ENDOMETRIOSIS 101
You’ve probably heard the term Endo mentioned, especially if you’re in the women’s health or fertility world – but what actually is Endo?
In this post we will briefly describe what Endo is and some of its main symptoms. If you think this might sound like you, we’ve also got the diagnostic criteria and some next steps listed below as well.
Co-written by Megan Churchill, Dietetics Student
What is Endo?
Endometriosis (or Endo, for short) is a chronic inflammatory disorder of the female reproductive organs where tissues which are similar to the lining of the uterus, begin growing in other parts of the body.
Common places this tissue may grow include within the pelvis, the ovaries, fallopian tubes, or on the outer surface of the uterus, however, endometriosis has been found within every organ. (1). The tissue growth is also stimulated by the female hormone estrogen – higher levels of circulating estrogen can not only cause this increase tissue growth but can also lead to heavier and more frequent periods.
The estimated prevalence of endometriosis is approximately 7% of Canadian women, typically affecting women of childbearing age (15 to 49) (2).
The exact cause of endometriosis is currently unknown, however genetic factors contribute to developing endometriosis, and women who give birth for the first time after 30 years old are also at an increased risk (3). Hormonal, immune, environmental and lifestyle factors also seem to play a role in the development.
Signs and Symptoms:
Associated Symptoms of endometriosis include (3,4):
Severe menstrual pain
Excessive menstrual bleeding
Chronic and severe pelvic pain or lower back pain
Pain during intercourse
Spotting in between menstruation
Abnormal menstrual flow
Digestive upset (frequent bloating , abdominal pain, IBS)
Painful urination or bowel movements during menstruation
Difficulty getting pregnant
How is Endo Diagnosed?
If you have any of the symptoms listed above it is recommended to talk to your health care provider who can run diagnostic tests. Diagnostic tests for endometriosis include a pelvic exam, an ultrasound, and an MRI (3,4,5). During these tests your health care provider will be examining for cysts on your uterus, or on your ovaries (4). Occasionally, health care providers will have to perform a laparoscopy surgery to view the endometrium – this is the only way physicians can be 100% sure a patient has endometriosis; however, many physicians will diagnose based on the findings from the pelvic exam, ultrasound and/or MRI (4). It is important to note, though, the diagnosis for endometriosis can often take several years from the time a patient first brings their concerns to their doctor, and encouraging the laparoscopic procedure can be helpful for diagnosing endo in women who may have presented normally on some of the other tests.
Currently, there is no known cure for endo, but it has been divided into 4 separate stages based on how much the tissue has spread and if there are additions cysts or adhesions. These stages do not necessarily align with your symptoms or with infertility rates – there are simply a way to measure where the tissue has spread, and how severe any cysts or adhesions are.
Treating Endo:
There are multiple treatments options available for endo - some of these will be medical, while others may include brining in other health care providers to build a comprehensive team for your care.
Medical treatment options include (6):
Pain medications such as Advil, Motrin, or Aleve
Birth control pills
Hormone therapy
Laparoscopy surgery to remove scar tissue
Including a Pelvic Floor Physiotherapist on your team can help with pain management. Having the support of a Psychologist, or even undergoing hypnotherapy, has also show benefit for improving symptoms in those struggling with endo.
Did you know you can also help treat endometriosis with your diet?!
Of course, seeing a dietitian, specifically one who specializes in fertility, can play a huge role in the management of your endo. Altering your diet may help to reduce symptom severity, and to optimize fertility.
As endometriosis is an inflammatory disorder and often presents with higher levels of circulating estrogen – targeting these two areas is often the focus on nutrition counselling approaches.
When working with a patient with Endo, I would typically first target the inflammation and trying to reduce those levels, and would then look at ways we can balance hormones, improve fertility (if that is a goal of yours) and improve overall gut health and function.
Dietary interventions that may help to reduce some of the symptoms of endo include (7,8):
Increasing consumption of vegetables
Focus on increasing antioxidant rich foods
Increase food or supplement sources of B-vitamins
Increase intake of foods containing omega 3, or supplement if needed
Increase foods high in fibre
Include dairy products rich in calcium and vitamin D (unless there is an intolerance or allergy)
In addition, I tend not to focus too much on avoiding or restricting foods, but high intake of some foods may potentially increase symptoms, or even increase the risk of developing endometriosis, so it may best to reduce intake of the following:
Alcohol
Red Meat and ham
Foods high in Trans Fats
If you are looking to follow a diet to help reduce your symptoms of endometriosis, the Mediterranean diet pattern has shown to reduce general pain in patients with endometriosis (7). The Mediterranean diet includes consuming fresh fruits and vegetables, white meat, and fish while limiting red meats and fat from animals (7).
Additionally, some women with endo will also experience increased digestive discomfort and may have IBS. In these cases, a low FODMAP elimination diet may be helpful to find trigger foods, but this should only be done under the supervision of a dietitian.
There is a lot of information on the internet that can be very confusing. If you are feeling overwhelmed about the information out there and are ready for an evidence-based treatment approach to your health and nutrition, contact us to book an appointment today.
References:
1. Eisenberg, V.H., et al., Epidemiology of endometriosis: A large population-based database study from a healthcare provider with 2 million members. Int J Obstet Gynaecol, 2017. 125(1): p. 55-62.
2. Singh S, Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: Cross-sectional survey of 30 000 Women. J Obstet Gynaecol Can. 2020; 42(7): 829-838.
3. Johns Hopkins Medicine. Endometriosis [Internet]. Johns Hopkins Medicine. 2021 [Cited May 3, 2021]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis
4. Womens Health. Endometriosis [Internet]. Womens Health. 2019 [Cited May 3, 2021]. Available from: https://www.womenshealth.gov/a-z-topics/endometriosis
5. Mounsey AL, Wilgus A, Slawson DC. Diagnosis and Management of Endometriosis. Am Fam Physician. 2006; 74(4): 594-600.
6. HealthLink BC. Endometriosis [Internet]. HealthLink BC. 2019 [Cited May 4, 2021]. Available from: https://www.healthlinkbc.ca/health-topics/hw102998.
7. Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Bally L, Mueller MD. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reprod Sci. 2021.
8. Halpern, G., Schor, E., and Kopelman, A., Nutritional aspects related to endometriosis. Rev Assoc Med Bras, 2015. 61(6): p. 519-523.
