Endometriosis and the Integrative Approach
By Erin Lindberg / Mar 26, 2023
While there is no known cure for endometriosis, conventional medicine is yet to find a way to ‘treat’ endometriosis; mainly focusing on temporary symptom relief through surgery/hysterectomy, hormone therapies/birth control pills or prescription painkillers. Each comes with their own undesirable side effects and risks, while simultaneously failing to address the root cause of the problem.
Shared later, is a more integrative approach to managing endometriosis in lieu of succumbing to the pharmaceutical and surgical push, which includes a more holistic approach aiming to reduce inflammation, enhance immune function, alleviate pain, balance hormones and support natural detoxification through diet, lifestyle changes, supplements and therapies.
What Is Endometriosis?
Endometriosis is a complex, inflammatory condition in which tissue similar to that which lines the uterus, is found outside the uterus, where it creates a chronic inflammatory reaction that results in lesions, cysts, scar tissue and adhesions. The endometriosis lesions and growths most often exist in the peritoneal cavity, fallopian tubes, ovaries, the bowel, bladder and rarely found on the diaphragm and lungs.
The tissue outside the uterus responds to the hormone fluctuations that affect the menstrual cycle in the same way it would if it were in the uterus, building up each month before the period, and then breaking down when the body signals that it’s time to shed the lining. Because the body does not recognize the presence of this endometriosis tissue it leads to a chronic cycle of inflammation. The immune system continuously tries to manage the situation and repair the tissue significantly contributing to the inflammation. This inflammatory process leads to the formation of scar tissue and adhesions causing neighboring organs to stick together and an increasingly abnormal immune response worsening symptoms over time.
Symptoms of Endometriosis
Endometriosis is difficult to diagnose. Exploratory laparoscopy surgery is currently the only fully viable method to diagnose or rule it out. It is diagnosed in 4 stages of severity, from stage 1/mild to stage 4/severe. However, the stage of endometriosis does not dictate the severity of symptoms. Someone could have stage 3 endometriosis and not find out they have it until they’re having trouble conceiving. Symptoms often correlate with menstrual cycles since the endometriosis tissue is estrogen-dependent like the endometrial lining of the uterus. The biologically active estrogen, estradiol, aggravates the pathological processes (inflammation and growth) and the symptoms associated with endometriosis. Estrogen receptor levels in endometriosis tissue are >100 times higher than those in endometrial tissue.  Depending on the location and severity of the endometriosis lesions, symptoms can vary quite a bit. Endometriosis is a whole-body condition and is different for everyone affected.
Symptoms often include, but are not limited to:
Causes and Contributing Factors of Endometriosis
Currently, this complicated condition is still not well understood but more and more research is being done, which is promising. There are multiple proposed theories on how and why endometriosis develops, including immune system dysfunction, oxidative stress and inflammation, genetics, development in utero and retrograde menstruation to name a few.
There is a strong body of evidence supporting the connection between endometriosis, inflammation and immune system dysfunction.  Researchers have concluded that endometriosis has almost all the hallmarks of an autoimmune disease and has been found to occur in conjunction with other autoimmune conditions like multiple sclerosis, rheumatoid arthritis and inflammatory bowel diseases, including Crohn's and ulcerative colitis.  Inflammation is connected to our gut function and liver health (it’s ability to detox effectively) because gut and liver health play an important role in autoimmunity and the development of autoimmune disease.
Additionally, research demonstrates that hormonal imbalance does not cause endometriosis, but can definitely exacerbate it, primarily with excess estrogen. In a balanced hormonal system, all the hormones work in concert, communicating messages between each other and our organs harmoniously. Unfortunately, when one of the hormones becomes imbalanced, it can cause a flow-on effect to this communication and lead to undesirable symptoms. One of the most common hormones to fall out of balance is estrogen. The balance of estrogen can be disrupted by poor diet, stress, lack of sleep, impaired liver function, an unhealthy gut microbiome or exposure to environmental toxins. The body can create too much estrogen (internal) or struggle to properly eliminate natural estrogen through the liver and bowel. Secondly, exposure to external sources of estrogen-like substances (xenoestrogens) increase estrogen levels in the body.
Once the body has used estrogen it needs to be metabolized and eliminated. The first step takes place in the liver where natural and estrogen-like substances are broken down. The liver requires several nutrients, including magnesium, to break down estrogen. A deficiency in nutrients can slow or impair liver breakdown of estrogen and other hormones. Other factors that have been linked to the development of endometriosis include high intake of alcohol, which can increase estrogen in the body and decrease the liver’s detoxification function.  Liver function may also be impaired by high intake of caffeine and pharmaceutical drugs.
The second step takes place in the gut where the metabolized estrogen is packaged up and eliminated via the stool. One study found that 80% of women with endometriosis have SIBO, and another suggested that the health of the intestinal bacteria played a critical role in the development and progression of endometriosis.  Imbalanced gut bacteria can lead to excess estrogen, as higher levels of bad versus good bacteria, which are responsible for breaking down estrogen, can cause more estrogen to be reabsorbed rather than eliminated via the stool. Additionally, endometriosis can directly affect the GI tract, so it goes both ways. Prostaglandins, which are released during menstruation by the uterus and the endometrial lesions, affect the smooth muscle of the bowel and cause symptoms such as intestinal cramping and diarrhea. The endometrial cells can even invade through the wall of the intestines. This interferes with the gut’s ability to keep waste products moving (motility), resulting in SIBO, yeast overgrowth, and bacterial imbalance. When either or both of these processes are not functioning optimally, estrogen can be reabsorbed into circulation rather than eliminated, contributing to high levels of estrogen which will only worsen endometriosis. You can now see the importance of supporting liver and gut health.
Chronic inflammation is induced by the presence of the endometriosis tissue. As a result, there are high numbers of immune cells like macrophages and mast cells in the peritoneal cavity and in the endometriosis lesions due to the body’s immune response. These cells contribute to the inflammation as they try to manage the situation and repair the tissue.
Histamines are chemicals stored in the mast cells and are involved in nerve transmission and immune response regulation. When mast cells are triggered, they release histamines. When a person has a histamine sensitivity or intolerance, certain foods or environmental stimulants can cause a stress response and a host of symptoms. Some signs/symptoms of Histamine Intolerance to look for: flushing and temperature regulation issues, sneezing, itchy skin, hives, headaches/migraines, wheezing, burning in mouth/hands/feet, tightness/fullness in throat, Postural Orthostatic Hypotension Syndrome (POTS) or other forms of dysautonomia, dizziness/vertigo, low blood pressure, tachycardia, heart palpitations, swelling, anxiety/panic attacks, confusion/irritability and difficulty sleeping/sleep disturbances. In women with endometriosis, mast cells are present in much higher quantities in the endometriosis tissue.  As the condition progresses, the immune system response becomes increasingly dysfunctional.
The HPA axis is the principal effector of the stress response. HPA axis dysfunction results when one or more of the three components of the HPA axis (hypothalamus, pituitary gland and adrenal gland) is not doing what it should be doing. For example, if the hypothalamus fails to signal the pituitary gland to release ACTH, then the adrenal gland won’t produce sufficient amounts of cortisol. Working together, these 3 components regulate energy levels, stress response, metabolism, mood, motivation, and immune system. Here’s how it works:
Usually, the root cause of HPA axis dysfunction is inflammation due to a variety of stressors, including emotional stress (at home or work), undiagnosed infections, exposure to environmental toxins and pollutants, food sensitivities or poor diet. Inflammation will cause dysregulation of the signals in the brain coming from the hypothalamus, causing a chain reaction that impacts the pituitary gland and ultimately the adrenal glands. This will have a “whole body” effect with numerous symptoms that are difficult to trace to any single illness or dysfunction. In summary, immune system dysregulation is intrinsically linked with endometriosis, and working on nutrition, limiting histamine triggers, supporting gut and liver health and HPA axis dysfunction can help lower inflammation and stabilize the immune system.
Genetics also plays a role in the development of endometriosis. It’s been found that women who have a close relative with the condition are 7-10 times more likely to develop endometriosis. There are theories that suggest implants of the endometriosis tissue on the external surface of the pelvic organs during embryonic development, and then become “active” as puberty begins. It is also suggested that women with endometriosis due to genetic mutations, over respond to estrogen which encourages growth of the lesions, while progesterone receptors are being silenced and becoming unresponsive to progesterone, which would normally balance out the strong influence of estrogen.
Lastly, there is a belief that retrograde menstruation may also be a cause of endometriosis. Normally, menstrual blood should flow from the uterus out of the body, but instead of the blood flowing out of the body through the vagina, the endometrial lining flows backward through the fallopian tubes and into the abdomen. There is a link, however not every woman who experiences retrograde menstruation has endometriosis.
Integrative Treatment of Endometriosis:
Endometriosis is a complicated condition, and not everyone will be able to significantly reduce or eliminate their symptoms, but there are several mainstream treatment options that can help manage symptoms, slow progression and improve quality of life. Some may need or opt to have excision surgery by a skilled surgeon to remove the lesions and scar tissue, however lifestyle and dietary changes are pivotal parts of addressing endometriosis naturally.
An integrative approach to endometriosis takes into account the whole person, physical, emotional and spiritual. It involves combining conventional medical treatment with complementary therapies. Integrative therapy aims to address the underlying causes of a person’s health concerns rather than simply treating the symptoms. Below are some integrative approaches to help you manage endometriosis naturally on the basis of immunomodulation and anti-inflammatory therapy. Treatment typically involves identifying and reducing the impact of stressors, reducing exposure to environmental toxins, detoxing the body, and adjusting to a supportive diet and possibly restoring gut health.
Mind-body techniques can help to manage these symptoms by calming the nervous system, reducing stress levels and promoting “the relaxation response”, generally characterized by a reduction in blood pressure, respiratory rate, body temperature and resting heart rate, and relaxed muscles. Try practicing short periods of mindfulness and breathing techniques throughout the day. For many, changing when and how you eat is more important than changing what you eat. Incorporate mindful eating, chewing food 20-40 times and eating with more pleasure and enjoyment. Finish eating for the day by 7-8 pm. Eating during the most productive hours of the day is important for blood sugar regulation and hormone balance.
Vagus nerve toning using vagal nerve stimulation and/or exercises help support parasympathetic dominance, enabling the body to counter cortisol levels and effectively releasing stress from the cells, promoting relaxation, sleep and digestion. Excess cortisol production from being in a chronic state of stress can lower progesterone production increasing estrogen dominance. Meditation, grounding, visualization, JFB Myofascial Release, Yoga and Tai Chi are other techniques to support parasympathetic dominance and optimize stress resilience.
Inflammation is a key factor in the development and progression of endometriosis. Eating specific foods can trigger a stress response and can contribute to inflammation in the body, while others have anti-inflammatory properties that can help to reduce the inflammation. Keeping a food diary can be helpful when you’re trying to see what, if anything, triggers or makes your symptoms worse. There are no bad foods, there are just foods that may not agree with your body, foods that you may be allergic to or intolerant of.
Attempt to limit, but not completely eliminate, highest histamine foods such as fermented or soured foods, such as yogurt and sour cream, kombucha, vegetables and pickles, fermented soy and grains (such as sourdough bread), cured meats, smoked and canned fish (sardines or tuna), aged cheeses, alcohol beverages, tomatoes, eggplant, spinach and vinegar. Focus on adding low histamine and high flavonoid foods versus strictly eliminating high histamine foods.
Notice some foods that are highest in flavonoids are also high in histamine. It’s essential not to create a fear of food within the nervous system, and instead promote enjoyment of foods high in flavonoids. Limited consumption should be fine as long as the focus is on a whole foods diet low in packaged and processed foods. Fortunately, by reducing the histamine load, strategically antagonizing histamine receptors and supporting optimal digestive function and a healthy, diverse gut microbiome the immune challenge of histamine intolerance that many people with autoimmune diseases struggle with can be overcome.
The rise in body temperature stimulates production and mobilization of white blood cells and killer T cells, which means your body’s natural healing mechanisms are optimized. At the cellular level, the light waves can alter membranes, DNA/proteins and cell fluids. Altered cell membranes and mitochondrial activity take place, impacting your body’s energy and metabolism. Stimulation of your lymphatic system and circulatory system, oxygenates cells, regenerates damaged tissue and eliminates toxins.
Sauna time also stimulates the production of endorphins in your body helping with pain relief, the deep heat promotes relaxation of tense muscles as well as producing a parasympathetic healing effect, helping with stress relief and balancing cortisol levels. Only 15-30 minutes of time in an infrared sauna can impact your health significantly and has the potential of helping restore balance if you are dealing with chronic pain, inflammation, low energy or poor circulation.
Contrary to popular belief, endometriosis is not a problem with reproductive organs. It just happens to manifest in the body as reproductive problems. This is why uterus and ovary removal is not a solution. We need to start moving away from the belief that endometriosis is a gynecological condition and instead embrace the understanding that it is a full body condition driven by immune system dysfunction and chronic inflammation that happens to affect the reproductive organs and menstrual cycle significantly. It is a condition that is heavily influenced by dietary and lifestyle components and these interventions should be cornerstone in one's treatment.
Endometriosis is a full body complex condition that will often require a multidisciplinary approach to treatment. Integrative therapy is not a replacement for conventional medical treatment of endometriosis but rather a complementary approach to achieve better outcomes.
By addressing both the physical and emotional aspects of endometriosis, integrative therapy can help women achieve a better quality of life and attack some of the suspected root causes of endometriosis as well.
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-----THIS INFORMATION IS NOT A SUBSTITUTE FOR, NOR DOES IT REPLACE, PERSONALIZED MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. IF YOU HAVE ANY CONCERNS OR QUESTIONS ABOUT YOUR HEALTH, YOU SHOULD ALWAYS CONSULT WITH A HEALTH-CARE PROFESSIONAL. THE USE OF ANY INFORMATION PROVIDED IS SOLELY AT YOUR OWN RISK. -----