- Painful periods (known as dysmenorrhea)
- Heavy bleeding (menorrhagia)
- Irregular periods
- Pelvic pain unrelated to the menstrual cycle
- Pain during sex (dyspareunia)
- Back pain and bowel problems (such as irritable bowel syndrome)
- Increased urinary tract infections (UTI) and other bladder and urinary problems
What is Endometriosis? In healthy people, the tissue that lines the uterus (known as the endometrium) responds to hormonal changes to grow and then break down during the menstrual cycle. This blood-rich tissue is where an embryo implants after conception, and is what nourishes and sustains the growing embryo. In people with endometriosis, endometrial cells are found outside the uterus, such as in the ovaries, the colon, the ligaments supporting the uterus, or even in the lungs. Despite being in the wrong place, these cells continue to respond to hormonal signals to produce blood. Because the blood produced by displaced endometrial cells has no clear exit, this can lead to tissue inflammation, irritation and pain, with symptoms recurring every month. Over time, scarring can develop, which may result in additional problems. These problems depend on the type of tissue involved but may include obstruction of the fallopian tubes or colon, displacement of the uterus, or problems with sexual intercourse, urination, bowel function, or even respiratory function. As the cycle continues, these symptoms typically get worse as scar tissue accumulates.
Getting a Diagnosis Many women with endometriosis suffer in silence, sometimes through embarrassment, reluctance to seek medical help or due to poor access to medical help. In some cases, women simply assume that their symptoms are a normal part of the menstrual cycle and are not able to be treated. Even for those who do seek help, getting a diagnosis can take a long time. This condition of the reproductive system is hard to detect, often requiring exploratory surgery to determine if cells normally found in the uterus have become lodged in other tissue.
What Causes Endometriosis? The cause of endometriosis remains unknown, but retrograde menstruation is thought to be involved in most cases. This is where blood that usually exits the body during menstruation instead becomes lodged outside the uterus, leaving behind endometrial cells that bleed just like normal endometrial tissue. In some cases, endometriosis may arise after endometrial tissue is displaced by accident during surgery, such as a caesarian-section. Hormone disruption has also been proposed as a possible mechanism for the development of endometriosis, with a group of chemicals called phthalates the focus of current research by many endocrinologists (specialists in the hormonal system). Phthalates are used to make plastics more flexible and harder to break, and diet is the main source of exposure to phthalates. Fatty foods such as milk, butter, and meats are a major source, and, somewhat ironically, medical equipment such as intravenous tubing and gloves also pose a risk of exposure. Phthalates compromise the body’s production of testosterone while suppressing enzymes such as oestrogen sulphotransferase, resulting in significant hormonal imbalance as oestrogen levels remain elevated. This imbalance contributes to the development of fibroids, endometriosis and a range of oestrogen-dependent cancers.
Managing Endometriosis Although it is not known what causes endometriosis, there is some evidence to suggest that limiting exposure to endocrine disruptors such as phthalates may help minimise risk. Practically speaking, this means:
- Eating organic produce wherever possible
- Avoiding plastic-wrapped foods and processed foods
- Storing foods in glass containers
- Using cooking utensils made of wood or metal, not plastic
- Avoiding heating food in plastic containers or packaging
- Minimising intake of fatty foods (especially animal products).
Phthalates are also found in cleaning products, clothing, make-up and toiletries, and furniture. As such, many people with endometriosis are careful to use products that are free from phthalates, bisphenol-A, polychlorinated biphenyls (PCBs), and other potential endocrine disruptors.
Endometriosis Treatment There is no known cure for endometriosis, although surgery to remove adhesions and fibrous tissue may be appropriate for some people. Most patients use painkillers to relieve symptoms, while medications and lifestyle and dietary modifications (such as limiting refined carbohydrates and red meat intake) can help with hormone balance. Some natural remedies have also been used historically to help with symptoms related to endometriosis. Such remedies include:
- Blue cohosh and black cohosh
- John's wort
- Dong quai
- False unicorn
- Evening primrose oil
- Chasteberry/vitex (Agnus castus)
- Uva ursi (bear berry)
- Red raspberry
- White willow.