Looking At Endometriosis Holistically | with Emily Bathgate

• Proliferate (reproduce and increase… and quickly!)
• Migrate (move or travel to other areas of the body, including the ovaries, bladder or bowel)
• Oxidise (leading to cell and tissue damage)
• Cause an increase in oestrogen production
• Lead to dysbiosis (an imbalance of 'good' and 'bad' microflora), immune dysregulation, and inflammation.

• Painful periods
• Pain with sex
• Chronic pelvic pain
• Pain with bowel movements and/or urination
• Infertility
• Irritable Bowel Syndrome (or IBS – an umbrella syndrome for seemingly ‘unexplained’ gastrointestinal symptoms like abdominal pain, cramping, bloating, gas, diarrhoea and/or constipation)
• Depression and anxiety
• Fatigue

• Hormonal - Endometriosis is commonly associated with higher levels of oestrogen and is believed to be at least partly oestrogen driven.
• Immune Dysregulation - Chronic inflammation and oxidisation of endometrial tissue can essentially cause a wound that isn’t able to heal, and this is at least partly down to a dysregulated immune system. It’s also been shown that both mast cell and histamine activation (just two aspects of our immune response) contribute to endo pain and inflammation.
• Dysbiosis - An imbalanced microbiome isn’t very helpful for health generally (including for healthy immune function), but a lower microflora diversity is often found in endometriosis. Beyond this, a decrease in butyrate-producing bacteria is observed in endo: these bacteria are important for protecting gastrointestinal integrity and for managing gastrointestinal inflammation. It's also important to consider the impact of a lower diversity and bacterial imbalance in the reproductive (vaginal and endometrial) microbiome, too!
• Genetic - It’s believed that endometriosis can come about due to both genetic and epigenetic factors.
• Diet - Studies show that there is an increased risk of endometriosis with a diet excessively high in red meats, alcohol, and high glycaemic index carbohydrates (think cereals, white or wholemeal bread, Jasmine rice, white potato, oat + rice milk).
• Lifestyle - It has been shown that high stress and poor sleep can also increase the risk of, and exacerbate the symptoms of, endometriosis.
• Environment - Many of us are exposed to endocrine-disrupting chemicals (EDCs) regularly, and research points towards this exposure contributing to endometriosis. As the name implies, chemicals like flame retardants, phthalates, BPA, and pesticides disrupt the endocrine system (the complex network of organs and glands controlling metabolism, reproduction and development). EDC exposure in utero (i.e. while we’re in our mother’s uterus), through puberty and in adulthood can contribute to endometriosis.

• Non-steroidal Anti-inflammatory Drugs (NSAIDs), like ibuprofen, for temporary pain relief
• The oral contraceptive pill or Mirena relieves mild to moderate pain by essentially preventing menstrual cycling
• Surgery – either a laparoscopy, which is a keyhole surgery that allows extrauterine endometrial cells to be either removed or ablated (and is also used to uncover and diagnose endometriosis), or a hysterectomy, which is the surgical removal of the uterus entirely

1. Test, Don't Guess Considering that endometriosis is an oestrogen-driven condition, we want to measure the impact of an individual's oestrogen levels and metabolism on their condition. At the same time, androgens, like testosterone, are converted to oestrogen with the help of an enzyme known as aromatase. If the aromatase pathway is impacted (for example by excess alcohol consumption or excess body weight), or if androgen levels are exceptionally high, this may contribute to higher levels of oestrogen. I love utilising the DUTCH Test for this reason, as (unlike bloodwork alone) it shows the levels of all three major forms of oestrogen (oestrone, oestradiol, and oestriol) as well as how the body metabolises these.

2. Ditch EDCs When we’re considering oestrogen's impact on endometriosis, it's also important to consider an individual’s exposure to xenoestrogens – EDCs that can interfere with the body’s natural oestrogen balance. Xenoestrogens are commonly found in many plastics, preservatives, and pesticides. Get to work on swapping your plastic bottles and food containers to glass or stainless steel, opt for natural cleaning and personal care products, eat organic where possible and try and avoid the dirty dozen when food shopping.

3. Give Your Liver Some Love Your liver is incredibly important when it comes to the detoxification of excess oestrogen, xenoestrogens and other impacting substances. When it comes to endometriosis, and even oestrogen metabolism support generally, we want to support your Phase I and Phase II liver pathways. Phase I of liver detoxification is a pathway responsible for converting toxic chemicals and wastes into less-harmful versions as your first line of defence. It’s then the role of Phase II liver detoxification to neutralise these toxins ready for elimination by the body. You can give your Phase I detox pathway some support by consuming more antioxidant-rich green tea, rosemary, and broccoli sprouts. And then give your Phase II detox pathway a boost with some turmeric, NAC or glutathione (or glutathione-rich foods, like avocado, spinach, broccoli and asparagus), calcium-D-glucarate, and some cruciferous (think broccoli, cabbage, cauliflower, kale, brussel and broccoli sprouts) and allium (garlic, onion, shallots, and leeks) veggies. I wrote another journal article about the ins and outs of detoxification here.

4. Give Bowel Excretion With your liver packaging up toxins – including excess hormones – we want to prime your bowel to be able to excrete and eliminate them. Put very simply, we want to ensure that your microbiome is beautifully healthy to help you out. Consuming adequate fibre (and particularly soluble fibre – I love suggesting ground flaxseed especially! But also, oats, black beans, apples, and carrots) helps to bulk the stools for easy elimination. You’ll also want to make sure that adequate hydration is also something on your daily to-do list, as this will further support elimination – both through bowel and kidneys (urine). Prebiotic fibre (again, oats and apples, as well as garlic, onion, and Jerusalem artichoke) helps to feed and fuel the good bacteria in the microbiome. Meanwhile, adding strains of good bacteria (by working with probiotics) helps to restore balance to the microbiome.

5. Pain Starts With P(EA) In 3 Two nutrients I particularly like to work with for endometriosis pain management are PEA and Omega 3. PEA (known more formally as palmitoylethanolamide) is a chemical capable of binding to cells to reduce pain and swelling. While studies show its ability to significantly reduce chronic pelvic pain and period pain, PEA is also able to suppress mast cell degranulation and histamine release by modulating the inflammatory response. The less inflammation, the less pain and the less endometrial proliferation we see. Omega 3 is one of my favourite anti-inflammatory nutrients, and something I use with almost all of my skin health clients. In the case of endometriosis, as well as being a potent anti-inflammatory, omega 3 has also been shown to be anti-proliferative and antiangiogenic, slowing the growth of further endometrial-like tissue outside of the uterus.