Endometriosis: A Naturopathic Primer

What is endometriosis?

Endometriosis is a very common condition that’s thought to affect over 10% of women¹. It describes the finding of endometrial tissue outside the uterus, which should normally only be lining the inside of the uterus and shed during periods. Most commonly, endometriosis patches are found in other parts of the pelvis, but they can be found anywhere in the body, including the chest or central nervous system (I’ve linked a case report of psychiatric symptoms caused by brain endometriosis below¹). These cells act differently than regular endometrial cells in the uterus, with different release patterns of inflammatory messengers and hormones. During menstrual periods, these tissues bleed into the pelvis and abdomen, triggering pain and inflammation, and can cause scarring over time. Scarring from inflammation or repeated surgery can form “adhesions”, which are fibrous bands that affect the movement and function of organs and contribute to the chronic pain associated with this condition.

What are common symptoms of endometriosis?

• Very painful periods – often, pain starts before the period and extends for multiple days; pelvic or abdominal pain may be seen chronically or at other points in the cycle
• Heavy and/or clotted periods (this symptom is somewhat less consistent and depends on the patient)
• Pain or discomfort relating to bowel movements, urinating or intimacy
• Reduced fertility
• Fatigue – the endo fatigue is real!
• Digestive symptoms are common, including constipation (sometimes diarrhea), bloating, distention, nausea and reflux

Are there other diagnoses that could be causing my symptoms?

There are lots of conditions with symptoms that can overlap with endometriosis, which is why a thorough workup is so important. Are you ready for the list?

• Ectopic pregnancy
• Polycystic ovarian syndrome
• Primary dysmenorrhea (painful periods without a secondary cause)
• Post-surgical adhesions in the abdomen or pelvis
• Inflammatory bowel disease
• Appendicitis
• Diverticulitis
• A malformed uterus
• Other types of ovarian cysts
• Pelvic inflammatory disease (PID) caused by sexually transmitted infections like Chlamydia or Gonorrhea
• Bladder infections
• Certain cancers (colon, ovarian, cervical, uterine)

What’s an endometrioma?

An “endometrioma” is a name for endometrial tissue that has formed a cyst (or cysts) on one or both ovaries. They’ve been affectionately (sarcastically) termed “chocolate cysts” because they contain old blood. The presence and size of endometriomas has an influence on whether medication or surgery is appropriate for each patient, and it even plays a role in optimizing natural lifestyle treatments.

Is endometriosis a hormonal condition?

In both conventional and alternative circles, endometriosis has historically been seen as a hormonal condition. This has led to a focus on hormonal drugs in the conventional world, with the main drugs being oral contraceptive pills and GnRH blockers, both acting on the brain (hypothalamus and pituitary) to reduce hormonal signalling in the pelvis. In the alternative world, dietary changes and supplements for “estrogen dominance” have been a mainstay of treatment. While these options offer some benefits, leading doctors and researchers in the field now understand that endometriosis is responsive to hormones, but not fully caused by hormones³. Not all women with higher estrogen develop endometriosis, and not all women with symptomatic endometriosis have high estrogen! Researchers have been shedding light on the inflammatory pathways, immune system changes and microbiome imbalances that contribute to endometriosis development and progression. These are vital areas to focus your treatment efforts, and this is where our naturopathic services make a big impact.

How is it diagnosed?

While the gold standard for diagnosis continues to be laparoscopic surgery done by an experienced gynecologist, certain lab tests and pelvic ultrasounds give us helpful information to use in creating and tailoring a treatment plan for you.

Wondering what tests you should consider if you have endometriosis (or suspect you have it)? Stay tuned for a future blog post!

1. U.S. Department of Health & Human Services Office on Women’s Health Endometriosis Fact Sheet. Last updated 2021. Retrieved from: https://www.womenshealth.gov/a-z-topics/endometriosis
2. Elefante C, Brancati GE, Oragvelidze E, Lattanzi L, Maremmani I, Perugi G. Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review. J Clin Med. 2022 Dec 4;11(23):7212. doi: 10.3390/jcm11237212. PMID: 36498786; PMCID: PMC9738496.
3. Zhang, H., Sheng, S., Pan, Z., Zhao, L., Yang, C., Li, C., & Wang, F. (2023). Immune and endocrine regulation in endometriosis: what we know. Journal of Endometriosis and Uterine Disorders, 4, 100049. https://doi.org/10.1016/j.jeud.2023.100049