Endometriosis
Endometriosis is a condition in which the tissue which normally lines the inside of the uterus, called the endometrium, grows outside the uterus. The most common places this endometrial tissue grows is within the pelvic cavity, such as on the ovaries, fallopian tubes, bladder or bowel. Less commonly endometrial growths may occur outside the pelvic cavity. This misplaced endometrial tissue responds to hormones associated with the menstrual cycle and thus will thicken, degrade, and bleed with each menstrual cycle. Symptoms associated with endometriosis include heavy bleeding during menses, spotting in between periods, infertility, and pain (often severe) associated the menstrual cycle but which can also occur in other areas of endometrial growth as well.
Approximately 6 to 10% of women of reproductive age suffer from endometriosis. Some women are at an increased risk for endometriosis, including women who started their period at an early age, with a mother or sister with endometriosis, women with long, heavy periods, women who have never given birth, those with a history of retrograde menstrual flow or surgery to the pelvic area (such as a C-section). Complications associated with endometriosis include the formation of scar tissue and adhesions, increased risk of ovarian cancer as well as infertility. Endometriosis is diagnosed through a combination of techniques usually involving a pelvic exam, the use of ultrasound to visualize the pelvic organs, and sometimes through a procedure called a laparoscopy (in which a surgeon inserts a laparoscope into the abdomen to assess for signs of endometrial growth).
If you have been diagnosed with Endometriosis
There is no cure for endometriosis, but treatment is available to minimize symptoms and help alleviate complications such as infertility. Common treatments include pain medication/management techniques, hormone therapy, and specific surgical procedures to remove endometrial lesions, scar tissue, or for pain management. In severe cases, a hysterectomy (the surgical removal of the uterus, may be performed.
A Whole Health Perspective
Looking at Endometriosis through a Whole Health model, we explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
1. Physical – The endometrium is the tissue that lines uterus. In response to female hormones such as estrogen and progesterone, this layer thickens in preparation for potential implantation of a fertilized egg, then sheds during menses. The shedding of this layer, in response to hormone levels, can be accompanied by symptoms such as cramping, swelling, and fatigue. Endometrial growth outside of the uterus undergoes the same cycle of thickening and shedding, and can cause the same types of symptoms. These areas of growth thicken then shed, causing bleeding, inflammation, and irritation of the tissues outside the uterine cavity. This can result in swelling and pain in any area of endometrial growth. In addition to cramping and pain associated with menses, one may experience painful defecation, diarrhea, bloating, urination, pain with sex, and increased fatigue. As well as a small increase in ovarian cancer risk, endometriosis also appears to increase one’s risk for developing coronary heart disease. Additionally, women with lower genital tract infections are at a higher risk for endometriosis.
Two body systems which affect and are effected by endometriosis include the endocrine (hormonal) system and the immune system. Controlling levels of estrogen, a hormone, may be important in reducing symptoms of endometriosis. Increase sensitivity to, and production of, estrogen can result in increased cramping and pain (due to the production of chemicals called prostaglandins and cytokines). This can occur not only in the areas of endometrial tissue, but in the surrounding tissues and organs as well. Certain medications can be used to alter hormone levels or treat pain. Harvard Medical School suggests lifestyle modifications such as stress reduction, moderate exercise, and dietary changes may help control estrogen levels as well.
The increase in inflammatory chemicals seen in endometriosis may represent a disruption in normal immune response. The immune system in women with endometriosis may be compromised resulting both in a failure to recognize misplaced endometrial tissue and an increase in inflammatory chemicals. Research indicates there is an association between endometriosis and other immune-related disease, such as lupus and rheumatoid arthritis as well.
Both estrogen production and the immune system can be affected by chronic stress. This is in part due to the influence of the adrenal glands, located atop the kidneys, and responsible for the stress reaction. The adrenal glands are part of a stress signaling system, called the Hypothalamus-Pituitary-Adrenal Axis. Disturbance in this system, sometimes caused by exposure to chronic stress, affects hormone levels and immune function. In fact, studies reveal that alterations in one important adrenal hormone, cortisol, is associated with endometriosis. Because repeated exposure to stress can cause adrenal dysfunction and potentially alter the endocrine (hormonal) system and immune system, stress management techniques such as moderate exercise, adequate sleep, breathing techniques, yoga, etc. could reduce the symptoms associated with endometriosis. Some Chinese medicine treatments, such as acupuncture and moxibustion, may be effective in managing endometriosis, as may other Complementary Alternative Medicine techniques.
2. Nutritional/Chemical – What we consume has the potential to contribute to a state of health or a state of disease. A diet which limits trans-fats, sugar, caffeine, artificial preservatives and flavorings, and is high in healthy sources of cholesterol, protein, vitamins A, C, E, and B complex, essential fatty acids, and essential minerals supports overall health and the healthy function of the adrenal glands. Research indicates a diet high in caffeine, red meats and trans-fats, but low in vegetables and omega-3 fatty acids, is associated with endometriosis. An anti-inflammatory diet may potentially decrease symptoms by decreasing systemic inflammation.
Toxins found in foods and food containers can mimic the effects of estrogen (sometimes called endocrine disrupting chemicals). Exposure to these toxins or foods which could contain them, such as fatty meat, dairy products, and non-organic fruits and vegetables, could potentially effect the pathophysiology of endometriosis. Foods which contain phytoestrogens, such as soy, should be monitored for their effects on symptoms because they may, in certain amounts, mimic the effects of estrogen.
3. Emotional – Because chronic stress can increase the risk for both hormonal and immune dysfunction, learning to recognize, control, and limit exposure to chronic stress could potentially decrease the risk for endometriosis and the symptoms associated with it. Increased stress can contribute to the development and perception of pain, a sometimes extreme symptom of endometriosis. Stress is accumulated not just through major life events, such as divorce or job changes, but also through every day experiences like weather changes, loud noises and lights, and difficult relationships. Thus, engaging in stress reduction activities, such as yoga, prayer, meditation, mild to moderate exercise, etc. can limit the potential damage of accumulated stress. There is an association between endometriosis and psychiatric difficulties, thus talking with a mental health professional for advice and treatment for co-occurring diseases may be helpful as well.
Emotions communicate with all body systems through chemicals called neuropeptides and neurotransmitters, and especially the endocrine and immune systems which play a role in endometriosis. Release of adrenal gland hormones such as cortisol is also affected by our emotions. Becoming aware of emotional responses (frustration, anger, grief, joy, contentment, etc.) and engaging in activities such as those listed above can assist in the health of the hormonal/endocrine and immune systems, as well as many others.
4. Environmental – Exposure to environmental toxins, especially endocrine disrupting chemicals, may increase the risk of endometriosis. These toxins may be found in the soil, food, water, or airborne. Monitoring the environment for toxic exposure can be important. Smoking increases overall stress upon multiple body systems, and could potentially encourage dysregulation of the endocrine system and immune system and inflammatory response.
Other environmental factors which increase stress, adrenal gland production of cortisol, and potentially alter the hormonal and immune systems, include abrupt changes in temperature or barometric pressure, bright lights, loud noises, difficult relationships at home or work, etc. Exposure to the natural world can decrease stress and could potentially decrease symptoms. Because exercise can decrease inflammatory chemicals, decrease the stress response, and encourage healthy emotional responses, mild to moderate exercise is recommended for women with endometriosis.
5. Beliefs, Values and Worldview – also identified as Spirituality – Spiritual expression, whether through prayer, meditation, yoga, traditional worship, connection with nature, etc. has an influence on health and wellbeing, often by encouraging an understanding and connection between mind, body, and spirit. Some studies suggest engaging in spiritual/religious discussion and activity may increase one’s quality of life by encouraging optimism, support, and expression of emotion. Possible feelings of isolation, living in discordance with one’s values, or inability to connect with support and the natural surroundings due to illness or other factors could increase stress and exacerbate symptoms.