Endometriosis is a chronic inflammatory condition that causes excruciating and debilitating pelvic pain with the female menstrual cycle. The disease is estimated to affect between 5-10% of women and is implicated in approximately 20% of infertility cases.
It’s important to point out here that some cases of endometriosis are termed “silent endometriosis” because there is no pain, but can be a cause of unexplained infertility, failed IVF cycles and miscarriage. See Dr. Braverman’s work for more information.
Endometrial tissue is said to travel and land outside of the uterine cavity and lesions can be found on the bladder, bowels lungs and other organs. The lesions are then acted on by reproductive hormones through the menstrual cycle. The disease affects people of all races and genders.
How does endometriosis happen?
There are a few theories as to how this happens, but nobody knows for certain. The first is retrograde flow of endometrial tissue into the pelvic cavity via the fallopian tubes, but all women will have retrograde flow but not all develop endometriosis. The second is that endometrial tissue is laid down before birth during fetal development and only gets activated once your hormones start rising your reproductive years. Further theories suggest that there is a strong genetic component to the disease.
If you have very painful periods, you might have endometriosis
Signs and symptoms
Painful periods – including lower back and abdominal pain
Pain with bowel movement or urination – even outside of the menstrual period
Painful intercourse – during and/or after
Infertility – occurs in up to 20% of infertility cases
Excessive bleeding – with the period or between periods
Fatigue
Autoimmune disease, most commonly Hashimoto’s thyroiditis
Sadly, it takes an average of 7-10 years for women to be properly diagnosed because of the invasiveness of the best available diagnostic procedure, which is laparoscopic investigation. Recent research gives hope that diagnosis, at least for some women, can be made in a timelier manner in order to expedite her time to implement treatment, symptom relief and improved well-being.
Testing considerations
Laproscopic surgery is the gold standard for diagnosing endometriosis, however, given the invasiveness of the procedure, diagnosis tends to be delayed for most women and can take up to 7-10 years. Recent research gives hope that diagnosis, at least for some women, can be made in a timelier manner using a relatively inexpensive and accessible blood test called CA-125.
CA-125 blood test
CA-125 is typically used as a marker for ovarian cancer but clinical data demonstrates that when timed properly in a woman’s cycle it can help rule in endometriosis. Serum CA-125 tested mid-cycle, over 26 IU/mL can predict endometriosis with a sensitivity of 89% and specificity of 88%. If mid-cycle levels are negative, it’s recommended that she re-test during the period again. If either reading is positive, endometriosis is very likely and treatment for endometriosis should be offered.
Vitamin D blood test
While vitamin D testing is in no way diagnostic it’s important to test and treat low levels appropriately. Research demonstrates that low vitamin D levels put women at increased risk of endometriosis and are correlated with increased severity of endometriosis pain.
Treatment for endometriosis
In my practice I take a holistic and evidence-informed approach with endometriosis and a plan usually includes some or all of the following recommendations, tailored for the individual’s health concerns, fertility status as well as personal and family history.
Nutrition
Reduce dioxin exposure from red meat
Achieve protein adequacy through soy (non-GMO), poultry, fish, shellfish and eggs
Increase antioxidant status through plenty of colourful vegetables and fruit
Increase phytoestrogenic foods such as soy and ground flax seeds
Reduce or eliminate alcohol
Avoid trans-fats in the form of baked goods,
Choosing low-fat, high-protein sources of dairy
Fueling appropriately for BMI, stress and activity levels
Vitamin D testing and dosing based on blood levels, until sufficient levels are reached
Acupuncture
There is good evidence that weekly acupuncture decreases menstrual and non-menstrual pelvic pain with endometriosis
Evidence-based supplements
Anti-inflammatory agents like omega 3 oils, turmeric, ginger and boswellia
Antioxidants like melatonin, zinc, n-acetyl-cysteine
Exercise
4 x weekly to promote blood flow and oxygenation of pelvic organs and tissue
Tracking painkiller use is the best way to monitor treatment
Often women will have been taking huge amounts of painkillers to manage pelvic pain, so we want to see that number go down within 2-3 cycles after starting treatment. I recommend using a period tracker app, like Clue, and note down how many painkillers you use on any given day. You may also want to track the intensity of the pain out of 10 and what you missed out on because of the pain.
The goal is to get women back to feeling their best, carrying healthy babies to term, and showing up fully in their lives, without pain.
PMID: 26246541, 33151250, 32430755, 28660213