What Every Woman Should Know
By Melissa Bedford, 4th year Naturopathic Medical Student
I don’t know about you, but prior to starting my naturopathic medical education, I had never heard the word “endometriosis” before – let alone knew anything about the condition. And yet endometriosis is very common, affecting up to 10% of reproductive-aged women, up to 50% of women with infertility, and up to 70% of women with chronic pelvic pain.1 On top of that, studies have shown that it can take over seven years to receive a diagnosis of endometriosis.1 Seven years! That’s an awfully long time to struggle with pain. My goal with this article is to arm you with easy-to-understand, salient details about endometriosis so that anyone experiencing these symptoms feels safe and empowered to seek medical attention.
What is Endometriosis?
Endometrial tissue is the innermost lining of the uterus. In the follicular phase (Days 1-14) of a 28 day menstrual cycle, estrogen causes the endometrial lining to thicken. In the luteal phase (Days 15-28), progesterone initially maintains the endometrial lining, but then as progesterone levels drop, the lining is shed as menstrual bleeding (our period).
In endometriosis, endometrial tissue rebelliously wanders outside the uterus and is found on structures where it should not be – these are often referred to as endometrial implants.1,2 Implants can be found almost anywhere but are most often located in the pelvis, with the most common site being the ovaries.1,2 Other sites within the pelvis include uterine ligaments, fallopian tubes, the large intestine, and the bladder.1 Just like endometrial tissue within the uterus, these implants respond to hormonal signals.2,3 Implants proliferate in response to estrogen but when progesterone levels start to fall in the latter half of the luteal phase, they cannot be shed like normal intra-uterine endometrial tissue can.3,4 The result is inflammation and pain.
Symptoms of Endometriosis
It is possible to be completely asymptomatic with endometriosis, or to experience one or several of the following symptoms1,2:
- Painful menstruation
- Pain with sexual intercourse
- Bleeding after sexual intercourse
- Chronic pelvic pain
- Heavy menstrual periods
- Bleeding between menstrual periods
- Low back pain
- Bowel and bladder dysfunction
Endometriosis & Infertility
Up to 50% of women with infertility have endometriosis – this is a huge number of women.5 Our current understanding of the connection between endometriosis and infertility relates to inflammation and anatomical changes.5 Endometriosis is associated with an inflammatory response, and sustained inflammation is never a good thing. Inflammation can hinder: maturation of ovarian follicles (each of which holds an ovum), fertilization of an ovum by sperm, implantation of a fertilized ovum in the uterus.5 Over time, endometrial implants (and the inflammation associated with them) can cause scarring and alterations to the anatomy of the reproductive tract.5 Please note that many women with endometriosis will not struggle with infertility – endometriosis and infertility do not always go hand-in-hand.
How is Endometriosis Diagnosed?
Endometriosis is typically diagnosed clinically.1 Imaging such as transvaginal ultrasound can help with detection of endometrial implants.1 The gold standard to attain a definitive diagnosis is by biopsy of suspected implants.1,3
What are Risk Factors for Endometriosis?
Risk factors associated with endometriosis include:
- First-degree relative with endometriosis2,4
- Early menarche (onset of menstruation before age 12)1,2
- Late menopause1,2
- Nulliparity (has not borne children)1,2
- Prolonged menstruation (> 5 days)2
- Menstrual cycles < 28 days1,2
There is something meaningful to pull out from these risk factors – many of them signal a state of high estrogen. In endometriosis, implants both respond to and produce estrogen, so the normal rhythm of estrogen that we see in a healthy state can be thrown out of whack.4
Naturopathic Medicine & Endometriosis
Here’s the good news – Naturopathic Medicine can offer a lot of relief to women struggling with endometriosis. We will come up with a plan that provides you with symptomatic relief in the short term while we tackle the underlying inflammation. At the most basic level, we want to ensure that your organs of detoxification are functioning optimally so that excess estrogen can be efficiently removed from your body – the liver and large intestine are big players here. We also want to optimize your immune system in order to address the inflammation created by the implants, and optimize your entire hormonal system because estrogen and progesterone are just two players in a complex, interconnected, multi-player system. Your treatment plan will be uniquely designed for you because the environment in which endometriosis occurs is never exactly the same.
Naturopathic Doctors may use one or several of the following treatment modalities to help treat endometriosis:
- Lab testing
- Clinical nutrition
- Herbal medicine
1. Schenken, R. S. (June 2020). Endometriosis: Pathogenesis, clinical features, and diagnosis. Accessed on July 20, 2020 from https://www.uptodate.com/contents/endometriosis-pathogenesis-clinical-features-and-diagnosis
2. Schrager, S., Falleroni, J., and Edgoose, J. (January 2013). Evaluation and Treatment of Endometriosis. Am Fam Physician. 87(2): 107-113.
3. Davila, G., Kapoor, D., Alderman, E., Hiraoka, M., Ghoniem, G., and Peskin, B. (July 2018). Endometriosis. Accessed on July 20, 2020 from https://emedicine.medscape.com/article/271899-overview
4. Laufer, M. R. (June 2020). Endometriosis in adolescents: Diagnosis and treatment. Accessed on July 20, 2020 from https://www.uptodate.com/contents/endometriosis-in-adolescents-diagnosis-and-treatment
5. Hornstein, M. D. and Gibbons, W. E. (December 2019). Treatment of infertility in women with endometriosis. Accessed on July 20, 2020 from https://www.uptodate.com/contents/treatment-of-infertility-in-women-with-endometriosis
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