I don’t know about you, but prior to starting my naturopathic medical education, I had never heard the word “endometriosis” before – let alone knew anything about the condition. And yet endometriosis is very common, affecting up to 10% of reproductive-aged women, up to 50% of women with infertility, and up to 70% of women with chronic pelvic pain. On top of that, studies have shown that it can take over 7 years to receive a diagnosis of endometriosis. 7 years! That’s an awfully long time to struggle with pain. My goal with this article is to arm you with easy-to-understand, salient details about endometriosis so that anyone experiencing these symptoms feels safe and empowered to seek medical attention.
What is Endometriosis?
Endometrial tissue is the innermost lining of the uterus. In the follicular phase (Days 1-14) of a 28 day menstrual cycle, estrogen causes the endometrial lining to thicken. In the luteal phase (Days 15-28), progesterone initially maintains the endometrial lining, but then as progesterone levels drop, the lining is shed as menstrual bleeding (our period).
In endometriosis, endometrial tissue rebelliously wanders outside the uterus and is found on structures where it shouldn’t be – these are often referred to as endometrial implants. Implants can be found almost anywhere but are most often located in the pelvis, with the most common site being the ovaries. Other sites within the pelvis include uterine ligaments, fallopian tubes, the large intestine, and the bladder. Just like endometrial tissue within the uterus, these implants respond to hormonal signals. Implants proliferate in response to estrogen but when progesterone levels start to fall in the latter half of the luteal phase, they can’t be shed like normal intra-uterine endometrial tissue can. The result is inflammation and pain.
Symptoms of Endometriosis
It is possible to be completely asymptomatic with endometriosis, or to experience one or several of the following symptoms:
- Painful menstruation
- Pain with sexual intercourse
- Bleeding after sexual intercourse
- Chronic pelvic pain
- Heavy menstrual periods
- Bleeding between menstrual periods
- Low back pain
- Bowel and bladder dysfunction
See related: Healthy hormones and the menstrual cycle
Endometriosis & Infertility
Up to 50% of women with infertility have endometriosis – this is a huge number of women. Our current understanding of the connection between endometriosis and infertility relates to inflammation and anatomical changes. Endometriosis is associated with an inflammatory response, and sustained inflammation is never a good thing. Inflammation can hinder: maturation of ovarian follicles (each of which holds an ovum), fertilization of an ovum by sperm, implantation of a fertilized ovum in the uterus. Over time, endometrial implants (and the inflammation associated with them) can cause scarring and alterations to the anatomy of the reproductive tract.
How Is Endometriosis Diagnosed?
Endometriosis is typically diagnosed clinically (meaning it is diagnosed on the basis of the symptoms you report to your doctor and the signs your doctor observes). Imaging such as transvaginal ultrasound can help with detection of endometrial implants. The gold standard to attain a definitive diagnosis is by biopsy of suspected implants.
What are Risk Factors for Endometriosis?
While this list is not exhaustive, risk factors associated with endometriosis include:
- First-degree relative with endometriosis
- Early menarche (onset of menstruation before age 12)
- Late menopause
- Nulliparity (has not borne children)
- Prolonged menstruation (> 5 days)
- Menstrual cycles < 28 days
There is something meaningful to pull out from these risk factors – many of them signal a state of high estrogen. In a healthy state, estrogen and progesterone levels are harmonious – estrogen is the star of the follicular phase and progesterone the star of the luteal phase. In endometriosis, implants both respond to and produce estrogen. Estrogen promotes the production of inflammatory molecules – those inflammatory molecules promote the production of estrogen – and a self-perpetuating cycle develops.
Naturopathic Medicine & Endometriosis
Here’s the good news – naturopathic medicine can offer a lot of relief to women struggling with endometriosis. Together with your Naturopathic Doctor, we will come up with a plan that provides you with symptomatic relief in the short term while we tackle the underlying inflammation. At the most basic level, we want to ensure that your organs of detoxification are functioning optimally so that excess estrogen can be efficiently removed from your body – the liver and large intestine are big players here. We also want to optimize your immune system in order to address the inflammation created by the implants, and optimize your entire hormonal system because estrogen and progesterone are just two players in a complex, interconnected, multi-player system. Your treatment plan will be uniquely designed for you because the environment in which endometriosis occurs is never exactly the same.
If you have any questions about endometriosis, or if you would like to learn more about how naturopathic medicine can help, please do not hesitate to reach out! Book your free 15 minute meet & greet.
This post is intended for educational purposes only. Please speak to your licensed health care provider before implementing any health recommendations or treatments.
Learn more about naturopathic care for perimenopause, menopause, and PMS & PMDD.
Davila, G., Kapoor, D., Alderman, E., Hiraoka, M., Ghoniem, G., and Peskin, B. (July 2018). Endometriosis. Accessed on July 20, 2020 from https://emedicine.medscape.com/article/271899-overview
Hornstein, M. D. and Gibbons, W. E. (December 2019). Treatment of infertility in women with endometriosis. Accessed on July 20, 2020 from https://www.uptodate.com/contents/treatment-of-infertility-in-women-with-endometriosis
Laufer, M. R. (June 2020). Endometriosis in adolescents: Diagnosis and treatment. Accessed on July 20, 2020 from https://www.uptodate.com/contents/endometriosis-in-adolescents-diagnosis-and-treatment
Schenken, R. S. (June 2020). Endometriosis: Pathogenesis, clinical features, and diagnosis. Accessed on July 20, 2020 from https://www.uptodate.com/contents/endometriosis-pathogenesis-clinical-features-and-diagnosis
Schrager, S., Falleroni, J., and Edgoose, J. (January 2013). Evaluation and Treatment of Endometriosis. Am Fam Physician. 87(2): 107-113.
Photo by Jason Hartono on Unsplash