Endometriosis: Root causes, Tests, Natural Therapies

Endometriosis is a medical condition in which the tissue that normally lines the inside of the uterus, called the endometrium, grows outside the uterus. This displaced tissue can be found on the ovaries, fallopian tubes, outer surface of the uterus, pelvic cavity, and other organs in the abdominal region.

Causes of Endometriosis

The exact cause of endometriosis is unknown, but there are several theories, including retrograde menstruation (when menstrual blood flows backward into the pelvic cavity), immune system disorders, hormonal imbalances, and genetic factors.

However, there are several theories and factors that may contribute to the development of the condition. These include:

Retrograde menstruation: This is one of the leading theories explaining how endometriosis occurs. Retrograde menstruation happens when some of the menstrual blood, which contains endometrial cells, flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. These displaced endometrial cells can implant and grow in the pelvic region, leading to endometriosis.

Hormonal imbalances: Endometriosis is influenced by hormones, particularly estrogen. Estrogen is involved in stimulating the growth of the endometrial tissue during the menstrual cycle. It is believed that abnormal estrogen levels or an imbalance in the ratio of estrogen to progesterone may contribute to the development and progression of endometriosis.

Immune system dysfunction: The immune system plays a role in recognizing and eliminating abnormal or misplaced cells in the body. In women with endometriosis, the immune system may not function properly, allowing the misplaced endometrial cells to implant and grow in abnormal locations.

Genetic factors: There is evidence suggesting that endometriosis may have a genetic component. Having a close family member, such as a mother or sister, with endometriosis increases the risk of developing the condition.

Metaplasia: Some researchers propose that endometriosis may occur through metaplasia, which is the transformation of normal cells into endometrial-like cells in other areas of the body.

While these factors are considered potential contributors to the development of endometriosis, the exact cause can vary among individuals, and it may involve a combination of multiple factors.

Root Causes of Endometriosis

Functional medicine aims to address the underlying root causes of a health condition rather than just managing the symptoms.

Hormonal imbalances: Hormonal dysregulation, particularly an imbalance between estrogen and progesterone, is often associated with endometriosis. Functional medicine practitioners may investigate factors that contribute to hormonal imbalances, such as impaired liver detoxification, nutrient deficiencies, stress, and disrupted gut health.

Inflammation and immune dysfunction: Chronic inflammation and immune system dysfunction are believed to play a role in the development and progression of endometriosis. Functional medicine may focus on identifying and addressing potential triggers of inflammation, such as food sensitivities, gut microbiome imbalances (dysbiosis), environmental toxins, and chronic infections.

Gut health: The gut and its microbiome have a significant impact on overall health, including hormonal balance and immune function. Dysbiosis (imbalance of gut bacteria) and intestinal permeability (leaky gut) may contribute to inflammation and immune dysregulation associated with endometriosis. Functional medicine may involve assessing and improving gut health through dietary changes, probiotics, and targeted treatments.

Environmental toxins: Exposure to environmental toxins, such as pesticides, heavy metals, and endocrine-disrupting chemicals, can disrupt hormonal balance and contribute to endometriosis. Functional medicine may involve minimizing exposure to toxins and supporting detoxification pathways.

Stress and lifestyle factors: Chronic stress and certain lifestyle factors, such as poor diet, inadequate sleep, and sedentary behavior, can influence hormonal balance and immune function, potentially exacerbating endometriosis symptoms. Functional medicine may address these factors through stress management techniques, tailored dietary recommendations, sleep optimization, and exercise.

Endometriosis is a complex condition, and individual cases may involve a combination of these factors or other unique considerations. A functional medicine approach aims to personalize treatment based on an individual's specific needs and circumstances, focusing on optimizing overall health and addressing the underlying causes of the condition.

Symptoms of Endometriosis

The symptoms of endometriosis can vary from person to person, and some individuals may experience more severe symptoms than others. Common signs and symptoms of endometriosis include:

Pelvic pain: This is the most common symptom of endometriosis. It is often described as chronic pelvic pain that may be dull, aching, or cramp-like. The pain can occur before, during, or after menstruation and may worsen over time.
Painful periods (dysmenorrhea): Many women with endometriosis experience severe menstrual cramps that may be accompanied by lower back and abdominal pain. The pain can be debilitating and may interfere with daily activities.
Pain during or after sexual intercourse: Endometriosis can cause pain during or after sexual activity, known as dyspareunia. The pain may be deep, sharp, or throbbing and can last for hours or days.
Heavy or irregular menstrual bleeding: Endometriosis can lead to heavy or prolonged menstrual periods or irregular bleeding. Some women may also experience spotting between periods.
Chronic fatigue: Endometriosis can cause persistent fatigue and low energy levels. The exact cause of fatigue in endometriosis is not fully understood but may be related to the inflammatory response and hormonal imbalances associated with the condition.
Gastrointestinal symptoms: Some women with endometriosis may experience gastrointestinal symptoms such as bloating, nausea, diarrhea, constipation, or abdominal discomfort, particularly during menstruation.
Painful bowel movements or urination: Endometriosis can cause pain or discomfort during bowel movements or urination, especially during menstruation. Some individuals may also experience an increased frequency of urination.
Infertility: Endometriosis is associated with a higher risk of infertility or difficulty conceiving. The exact mechanisms by which endometriosis affects fertility are complex and can involve factors such as pelvic adhesions, hormonal imbalances, inflammation, and anatomical distortions.

The severity of symptoms does not always correlate with the extent or stage of the disease. Some individuals with mild endometriosis may experience severe pain, while others with more extensive endometriosis may have little to no symptoms.

Laboratory Tests for Endometriosis

Diagnosing endometriosis typically involves a combination of a detailed medical history, physical examination, and imaging studies. Laboratory tests alone cannot definitively diagnose endometriosis, but they may be used to rule out other conditions and provide additional information.

Complete Blood Count (CBC): A CBC measures various components of the blood, including red blood cells, white blood cells, and platelets. It can help identify signs of anemia, which can be associated with heavy menstrual bleeding in endometriosis.

C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR): CRP and ESR are markers of inflammation in the body. While they are not specific to endometriosis, elevated levels may indicate the presence of inflammation that could be related to endometriosis or other conditions.

CA 125: CA 125 is a protein that can be elevated in the blood of some individuals with endometriosis. However, it is not specific to endometriosis and can also be elevated in other conditions, such as ovarian cysts and pelvic inflammatory disease. CA 125 is typically used in combination with other diagnostic tools, such as imaging studies, to help evaluate and monitor endometriosis.

Hormone levels: Hormonal imbalances, particularly involving estrogen and progesterone, are associated with endometriosis. Measuring hormone levels, such as estrogen, progesterone, and follicle-stimulating hormone (FSH), may help identify any abnormalities. However, hormonal testing alone is not sufficient to diagnose endometriosis.

Definitive diagnosis of endometriosis is typically made through laparoscopic surgery, a minimally invasive procedure in which a surgeon examines the pelvic cavity for the presence of endometrial implants and adhesions. This allows for direct visualization and confirmation of the disease. Imaging studies like ultrasound or MRI may also be used to detect certain signs of endometriosis, such as ovarian cysts or deep infiltrating endometriosis.

Functional Medicine Laboratory Tests for Endometriosis

Functional medicine practitioners may consider a range of laboratory tests to gather additional insights into the underlying factors contributing to endometriosis. These tests can help identify potential imbalances, deficiencies, and dysfunctions in the body.

Hormone panel (CycloScan®): A comprehensive hormone panel can assess hormone levels, including estrogen and progesterone during the entire menstrual cycle, testosterone, and other related hormones. It can help identify hormonal imbalances that contribute to the development or progression of endometriosis.

Adrenal function testing (AdrenalScan®): Chronic stress and adrenal dysfunction can impact hormone balance and contribute to the development of endometriosis. Testing cortisol and DHEA-S levels provides insights into adrenal function and helps guide stress management strategies.

Comprehensive stool analysis (EnteroScan®): The gut plays a crucial role in overall health, including hormone metabolism and immune function. Assessing the gut microbiome, digestive function, and potential gut infections through a comprehensive stool analysis helps identify gut imbalances or dysfunctions that may contribute to endometriosis.

Food sensitivity testing (TrophoScan®): Some women with endometriosis may have food sensitivities or intolerances that can contribute to inflammation and worsen symptoms. Identifying specific food triggers through IgG antibody testing, may guide personalized dietary recommendations.

Nutritional deficiency testing: Nutrient deficiencies can impact hormonal balance, immune function, and overall health. Testing for deficiencies in key nutrients like vitamin D, B vitamins, magnesium, and omega-3 fatty acids (OmegaScan®) can help guide targeted supplementation and dietary recommendations.

Genetic testing: Certain genetic variants may increase the risk of developing endometriosis or influence how the body processes hormones and inflammation. Genetic testing can provide insights into potential genetic predispositions and guide personalized treatment strategies.

The selection of laboratory tests may vary depending on the individual's specific symptoms, health history, and the practitioner's clinical judgment. These tests are used to gather additional information and support a comprehensive approach to addressing the underlying causes and imbalances associated with endometriosis.

Endometriosis Conventional Therapies

The conventional treatment options for endometriosis focus on managing symptoms, reducing pain, and improving fertility outcomes. The specific approach may vary based on the severity of symptoms, the individual's age and desire for future fertility, and the overall health of the patient.

Pain medication: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help alleviate pain and reduce inflammation associated with endometriosis. For severe pain, stronger prescription pain medications may be prescribed.

Hormonal therapy: Hormonal therapies aim to suppress estrogen production and reduce the stimulation of endometrial tissue growth. Common hormonal treatments include:

Birth control pills: Combination oral contraceptives containing estrogen and progestin are often prescribed to regulate the menstrual cycle and reduce pain.
Progestin-only contraceptives: Progestin-only pills, hormonal IUDs (intrauterine devices), or contraceptive injections may be used to suppress the growth of endometrial tissue.
GnRH agonists or antagonists: These medications induce a temporary menopause-like state, suppressing estrogen production and causing regression of endometrial tissue. They are typically used for a short period due to side effects and may be accompanied by add-back hormonal therapy to minimize bone density loss.

Surgery: Laparoscopic surgery is considered the gold standard for diagnosing and treating endometriosis. During surgery, the endometrial implants and scar tissue are excised or ablated (destroyed). This procedure can provide temporary relief from symptoms, improve fertility, and be combined with other interventions like ovarian cystectomy or adhesion removal.

Assisted reproductive technologies (ART): In cases of severe endometriosis-related infertility, ART procedures such as in vitro fertilization (IVF) may be recommended. IVF involves collecting eggs, fertilizing them with sperm in a laboratory, and transferring the resulting embryos to the uterus.

While these conventional therapies can be effective in managing endometriosis symptoms, they often focus on symptom control rather than addressing the underlying causes. Furthermore, they may have potential side effects and limitations.

Natural Therapies for Endometriosis

Natural therapies for endometriosis aim to support overall health, reduce inflammation, balance hormones, and alleviate symptoms. It's important to note that while natural therapies can provide symptom relief and support overall well-being, they may not cure endometriosis.

Dietary changes: A nutritious, anti-inflammatory diet can help manage endometriosis symptoms. Focus on consuming whole, unprocessed foods, plenty of fruits and vegetables, lean proteins, healthy fats (such as omega-3 fatty acids), and fiber. Some individuals find that reducing or eliminating certain foods like gluten, dairy, caffeine, and processed sugars can help alleviate symptoms.

Herbal remedies: Certain herbs may possess anti-inflammatory and hormone-balancing properties. Examples include turmeric, ginger, chasteberry (vitex), cramp bark, and evening primrose oil. These herbs are often used in the form of teas, tinctures, or supplements.

Turmeric (Curcuma longa): Turmeric is known for its anti-inflammatory properties. Curcumin, the active compound in turmeric, has shown the potential to reduce inflammation and relieve pain associated with endometriosis. It can be consumed as a spice in cooking or taken as a supplement.
Ginger (Zingiber officinale): Ginger has anti-inflammatory and analgesic properties and may help reduce pain and inflammation associated with endometriosis. It can be consumed as tea, added to meals, or taken as a supplement.
Chasteberry (Vitex agnus-castus): Also known as vitex or monk's pepper, chasteberry is commonly used to support hormonal balance. It may help regulate menstrual cycles and relieve symptoms such as breast tenderness and mood swings. Chasteberry is available in various forms, including capsules, tinctures, or standardized extracts.
Cramp bark (Viburnum opulus): Cramp bark is known for its antispasmodic properties and may help alleviate menstrual cramps and pelvic pain associated with endometriosis. It can be taken as a tea or in tincture form.
Evening primrose oil (Oenothera biennis): Evening primrose oil contains gamma-linolenic acid (GLA), which has anti-inflammatory properties. It may help reduce pain and inflammation associated with endometriosis. Evening primrose oil is typically available in capsules.

It's crucial to remember that herbal remedies can have interactions with medications or existing health conditions, and their safety and efficacy vary from person to person. Therefore, it's important to consult with a healthcare professional before incorporating any herbal remedies into your treatment plan. They can provide personalized guidance, consider potential interactions, and ensure the appropriate dosage for your specific needs.

Acupuncture: Acupuncture, an ancient Chinese therapy involving the insertion of thin needles into specific points on the body, may help reduce pain and improve hormonal balance. It is believed to stimulate the flow of energy and promote overall well-being.

Stress management: Chronic stress can worsen symptoms of endometriosis. Practices such as mindfulness meditation, deep breathing exercises, yoga, and regular exercise can help reduce stress levels and improve overall well-being.

Physical therapy: Pelvic floor physical therapy may be beneficial for managing pelvic pain associated with endometriosis. A specialized physical therapist can provide exercises and techniques to relax and strengthen the pelvic floor muscles.

Supplements: Certain supplements may support hormone balance, reduce inflammation, and alleviate symptoms. Examples include omega-3 fatty acids, vitamin D, magnesium, and herbal supplements like DIM (diindolylmethane) or evening primrose oil.

It's important to approach natural therapies as part of a holistic treatment plan and integrate them alongside conventional medical care.

Vasilis J. Sideris
Biologist
Medical Doctor, Biopathologist (Microbiologist)
Certified Functional Medicine Practitioner, CFMP^®