Naturopathic Medicine offers a holistic approach to effective management of endometriosis

Unlike conventional approaches to treatment, Naturopathic Medicine takes into consideration the multi-faceted and inter-related characteristics of endometriosis, in order to find effective and lasting treatment options for managing the symptoms associated with endometriosis, including reduced pelvic pain, improved fertility outcomes, and fostering an enhanced sense of agency in one’s state of well-being.

What is Endometriosis?

Endometriosis is a chronic disease that occurs when cells that typically grow only in the lining of the uterus, are found anywhere else in the body. Endometriomas (parcels of uterine-lining tissue found outside the uterus) are often found around the fallopian tubes, ovaries and lower pelvic area, but can also be found elsewhere in the body. Endometriosis affects an estimated 10-15% of women. Folks with infertility or chronic pelvic pain are 30-45% more likely to have this disease. Common signs and symptoms include cyclical and/or chronic pelvic pain, severe period cramps, heavy or irregular period bleeding, pain with bowel movements, painful vaginal penetration, struggles with fertility, urinary tract symptoms, and digestive symptoms. Conventional therapeutic approaches have a limited effect in reducing symptoms and severity of disease, which is why treatments that fall under the naturopathic scope of care are so important in improving quality of life and preserving fertility goals of endometriosis patients. 

Key features of endometriosis and conventional treatment options

Endometriosis is an inflammatory condition that is mediated by reproductive hormones. While conventional therapies most often target hormonal regulation, they have disappointingly poor outcomes with respect to pain reduction and improvement of disease severity. Endometriosis patients are often given two treatment options - hormonal birth control, or medically induced menopause. The third option, which is often effective but always temporary, is surgical excision of affected tissues and/or hysterectomy. The fact is, we can do better to manage the debilitating effects of this disease.

Beyond the hormonal aspect, endometriosis is also characterized by a particular set of immune system changes, a tendency to a state of elevated inflammation, as well as a common microbiome profile.

The frustrating facts: 

• Currently, there’s no cure for endometriosis

• Hormone-based therapies are of limited effectiveness, and are not an option at all for some

• Conventional therapies tend to be incompatible with pregnancy and often ignore endometriosis after menopause

• Surgical interventions can be effective at reducing symptoms, and preserving fertility however recurrence is considered inevitable

• Surgeries are invasive and carry their own risk of adverse effects

The encouraging news about Naturopathic treatments for endometriosis:

• They can reduce pain, support fertility and improve quality of life

• They target a variety of predisposing and disease driving factors to reduce symptom severity

• They support an improvement in overall health

• They are compatible with fertility goals, pregnancy and post-menopause care

What does gut health have to do with period pain?

There are a few connections to be made here. For starters, when we support gut health, we support: improved nutritional status, improved energy and resilience, a reduction in inflammation, more robust immune system regulation, and greater microbial balance across systems (from the gut to the rectal, uterine and vaginal areas). With great gut health, also comes greater bowel regularity which is a huge win for endometriosis patients who tend to suffer from (often painful) constipation. 

Gut health can be a major driver of inflammation. And since inflammation is the central feature of endometriosis, reducing it is critical. When we cut inflammation, we can reduce pain and often slow the progression of disease. The composition of our gut bug community, aka our microbiota, can determine whether there’s a pro-inflammatory or anti-inflammatory push coming from our gut. Indeed, an overgrowth of certain microbes will drive a chronic inflammatory response in the body.

There’s also a connection with dysbiosis and increased estrogen levels. Since endometriosis is an inflammatory condition that’s mediated by estrogen, this is another important factor in disease severity and management. So our particular microbiota has an impact on our levels of inflammation, estrogen production, and quality of our digestion - three crucial areas affected in endometriosis.

The nitty gritty on gut bugs and endometriosis

There are trillions of diverse microbes growing in and on us. They have a huge role to play in our health, and the particular balance and diversity of our microbiota have been connected with a variety of conditions. Research has shown common microbiota composition with endometriosis patients compared with those without endometriosis. While microbial populations differ in our gut, vaginal, uterine and rectal areas, there seems to be cross-communication and an impact of our gut microbiome on other areas of the body. Which means that supporting a healthy balance of gut bugs can support balance in other areas of our body. 

We also know that the severity of microbial imbalance correlates with disease severity. Strikingly, we’ve even been able to observe a change in microbial balance immediately after a surgical removal of endometriomas. This change was only temporary however, with the imbalance returning as the disease continued to progress after treatment. So we can see that this is not simply a question of pre-disposition, but an actual connection with severity of disease as the condition waxes and wanes with treatment. We also know that though surgical interventions can be extremely impactful on improving symptoms, including pain relief and fertility preservation, they are not enough to manage this chronic condition alone. Between the potential impacts of the local microbiota in the uterus, and the broader systemic impacts of the gut microbiome on the pelvic microbiota, the inflammatory response, estrogen levels and immune signaling, it’s clear that the microbiome has a huge role to play in endometriosis. 

Endometriosis, gut health and the immune system

Our microbiome is a key mediator of immune health. With a tendency for inflammation to flare, and dysregulation of the immune system in endometriosis, finding ways to support both of these systems is critical in managing disease severity and progression. By supporting a balanced microbiome, we can reduce inflammation and bring greater stability to the immune system. The composition of our gut bugs can determine which types of immune cells are primed to fire, and how effective an immune response will be. In endometriosis, parts of the immune system are over-reactive, and aggravate the progression of disease. By supporting our gut bug community, we can calm the overactive immune response, and support effective immune regulation to the effect of improving endometriosis symptoms as well as supporting overall health. 

What does it all mean?

The central role of our microbiome in supporting nutritional status, mediating inflammation, impacting circulating estrogen levels and modulating immune function are all critically important to the development and proliferation of endometriosis. Gut health and the microbiome are pivotal areas for continued research into endometriosis, and cannot be ignored in any comprehensive approach to treatment that seeks to improve quality of life for folks dealing with this potentially debilitating condition.

 If your care provider tells you that the only treatment options for endometriosis are hormonal therapies or surgery, they are misinformed. Both of these options can be explored in tandem with Naturopathic care. Talk to your Naturopathic Doctor about how you can improve your endometriosis symptoms by supporting gut health and the microbiome.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233437/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198999/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379373/
https://pubmed.ncbi.nlm.nih.gov/26901277/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774211/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391253/