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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. 

The Most Important Test for Preventing Miscarriage

Pregnancy is one of the most significant women’s health topics – we spend our teens and early 20’s avoiding pregnancy, and many of us spend our 30’s and early 40’s trying to get pregnant.  And once a woman is pregnant, we want to ensure a healthy pregnancy with the outcome of a happy, healthy baby.

Lack of Lab Testing

In Ontario, where I run my women’s health practice, the standard of care is for women to receive only very basic testing when they discover they are pregnant.  Women are screened for sexually transmitted illnesses (chlamydia, gonorrhea, syphilis), public health testing (rubella), blood type and Rh factor.  But few women are screened for one of the most common, and preventable, causes of miscarriage – one that can be easily identified and often has no symptoms. 

Comprehensive Testing

The one test I insist all women in my practice have at the first sign of pregnancy is a comprehensive thyroid panel.  The thyroid gland, sitting in your throat near your voice box, is one of the most important hormone producing gland in your body.  Thyroid hormones are essential for metabolism – creating energy in our cells to meet the demands of our body.  In pregnancy we need to be able to make a lot of energy – making a whole new human is hard work! 

In pregnancy our requirements for thyroid hormones increase – and if our body isn’t able to meet that demand, the result can be early pregnancy loss (miscarriage).  We can identify women who may be at risk for this by running a simple TSH (thyroid stimulating hormone) test and treating women who fall outside the normal range with thyroid replacement hormones during pregnancy. 

But TSH isn’t the only important thyroid test for a pregnant woman.  Testing thyroid antibodies, especially anti TPO antibody is also essential for preventing miscarriage.  Thyroid autoimmune disease is the most common autoimmune disease in women who are in their childbearing years – impacting up to 15% of women.  Many of these women have no symptoms of thyroid disease and their TSH levels are totally normal.

Having TPO antibodies however, is a major risk factor for miscarriage.  There is a strong association with TPO antibodies and miscarriage, preterm delivery, and other negative outcomes in pregnancy (such as low birth weight and smaller head circumference). 

Getting Tested

Despite all the evidence, known to doctors since the 1990s, comprehensive thyroid testing still isn’t available as a screening test for most women in early pregnancy. But that shouldn’t stop you from seeking it out. Available from your Naturopathic Doctor for under a hundred dollars, this test could make all the difference in your pregnancy. And since this cause of miscarriage is completely treatable, I encourage you to have the test done as soon as possible after you discover you are pregnant. Miscarriage is all too common already, I don’t want any more women to have miscarriages that could be prevented.

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.


Going Grey

Purple, blue, red, pink – bright vibrant hair colours are all the rage these days!  But grey?  Is anyone really excited to see those grey hairs popping up?  Why are they there, and what can we do about it?  The answers may surprise you.

Aging Grey

Our hair follicles contain cells that make pigment, called melanin.  This melanin gives your hair its distinct colour.  As we age, these pigment cells start to die off and new hairs grow in lighter – in an array of shades from grey to silver and white.  Once that pigment cell is dead, it won’t come back – the hairs growing from that follicle will never be coloured again. 

And aging is inevitable.  Dermatologists often quote the 50-50-50 Rule – 50% of the population will be 50% grey by 50 years of age.  However, it differs for everyone.  It seems that white people tend to start going grey in their 30s, Asians in their late 30s and black people in their mid-40s. 

Grandma Was Great, and Grey

But it’s mostly your genes that determine how early you go grey – and how quickly!  (Thanks Mum.)  If your parents went grey early, it’s more likely that you will too.

Premature Greying

Genetic or otherwise, premature greying happens.  If you go grey 10 years earlier than the average person does, feel free to complain about it!  You can consider it premature if your hair is going grey before:

  • 20 years old if you’re white
  • 25 years old if you’re Asian
  • 30 years old if you’re black

Contributing to the Grey

There are health concerns that can contribute to grey hair.  If you’re convinced it’s not all in your genes, look at these factors to see if they are adding to your silver streaks.

  1. Lack of vitamin B12 – common in vegans and vegetarians
  2. Vitamin D deficiency – common in northern climates, especially during the winter months
  3. Low calcium – from poor intake or a parathyroid dysfunction, low levels are associated with premature greying
  4. Low iron levels – more common in women and vegans and vegetarians, low levels can contribute to greying and to hair loss
  5. Thyroid hormone imbalance – more common in women, impacting up to 1 in 6 women
  6. Vitiligo – an autoimmune disease that destroys pigment making cells
  7. Copper imbalance – copper can boost the production of melanin, the compound that gives hair its colour.  But don’t just start taking it – copper needs to be carefully balanced with zinc or it can cause mood swings, depression and anxiety.
  8. Smoking – smokers are much more likely to go grey before 30 years of age – 2 ½ times more likely!

What To Do About Grey Hair

Dye it or don’t, but whatever you do don’t pluck it!  Or at least don’t make a habit of it!  Repeatedly plucking hairs can damage the hair follicle and result in kinkier, less healthy hair growing in. 

Hair is made mostly of protein, so foods that are high in proteins are essential for healthy hair.  Nutrients like iron, calcium, zinc, vitamin D, omega 3 fatty acids, B12 and B6 have also been found to support hair health.  Some vegetarians and vegans, and people with digestive issues, may have difficulty getting enough of these from their food and might want to look at taking targeted supplements. 

Eating every 4-5 hours may also help to support hair health.  Hair is not considered an essential tissue by the body, and research suggests that if we go too long between meals the energy available to non-essential tissues could be reduced and could impact hair health. 

Consider having your nutrient levels tested to see if they are negatively impacting your healthy hair. And meet with a Naturopathic Doctor to discuss your diet if you feel like it could use a boost as well!

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.