Though endometriosis affects one in 10 women, those suffering from the disease spend years in agony awaiting the correct diagnosis. Concerns about extreme period pain are casually tossed aside with advice on learning to tolerate the agony. “Often women assume their painful periods are normal and don’t think to bring it up to their doctor; or, if they do, their pain can be dismissed as normal, that it is “part of being a woman,” says Dr Sara Gottfried MD, three-time New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet, and Younger. Women, especially those with endometriosis, have learnt to navigate period pain so that we can be present for work and play, despite physical and mental discomfort. There is no cure for endometriosis. The only options offered are a confusing maze of surgery, birth control, pregnancy and/or hysterectomy.

While there is no doubt that in some cases surgery or hysterectomy can prove beneficial, a quick look at new research reveals a pandora’s box of supplements that hold the potential to help women with endometriosis. Strangely enough, diet and supplements aren’t part of the advice doled out by most doctors. It is essential to understand that lifestyle changes can make an impact on the progression of the disease. Even though there isn’t a 100 per cent guarantee, food and supplements can help manage not only the symptoms but also help determine whether you would eventually need a surgery. Dr Gottfried helps us understand this tricky disease and takes us through diet, lifestyle changes and supplements to reduce the impact of endometriosis.

What is the cause?

“Endometriosis is when cells of the endometrium, or uterine lining, migrate and implant outside the uterus, usually on the ovaries or other pelvic organs, causing inflammation and sometimes extreme pain.” In her work Dr Gottfried has found several root causes including dysestrogenism and progesterone resistance. “Dominance can be due to a number of causes such as impaired oestrogen metabolism.” She explains that the hormone starts as estradiol, but it can be broken down into estrone and metabolites. “It’s crucial for your body to break down the oestrogen in order to maintain balance—you must inactivate oestrogen to maintain normal levels, and inactivation occurs mostly in the liver in two phases.” Dr Gottfried says that if there is a problem with the metabolism and breakdown, then instead of being excreted, the hormone can remain recirculating in the bloodstream and it becomes difficult for the body to regulate oestrogen levels.

The second cause is low progesterone or progesterone resistance. “Oestrogen and progesterone are in balance with one another but if progesterone is low, then oestrogen dominates because the levels are relatively high compared to its partner hormone, progesterone.” She quotes one study, where nearly half of the women with endometriosis had either low blood progesterone or a short luteal phase. “Progesterone resistance seems to contribute to the development of endometriosis. Women with endometriosis don’t make enough progesterone receptors, particularly in the endometriosis growths, or cells become numb to progesterone.” That makes it difficult to shut down oestrogen activity, so oestrogen levels rise, especially around the aberrant growths.

Endometriosis and your gut

“Think first of gut function, even if you do not have gut symptoms: You may have small intestinal bacterial overgrowth (SIBO), which is common in endometriosis,” says Dr Gottfried. “Another common diagnosis that is conflated with endometriosis is irritable bowel syndrome, a condition with many causal factors and a high prevalence of SIBO.” Women with endometriosis have a range of digestive symptoms including bloating, constipation, painful bowel movements, nausea and/or vomiting. While ancient wisdom says that all diseases begin in the gut, few work on improving GI symptoms.

“When people think of hormone production, they usually think of glands throughout the body like the thyroid, adrenals, and reproductive organs.” But the gut microbiome may be the most important organ of the endocrine system. ”When it’s healthy, it does its job well, but when it is unhealthy, it throws your hormones out of tune.” The result, she says in some women, is that it can continue recirculating, leading to dominance. “Not only does your gut microbiome help create maintain oestrogen balance overall, a specific group of microbes called the estrobolome reduces harmful side effects of more potent oestrogen, by helping to metabolise excess to keep it from causing problems.”

That’s great news because too much oestrogen can cause weight gain, mood issues, painful menstrual cycles, endometriosis, and potentially breast, endometrial, and prostate cancer. “The main way to ensure that oestrogen metabolites are excreted is to have a gut that is firing on all cylinders.” Her advice is to feed it well with fresh veggies, including prebiotics. Prebiotics are a type of plant fibre that feeds the good bacteria in your gut. They include: asparagus, burdock root, Jerusalem artichoke, jicama, garlic, onion, leeks, unripe (green) bananas, flaxseeds, seaweed, konjac root (you can find this prebiotic source in shirataki noodles), and yacon root. She also recommends reducing sugar and alcohol to an absolute minimum or avoid it altogether. 

Essential food rules

“Follow a plant-based diet, drastically reduce red meat intake and avoid CAFO meat at all costs.” CAFO stands for concentrated animal feeding operation, where livestock is packed cheek to jowl in confined units upto 45 days in a year. Additionally, eating a plant-based diet will ensure a good intake of fibre. “One of the most important facts to remember about oestrogen is-use it and lose it, therefore a healthy intake of fibre will ensure that metabolites are excreted from the body.” Dr Gottfried recommends that you consume 35 to 45 grams of fibre per day as part of a healthy food plan; most women only consume about 13 grams per day. “Even with seven or more servings of fresh fruits and vegetables per day, most women need medicinal fibre, taken as a supplement.” Dr Gottfried suggests rotating several including psyllium husk, inulin and glucomanann.

Supplement Help

NAC

N-Acetyl-L-Cysteine (NAC) is the supplement form of the amino acid cysteine, which plays several important roles in the body, including replenishing the powerful antioxidant glutathione. Dr Gottfried suggests taking a 900mg dose once or twice a day.

Curcumin and Balanced Omegas

“These include fish oil (EFA, DHA) and GLA from borage oil and/or evening primrose oil.” She recommends 3-6gms of fish oil and 2gms of GLA everyday. As for curcumin, not only does it have anti-inflammatory properties but also it has been found to reduce estradiol product and suppress tissue migration from the uterus.

DIM

“Di-indole Methane (DIM) is the most potent promoter of 2-hydroxylase, the enzyme that helps to correct oestrogen dominance by making more 2-hydroxy-estrone and 2-hydroxy-estradiol.” Put simply, it has been shown to favour the production of protective oestrogen and reduce bad levels. It occurs naturally in the brassica or cruciferous family, such as cabbage, broccoli, Brussels sprouts, and cauliflower. “Unfortunately, you have to eat bushels of broccoli or Brussels sprouts to benefit your oestrogen balance.” The good news is that you can ingest it in a capsule. “The dosage is approximately 200 mg/day.” Other than DIM, Dr Gottfried also uses a product that contains flaxseed lignans, calcium D-glucarate, and zinc.

SPMs

Specialised Presolving Mediators (SPMs) help switch off the inflammation response in the body. They do so not by suppressing the inflammation itself, but by down regulating it once its job (for instance in wound repair) is over. “I suggest taking them with a baby aspirin in patients in whom it is safe (discuss with your healthcare practitioner).”

Lifestyle changes

“I describe cortisol as a bully. If stress is high and cortisol levels go up, it robs the sex hormones to meet the high demand for stress hormones, leading to an imbalance of oestrogen and progesterone.” Any woman with endometriosis will tell you that her disease got worse during trying times. “Exercise reduces stress, helps oestrogen metabolism and overall gut health, but chronic cardio (hours on the treadmill, marathons) can raise cortisol,” so balance is key.

There’s also talk of endocrine disruptors in personal care products that cause hormone imbalances. “Xenoestrogens, found in many products in the form of phthalates, are synthetic chemicals that mimic oestrogen.” They are often found in many beauty and personal care products in the form of phthalates. “There’s a delicate balance between oestrogen and progesterone in the female body, and phthalates disrupt it.”

Ultimately though, it is essential to realise that it is your body and you must make your own decision—there's so much out there on the internet. It is clear that endometriosis is a tricky disease that confuses even the most distinguished experts, so the commitment to experiment with different lifestyle changes, supplements and food habits, as well as a doctor that'll respect and work along with your choices is a must-have.

Vasudha Rai is a certified yoga teacher and has been writing on beauty, health and wellness for 15 years. Find her at Vbeauty.co

Be sure to see: https://www.berkleycenter.com/services/endometriosis/