to map out your oestrogen clearance genes with some simple tests.

Yeast overgrowth
Candida albicans is a microscopic yeast that inhabits our body naturally, but if there is excessive overgrowth, then things can become problematic. Research suggests that when this yeast becomes too abundant, it may also drive endometriosis. What’s tricky is that it can be difficult to distinguish between the two conditions as the symptoms are very similar. Chemical sensitivities, bloating, constipation, urinary ailments, vaginal yeast infections and allergies can be present with both yeast overgrowth and endometriosis.

One of the main ways to manage yeast infections is via diet as we know that consuming too much sugar feeds the yeast. So, it makes sense to reduce or eliminate refined foods that are high in sugar such as cakes, biscuits and sugary drinks and steer towards a more whole food natural diet rich in vegetables, lean meats, fish, and healthy fats. Sugar is also known to disrupt our hormones and increase inflammation, which means that by cutting right back on refined sugars this should in turn provide a balancing effect on our hormone health and vitality.

Chemicals & plastics
There are plenty of potential pollutants in our environment so we all need to take measures to prevent ingesting chemicals via our water, food and skin. There is growing evidence that hormone disrupting chemicals may be involved in the severity and progression of endometriosis.

The evidence shows an association between microplastics (such as BPA), organochlorinated environmental pollutants and phthalates and the prevalence of endometriosis. It’s important to be mindful of this and choose products to reduce your toxic load.

Dietary and lifestyle interventions to support Endometriosis

As you can see, there are many reasons why endometriosis is both difficult to diagnose and to manage. With so many contributing factors, changes in diet and lifestyle are often the first steps in easing the burden of this tricky condition.

Dietary

General nutrition – Think eating brightly coloured fruits and veggies and plenty of polyphenols here! Plants have been shown to have compounds beneficial to health and they help feed our gut microbiome, some plants also help reduce inflammation. This is where eating the rainbow comes into play, the more colours the better. Research suggests a Mediterranean style diet, rich in plants, fruits, healthy fats and proteins may reduce the risk of endometriosis. I haven’t (yet) seen evidence that it affects the day to day symptoms, but it’s a great diet in many ways so you won’t be doing any harm with it.
Brassicas – Research shows that brassica vegetables contain the plant compounds glucosinolates and isothiocyanates which are natural anti-inflammatories. Consuming a couple of servings of broccoli, cabbage, cauliflower, rocket and Brussels sprouts per day may help to reduce the symptoms and progression of endometriosis.
Antioxidants – A study in 2022 showed that plant compounds such as curcumin, quercetin and resveratrol have antioxidant properties which act on reducing inflammation and quelling oxidative stress. We know that the balance between oxidative stress and antioxidants is often out of whack with this condition, so increase your intake of foods high in antioxidants such as red grapes, red peppers, red onions, apples, blueberries, broccoli, walnuts, kale, green tea, strawberries, beans, oats and dark chocolate.
Minerals – Zinc, magnesium and selenium are all super important. Magnesium helps to relax and smooth muscles, which can be helpful with contracting fallopian tubes and pelvic pain. Magnesium-rich foods include dark leafy greens, wholegrains, nuts and seeds. Selenium may help lower acute and chronic inflammation and can be found in the humble Brazil nut – just 2-4 a day. Whilst zinc helps support the immune system but is also an important antioxidant; eat red meat, shellfish, legumes and seeds to keep zinc topped up.
Vitamin D – Women with severe endometriosis often have lower than optimal levels of vitamin D. This is super easy to test for and easily rectified with supplements during the winter, as recommend by the NHS. Although vitamin D in food is limited, you can find some in salmon, herring and sardines and egg yolks. During the summer months we can obtain vitamin D from sun exposure.
Omega-3 – Studies demonstrate that women that have adequate levels of omega-3 were less likely to have endometriosis. In fact, a study that looked at adolescents noted a 50% drop in symptom scores when they were supplemented with fish oils. You’ll find omega-3 in oily fish such as salmon, mackerel, anchovies, sardines and herring. Plant sources include flaxseeds, chia seeds and walnuts.
Gut support – Here we need to consider the gut lining as well as the gut microbiome. Consuming prebiotics and probiotics can be beneficial as they help to support the production of butyrate. Butyrate promotes a healthy microbiome and gut lining and modulates the immune system with its anti-inflammatory properties. Prebiotic foods include garlic, leeks, artichoke, onion, cabbage, sweet potatoes, raw honey, legumes, berries, bananas, dark chocolate and ginger. Probiotic foods are kefir, kombucha, soya sauce, kimchi, natural yoghurt, picked foods and tempeh.

Lifestyle

Mindfulness/Meditation – Being able to switch off and relax is really important with this condition as anxiety, stress and worries often feed and exacerbate the condition. The benefits of meditation and mindfulness are well known now, and there are lots of apps and YouTube videos available, so choose one that best suits your style.
Stress reduction – We all have our own ways that allow us to switch off and relax. I love an Epsom salt bath and a cup of turmeric latte to help me relax and unwind. But, we’re all different and I urge you to find your thing – maybe it’s a dog walk with a friend, massage or facial, reading a book, listening to some music or playing an instrument, or maybe it’s just sitting still in nature and listening to the world around you. Carve out 10-20 minutes per day to allow your nervous system to relax.
Avoid pollutants – Toxins are all around us and these days we are much more aware of them, so we can better avoid them. Some easy wins are eating organic foods when you can, swapping skin care and cosmetics for naturally produced products, use a stainless steel water bottle instead of plastic and buy a BPA-free refillable coffee mug, if you’re a frequent coffee shop visitor.

Detoxification

Endometriosis is classed as an oestrogen dependent condition by some researchers, so ensuring that your metabolism and detoxification of oestrogen is in tip top condition is essential. For this we need to consider genetics, liver and gut support.

Genetics – There are simple DNA tests you can do to uncover your oestrogen clearance pathways, and once you know these, you can implement nutritional support if any need a little boost. These need to be arranged through a practitioner who has been trained in genomics.
Liver – The best way to support your liver is to avoid alcohol and heavily produced corn syrups that are found in processed foods. Our livers also love bitter foods such as green tea, garlic, berries, grapes and grapefruit. Sulphurous foods such as broccoli, cabbage, greens and Brussels also help support oestrogen detoxification.
Gut health – Supporting your gut health with both prebiotic and probiotic foods to help support butyrate production will go some way to creating a strong, diverse healthy microbiome and gut lining.

Round-up

Endometriosis is a complicated condition, but it is possible to unpick certain drivers and focus on your diet and lifestyle. These changes will go some way to dial down the pain and other endometriosis symptoms.

At NatureDoc we have a clinical team of Nutritional Therapists who can help you navigate your endometriosis journey. We’re here to help you implement simple nutrition and lifestyle changes, with specialist hormone, gut and nutrition tests at hand if necessary to pinpoint specific issues that can be addressed.

References

Responses

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Valentina Wharton Sun, 12th Feb 2023

Thanks for raising awareness of this debilitating disease that affects one in ten people. Your article is full of loads of helpful information which will help those suffering. Personally, I’ve found that diet has really helped manage my symptoms much more so than synthetic hormones which I was prescribed many times. Great article with some useful links attached. Thank you!