An Integrative Approach to Endometriosis

What is Endometriosis?

Endometriosis occurs when endometrial tissue, the tissue that lines the uterus, grows outside the uterus. It may develop on the ovaries, fallopian tubes, and abdominal cavity.

Endometrial tissue responds to changing hormones throughout the menstrual cycle, proliferating with estrogen signals, and shedding each month that pregnancy doesn’t occur with a period. When endometrial tissue outside the uterus sheds, it may remain in the body, causing pain, cysts, and other issues.

Many factors may contribute to endometriosis, including inflammation, hormone imbalance, and immune dysfunction. Those with endometriosis may be more likely to develop an autoimmune disease like Hashimoto’s thyroiditis. Endometriosis can also coexist with other conditions, including PCOS.

Endometriosis may be challenging to diagnose as imaging technology might not capture the tissue depending on where it is. Laparoscopy and biopsy, which is quite invasive, are required for a conclusive diagnosis.

Symptoms of Endometriosis

Endometriosis symptoms are cyclical, occurring along with the monthly period, and include:

• Menstrual pain
• Heavy periods
• Abdominal pain
• Pelvic pain
• Painful sex
• Changes in bowel movements and urinary habits
• Pain with urination or bowel movements
• Back pain
• Fatigue
• Infertility

It’s possible to observe other cyclical symptoms as well. For example, I had a patient who would get nosebleeds along with her period.

What Causes Endometriosis?

In the medical literature, the cause of endometriosis is unknown. Some theorize the stage is set for endometriosis at birth when the baby girl experiences a sudden withdrawal of the mother’s hormones. Endometriosis symptoms begin in puberty when her estrogen levels rise and she begins menstruating.

Other evidence suggests that endometrial cells leak out of the uterus via the fallopian tubes in all women, but women with endometriosis don’t have the proper immune response to take care of the escaped cells.

In reality, many underlying factors likely create a perfect storm for endometriosis. These may include:

• Genetics - Endometriosis tends to run in families suggesting a genetic link. However, we can modify genetic expression (epigenetics) with lifestyle changes.
• Immune dysregulation – Lack of immune response to endometrial tissue outside of the uterus.
• Excess estrogen – High estrogen levels may promote excess growth the endometrial tissue. Progesterone resistance may contribute to estrogen dominance.
• Underlying inflammation – Consider factors such as an inflammatory diet, toxin exposure, and hidden infections.
• Microbiome imbalance – the microbiome influences hormonal balance and the body’s immune response. Those with endometriosis show microbiome differences compared to those without endometriosis.

Conventional Treatment

The conventional approach to endometriosis is based on managing the symptoms. Allopathic treatment options include:

• Pain management – NSAIDs and opioids
• Medication – oral contraceptives, GnRh agonists, gnRh antagonists and others
• Surgery

Integrative Approach

In addition to medications and surgery, an integrative approach looks at the underlying factors contributing to endometriosis development and symptoms. Working to balance hormones, support a healthy immune response, correct gut imbalances, and decrease inflammation provides a whole-body approach.

At TārāMD, we aren’t just looking at the reproductive organs in our patients with endometriosis but work to address each woman’s unique root causes.

Some interventions to consider include the following:

• Reduce exposure to endocrine disruptors. These toxins shift hormone balance in the body, and many toxins, including BPA and phthalates found in plastics, clothing, and cosmetics, act like estrogen in the body. For someone with endometriosis, estrogen-mimicking chemicals can exacerbate symptoms.

• Use food as medicine. Your personalized diet is a powerful tool for addressing root causes. For example, eating more plants and fish while eliminating gluten may reduce inflammation. Increasing flax seeds and cruciferous vegetables help detoxify excess estrogen. Turmeric, ginger, garlic, mushrooms, and other foods have immune-enhancing properties.

• Prioritize gut health. Make sure you are having regular bowel movements, as this is how estrogen leaves the body. Consider a comprehensive stool test to assess your microbiome and identify possible infections that may be causing inflammation.

• Try physical medicine. Pelvic floor physical therapy, abdominal massage, and acupuncture are supportive options for pain management and improving abdominal circulation. SoLa Pelvic Therapy is a new service available at TaraMD.

• Optimize daily habits. Movement, sleep, stress management, and other lifestyle factors may influence symptoms. For example, regular exercise helps increase blood flow. Consider adding in hip circles (belly dancing, anyone?) to improve circulation in the pelvis.

• Use targeted supplements. With diet and lifestyle factors dialed in, take healing to the next level with supplemental support. Use supplements to ease discomfort while you work on other underlying causes and experiment with treatment options. Supplements to consider include:
• Anti-inflammatory supplements - curcumin, resveratrol, omega-3s, ginger, green tea
• Estrogen-balancing supplements – I3C, DIM, vitex, calcium-d-glucarate
• Immune-balancing supplements – vitamin C, vitamin D. alpha lipoic acid, glutathione
• Gut-healing supplements – probiotics, prebiotics, glutamine

• Build a supportive team. So often, women are dismissed in the healthcare system or only offered surgery without a deeper exploration of what the body is communicating. It’s important that you feel heard and cared for by your healthcare team. Your team might include your gynecologist/MD, nutritionist, pelvic therapy practitioner, and acupuncturist.

The monthly agony of endometriosis isn’t a life sentence. Approaching root causes from all angles helps ease symptoms as well as build robust health that lasts a lifetime. Supporting you in your healing journey is what we do best at TārāMD. If you are ready to make changes, please reach out.