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  • Endometriosis involves uterine-like tissue growth outside the womb, causing varied symptoms like severe pain and fatigue.
  • While there's no cure, treatments range from surgery to hormonal therapies and pain management.
  • Supplements like NAC, iron, omega-3, broccoli extract, phytoestrogens and liver support herbs may aid symptom management by addressing inflammation and hormone balance.


What is endometriosis?

Endometriosis is a condition which affects at least 1 in 10 women in the UK. However, the typical timescale for obtaining a diagnosis is 8-10 years so it is possible there are more than the 1.5 million of women in the UK alone who have the condition. There is a ‘grading system’ in place to plot the invasiveness of the lesions, they go from stage one to four. It is worth noting that the stage does not necessarily correlate with the severity of symptoms.

With endometriosis, cells similar to the cells found in the uterus grow in areas outside of the womb lining. Common areas include the bowel, ligaments, ovaries, fallopian tubes and the bladder. In some cases, it can even be found on organs such as the liver and kidneys.

What are the symptoms of endometriosis?

There are many symptoms of endometriosis and not all who have the condition experience the same conditions. The main symptoms of endometriosis are:

• Extremely painful periods.
• Fatigue.
• Low iron.
• Back pain.
• Bloating, sometimes called ‘endo belly’.
• Constipation or diarrhoea.
• Pain with bladder movements.
• Leg pain.
• Irregular periods.
• Infertility.
• Pain with intercourse.
• Pain before or with bowel movements.
• Night sweats.
• Weight difficulties.
• Headaches.
• Depression.
• Anxiety.
• Insomnia and sleep issues.
• Brain fog.
• High inflammatory markers.
• Endometriomas – a blood filled cyst, sometimes called a ‘chocolate cyst’.

What causes endometriosis?

There isn’t a confirmed cause for endometriosis however there are some theories. One theory is called retrograde menstruation. This is when instead of period blood flowing out of the body, it instead also moves back through the fallopian tubes, through to the pelvic cavity where it can then leave deposits, forming plaques and nodules which in a way stick organs together.

There may be an autoimmune element to endometriosis. Some studies have found irregularities in part of the immune system such as TH1 cells and IFNy overproduction. Additionally, immune cells like neutrophils, macrophages and natural killer cells may also be involved in the growth, angiogenesis (new blood vessels developing from existing blood vessels) and movement of endometriosis’ cells. More research is needed in this area but there are certainly links between the immune system and endometriosis, with differences in immune cells between those with endometriosis and those without it.

Although not necessarily a cause of endometriosis, inflammation seems to play a large role, in a bit of a cycle in which inflammation causes dysfunction to hormone function and the endometrial tissues cause inflammation. In my clinical work and my own diet (I have stage four endometriosis) I find it helpful to aim for an anti-inflammatory diet where possible, limiting pro-inflammatory food like sugar, gluten and processed oils.

What are the treatments for endometriosis?

There is currently no cure for endometriosis and so no clear-cut answer to treat it. There are various treatments, from medication to surgery, all of which have their own side effects to take into consideration. Some of the common medical interventions for endometriosis include:

Ablation: This is usually done through keyhole surgery, it is the lasering/burning off tissue from the surface.

Excision: Considered the ‘gold standard’ for surgical management of endometriosis, the lesions and plaques are cut out of the tissue.

Chemical menopause: Some drugs, usually given by injection, ‘trick’ the body into thinking it is in menopause.

Progesterone: Given as either a coil or a daily tablet, progesterone is thought to calm the oestrogen levels which drive endometriosis.

Hysterectomy: In some cases, a hysterectomy is done, however, some people still experience symptoms.

Pain killers: Over the counter and prescribed medication such as paracetamol, ibuprofen, codeine and naproxen.

The best supplements for endometriosis

As everyone who has endometriosis experiences it slightly differently, I usually set out to create a ‘foundation’ of supplements and then build on for individual symptoms from there. Natural supplements for endometriosis include:

Oestrogen Balance

Many women with endometriosis have oestrogen dominance which may worsen symptoms. I recommend Oestrogen Balance as a multivitamin for those with endometriosis as it has essential nutrients and phytoestrogens (which can interact with oestrogen receptors) from a non-soy source, as well as antioxidants such as curcumin, NAC and glycine to support the liver in metabolising hormones.

Iron

Many people with endometriosis also struggle with low iron due to heavy periods. A high-quality iron supplement with vitamin C to aid absorption can be very helpful with supporting heavy periods and low energy.

NAC (N-acetyl cysteine)

NAC is an amino acid derived supplement. A promising study found that taking NAC helped to reduce and/or stall the growth of endometriomas (a blood-filled cyst unique to endometriosis) compared to those who didn’t take it.

Liver Support

All roads lead to the liver, including your hormones! Due to the higher levels of oestrogen and higher use of medications like paracetamol, supporting the liver with herbs such as milk thistle and dandelion is helpful within the holistic approach to managing endometriosis.

Ginger and Artichoke

Once your liver is finished processing your hormones, they then exit through various pathways, including in a bowel movement. If you are constipated, the oestrogen gets ‘uncoupled’ and must go through the liver again. A combination of ginger and artichoke supports the movement of bowel as well as magnesium citrate which may soften the stool.

Quercetin

Histamine is something mostly thought of exclusively with hay fever but you have histamine receptors in areas like the bladder. Histamine is stored in mast cells and is encouraged to be released in response to high oestrogen, interestingly high histamine may also increase oestrogen levels. This two-way relationship with both almost encouraging the other can contribute to bladder irritation, headaches, and brain fog. Quercetin is a bioflavonoid which helps to support healthy histamine levels.

Omega-3

Pro-resolving mediators are metabolites derived from omega 3 fatty acids. As described earlier, there is often inflammation with endometriosis which can contribute to fatigue and pain. Pro-resolving mediators are different to omega-3 supplements as they provide a more targeted approach to tissues affected by inflammation.

References:
1. Immune & Endometriosis https://pmc.ncbi.nlm.nih.gov/articles/PMC9265783/
2. T Cell Regulation & Endometrioses https://pmc.ncbi.nlm.nih.gov/articles/PMC9355085/
3. Retrograde Menstruation https://pubmed.ncbi.nlm.nih.gov/36746607/
4. Medical Management https://pubmed.ncbi.nlm.nih.gov/28590310/
5. NAC https://pmc.ncbi.nlm.nih.gov/articles/PMC10048621/
6. NAC https://pubmed.ncbi.nlm.nih.gov/23737821/

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