Endometriosis and Nutritional Therapy

Endometriosis affects hundreds of women.  A recent client of mine thanked me for the background information including explaining possible contributory factors to her condition, so I thought I might share this.

Endometriosis is diagnosed when tissue normally found in the endometrium (the lining of the uterus) is found outside the uterus. It can be accompanied by painful periods, pain during intercourse, heavy bleeding, infertility and pain during urination or bowel movements. The following factors play a role in endometriosis:

  • Menstrual flow: the leading theory amongst scientists is that endometriosis is caused by retrograde (backwards) flow of menstrual blood. Normal tissue in the endometrium- then becomes inflamed, has high levels of oestrogen which leads to aromatase and inflammation, as explained below. Endometrial tissue can also be found outside the womb. It is worth noting that when sex hormone production stops in the ovaries, as in post-menopausal women or women that had a hysterectomy, further oestrogen and progesterone are produced by the adrenal glands. Adipose (fat) tissue can also produce oestrogen.
  • Aromatase: Endometrial tissue produces an enzyme called aromatase, which in turn, leads to oestrogen production. Oestrogen itself in high amounts is inflammatory as it stimulates an inflammatory compound (PGE2) which then stimulates the aromatase enzyme – a vicious cycle of more and more oestrogen production and/or inflammation.
  • Gut flora: If we have adequate amounts of our own probiotics, the activity of an enzyme that recycles old, “used” oestrogen back into the bloodstream can be controlled. Healthy gut microflora (probiotics) can also help to lower levels of circulating oestrogen by increasing the production of a protein that “binds” sex hormones and helps to balance hormone levels.
  • Constipation: this may mean that old hormones don’t get cleared out soon enough, providing the opportunity for the unwanted recycling of oestrogen and high levels of oestrogen compared to progesterone.
  • Thyroid function: an under-active thyroid could mean slow clearance of old, “used” hormones (similar to what happens with constipation), adding to excess oestrogen levels.
  • Low dietary fibre: enough fibre in the diet (from whole-grains, nuts, seeds and LOTS of fruit and vegetables) will not only help with constipation, but it also serves as food for our own probiotics. Other foods that can increase probiotic levels include leeks, garlic, artichoke and onions, fermented foods like sauerkraut and drinks like kefir and kombucha.

Current pharmaceutical recommendations:

Many of my clients are on synthetic progesterone (progestin) from brands like the Mirena coil or Depo-provera, with limited if any improvement. They often suffer side-effects like not having periods at all, more abdominal pain, headaches and anxiety. It may well be that these drugs are adding not only to a woman’s pain from the original endometriosis, but also to her underlying hormonal imbalance.

How nutritional therapy can help endometriosis

As endometriosis is an inflammatory condition, the emphasis would naturally be on anti-inflammatory foods. These include oily fish for their omega-3 content, green tea, spices like cinnamon, ginger and turmeric. Colourful foods like dark berries, carrots, sweet potatoes and leafy vegetables (and MANY more) provide vitamins and minerals to strengthen our immune system, thereby giving the body the nutrients to fight inflammation. Cruciferous vegetables (broccoli, kale, Swiss chard, etc.) not only contain magnesium, but also a compound called indole-3-carbinol which assists the body in healthy oestrogen metabolism and thus an improved progesterone: oestrogen balance. Foods high in fibre (as mentioned above), legumes like chickpeas and lentils and good fats from olive oil, nuts, avocados, etc. can all help to restore hormonal imbalance.

Supplements (aimed at lowering inflammation):

These would include, among others, sources of omega-3 oil (fish or krill oil), vitamin D with added vitamin K, magnesium (my favourite) and last but not least, probiotics. This is my basic protocol, but I may add other supplements, e.g. zinc, depending on a client’s unique presentation.

Diagnostic testing:

There are female hormone panels such as the DUTCH test available from companies like Precision Analytical in the US and Regenerus in the UK. Genova Diagnostics also do comprehensive hormone tests. These tests are more in-depth (by far) than what is currently available on the NHS. Your nutritional therapist should be able to provide more guidance.

A nutritional therapist will also look at lifestyle factors in someone with endometriosis, This could be simply ways of reducing stress, (which has SUCH a deleterious effect on both our gut probiotics and female hormones) or sleep patterns, alcohol intake (which depletes your zinc levels and can exacerbate endometriosis), exercise patterns, etc.

This, for me is the beauty of nutritional therapy – it is a comprehensive approach that takes into account the many unique facets (and obstacles) in the life of the person sitting in front of you. The wider our approach, the better our information as to where our nutritional intervention would have the greatest healing effect.