This week is Endometriosis Awareness Week led by Endometriosis UK focusing this year on timely diagnosis of this under recognized condition. Currently in the UK it takes on average seven and a half years to receive a diagnosis. It is estimated 1 in 10 women of a reproductive age suffer with endometriosis and 10% of women worldwide suffer with this condition – so you are most certainly not alone if you are affected by this potentially debilitating condition. The quote featured in the image above is from someone I am currently supporting – provided here with their permission – who has made improvements as a result of diet and lifestyle changes to improve symptoms but has always found it hard to discuss her condition as people just think it’s “having a bad period”. In recent years endometriosis has been getting some air time on the mainstream news and in the press but like many conditions it is sidelined and not a topic people want to talk about, often as it is deemed embarrassing or not something that should be openly discussed.
What is endometriosis?
Endometriosis is a chronic condition where cells that should be in the uterus are found in other parts of the body – usually around the abdomen (as shown in the diagram below) but in some cases they can spread to other areas of the body.
As a woman’s natural cycle progresses there are hormonal changes, you will likely be familiar with these names; estrogen and progesterone, but also testosterone – yes women have testosterone too! Changes in hormone levels allow for a pregnancy to progress by preparing the uterus if there is a fertilized egg or if pregnancy does not occur, the lining is shed and menstruation occurs. This is all normal. However, when endometrium cells find their way outside of the uterus and attach to pelvic organs, they still react to the changes in hormone levels, and act in the same way to a period and they bleed internally but cannot leave the body. This can lead to:
- pain (usually abdominal and can be severe).
- adhesion’s – where scar tissue forms.
Symptoms of Endometriosis
There can be many symptoms associated to endometriosis, however you may not experience them all, they may come and go – yet another reason why it can take so long to be diagnosed, they can include:
- chronic pain usually abdominal but also potentially lower back particularly in the run up to and during your period.
- painful during or after sex.
- pain associated to bowel and bladder movements particularly during your period, and either constipation or diarrhea.
- heavy periods or bleeding between periods.
- possible fertility issues.
As a result of these symptoms some women can find their day to day lives can be significantly effected such as work, socializing, exercising being able to carry out normal tasks of daily living. If symptoms are bad and this can lead to feeling low and for some bouts of depression, low self esteem or confidence effecting work, family and social life. If it important to seek support from your GP as a first port of call to discuss your symptoms.
What causes endometriosis?
There is no consensus on the actual ’cause’ of the condition, however our genetics, environment and lifestyle are likely to play a role in the development and progression of the condition. Retrograde menstruation is considered to likely play a role, this is where menstrual fluid flows from the uterus in to the fallopian tubes and escapes in to the pelvic cavity as our ovaries are not directly attached to our fallopian tubes. There are other potential causes that are discussed here, but there are several factor that can potentially mean you are at a higher risk of endometriosis, so if you have symptoms and any of the following apply to you it is helpful to mention these when visiting your GP;
- Starting your period at an early age.
- Having short periods (less than 27 days).
- Never giving birth.
- Being older when you go through the menopause.
- Family history (e.g. mum, sister, aunt) of endometriosis.
Why does it take so long to get diagnosed?
The only definitive way to receive a firm diagnosis of endometriosis is via a procedure called a laparoscopy which is where a small (laparoscopic) camera is inserted into the abdomen via a small cut near your belly button. This allows doctors to look for signs of endometrium tissue, adhesion’s and inflammation as a result of endometriosis. Some people may first be given blood tests, internal exams or scans which are helpful to assess other signs and symptoms you are suffering. These tests are also helpful to rule out other conditions where symptoms may be very similar such as pelvic inflammatory disease, ovarian cysts, irritable bowel syndrome (IBS – both diarrhea and constipation types), it is sometimes possible to have endometriosis and IBS or other conditions.
This years Endometriosis Awareness Week is to help raise awareness about getting a diagnosis, and so it is vital if you are experiencing the symptoms to go to your GP, be as open and honest with them. It can be helpful to keep a diary of your symptoms to allow you to monitor them – there are some great free apps to help monitor your menstrual cycle, not just duration, but also other symptoms, energy, mood. If you don’t feel you are getting the answers there may be the option for a referral to one of the Specialist Endometriosis Centres.
If I have been diagnosed, is there anything I can do?
Most medical interventions for endometriosis involve medications or surgery to help slow the progression, ease pain and improve fertility chances – and it is always best to speak to your GP and specialist to ensure you have all the information to help select best course of action for you.
The causative factors of endometriosis are often out of our control, and so it can be helpful to focus on the things within your control. These factors may have an influence on the development of your endometriosis (and other hormone related conditions for that matter) and include:
- Your stress levels – remember stress can include physical, emotional, social, or financial stress.
- Your work/life balance, getting time to de-stress, relax, have a bath, take some ‘you’ time, have fun, laugh.
- Activity and exercise levels.
- Your diet – remember food is not just fuel, but information, that influences messages sent in the body, if poor information goes in, the messages are also poor.
- The quantity and quality of sleep you are getting.
- Genetic factors (SNPs) that may be influencing your bodies ability to breakdown and excrete excess hormones – whilst we can’t change these we can influence through our diet and lifestyle factors mentioned above.
There is a vast plethora of information now available to the public thanks to the internet, some fantastic books, webinars, and access to the scientific and medical research that continues. However it can be difficult to know where to turn. Endometriosis UK have a helpline and support groups which can be a positive place to start to get some reassurance you are by no means alone. An interesting read is this article featured in What Doctors Don’t Tell You, where a friend and colleague mine gives her very honest account of her experience. This book provides some interesting approaches that can be taken into consideration when managing endometriosis;
Nutritional Therapy offers specific targeted support for you, to support your body in coping with everything endometriosis can throw at it by addressing those factors we can influence. However, it is also important to mention that working from a Functional Medicine standpoint I don’t just look at a single condition, diagnosis or symptom. Instead, we look at the wider picture to assess your overall health status, in conjunction with symptoms, diagnoses, family medical history, current diet and lifestyle to identify nutritional or hormone imbalances, systems under stress and where possible the root cause and provide appropriate support and/or referral. If you are interested to know more, feel free to contact us to arrange a free 20 minute mini-consultation to talk through the process, and see if this approach might be right for you.
Endometriosis UK https://www.endometriosis-uk.org
Institute for Functional Medicine https://www.ifm.org/functional-medicine/