March is always Endometriosis Awareness Month, but sufferers of this particularly complex and distressing condition are more than ‘aware’ of it. It hits full on every month, causing everything from pain on ovulation, to bad period pain, to excruciating period pain, often accompanied by diarrhoea, vomiting and fainting. Strong pain is incredibly debilitating and of course heavy bleeding may also cause iron loss and anaemia. I have just read a study looking at the economic burden of endometriosis, and suffice to say it costs a lot of money! And for my clients it is a huge risk factor for infertility. It is a very complex condition, probably genetic, involving the immune system; auto-immunity may play a role, hormonal, driven by oestrogen, and highly inflammatory.
But endometriosis is also widely misdiagnosed; after all teenage girls always exaggerate everything specially to get off games, “just take a painkiller and live with it, it’s all part of being a woman”, and the ultimate irony, “it’ll get better when you are pregnant”. Great, just what you want to hear. Women become enormously resigned to the pain, and it can take until there are fertility investigations for endometriosis to be diagnosed, never mind treated.
For those of you who are unsure what endometriosis actually is . . .
It is defined as the presence of endometrial (womb/uterine) tissue that can grow anywhere in the pelvic cavity, outside of the endometrium and is responsive therefore to all the hormonal fluctuations of a monthly menstrual cycle. This tissue then induces a chronic inflammatory response causing the pain associated with the condition. Blood filled endometrial cysts known as ‘chocolate cysts’, may form on the ovaries and inflamed lesions cause scarring, which then tugs and pulls on the organs where the endometriosis has formed, like the ovaries, fallopian tubes, bowels and bladder.
How and why some women have endometriosis is a bit of a mystery. In terms of risk to health, as we have just mentioned, endometriosis affects fertility. The adhesions can cause scarring in the fallopian tubes, and they become blocked and the chronic long-term inflammation causes high levels of oxidative stress, free radicals that damage the cells of the ovaries, ovarian reserve and egg quality. It is speculated (but controversial) that high levels of cytokines and NK cells may also be associated with the potential autoimmune component of endometriosis as well. So, what to do about it? Well, researchers have identified several diet and lifestyle risk factors that may be involved. So, when my clients come to see me, they are often on the way to IVF and this preparatory stage is very important.
Three months preparation is ideal, until egg collection, where we can reduce the inflammation to the developing follicles and give them a fighting chance. I usually recommend a very plant- based diet for my clients, with the only non-plant foods coming from a little chicken or turkey and fish and some eggs; the rest is from pulses, seeds and nuts and lots of vegetables. A little organic tofu is fine in my opinion, two meals a week is not going to cause harm, in fact the phytoestrogens in soy may even protect the cells from more pathogenic forms of oestrogen. And one or two soya-based meals a week will not harm sperm either.
GLUTEN
There is now some good evidence linking gluten-avoidance with relieving some of the symptoms of endometriosis. And I do always recommend avoiding it, if possible. Gluten may ‘switch on’ oestrogen modulating genes, and some specialists recommend avoiding wheat in the second half of the cycle and during a period, as this also seems to alleviate pain. Nowadays, it is not so difficult to avoid it and it’s worth giving it a go.
DAIRY PRODUCTS
These are one of the food groups that I recommend cutting down on for my clients with endometriosis. Dairy products (probably due to both the oestrogens and the growth factors in milk) may play a role in driving the condition. But to be honest it’s hard to find evidence that supports this, which is why I recommend a little but low fat, dairy. So, try and have no more than one portion of low-fat organic dairy a day if you want to eat it. (not full fat for endo).
But if you are planning to do IVF, then the time to go with FULL fat dairy is from the beginning of stimulation, until egg collection. Those oestrogens and growth factors may have a positive effect on follicle and egg development.
RED MEAT
This is a food that I would recommend avoiding with endometriosis, mainly due to the presence of both dioxins (see below) and inflammatory compounds in meat. You may have it once a week, but ensure it is organic and lean.
DIOXINS
Dioxins are environmental chemicals and in early animal studies one in particular stood out called TCCD, which appeared to be very strongly associated with a worsening of endometriosis. But at the time hospital studies on humans failed to confirm this link. However, no we know so much about epigenetics, the way that genes are expressed (or not) according to environmental factors, the association between dioxin exposure and endometriosis in women with an individual susceptibility, appears to be a very real factor. This is all very well, but how can you avoid them? Well, it’s a bit difficult because these industrial chemical pollutants are everywhere, in our air, water and soil. But it is believed that 90% of human exposure comes from food, mainly fatty animal products (dioxins are stored in animal fat).
And even common chemicals that we come in contact with every day are dioxins; chlorine is one, which is in everything from tea bags to sanitary products as bleach, so just go for unbleached like Clipper tea bags and organic sanitary wear. I always advise my clients not to use tampons, it seems so counterintuitive to the flow of blood, almost like blocking it and sending it backwards, increasing the painful contractions that are trying to get rid of it. But the research does not show that tampon use affects endo, in fact there is some that indicates that tampon use is helpful, I have no idea why myself! But I would suggest always using unbleached, as above, anyway. Or even better, washable organic cotton pads, which I think can be more absorbent than disposable towels. There are lots of different brands around.
Reducing all environmental chemicals is a good idea too; from parabens in toiletries, to the chemicals in cleaning products, scented candles, air fresheners, and plastics. Go BPA free with plastics; use glass bottles, reduce tinned foods, use a bamboo BPA-free sustainable take-out coffee/tea cup like Clipper. Eat organic as much as you can, especially whole grains, eggs, tomatoes and peppers and root vegetables, chicken and salmon (or wild).
In terms of supplements, omega three fatty acids are extremely anti-inflammatory and blood thinning, helping to reduce the painful clots. A plant compound called Resveratrol has been well researched for its benefits on endometriosis, as is N-Acetyl Cysteine and of course turmeric, or curcumin. And magnesium to help with the pain.
Exercise is beneficial, so don’t stop moving, even during your period. And sitting down all day is just terrible for endometriosis.
Heat from a hot water bottle or a hot pad that you just stick on under your clothes (From Boots), warm castor oil packs (a very old- fashioned remedy), herbs like agnus-castus and cramp bark (best sorted by a herbalist), acupuncture and reflexology also can really help.
And believe it or sexual intercourse during a period may actually be helpful; with both female orgasm and the highly anti-inflammatory compounds in semen called prostaglandins reducing the pain. I’ll leave that one with you!
Think of this as a three-month preparatory time so those eggs can be the best quality they can be, and you may reduce the pain as well.
