You might have heard me say this before: Your period is not a curse.
The truth is that your period is actually a sign of amazing things happening inside your body (regardless of if you ever even want kids!).
But…for some women, your period can feel like a curse from hell – all due to a condition called endometriosis.
Listen up ladies: If your periods are painful, long, heavy, and something you downright dread, please read this article.
If your doctor has told you they suspect endometriosis, please read this article.
If you’ve been suffering for YEARS without relief, please read this article.
One in 10 women in the U.S. is estimated to have endometriosis. (And it takes an average of 8-12 years to be diagnosed).
I won’t pretend I have a magic cure for endo (I wish I did!). But what I can do is share what I know, and assure you: You aren’t crazy. It does hurt. But it doesn’t have to be this bad forever.
This is a big topic, so I’m going to be covering it in two posts. Today, in Part 1, we’ll learn what endometriosis is, its symptoms, and what we (think) causes it. Part 2 will be all about actionable solutions you can put into practice right away.
What Is Endometriosis?
Have you ever wondered what your period is actually made of? It’s not just the same blood you see when you cut your finger – it’s actually endometrial tissue. Over the course of the month, women grow endometrial tissue in the lining of the uterus. When you have your period, that tissue is shed. (If you get pregnant, that endometrial tissue is important for supporting the fetus).
Endometrial tissue is “hormonally responsive” which means it reacts to normal hormone changes that come with your monthly cycle. Blood flow is controlled by inflammatory compounds called prostaglandins.
A normal woman grows endometrial tissue in the uterus and then sheds it during her period. It’s all relatively painless.
But in a woman with endometriosis, the endometrial tissue grows outside the uterus. Most commonly it grows around the fallopian tubes and ovaries, but it can extend into the digestive system and really start growing anywhere in the body.
Endometrial tissue is hormonally responsive no matter where it is in the body – when hormone levels fluctuate (as they should to create your monthly cycle), all endometrial tissue (even that which has overgrown) will respond.
That means more inflammatory prostaglandins leading to pain, inflammation, and even scar tissue (adhesions) where endometrial tissue is located.
This can cause extreme pain during your period, from ovulation through your period, mid-cycle, and, for some women, all month long.
Pain can range from mild to excruciating, and frustratingly, the extent of the endometriosis does not correlate with how severe symptoms are. A little endometriosis can cause a LOT of pain.
Aside from pain, endometriosis regularly causes digestive issues and can impact fertility. It also increases PMS.
It’s estimated, however, that 20-25% of women with endometriosis have no symptoms. They may only be diagnosed when they have fertility issues.
If you do have extremely painful periods, heavy bleeding, and even symptoms like IBS that haven’t responded to treatment, please know that it is not normal and can be a sign of endometriosis. It takes the average woman 8-12 years to be diagnosed with endo. That’s 8-12 years of suffering you shouldn’t have to endure!
What Causes Endometriosis?
The sad truth is that we don’t know for sure what causes endometriosis. Both traditional and functional medicine practitioners agree on certain things – but there’s no one proven cause.
While not currently classified as an autoimmune disease, endometriosis is known to have autoimmune features. It is also known to be related to hormone imbalance.
One other theory is about retrograde blood flow – basically when blood flow washes back up into the uterus and fallopian tubes. But, not all women who have some degree of retrograde blood flow develop endo – which means retrograde blood flow is just one of the mechanisms of endometriosis.
Because there isn’t a good understanding of what causes endometriosis in traditional medicine, most traditional solutions are focused on pain and symptom management…
Traditional Endometriosis Treatments (The Good, Bad & Ugly)
In traditional medicine, typical endometriosis treatments include:
- Oral contraceptives or the hormonal IUD (to block ovulation)
- Pain management (Ibuprofen, etc.)
- Surgery (ablation to remove endometriosis and even complete hysterectomy)
I will never shame a woman for using any of these treatments, and I think (at times) they have merit.
The biggest “red flag” is using oral contraceptives to block ovulation. Like with other conditions, oral contraceptives just work as a “band-aid” and do not address underlying causes. When you stop the pill, symptoms will resume. And because the artificial progestins in birth control can exacerbate estrogen dominance, long-term oral contraceptives can make endometriosis worse.
Not to mention that oral contraceptives can be just as damaging to the gut as antibiotics, and that can exacerbate leaky gut!
Are you using oral contraceptives to manage endometriosis? I’d love to explore what other treatment options are available to you. Book a free 15-minute consult with my team today.
Ablation surgery, on the other hand, can be transformative for women who have progressed endometriosis – and can even restore fertility in some cases! However, I think surgery should always be accompanied by other approaches to address underlying causes and inflammation.
I think a total hysterectomy is unfortunate…and I hope that most women with endometriosis don’t get to the point where such an extreme surgery seems like the only answer. In Chinese medicine, the uterus is considered the second heart, and a recent study showed women who had hysterectomies had higher rates of depression.
And while there is nothing wrong with pain management, functional practitioners like myself tend to focus more on suspected root causes of endo so that we can move beyond just pain management and toward resolution of symptoms.
Let’s talk about that now…
A Functional Perspective On What Causes Endometriosis
I often call endometriosis a disease of hormone imbalance. Specifically, endometriosis is associated with estrogen dominance due to low progesterone (where estrogen becomes high relative to low progesterone).
Low progesterone can have many causes. The most common I see are genetic, due to extended use of hormonal contraceptives (which tend to increase estrogen and decrease progesterone), and as a result of chronic stress. If you have adrenal dysfunction or HPA axis dysfunction, your body may downregulate progesterone to prevent conception during stress.
What you might not know is that estrogen dominance is a component of many autoimmune conditions. (And that may be why autoimmunity is more common in men than women). This might be because high estrogen levels are inflammatory.
Like I mentioned earlier, endometriosis isn’t considered an autoimmune disease (yet). But it definitely has the “hallmarks” of autoimmunity: inflammation and immune dysregulation.
With endometriosis specifically, there is both a localized, chronic inflammation and the presence of self-antibodies. What we don’t yet know is if this is a response to endometriosis or the actual cause of endometriosis.
But we do know that there is also an increased number cytokines, an inflammatory component, and lower levels of apoptosis, which means cells aren’t dying at a normal rate.
All of this points to autoimmune – as does the fact that endometriosis also frequently occurs alongside other autoimmune diseases like MS, Hashimoto’s, lupus, and Inflammatory Bowel Diseases like Crohn’s and Ulcerative Colitis.
Research at the University of Tennessee has also shown that 100% of women with endometriosis also have leaky gut. (This doesn’t mean 100% of women in the world have leaky gut if they endometriosis – just women in the study – but it is a compelling number!)
That makes sense, since functional practitioners have long seen a strong link between leaky gut and the development of all kinds of autoimmune conditions.
I Have Endometriosis…Now What?
I never want to see another woman with endometriosis given a prescription for the Pill and a suggestion for a heating pad as a “solution” ever again.
As a functional medicine practitioner, my mission is to help you address endometriosis holistically.
Make sure you check out part 2 of this article for more information on exactly how I support my patients with endometriosis.
P.S. Also be sure to listen to my guest podcast appearance where I spoke with Tawnee Gibson of Endurance Planet all about endometriosis! Listen here.