Endometriosis: Fighting For Your Fertility
What Is Endometriosis?
Endometriosis is a chronic inflammatory condition that affects 10-15% of women. It occurs when tissue that is similar to the endometrium (uterine lining) grows outside of the uterus, usually within the pelvic or abdominal cavities and on organs such as the ovaries, fallopian tubes, bladder, bowel, and rectum. In rare cases, it may also spread to other areas of the body, such as the diaphragm, lungs, ureters, cervix, vagina, and even the brain. Endometriosis is a common cause of infertility and is estimated to contribute to 30-40% of infertility cases. In this article, we explore the impact of endometriosis on fertility and the various diet and lifestyle changes that may improve disease symptoms and pregnancy odds.
Endometriosis Symptoms and Diagnosis
Endometriosis can occur in 4 stages, ranging from minimal to severe. The primary symptom is pain, which can manifest in a variety of ways. The severity of symptoms does not necessarily reflect the severity or stage of the disease. Women with severe or later stage endometriosis may have very few symptoms, while women with earlier stage endometriosis may experience severe or even debilitating symptoms. Possible symptoms include:
Pain in the pelvis, abdomen, low back or legs
Painful bowel movements or urination
Spotting between periods
Digestive problems – constipation, diarrhea, gas, bloating, nausea, cramping, pain
Joint and/or nerve pain
Doctors may use blood tests or a variety of diagnostic imaging techniques to investigate the possibility of endometriosis, but the only way to truly and accurately diagnose the condition is through laparoscopic surgery. The surgery involves a small incision(s) in the abdomen, through which a camera is inserted to explore the pelvic organs and abdominal cavity for evidence of endometriosis lesions.
What Causes Endometriosis?
Endometriosis is a complex and poorly understood condition. Although its cause has not yet been established, there are some theories for how it develops and studies have been able to identify several potential contributing factors. It is believed to be the result of a complicated interplay between genetics and environment.
One theory of endometriosis is that it is caused by a backflow of menstrual debris into the fallopian tubes and pelvic cavity (retrograde menstruation), where endometrial tissue begins to take root and grow. However, it is now understood that up to 90% of women experience retrograde menstruation, while only 10% develop endometriosis. This indicates that there is more involved in the disease than just menstrual backflow.
Another theory of the development of endometriosis suggests that immature cells in the pelvic and abdominal cavities may inappropriately develop into endometrial tissue. Some researchers believe that this actually happens to female offspring in utero or during early childhood development, setting the stage for them to begin experiencing symptoms after the onset of puberty.
The growth and proliferation of endometriosis lesions is dependent on the presence of estrogen. This means that the disease affects women primarily during their cycling years, when estrogen is being produced at high levels in the ovaries. Hormone imbalances and excess estrogen are very common in women with endometriosis and can contribute to the spread of the disease as well as the severity of symptoms. Women with the endometriosis may also have a predisposition toward increased production and decreased metabolism of estrogen.
Inflammation and Immune System Dysfunction
Women with endometriosis have been found to have several alterations in immune system function, including changes in T-cell activity and increased production of inflammatory molecules, both of which contribute to the symptoms and spread of the disease. Studies have also shown a significantly higher prevalence of allergic conditions and autoimmune disease in women diagnosed with endometriosis. These findings suggest that the immune system plays a critical role in both the development and progression of the condition.
Though most studies acknowledge that environmental factors play a significant role in endometriosis, research also strongly suggests that there is a genetic component as well. This is supported by the fact that women with a first degree relative with endometriosis are at significantly higher risk of developing the disease.
Research has shown that certain common environmental toxins can disrupt hormone balance in the body and contribute to endometriosis, including dioxins, phthalates, PCBs, pesticides, and benzophenones. These toxins have the ability to mimic estrogen in the body, which can encourage development of endometriosis lesions and worsen symptoms.
Studies have shown that intestinal dysbiosis (an imbalance between beneficial and pathogenic bacteria in the gut) may have an impact on endometriosis. Altered gut bacteria can activate the immune system, trigger the production of inflammatory molecules, and lead to increased estrogen, all of which aggravate the disease and increase symptoms. Studies have also shown that imbalances in the microbial environment within the reproductive tract (uterus, vagina, fallopian tubes) can contribute to endometriosis through uterine inflammation and altered immune function.
Endometriosis and Infertility
Endometriosis is a very common cause of infertility in women and there are multiple ways it can impact fertility, including:
Adhesions and scarring– inflammation from endometriosis lesions can cause organs and tissues to fuse together in certain places. This may lead to changes in the anatomy of reproductive organs and cause scarring that can affect the functionality of the uterus, ovaries, fallopian tubes, and cervix.
Ovarian dysfunction – damage to ovaries may result in fewer eggs produced and disrupted ovulation. Inflammation may also reduce egg quality.
Inflammation in the uterus– causes difficulties with implantation and embryo development and may lead to trouble conceiving or early pregnancy loss.
Progesterone receptor issues– inability of reproductive tissue to respond to progesterone, leading to menstrual cycle abnormalities and difficulty conceiving or sustaining a pregnancy
Conventional Treatment Options
Conventional treatment for endometriosis depends on the severity of symptoms and the goals of the woman. Although hormonal treatments, such as birth control, may be used to control symptoms, these treatments prevent pregnancy and would not be suitable for a woman trying to conceive. Currently, the only conventional ways to treat infertility caused by endometriosis are:
Surgery– removes visible endo and adhesions to restore normal anatomy and enhance fertility
Assisted reproductive technology (ART)– intended to bypass potential obstacles to fertility
Natural Ways to Support Fertility
Adopt an anti-inflammatory diet
The primary focus of a dietary protocol for endometriosis should be removing foods that contribute to inflammation. This means significantly reducing or eliminating processed foods, refined carbohydrates, added sugar, trans fats, processed vegetable oils (corn, canola, soybean, cottonseed, sunflower/safflower), alcohol, and caffeine.
Overall, your focus should be on eating fresh, whole, nutrient-dense foods. Eat plenty of vegetables, low-sugar fruits, fiber, anti-inflammatory fats (such as olive oil, fish oil, nuts and seeds, avocados, etc.), and high-quality proteins. Avoid conventional animal products, which are raised with antibiotics and hormones, and instead choose organic, pasture-raised animals and wild-caught seafood. You should also purchase organic produce whenever possible to avoid harmful pesticide exposure.
Research also shows that many women find significant symptom relief through adopting a gluten-free diet. Food sensitivities, such as gluten, dairy, eggs, corn, and soy, can activate the immune system and cause inflammation that will worsen symptoms. You may be unaware that you react to these foods, so it can be very helpful to eliminate them on a trial basis (30-90 days) to see how you feel. If you have severe allergies, sensitivities, or suffer from an autoimmune condition, you may benefit from a more thorough elimination challenge, such as the Whole30 or the Autoimmune Protocol (AIP).
Address gut issues and dysbiosis
Studies show that 90% of women with endometriosis also have gastrointestinal symptoms! In particular, it is very common for women with endometriosis to receive a diagnosis of irritable bowel syndrome (IBS). If you have digestive problems, such as gas, bloating, cramping, pain, reflux, etc., you should work with an experienced functional medicine practitioner to properly diagnose and address these issues. You may need some specialized labs tests, such as:
Stool test– to investigate bacterial imbalances, infections, and/or poor digestive function
Lactulose breath test– to investigate bacterial overgrowth in the small intestine (SIBO)
Food sensitivity test– to uncover dietary triggers that may be contributing to symptoms
In the meantime, there are some things you can try to help alleviate symptoms and improve your digestive health, including:
Removing grains from your diet or trying an elimination protocol (such as Whole30 or AIP)
Regularly consuming fermented foods or taking a quality probiotic supplement
Adding bone broth or collagen powder to your daily routine
Reducing consumption of fermentable carbohydrates (FODMAPs)
Support the liver and detoxification pathways
Your liver is primarily responsible for detoxifying hormones that are no longer needed in the body. This means that the ability to clear excess estrogen that can contribute to disease progression is highly dependent on a properly functioning liver. You can support liver function and detoxification through food, supplements, and lifestyle habits, but it is wise to work with an experienced functional medicine practitioner to receive individualized guidance. Some ideas to get you started are:
Eat brassica family vegetables– broccoli, cauliflower, kale, cabbage, brussels sprouts
Eat liver-friendly foods– garlic, onions, beets, lemons, burdock root, dandelion greens
Try gentle detox methods– exercise, skin brushing, infrared sauna, epsom salt baths
Consider detox support– Calcium-d-glucarate, B vitamins, NAC, diindolymethane
Get enough exercise and manage your stress
In addition to reducing the risk of chronic disease in general, exercise is known to have a beneficial effect on inflammation and may help significantly reduce pain from endometriosis. Exercise is also beneficial for hormone balance and has been shown to improve fertility. You should aim to get at least 30 minutes of moderate intensity exercise (breaking a sweat) 4-5 days per week.
Managing stress is also very important. Chronic stress can contribute to hormone imbalance (including excess estrogen) and cause inflammation and immune system dysfunction, all of which can worsen endometriosis symptoms and impair fertility. You can start working on stress management by setting aside time every day to engage in an activity that helps you relax. Examples include mindfulness, creative activities, light exercise, self-care, unstructured time, and enjoying time with friends or family.
Avoid endocrine disruptors
You should do your very best to avoid endocrine disrupting toxins that research has shown can contribute to hormone imbalance and endometriosis. Here are the most well-researched chemicals and ways to avoid them:
Dioxin– purchase organic tampons (or use a menstrual cup) and avoid conventionally-raised animal products
Phthalates– avoid storing or heating food in plastic containers (includes drinking from disposable plastic bottles), do not use air fresheners, and purchase self-care and cleaning products that are labelled fragrance-free and phthalate-free
PCBs – choose wild-caught seafood from clean waters and purchase organic/pasture-raised animal products and organic produce
Benzophenone– avoid sunscreens that contain the UV shield oxybenzone
Try acupuncture or manual therapy
Many women find symptom relief, improved fertility, and better quality of life with therapies such as:
These techniques may help improve blood flow to pelvic organs, relieve pain, reduce inflammation, and improve fertility.
Work with your doctor on a supplement protocol
There are many supplements that have been shown to have a positive impact on endometriosis. However, not all supplements are right for all women, so it is important to work with a qualified practitioner who is experienced in creating individualized protocols for women with the endometriosis. Some supplements that may be helpful are:
Fish oil (DHA/EPA)
Antioxidants – vitamin A, C, E, N-acetyl-cysteine (NAC), zinc, selenium, etc.
Herbs – many options to help with liver support, hormone balance, and pain/inflammation