Skip to main content

Adenomyosis – The Missed Diagnosis for Women

In the realm of women’s health, most women have heard of PCOS, endometriosis, or fibroids.  But mention a diagnosis of adenomyosis and you’ll be met with blank stares.  Why is one of the most common uterine conditions something most women have never even heard of?

Adeno-whaty-osis?

Adenomyosis is a condition that is very similar to endometriosis.  In adenomyosis the inner layer of the uterus, the endometrium, pushes into the muscular layer of the uterus, the myometrium and decides to stay there. Endometriosis occurs when those same endometrial cells set up shop outside the uterus – on the outer walls of the uterus, the ovaries, the fallopian tubes and throughout the abdominal cavity. 

Unlike endometriosis, in most cases of adenomyosis, the endometrial cells that are out of place are not functional – they don’t respond to the hormones of our menstrual cycle and go through the paces of shedding blood each month. 

A Common(ly Missed) Diagnosis

We don’t really have a good estimate of how many women are currently experiencing adenomyosis.  Unlike many other gynecological conditions, adenomyosis diagnosis criteria aren’t as well established internationally.  Some studies estimate up to 20-30% of reproductive aged women may have adenomyosis. 

Up until recently the only way to diagnose adenomyosis was to do a hysterectomy, and then take a look at the layers of the uterus. Now (thankfully) we can diagnose adenomyosis through an MRI. 

Symptoms of Adenomyosis

Half of women with adenomyosis will never have symptoms that are significant enough for them to seek care.  They may notice they are having heavier or more painful periods, but they often chalk it up to getting older.  Women who do experience symptoms tend to be older – between the ages of 35 and 50.  Adenomyosis is rare in postmenopausal women, except when the drug tamoxifen is involved. 

Classic symptoms of adenomyosis are:

  • Painful periods
  • Heavy periods
  • Abdominal pressure and bloating
  • Pain during sex

In adenomyosis the uterus is also enlarged and lumpy, but most women wouldn’t notice this until it gets really enlarged. 

If It’s Not Adenomyosis

The most common misdiagnosis for adenomyosis is uterine fibroids.  Another type of benign (non cancerous) growth in the uterus, fibroids can grow in the wall of the uterus, on the outside wall of the uterus, just under the uterine lining or hang into the uterus.  Both adenomyosis and fibroids cause heavy and painful periods.  And some unlucky women can have both these conditions at the same time. 

Treating Adenomyosis

Adenomyosis is more common as women get older, and the potential for estrogen dominance increases.  Many women respond well to approaches for reducing estrogen dominance such as DIM, I3C, calcium d-glucarate, B-vitamins, probiotics and bioidentical progesterone.  Other options include treatments that reduce heavy periods, such as shepherd’s purse and ginger.  Anti-inflammatories such as turmeric and ginger may also be helpful for reducing the cramping associated with adenomyosis. 

Most importantly, you should consider working with a Naturopathic Doctor or functional medicine practitioner to develop a strategy for managing your adenomyosis symptoms, especially if you want to prevent a hysterectomy down the road.  Working with someone who can guide you to optimal hormone balance can be life-changing for women with adenomyosis, and the consequences of hormone balance (better moods, more libido, more energy) can help you live the fired up life you deserve.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Selected References

Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburts Frau. 2013;73(9):924-931. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859152/

Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Human Repro. 2012;27(12):3432-3439.

Endometriosis and Fatigue

One of the most common symptoms of endometriosis is one that is not being adequately assessed or managed – fatigue.  A 2018 study found that a majority of women with endometriosis experienced fatigue, a significantly higher number than in a control group of women.

Fatigue and Endometriosis

Women often report fatigue to their doctors, and many are disappointed by the lack of concern, or downright dismissal, of their symptoms.  Women in my practice have heard:

            “We’re all tired”

            “You’re just getting older.  Feeling tired is part of aging.”

            “Tired is just another word for being a parent.”

            “Try getting more sleep, you’ll feel better after a good night’s sleep.”

            “I could give you some Ambien…”

The reasons why women with endo have more fatigue are likely different, depending on the woman’s experience.  Some common contributing factors identified in the study include insomnia and sleep loss, depression, pain (causing both depression and sleep loss), and significant stress.  Living with a chronic pain condition like endometriosis is likely to be a drain – on your body, on your mind, on your emotions, and on your energy.

Managing Fatigue in Endometriosis

Unfortunately, many doctors don’t screen women with endometriosis for fatigue, and are not offering treatments to women who do report fatigue.  But there are some things you can do.

  1. Remove gluten from your diet.  Studies have found that eliminating gluten from your diet can reduce pain associated with endo for about 75% of women.  Removing gluten can also reduce brain fog and improve energy.  I suggest doing at least 6 weeks gluten free to see how it can impact your endo, and your energy.
  2. Take an omega 3 fatty acid supplement.  Used by the body to reduce inflammation, omega 3s also help to keep your nervous system, including your brain, functioning optimally.  Studies suggest that women with endometriosis take between 1-3g of omega 3s per day.  If you choose a fish based omega 3, be sure to choose one that is free of mercury, PCBs and other contaminants.
  3. Get a good night sleep.  There is nothing that will zap your energy more than a poor night sleep.  And if you can’t sleep, consider taking a melatonin supplement.  One study found that taking melatonin decreased pain scores in women with endo by almost 40% – not to mention how it impacted their sleep! 
  4. Try meditation.  It’s a bit cliché, but seriously, if you aren’t meditating, why not??  The benefits of meditation are almost too numerous to count, but improving sleep, calming stress, improving mood and supporting energy are certainly among them.  Meditation doesn’t have to be hard – you can download free, or inexpensive apps, and meditating for just 10 minutes a day can have positive benefits.  So give it a try, seriously! 
  5. See your Naturopathic Doctor.  Ultimately, fatigue is a real symptom of endometriosis.  It may be overlooked by many doctors, but it should not be overlooked by women.  You have the capacity to abundant energy, to share your magnificent self with the world.  When you work with an ND you get the ultimate in personalized medicine.  Your ND will help you to develop a strategy to treat your symptoms of endometriosis – including fatigue. 

Disclaimer

Fatigue is a common symptom of endometriosis.

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Select References

Ramin-Wright A, Kohl Schwarts AS, Geraedts K, et al. Fatigue – a symptom in endometriosis. Human Reproduction,33(8);2018:1459-1465

Schwertner A, Cocneicao Dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-81.

Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM.  Gluten-free diet: a new strategy for management of endometriosis related symptoms? Minerva Chir. 2012 Dec:67(6):499-504.

Endometriosis Staging

Many women in my practice have never heard of endometriosis before they are diagnosed with it.  And often that diagnosis took years to get.  Endometriosis is a notoriously difficult condition to diagnose – it can’t always be seen on an ultrasound and diagnosis often requires an MRI or a surgical procedure (a laparoscopy) to identify the endometriosis and provide information on staging.

The symptoms of endometriosis are often ignored as well, both by women and their health care providers.  Many women have to see 3 or more doctors before they receive an appropriate diagnosis – and delaying diagnosis can make this already difficult condition even more difficult to treat.

Endometriosis Staging

Once a diagnosis of endometriosis is made many women are given a staging level for their endo.  The American Society for Reproductive Medicine classification is based on a point system looking at the following characteristics:

  1. Location and size of the endometriosis – on the peritoneum and ovary – and whether it is superficial or deep
  2. Obstruction (obliteration) of the cul de sac – partial or complete
  3. Adhesions on the ovary and fallopian tubes – filmy or dense and their overall size

Based on the points given for these findings, a stage is given. 

            Stage I – Minimal endometriosis (less than 5 points)

            Stage II – Mild endometriosis (6-15 points)

            Stage III – Moderate endometriosis (16-40 points)

            Stage IV – Severe endometriosis (>40 points)

*Follow the link for the exact point calculations. 

Concerns with Staging Endometriosis

While staging of endometriosis can be useful for women and their health care providers to understand the overall appearance of the endometriosis, the staging system has some flaws.

The staging system only describes what the endo looks like – it doesn’t help a woman (or her health care team) predict pain levels, response to medications, risk for associated conditions, or quality of life.  Women with Stage IV may have minimally painful periods, while women with Stage I may suffer incredibly each month. 

Ultimately, I don’t treat women based on staging of their endometriosis.  I treat women based on their symptoms and their desired outcomes.  A woman who wants to get pregnant will be treated differently than a woman who wants to reduce pain – every woman in my practice is treated individually to help her achieve her optimal state of health while living with endo. 

For more information on endometriosis, check out the other articles in my endometriosis series, including Understanding Endometriosis, Endometriosis in Adolescence, Endometriosis and Infertility, The Endometriosis Diet and Endometriosis and Naturopathic Medicine.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Phytoestrogens: Hormone Balance With Food

Phytoestrogens, or plant-based estrogens, are compounds found in our food that can bind to our estrogen receptors.  While a lot of confusion exists on the impact this has on our hormone health, I’m going to help you understand the amazing balancing effects of phytoestrogens, and tell you why you should consider having more of them in your diet.

Why Phytoestrogens are Important

In our bodies we have three sources for estrogen: the estrogen we make (also known as endogenous estrogen), the estrogen we eat (phytoestrogens) and the estrogen-like compounds we are exposed to in our environment (xenoestrogens).

Each of these estrogens can bind to an estrogen receptor and cause an estrogen-like effect.  The chemical estrogens, or xenoestrogens, from the pesticides, herbicides, personal care products and other chemicals in our body have a much stronger impact than that of our own home-made estrogen.  And the plant estrogens have a much weaker effect.

The Balancing Effects of Estrogen

With many women suffering from conditions of excess estrogen – like fibroids, PCOS, obesity and estrogen dominance as well as estrogen sensitive conditions like endometriosis, fibrocystic breasts and breast cancer – lowering their body burden of estrogen is important.  For women with high estrogen, consuming more very mildly estrogenic phytoestrogens can prevent the negative impact of exposure to their body’s own estrogens as well as the chemical estrogens from the environment.  When you have lots of plant estrogens in your body they occupy the estrogen receptor, causing a very small estrogen-like impact, but most importantly, they prevent other stronger estrogens from binding to that receptor.  This results in an overall lower estrogen state in the body.

Following along so far?  It gets better!

When women are suffering from low estrogen – due to hysterectomy or menopause, phytoestrogens can also be helpful.  When women is no longer producing her own estrogen in optimal amounts, the small amount of an estrogen effect from a phytoestrogen can help to boost her estrogen levels and diminish symptoms of low estrogen like hot flashes, night sweats, insomnia and mood swings.

Food Sources of Phytoestrogens

More than 300 different plants contain phytoestrogens. There are several subclasses of phytoestrogens, some of which are listed below.

Lignans – Vegetables, fruits, nuts, cereals, spices, seeds; especially flax seeds

Isoflavones – Spinach, fruits, clovers, peas, beans; especially soy

Flavones – Beans, green vegetables, fruits, nuts

Chalcones – Licorice root

Diterpenoids – Coffee

Triterpenoids – Licorice root, hops

Coumarins – Cabbage, peas, spinach, licorice, clover

To increase dietary sources of phytoestrogens, consider the following foods:

Flax seeds – the highest food source of phytoestrogens is flax seed and oils. The phytoestrogens in flax seeds are lignans. Lignans have antitumour, antioxidant, and weakly estrogenic and antiestrogenic characteristics. They have been found in studies to decrease vaginal dryness, hot flashes or night sweats in women with low estrogen symptoms.

Soy, edamame, tofu, tempeh – the best known phytoestrogen, soy, when consumed in the diet, is safe for women with symptoms of both high and low estrogen.  For hot flashes and night sweats, women who consume soy tend to have less symptoms than women who do not.  Other research suggests that increasing soy foods in the diet stabilizes bone density, decreases cholesterol levels and has a favourable effect on cardiovascular risk profiles in menopausal women

Beans: soybeans, tempeh, black beans, white beans, kidney beans, lentils, mung beans, coffee

Grains: wheat berry, oats, barley, rice, alfalfa, wheat germ

Seeds and nuts: flaxseed, sesame seeds, fenugreek

Vegetablesyams, carrots

Fruits: apples, pomegranates

Herbs and spices: Mint, licorice root, ginseng, hops, fennel, anise, red clover

Harmonizing Your Hormones

If you are interested in exploring more ways to balance your hormones naturally, book a free 15 minute meet and greet appointment with me to discuss how you can bring harmony to your hormones and fire up your health!

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Ovarian Cysts: Simple and Complex

Ovarian cysts are small growths that form on or inside of the ovary. Many women are diagnosed with ovarian cysts on routine ultrasounds, and others are diagnosed when they experience changes in their menstrual cycles or painful periods. Often women are told they have cysts without really understanding what that means. This article will give you the knowledge you need to understand your diagnosis, and empower you to select the best treatment options for you and allow you to restore your optimal hormone health.

Simple Ovarian Cysts

Simple ovarian cysts are by far the most common type of ovarian cyst. A simple cyst forms when an egg fails to be released by the ovary at ovulation, or when the follicle the egg developed in continues to grow after ovulation. Simple ovarian cysts develop with exposure to estrogen, and are sometimes called ‘functional’ cysts.

Simple cysts often have no symptoms and will resolve on their own with time. Simple cysts are often found in a condition called Polycystic Ovarian Syndrome (PCOS) where many simple cysts develop and symptoms such as a lack of periods (amenorrhea), irregular periods, infertility, acne, hair loss or facial hair growth can occur.

Complex Ovarian Cysts

Complex cysts are much less common and are not formed during a typical menstrual cycle. There are three different types of complex ovarian cysts:

  • Cystadenomas – ovarian tissue filled with fluid or mucus
  • Dermoid cysts – composed of cells you have had since before you were born. Dermoid cysts contain cells that are used to produce dermal tissue, so they can contain skin, hair, fat, or teeth.
  • Endometriomas – a result of endometriosis. Endometriomas occur when cells from your uterine lining grow on or in the ovaries.

Complex ovarian cysts are most often benign, especially those that develop before menopause. Some ovarian cysts can be malignant so it is important to have them assessed fully.

Symptoms of Ovarian Cysts

Most simple ovarian cysts do not cause any symptoms at all. Some symptoms that may alert you to the possible presence of simplex or complex cysts include:

  • Bloating, pressure, or pain in the low abdomen
  • Frequent urination (if the cyst is large and pressing on the bladder)
  • Sudden severe pain (if the cyst ruptures)

If you have endometriomas – cysts associated with endometriosis, you may experience:

  • painful periods
  • pain during sex
  • pain during bowel movements
  • infertility

What Causes Cysts?

Simple cysts (like those in PCOS) are the result of hormonal and metabolic issues. You can read more about PCOS in these articles, Understanding PCOS, PCOS Types and Diagnosing PCOS.

Complex cysts can be present from birth and grow under hormone stimulation after puberty. Endometriomas, another complex cyst, occur when the lining of the uterus grows outside of the uterus, including on the ovaries. Cystadenomas can occur when ovarian cells mutate and grow (most often these are benign, but can be cancerous).

Diagnosis of Cysts

Most cysts are diagnosed with a transvaginal ultrasound. Some can also be detected with a simple pelvic exam. Often the type of cyst can be identified with an ultrasound, but occasionally a biopsy or blood test (such as CA-125) may also be used.

Treatment of Cysts

Simple cysts are easily treated with Naturopathic approaches – hormone balancing, blood sugar stabilization and improved ovarian response are common treatment goals.

Some complex cysts require no treatment, but some may need to be removed if they are large or causing significant symptoms. Most often the cyst is removed through a simple surgery caused laparoscopy.

Endometriomas are treated in the same manner as other types of endometriosis. If you have endometriosis, please read the Endometriosis series of articles written by Dr. Lisa on this website.

 

If you have any more questions about your ovarian cysts, don’t hesitate to get in touch!  You can send Dr. Lisa an email or book a free 15 minute meet and greet here.

 

SaveSave

Hormone Testing

The importance of hormones for human health can’t be understated. The over 50 hormones in the human body act as chemical messengers that control most major bodily functions – from hunger, stress, mood and emotions to reproduction.

The body maintains an intricate balance of hormones, a state called homeostasis. When this delicate balance is challenged a wide variety of symptoms can occur – insomnia, fatigue, depression, anxiety, weight gain, acne, premenstrual syndrome, endometriosis, PCOS, diabetes, menstrual irregularities, and many, many more.

When identifying an unbalanced hormonal state, hormone testing can provide valuable information that will allow you to take steps to restore your optimal hormone balance, resolve symptoms, and restore optimal health.

Hormone Testing

Three important factors need to be considered when seeking testing for hormone balance.

            Timing of Testing

Time of day and time of month are important factors in getting valuable information from hormone testing. For most hormones, testing should be done first thing in the morning. An exception to this rule is cortisol, which is often tested at multiple points over the course of the day.

Time of month, or more accurately, time of the menstrual cycle, is also an important consideration for women. Generally hormones should be tested about one week before an expected period, when levels are at their peak.

Testing Sample Type

There are three main ways to test for hormone levels – blood (serum), saliva or urine. Each has it’s benefits and can be used, depending on the information needed.

Blood – a simple blood draw can give a great deal of information about thyroid hormones, insulin and blood sugar levels, vitamin D, prolactin, FSH and LH. It’s a quick process with well established reference ranges. However, it’s not considered the best test for steroid hormones like estrogen and progesterone, as levels in the blood stream do not accurately reflect free hormone levels available for action in the body.

Saliva – a home saliva test kit will provide good information about the free hormone levels of many steroid hormones: cortisol, estrogen, progesterone, DHEAS and testosterone. This test is considered a good reflection of hormone balance in the body. The drawbacks to salivary testing are the less well established reference ranges and the lack of testing for hormone detoxification pathways.

Urine – a newer testing type for hormone balance, the dried urine test for comprehensive hormones (DUTCH), gives the most comprehensive overview of the entire hormone cascade.  Looking at the reproductive hormones of estrogen, progesterone and testosterone, as well as our stress hormones cortisol and cortisone, and our mood and mojo hormones and neurotransmitters, like DHEAs, serotonin and dopamine.  One of the greatest benefits of the DUTCH test is the ability to follow metabolism and detoxification patterns of the hormones, giving us an in depth understanding of where hormone imbalances come from, rather than just identifying what they are.

            Balance Over Absolute Values

The last important consideration for hormone testing is that the results of your hormone test should be interpreted by a practitioner with a great deal of expertise in hormone testing and hormone balancing. When looking at a hormone test the most important information is the balance between the different hormones, rather than the absolute values of each individual hormone. A low normal progesterone with a high normal estrogen results in the same symptoms as a normal estrogen and a very low (or abnormal) progesterone.

Hormones are responsible for a vast variety of functions in our bodies, and their imbalance is an important (and common!) cause of symptoms. If you suspect you may have a hormonal imbalance, book an appointment with your Naturopathic Doctor today to discuss your options.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Naturopathic Acupuncture

As a Naturopathic Doctor, I have received extensive training in Traditional Chinese Medicine (TCM) and acupuncture. TCM is a system of medicine that has been used to prevent, diagnose and treat disease for over 5000 years. It is based on the Eastern philosophy of “Qi” (life energy). Traditional Chinese Medicine seeks to balance the flow of Qi in the body in order to maintain health, treat illness and relieve pain.

Acupuncture is the use of very fine, sterile acupuncture needles inserted into specific points (acupoints) in the body to manipulate and control the flow of Qi. Acupuncture has been proven to be beneficial in the treatment of many conditions including joint pain, chronic back pain, digestive difficulties, menstrual irregularities, depression, insomnia, migraine and many others.

In my practice I use TCM and acupuncture for a variety of conditions, most notably fertility enhancement, IUI and IVF cycle support, female and male hormone balancing, menstrual irregularities, endometriosis, labour induction, menopause symptoms (hot flashes, night sweats), anxiety, depression, insomnia, headaches and digestive complaints (diarrhea, constipation, heartburn). Acupuncture is safe and effective for all adults, including pregnant women. Acupuncture provided by Dr. Lisa is covered by most extended insurance plans under Naturopathic Medicine.

Endometriosis in Teens

Endometriosis is one of the most common causes of menstrual pain in women in their 20s, 30s and 40s. Recently doctors and scientists have begun to recognize that symptoms of endometriosis can begin during adolescence and be a significant cause of menstrual pain in teens as well.

Unfortunately, endometriosis is often overlooked in teenaged girls – one study found that women with endometriosis symptoms starting before age 15 had to see a doctor an average of 4.2 times before it was correctly diagnosed. That was more than in any other age group!

This same study found that more than one-third of women with endometriosis had symptoms starting before 15 years of age.

Early diagnosis of endometriosis is important for teenagers. Only with proper diagnosis can these young women receive appropriate education on the future of their reproductive health and treatments that can minimize or eliminate their pain and preserve their future fertility.

How Do I Know if I Have Endometriosis?

6979261624_6407c5ac68The most common symptoms of endometriosis are:

  • Pain before and during your period
  • Pain with intercourse (in sexually active teens)
  • Infertility

For many teen girls pain with intercourse and infertility are not issues that they experience, which makes diagnosis more difficult. Other signs of endometriosis include:

  • Bleeding prior to your period (spotting)
  • Back or abdominal pain during your period
  • Pain with bowel movements
  • Painful digestive upset

In teen girls one symptom to look for is painful periods that do not respond well to pain medications like aspirin, ibuprofen, Advil, Aleve or naproxen.

Most teen girls with endometriosis will experience pain away from their periods; less than 10% had period pain alone and over 90% have pain both with their period and at other times during the month.

If you suspect you may have endometriosis your doctor will recommend an ultrasound and possibly a procedure called a laparoscopy. During a laparoscopy a small incision is made in the abdomen. A surgeon will be able to insert a camera into this incision and see if endometriosis is present – some endometriosis lesions can also be removed during this procedure.

Treatment for Endometriosis in Teen Girls

There are many available treatments for endometriosis. When started soon after diagnosis appropriate treatments can preserve a woman’s fertility and significantly decrease pain.

The most common mainstream treatment for endometriosis in adolescence is the birth control pill, used continuously or monthly, combined with pain medications to manage pain.

Naturopathic treatments focus on treating the underlying issues associated with endometriosis, normalizing hormone balance, decreasing pain and inflammation, optimizing immune function and supporting the body through the diet. You can read more about Understanding EndometriosisNaturopathic Medicine and Endometriosis, Acupuncture and Endometriosis and the Endometriosis Diet, all written by Naturopathic Doctor, Dr. Lisa Watson.

If you are a teen who wants to treat her endometriosis, book a consultation now to get started.  You can make a big impact on your future health if you act now.

References

Ballweg ML. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe. J Pediatr Adolesc Gynecol 2003;16(3 Suppl):S21–6.

Rowe T. Endometriosis: Diagnosis and Management. J Obstet Gynaecol Canada 2010;7(32)

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

The Endometriosis Diet

Niels H. Lauersen, MD says in his seminal book Getting Pregnant that endometriosis is “one of the most devastating, if not frustrating, of all gynecological ills”. 1 in 10 women suffer from the pains and frustrations of endometriosis, and there is no cure.

Despite this lack of cure, there is a lot that can be done to decrease the painful symptoms of endometriosis, prevent worsening of the endometrial growths, and support future fertility.

The first step in managing your endometriosis is to follow the Endometriosis Diet.

The Endometriosis Diet

The purpose of the Endometriosis Diet is multiple:

You can start the Endometriosis Diet soon after diagnosis, or at any time. This diet can help control the growth of endometriosis that has already appeared, decrease pain and other symptoms and in some cases prevent endometriosis from occurring at all.

Endometriosis Diet: Foods to Avoid

  1. Avoid alcohol

Alcohol depletes B vitamins that are necessary for hormone detoxification. It also has estrogen-like effects on the body and can worsen endometriosis symptoms.

  1. Avoid refined sugarFighting Sugar Addiction

Sugar is another culprit that can increase estrogen levels. It is also known to negatively impact immune function. Fruit is fine, but avoid all sources of refined sugars.

  1. Avoid caffeine

Women consuming two cups of coffee per day have twice the risk of developing endometriosis.

  1. Avoid red meat, especially grain-fed

Red meat is a rich source of arachidonic acid – which promotes production of inflammatory prostaglandins and increases inflammation and pain. Additionally, cattle and pigs fed grains treated with pesticides tend to concentrate these hormone-disrupting chemicals in their fat and muscle tissues. Consumption of these meats is a leading source of human exposure to organochlorines.

  1. Avoid dairy products

Dairy products are another potential source of hormone-disrupting chemicals, like the organochlorines. Organochlorines also impact the function of the immune system, weakening natural killer (NK) cell activity. Additionally, high fat dairy products may promote estrogen dominance, accelerating the growth of endometriosis.

  1. Avoid gluten

A 2012 study started 200 women with endometriosis on a gluten-free diet. 75% of the women reported an improvement in pain and none reported an increase in pain. All patients reported improved vitality and general health as well.

  1. Avoid refined and hydrogenated oils

Refined and hydrogenated vegetable oils contain omega 6 fatty acids that compete for absorption with anti-inflammatory omega 3s. Avoid canola, safflower, sunflower and so-called “vegetable” oils.

  1. Limit eggsFertile Cervical Fluid Testing

Eggs are a source of arachidonic acid and their consumption should be minimized.

  1. Limit peanuts

Another rich source of arachidonic acid. Healthier nuts include almonds, hazelnuts, pistachios, walnuts and cashews.

     10.  Avoid food sensitivities

Food sensitivities can contribute to inflammation, intestinal permeability and immune system disturbances. Food sensitivities are very individual – blood testing is generally recommended to identify what foods may causing negative effects in your body.

Endometriosis Diet: Foods to Enjoy

  1. Organic fruits and vegetables

Fruits and vegetables provide fiber that support healthy digestive function as well as nutrients to support immune function, detoxification and decrease inflammation. Women who consume two servings of fruit per day have a 20% decreased risk of endometriosis. Selecting organic fruits and vegetables will minimize intake of pesticides that disrupt hormone function.

  1. Vegetarian proteins

almonds are a source of calciumWomen who eat a vegetarian diet excrete 2-3 times more estrogen in their feces and have half as much estrogen in their blood as meat-eaters. Focusing on eating soy, almonds and other nuts and nut butters, beans, lentils and legumes.

  1. Fish

Fish, especially cold-water fish like salmon and mackerel, are a rich source of anti-inflammatory omega 3 fatty acids. Two servings per week is the ideal recommendation – more than this can result in undesirable exposure to PCBs and other environmental contaminants.

  1. Flax seeds

Another rich source of omega 3s, ground flax seeds also contain lignans that provide an ideal source of fiber to support digestion and healthy bacteria balance.

  1. Cabbage family vegetables

brussels sprouts are goitrogenicThe Brassica (cabbage) family of vegetables support detoxification and encourage a healthy estrogen balance by favouring production of the less active form of estrogen. Consume broccoli, brussels sprouts, cabbage, kale, kohl rabi and cauliflower regularly to reap these benefits.

  1. Leafy green vegetables

Leafy green vegetables provide key minerals for detoxification and support liver function. Frequent consumption of leafy greens (two servings per day) has been shown to significantly decrease the incidence of endometriosis.

  1. Onions, garlic and leeks

These vegetables contain organosulfur compounds that enhance immune function and induce enzymes that detoxify the liver. They are also rich sources of quercetin, a bioflavonoid that stimulates the immune system and decreases inflammation.

  1. High fiber foods

High fiber foods are incredibly important for endometriosis because they support the optimal balance of friendly bacteria in the digestive tract. Friendly bacteria support the elimination of estrogen in the feces. Focus on fiber in the form of vegetables, fruits and whole grains such as barley, quinoa, millet, brown and wild rice.

  1. Fermented foods

Fermented foods support estrogen balance by providing a food source of friendly bacteria. Olives, pickles, sauerkraut, kimchi, miso, tempeh and kombucha are excellent, delicious options.

Spices contribute to health     10. Spices

Spices such as ginger and turmeric are powerful anti-inflammatories and also support liver detoxification. Use them liberally throughout the day.

Far More Than Food

Following the Endometriosis Diet is going to improve more than just your endometriosis symptoms. It will likely improve your overall health and vitality as well. This is a healthy, whole-foods based diet that can help you feel great, inside and out.

Diet isn’t the only important aspect of endometriosis treatment. Other articles on this website cover Understanding Endometriosis, Acupuncture for Endometriosis, Endometriosis and the Immune System, Endometriosis and Infertility, Endometriosis in Adolescence and Naturopathic Treatment of Endometriosis. Read on, and if you’re ready to take a well-rounded, holistic approach to your endometriosis, feel free to book an initial consultation to get started.

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

Gluten-free diet: a new strategy for management of endometriosis related symptoms? Minerva Chir. 2012 Dec:67(6):499-504.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Naturopathic Medicine and Endometriosis

Endometriosis is a chronic condition affecting millions of Canadian women. It can begin at any age between the teens and 40s and impacts between 10-15% of women in these age groups.

There is no cure for endometriosis, but Naturopathic Medicine can offer women with this condition hope for improved hormone balance, decreased pain and support for fertility.

Prior to reading this article, I suggest you check out Understanding Endometriosis to learn how to recognize the symptoms of endometriosis and the underlying imbalances that lead to this frustrating condition.

Naturopathic Treatments for Endometriosis

A Naturopathic treatment plan for endometriosis will be highly individualized to each person, addressing their unique lifestyle, dietary and symptom needs. The treatment goals vary person to person, but always include a combination of the following:

  • Normalize the function of the immune system
  • Balance hormones
  • Support liver detoxification of hormones
  • Reduce and block pro-inflammatory chemicals produced by the body
  • Support the large intestine and microbiome (healthy bacteria)
  • Decrease stress

Vitamin CBy addressing these underlying imbalances in endometriosis Naturopathic Doctors can improve the overall health of women with endometriosis, decrease or eliminate symptoms of endometriosis and address the underlying cause of endometriosis.

Normalize Immune Function

There are many nutrients involved in healthy immune function. One of the largest categories of immune supportive nutrients are the antioxidants. Nutrients like vitamin C, beta carotene, vitamin E and selenium all enhance immune function and can be used to support endometriosis treatment. Many of these nutrients also decrease inflammation and can improve pain associated with endometriosis.

Vitamin D, an incredibly important nutrient for Canadians, has profound impacts on endometriosis. Vitamin D regulates cell growth and differentiation in endometriosis, enhances macrophage action and decreases inflammation. Vitamin D supplementation has been found in studies to reduce the weight of endometriosis lesions as well.

Balance Hormones

hormone balanceEndometriosis is a hormonally responsive condition – the growth of the endometrial lesions occurs under the influence of estrogen – so balancing hormone levels is an important treatment goal for all women with endometriosis.

Phytoestrogens, such as lentils, flax seeds and soy, can bind to estrogen receptors and have a less potent effect than our body’s own estrogen. When these phytoestrogens are bound to receptors they displace our own estrogen resulting in a lower estrogen effect overall. These foods should be incorporated into our diet daily for optimal hormone balancing effects.

Indole-3-carbinole and DIM (di-indolylmethane) from brassica vegetables are also estrogen regulating supplements that act much like phytoestrogens by binding estrogen receptors and decreasing our body’s estrogen response. Your Naturopathic Doctor may recommend these supplements, or recommend increasing consumption of broccoli, cauliflower, cabbage and brussels sprouts for hormone balancing in endometriosis.

Reduce Inflammation

Grapes are a source of resveratrolMany of the most profoundly effective treatments for endometriosis work by reducing inflammation in the body. Pycnogenol, a pine bark extract, has anti-inflammatory, immune supportive and anti-growth properties. Studies have shown significant improvements in pain symptoms in women using pycnogenol.

Resveratrol, a substance found in the skin of grapes, is especially beneficial for women with endometriosis and infertility. Resveratrol can decrease inflammation, reduce proliferation of endometrial lesions and protect eggs from the effects of aging.

N-acetyl cysteine (NAC) is one of the most promising treatments for endometriosis. Studies have found immune function improvements (increases in T regulatory cells, decreases in TNF-alpha), significant decreases in inflammation (including increases in glutathione – a cellular anti-inflammatory) as well as reduces in the size of existing endometrial lesions.

Support Liver Detoxification

The liver is essential for hormone balance as it is where our body detoxifies estrogen and prepares it for elimination. B vitamins are necessary for this function, allowing the liver to more efficiently inactivate and process estrogen.

Nutrients known as lipotropics also promote liver function by promoting the flow of fat and bile (containing estrogen for elimination) out of the body through the large intestines. Choline, betaine, methionine and dandelion are all prime examples of lipotropics that can be used to enhance liver detoxification in endometriosis.

oatmealSupport Large Intestines and Healthy Bacteria

Our body eliminates estrogen by attaching it to a carrier molecule (glucuronic acid) and excreting it through the bile into the stool. Unfriendly bacteria in the large intestines can prevent our ability to eliminate estrogen by breaking this bond between estrogen and it’s carrier. This estrogen is then recycled back into our body, resulting in higher circulating levels of estrogen.

We can modify this action, and support healthy hormone levels, by following the Endometriosis Diet which emphasizes healthy fiber and avoidance of unhealthy fats. Probiotic supplements can also be used in some cases to encourage healthy bacteria balance.

Decrease Stress

Stress occurs frequently in our fast-paced society, but we know that unhealthy levels of stress, or poor adaptation to stress is linked to decreased immune function and may trigger the kind of biochemical imbalances that lead to endometriosis. Studies have demonstrated that endometriosis grows more rapidly, or recurs faster and in greater quantities, during times of extreme emotional stress.

Breathing exercises, physical exercise, yoga, meditation, mindfulness, good quality sleep and adaptogenic herbs and supplements can decrease your stress response and help you to manage your endometriosis, naturally.

Not All Nutrients Are Beneficial

Just because it’s natural, does not mean it’s safe. It is strongly recommended to consult with a Naturopathic Doctor to develop a safe and effective endometriosis plan that will address your concerns and give you the best chances for success.

Additionally, some nutrients may negatively impact endometriosis. L-carnitine, an amino acid, was shown in one study to induce a condition resembling endometriosis with accompanying infertility when give to young female mice. We are not sure of the impact this may have on humans, but a cautious approach is recommended.

Treating Endometriosis

Understanding EndometriosisTo take a fully empowered, knowledgeable approach to your endometriosis I recommend you read the other articles written by Dr. Lisa Watson, ND on endometriosis: Understanding Endometriosis, The Endometriosis Diet, Endometriosis and the Immune System, Acupuncture and Endometriosis and Endometriosis and Infertility.  If you are ready to take the next step, book a complimentary 15 minute meet-and-greet appointment with Dr. Watson, or book an initial consultation.  You can feel better! Get started now.

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

Kohama T, et al. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. Journal of Reproductive Medicine; 2007:52(8),703-8

Vassiliadis S, Athanassakis I. A “conditionally essential” nutrient, L-carnitine, as a primary suspect in endometriosis. Fertil Steril. 2011 Jun 30;95(8):2759-60.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.