Endometriosis: A Functional Medicine Approach | with Angela Hywood

If you visit a GP or Gynaecologist, the medical approaches offered are generally one of two options: Drugs or surgery. The drugs prescribed are oral contraceptive pills to supply the body with synthetic hormones to induce a pharmacological menopausal state…less than ideal if you don't react well to the pill or are planning a baby. This means that they suppress ovulation and aim to reduce menstrual flow and the theory goes, reduce further lesion stimulation. The most common surgical procedure is a laparoscopy, which is aiming to remove the endometrial lesions and cysts. Laparoscopy is considered the gold standard regarding  as a diagnostic tool, meaning that at the same time as the diagnosis is made, the surgical removal of lesions can also be completed. Occasionally microsurgery might need to be undertaken to remove adhesions from fallopian tubes or walls of the pelvic cavity. The surgery is a somewhat invasive approach, and many women have reported still experiencing pain post-surgery, sometimes more severe than before. Surgery offers no guarantees.

What about Natural Medicine? How Functional Medicine can Help

Previously it was thought that hormonal correction should be the primary focus of treatment, due to the oestrogen sensitivity of the endometrial lesions, this is no longer the core approach from a functional medicine perspective- as we understand that endometriosis is a multifaceted condition, so the path to treatment should be multidimensional as well. Taking a new approach to therapy for Endometriosis offers unique opportunities to explore the disease, and this means that treatment will differ from patient to patient depending on their symptoms:

1. Pain is the biggest complaint, and this is due to the inflammatory component of the condition. Targeting this first can bring great relief to a patient, and thankfully, is an area where natural medicines, such as herbal medicine and nutritional medicine REALLY shine.
2. The Immune system must also be considered. More recent research has shown the significance of the body’s immune response to this disease, in cases of endometriosis, the immune system synthesizes inflammatory cytokines and autoantibodies that further inflame the lesions and stimulate their growth while reducing the activity of natural killer cells (3).
3. Oxidative stress has more recently become an area of focus with studies identifying a clear imbalance between reactive oxygen species (ROS) and antioxidants that are thought to play a role in the inflammatory nature of endometriosis. Production of ROS occurs due to standard metabolic functions, however, in cases of endometriosis, the ROS are thought to interfere with cell proliferation and have adverse effects within the peritoneal cavity (4).
4. Hormonal balancing is also to be considered, enhancing the body’s sensitivity to progesterone while supporting the body’s elimination and detoxification pathways to clear oestrogens.

A New Approach to Treatment

Taking a new approach to the treatment of endometriosis can be an excellent opportunity to seek advice from a functional medicine naturopathic practitioner. As a guide, the following interventions are supported by the current literature, making them appropriate considerations for use. Moving forward, a new approach to take towards treating endometriosis can, and should at least target one of the following. Ultimately any program should be tailored to the individual.

Managing Pain

The inflammatory nature of the condition is primarily responsible for the pain experienced. However, the severity of the pain itself is not a clear indication of the seriousness of the disease. Women with severe endometriosis might present with minimal pain, whereas a woman with intense, debilitating pain may only have a mild case. Specific herbal and nutritional mediciness, as well as modified diet and lifestyle, can significantly reduce the discomfort and promote quality of life for those suffering.

• Turmeric: A well-known herb, which has been shown to target endometrial tissue specifically, providing anti-inflammatory as well as analgesic properties. The curcumin in turmeric has been shown to suppress endometrial cell proliferation; it also addresses all areas of the inflammatory cascade that occurs in chronic inflammation (5).
• Evening primrose oil (EPO): consists of fatty acids that are beneficial for hormone health as they provide the building blocks for the cell membranes and steroid hormones. EPO may be used therapeutically in the management of endometriosis as it’s metabolized to produce series 1 prostaglandins (PGH1 specifically). These prostaglandins possess anti-inflammatory effects within the body as well as reduce excess collagen production, platelet aggregation, regulate T-lymphocyte function and reduce scar formation (6).
• Anti-inflammatory Diet: Ensuring the diet is used to reduce inflammation even further is paramount. The common culprits in a typical inflammatory diet are sugar, gluten, dairy and vegetable oils. However, the diet must be modified to suit the individual, identifying and removing any of the aggravating foods in their diet, or foods that may trigger an allergic response. This can range from high histamine foods, to FODMAPS and so on.
• Microcirculation Support  Ginger and cinnamon along with turmeric in foods and drinks can be used appropriately. These are known for their anti-inflammatory, pain relieving and blood stimulating properties that help to not only manage the pain but also reduce blood stagnation and prostaglandins (7).

Immune support

When it comes to enhancing immune function, the gut is always of primary focus. The immune response to endometriosis is not too dissimilar to other common autoimmune conditions each with intestinal hyperpermeability at their core.

• Zinc: is well loved and researched to repair intestinal hyperpermeability and supports the immune system as well as reducing inflammation and promoting wound healing of endometrial lesions.
• Gluten & Dairy: Removing gluten & cow dairy proteins from the diet can further help, as gluten is known to increase intestinal permeability and trigger an inflammatory response via cytokines, prostaglandins nad histamines
• Probiotics: Probiotic supplementation is of benefit, as the presence of lipopolysaccharides is linked to the presentation of endometriosis, these are endotoxins in the outer membrane of gram-negative bacteria (8). Probiotics, such as L. gasseri are effective for endometriosis, especially against menstrual pain and dysmenorrhea and contributes to improve the quality of life in the patients with endometriosis.
• Sugar-free diet: Dietary application as per above, including anti-inflammatory foods, herbs and removing refined sugars as these are known to weaken the immune system.

Balancing Hormones

Balancing hormones can be done through two mechanisms.

One is to support the body’s detoxification pathways, i.e., through liver and bowel, to assist in the clearance of estrogen, and
Two is to provide nutrient cofactors that increase cellular sensitivity to progesterone.

• Hormone Synthesis: Chaste Tree, Paeonia, Zinc, vitamin B6, and magnesium work synergistically together to support the production of progesterone (9). Magnesium also plays a role in the detoxification of estrogen in the liver and bowel, with a deficiency contributing to estrogen excess via aromatization.
• Hormone Metabolism: The inclusion of Rosemary, Schisandra, NAC, DIM, I3C and  cruciferous vegetables (ie, broccoli sprouts, brussels sprouts, cauliflower), support healthy oestrogen metabolism via phase 2 liver detoxification pathways.
• Methylation: It’s also really important to understand your genetics and ability to do a job called “methylation”. Do you carry the MTHFR gene or COMT genes? If so, you’ll need specific support to assist your hormones metabolism pathways.

Reducing Oxidative Stress

Oxidative stress occurs through some processes and is a crucial area of treatment targeting. The accumulation of iron within the pelvic region, environmental toxin exposure and the high estrogen/estrogen excess, are all are significant contributors to this (10).

• N-acetyl-cysteine (NAC) is a bioavailable form of cysteine that promotes glutathione synthesis (the body’s primary antioxidant). NAC provides not only anti-inflammatory and antioxidant actions but also targets pathways in the liver to promote detoxification. Clinical trials have also found that supplementation with NAC for 12 weeks resulted in decreased endometrial cyst size and reduced pain scores in participants (11).

There is a lot to consider when it comes to endometriosis that can leave both practitioners and patients feeling overwhelmed. For those suffering from this condition, it’s strongly advised to seek out care from a specialist naturopathic clinicals with a lot of experience with this condition. Considering functional medicine can be of great benefit, as this approach finds and treats the YOU  as an individual and not just the disease.

Our team would love to take care of you, and we have so many happy success stories to share with you.

Book a discovery call to have a chat with one of our team about your unique circumstances. We'd be honoured and to help you rise like a Phoenix from the flames of Endometriosis.

References

1. http://www.abc.net.au/health/library/stories/2004/03/25/1829440.htm
2. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reprod 2005;20(10):2698-2704.
3. Králíčková, M., & Vetvicka, V. (2015). Immunological aspects of endometriosis: a review. Annals of Translational Medicine, 3(11), 153. http://doi.org/10.3978/j.issn.2305-5839.2015.06.08
4. Scutiero, G., Iannone, P., Bernardi, G., Bonaccorsi, G., Spadaro, S., Volta, C. A., … & Nappi, L. (2017). Oxidative stress and endometriosis: a systematic review of the literature. Oxidative medicine and cellular longevity, 2017.
5. Arablou, T., & Kolahdouz-Mohammadi, R. (2018). Curcumin and endometriosis: Review on potential roles and molecular mechanisms. Biomedicine & Pharmacotherapy, 97, 91-97.
6. Paxton, 2015, p.87 – Paxton, F., (2015). Foundations of naturopathic nutrition. Sydney: Allen & Unwin.
7. Khayat, S., Kheirkhah, M., Behboodi Moghadam, Z., Fanaei, H., Kasaeian, A., & Javadimehr, M. (2014). Effect of Treatment with Ginger on the Severity of Premenstrual Syndrome Symptoms. ISRN Obstetrics and Gynecology, 2014, 792708. http://doi.org/10.1155/2014/792708
8. Khan, K. N., Fujishita, A., Hiraki, K., Kitajima, M., Nakashima, M., Fushiki, S., & Kitawaki, J. (2018). Bacterial contamination hypothesis: a new concept in endometriosis. Reproductive Medicine and Biology, 17(2), 125–133. http://doi.org/10.1002/rmb2.12083
9. Trickey, R., (2011). Women, hormones & the menstrual cycle. Fairfield, Vic.: Melbourne Holistic Health Group.
10. Yamaguchi, K., Mandai, M., Toyokuni, S., Hamanishi, J., Higuchi, T., Takakura, K., & Fujii, S. (2008). Contents of endometriotic cysts, especially the high concentration of free iron, are a possible cause of carcinogenesis in the cysts through the iron-induced persistent oxidative stress. Clinical Cancer Research, 14(1), 32-40.
11. Porpora, M. G., Brunelli, R., Costa, G., Imperiale, L., Krasnowska, E. K., Lundeberg, T., … Parasassi, T. (2013). A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evidence-Based Complementary and Alternative Medicine : eCAM, 2013, 240702. http://doi.org/10.1155/2013/24070