What Are the Drivers of Endometriosis?
Endometriosis is a relatively common condition, that impacts 1/10 menstruators throughout the world. That means millions of women suffer from #endo across the globe - and it's even more prevalent in women who have been diagnosed with infertility.
In the context of fertility, endo impacts 20-40% of those with a diagnosis of infertility. If we concentrate further on women diagnosed with infertility who also experience pelvic pain, the prevalence of endometriosis is 50%.
With it being such a common gynaecological condition, you'd think the research would be very clear about its origins, the nature of the condition, and effective treatment strategies. Unfortunately, endo is a different type of women's health problem than the classic hormonal conditions like PMS, perimenopause and PCOS. Research about the origins and the nature of endometriosis is ongoing, and as more is done we discover new targets for both natural and conventional treatment. Endometriosis is predominantly an inflammatory condition, that is affected (but not caused) by hormones.
This definition becomes important when we start to consider how to treat, or manage, this chronic condition - there is no cure for endometriosis, only management.
I want to review what we know about the factors that lead to, and exacerbate, endometriosis. Knowing these things helps us to understand why we approach treatment in the way that we do.
Here are the current factors involved in endometriosis - the things that may encourage the onset of the condition and that absolutely exacerbate the symptoms:
genetics: there is a clear genetic pattern with endometriosis (if your sister or mother has endo, you're more likely to have it than others without first degree relatives who suffer with it), and a growing body of research that is suggesting there are epigenetic causes as well. For example, epigenetic markers of dioxin exposure (an environmental toxin) are more common in women with endo than in those without. And not that the exposure has been within your lifetime - these epigenetic patterns are heritable as far back as at least 2 generations (your grandmother could be the one who was exposed, and this influences your risk)
neurological: endometriosis lesions are heavily innervated, which contributes to the pain they produce. The heavy innervation patterns also fuel more inflammation via stimulating macrophages
hormonal: though not caused by estrogen, endometriosis lesions are fuelled by it. Estradiol encourages growth of endo lesions, and they themselves produce more inflammation and estradiol in response (it's a feed-forward cycle). Though progeterone is a strategy to manage endo symptoms and does work fairly reliably, there is also some degree of progesterone resistance in endo lesions, meaning progesterone doesn't work for everyone and it doesn't fully halt the progression
immune: there is an autoimmune nature to endometriosis, and it responds well to a lot of the treatment strategies that we use to treat other autoimmune conditions like lupus, RA and autoimmune thyroid disease. The immune system is also the culprit for the excessive inflammation, and interestingly it seems to permit the growth of endo lesions in the pelvis in those who are susceptible
microbiome: there is a growing body of research that supports the involvement of the microbiome in endometriosis development and progression. Women with endo have been found to have high concentrations of gram negative bacteria in their pelvic fluid - gram negative bacteria have a bacterial toxin called LPS in their cell membranes which leads to inflammation when the levels are high. These bacteria may get here through upward growth from the vagina, or they may be seeded from the gastro-intestinal tract. What's going on in the gut, especially if there is intestinal permeability, must be addressed in order to manage your endo
hypoxia and high iron: low levels of oxygen and high levels of iron and heme are found in endometriosis lesions in the pelvis. This is important, because both of these conditions encourage more inflammation
As you read through this list, you may start to realize that endometriosis truly is a multi-factorial, whole body inflammatory disease. It is not a classic hormonal condition, although it's often lumped in as one when we talk about women's health.
Getting our definitions right, and understanding the underlying mechanisms as to how it develops and how it presents, is crucially important. We need more treatment options for endo because women with this condition have suffered for long enough.
From a naturopathic perspective, I address the above factors with a number of different strategies. We target the autoimmune nature with an anti-inflammatory diet, by removing foods that one is sensitive to, and by using low dose naltrexone (LDN), selenium and a few other treatment modalities. We address the inflammation with a number of effective supplements including turmeric, zinc, vitamin D, selenium, NAC, LDN, and acupuncture and laser therapy. We do work to address the microbiome with targeted antimicrobial supplements, probiotics and prebiotics. And we can help to balance the excessive estrogen environment with oral micronized or vaginal progesterone and estrogen elimination strategies. Fortunately, naturopathic treatment strategies work very well alongside the gold standard treatments that your gynaecologist has to offer - excision surgery and suppressive therapy.
If you'd like to talk more about how naturopathic approaches could help manage your endo, please feel free to reach out and book a free 15 minute consult with me! I look forward to chatting with you.