Endometriosis 101 Part 2: How I Help My Patients Dealing with Endometriosis
Check out "Endometriosis 101 Part 1: What Is this Condition & Why Is it Happening to Me?" HERE
While functional medicine practitioners don’t know with certainty the root cause of endometriosis either (we’re still waiting on the science), we focus on what we do know about the condition by working to reduce inflammation and support the immune system.
Pain management and even surgery might be part of our treatment plan - but I would never see a woman in endometriosis pain and just throw the birth control pill at her! I am not interested in band-aids. I want real solutions for my patients.
Here’s how we address endometriosis (but remember that every treatment plan needs to be customized for your unique needs):
These steps can happen in any order or all at once, depending on your situation.
#1 Heal The Gut
Addressing gut health should always be high on your list for really any health concern, but especially for anything autoimmune.
I often see bacterial infections like SIBO (Small Intestine Bacterial Overgrowth), parasites, viruses, mold and toxin exposure, and food sensitivities. In studies, 80% of women with endometriosis also had SIBO.
These can all be signs and triggers for leaky gut, so addressing them and then working to heal the gut is key to recovery.
I like to start with a comprehensive stool test like the GI Map to find any gut health issues. Then we’ll work to clear any infections and implement dietary changes to support the gut (this could be an elimination diet, but that is not always the answer!).
One dietary change I do recommend? Cutting dairy and soy. There is a lot of research to support the idea that dairy and endometriosis are not good together. Dairy is hormonal, it’s a really common allergen, and it’s also pro-inflammatory. (As is soy.)
Do you have to quit them both forever? Absolutely not. Once you have endometriosis under control, you can probably enjoy them again in moderation. And of course, quality and quantity matter a lot. Go for grass-fed and organic, minimally-processed dairy when you do have it.
Another thing I look for on stool tests is high beta-glucuronidase. Beta-glucuronidase is an enzyme produced by gut bacteria and can be elevated by parasites and other gut infections. When beta-glucuronidase is high, it can lead to estrogen buildup. If you have high beta-glucuronidase, I’ll use calcium d-glucarate and Lactobacillus to help lower this and reduce the estrogen recirculation.
#2 Reduce Inflammation
Next, we’ll take a look at your lifestyle and see what could be leading to increased inflammation. It could be late nights at the office, too many meals out, drinking too much, or even “healthy” habits like over-exercise or a really restrictive diet.
Overtraining isn’t an issue for all women - but you might be surprised how easy it is to become “overtrained” with even a moderate exercise regimen. Remember, overtraining isn’t necessarily about too much exercise… it’s about too much exercise relative to too little recovery. That’s why Olympic athletes can exercise so much without overtraining - they spend all the rest of their time recovering! But for women who have to work, commute, get dinner on the table, do laundry, etc. etc. etc. there is rarely enough recovery time!
Stress in any form is incredibly inflammatory, but it’s not the only inflammatory element to look out for. The modern world is pretty rife with chemicals… and no one wants to think about the cumulative effect of the pollution we breathe (drink and eat, too!), the chemicals in all the products we use (from cleaning to personal care), or the added ingredients in most of our food (including unwanted pesticides and other chemicals). But - it all adds up to a lot of potential inflammation.
But, you don’t have to start living like a monk and throw away everything plastic in your home. I’ll help you choose where you can make a few key changes to reduce overall inflammation.
#3 Stabilize Blood Sugar
One big myth is that weight loss can help with endo symptoms. If you’re carrying a lot of excess weight, losing weight can potentially help with symptoms (since hormones are produced in fat cells) - but that doesn’t mean weight loss is a “cure.”
If you’re already lean, the extra stress on the body of trying to lose more weight can make your symptoms worse. And even if weight loss is one part of your healing plan, it’s definitely not the whole story.
Rather than emphasize weight loss, I like to focus on stabilizing blood sugar with a whole-foods based diet.
This is really important because higher blood sugar levels lead to increased insulin, which stimulates the conversion of testosterone into estrogen. This is just another contributor to the high estrogen levels that are linked to endometriosis.
#4 Balance Hormones
You can’t diagnose hormone imbalance based on symptoms, so I never start a hormone protocol without testing. I use the DUTCH Hormone Panel with my patients.
Once we’ve identified your imbalance, we’ll come up with a plan to correct it - everything from herbals and supplements to acupuncture, exercise, diet, and stress management can come into play.
Some of the herbs and supplements I use most often are:
Melatonin
Melatonin is an antioxidant that has been shown to be able to reduce pelvic pain associated with endometriosis. Now, I don’t want to give out a dose because it’s not the typical low dose that people use to help them sleep. It’s actually a pretty high dose. And it can definitely make people groggy. As a practitioner, I want to make sure it’s appropriate for you. But in the right dosage, melatonin can reduce endometriosis pain by as much as 40%. And it’s safer than the pharmaceutical options by far!
Before supplementing, you can also do things to naturally increase your own melatonin levels like have good sleep hygiene, avoid caffeine, avoid blue light after three in the afternoon, and sleep in a dark room.
Vaginal Probiotics
This is one of my favorite tools - and yes, it is what it sounds like: just take probiotics, and stick them up there! This is really safe and one of the easiest ways to shift the vaginal microbiome.
(If you have chronic yeast or bladder infections, or bacterial vaginosis, this can also help with those conditions in many cases!)
The brands I recommend are Jarrow’s Fem-Dophilus and FloraFemme.
Pycnogenol
Pycnogenol is another really well-known antioxidant that’s very specific to lowering pain and lesions in endometriosis. It’s safe and effective for many women.
Bioidentical Progesterone
This really depends on the woman and proper hormone testing. Please don’t go buy some natural progesterone cream and start self-supplementing! Getting the dose right and monitoring while you use it is so important.
But this works because proper progesterone levels balance and oppose estrogen. Think of it like a teeter totter. But in women with endometriosis, there is evidence that they may have progesterone resistance and therefore need slightly higher progesterone levels than the average woman to achieve that balance.
DIM
Diindolylmethane (DIM, in short) is a phytochemical found is cruciferous veggies (think broccoli, cauliflower, brussels sprouts etc.) and it’s one of my favorite tools for estrogen dominance. It helps balance levels of different types of estrogen and block androgen receptors. Get it from eating lots of veggies, or try a supplement.
#5 Support Better Detox
Your body knows how to detox itself (thanks to your liver, kidneys & more) - and you don’t need a 10-day juice fast to “cleanse.” But that doesn’t mean we can’t support detox.
Your detox symptoms can easily become overburdened when you consider the amount of toxins you’re exposed to (pollution, chemicals in cosmetics, pesticides on food to name a few). Your liver can get “jammed” trying to detox as much as possible - which can then burn through your glutathione stores and leave you feeling totally burnt out.
And remember - your liver also plays a major role in detoxing excess estrogen, so if it’s jammed up, you’re setting yourself up for estrogen dominance.
I’ll have you take a look at where you’re being exposed to toxins as well as teach you some easy tricks for supporting the body’s detox processes.
These are some of the supplements I love for supporting better detox:
Calcium D-Glucarate
Calcium d-glucarate is one I mentioned before for gut health. It is a supplement that’s pretty safe to play with if you have endometriosis because you can assume that you have some level of estrogen dominance. But again, I like to use it based on stool testing so we can be certain that excess beta-glucuronidase enzyme is in fact a part of your issue. Because why take excessive supplements that are not doing for you what you need? That’s a waste of time and money.
N-Acetylcysteine
I always say this is the supplement I would take if I was trapped on a deserted island… it’s just awesome. It has many uses and it supports the production of or master antioxidant, glutathione (which we all need more of!)
In a double-blind study, 92 women with endometriosis were either given NAC or no treatment. And during the NAC treatment, they saw a distinct reduction in the number of cysts or tissue implants, as well as size. In the women using NAC, lesions stayed the same or actually shrunk.
In the no treatment group, lesions tended to grow! The NAC was more effective than hormonal treatments.
And the crazy part is that 24 women in the NAC treatment group who had scheduled laparoscopy actually cancelled their surgery because they had such a great reduction in pain. One woman even got pregnant!
I can’t recommend NAC highly enough. But quality does matter - I usually use physicians-grade from brands like Pure Encapsulations, Thorne, or Designs for Health. I like to use 500 mg, 2-3 times daily.
One caveat: if you have acute gastritis (inflammation of the gut lining) NAC can thin the gut wall slightly, so it might not be right for you.
Don’t Just Accept Endometriosis or Painful Periods
I would never lie and tell you that I have a magical cure for endometriosis. I don’t (and no one does).
What I do have is a holistic approach to healing that takes into account not just symptom management - but also addressing the root causes so that you can experience true relief.
Because there are multiple layers to healing endometriosis, I recommend you get support from an experienced practitioner. A practitioner can help you assess your gut health, hormones, and detox symptoms and strategize healing. Working with an experienced practitioner can turn and a long and frustrating process into a much shorter one. (The majority of my clients see major, lasting improvements in just 3-6 months.)
It’s very possible to be symptom-free, even with endometriosis. It’s very possible to see heavy bleeding, painful periods, and PMS go away. I’d love to help you.
You can book a free 15-minute consult with my team right now. During the call, we’ll listen to you and explore how we could guide your health forward (no obligation!).
Periods shouldn’t be painful or something to dread! I’d be honored to help you take back control and feel better.
P.S. Do you feel like you’re already eating well, managing stress, and STILL struggling with endometriosis? I’d love to learn more and see if we can’t get you feeling better. Book a free 15-minute consult today.
Endometriosis 101 Part 1: What Is this Condition & Why Is it Happening to Me?
Check out "Endometriosis 101 Part 2: How I Help My Patients Dealing with Endometriosis" HERE.
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.