All about Endometriosis

Endometriosis is an inflammatory, estrogen-dependent condition associated with pelvic pain and infertility. It is not often discussed or fully understood but with an estimated 1 in 10 woman suffering from this condition it is probably worth discussing (sorry guys this post isn’t for you). As of yet there is no cure for endo however through diet and lifestyle adjustments the condition can be improved.

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So what exactly is endometriosis?
 
It is an inflammatory condition whereby there is a presence of endometrial glands in areas outside of the uterus. In layman terms it is basically endometrial tissue growing where it shouldn’t. The pelvis peritoneum, ovaries and bowel are all common places where it can occur.
 
Symptoms associated with endometriosis include chronic pelvic pain and infertility just to name a few. The problem with endo is that diagnosis is difficult- only by surgical laparoscopy. Therefore this condition is heavily under diagnosed and on average there is a 6.7-year mean latency from onset of symptoms to a formal diagnosis (1).  
 
What causes endometriosis?
Whilst it is largely unknown what exactly causes endometriosis it is thought to be associated with oestrogen dominance (2).  This excess oestrogen can stimulate inappropriate growth and inflammation, which could be responsible for the condition. In recent years there have been interesting findings on a particular enzyme called aromatase that is responsible for regulating oestrogen synthesis (3). In many with the disease, aromatase is expressed aberrantly, stimulated by prostaglandin E2. This results in the production of oestrogen, which furthermore induces PGE2­ within those endometrial lesions (2).  The increased oestrogen can then contribute to the endometrial tissue growth that causes the disease. It is thought that the increase in aromatase contributes to inflammation and the pain that is associated with the condition (1). Because it appears that aromatase is a key player in all of this, it is important that we decrease levels of this in order to manage the condition. As said above, aromatase is stimulated by PGE2, a pro-inflammatory prostaglandin, thereby targeting inflammation we can aim to reduce endo symptoms.
 
If you suffer from endometriosis, it could be very worthwhile giving these a go:
 
Avoid (or limit- we are all human right?!) these foods:

• Sugar: pro inflammatory and can exacerbate symptoms.
• Carbohydrates: You do not need to stop consuming all carbohydrates, however a diet high in carbohydrates is thought to be pro-inflammatory.  This is particularly true for highly refined carbohydrates (4). Limiting your consumption of carbohydrates could be beneficial for symptoms. 
• Vegetable oils: are high in omega-6 and can be very pro-inflammatory.

 
 
It is important that you have an appropriate omega 3: omega 6 PUFA ratio. You can read more about that here but basically eating a diet that reduces inappropriate inflammation in the body is important. Also if you are eating meat and eggs, focus on free-range grass fed if possible. Grass fed animals have higher levels of omega-3s and lower levels of pro inflammatory omega 6 fatty acids- you can read more about the importance of grass fed meat here.
 
Also try supplementing with:

• Magnesium: Is thought to reduce inflammation (4) and can aid with endo symptoms.
• Fish oil: provides you with a good source of anti-inflammatory omega-3 PUFAs.

 
 

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1.         Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertility and Sterility. 2012;98(3):511-9.
2.         Ferrero S, Remorgida V, Maganza C, Venturini PL, Salvatore S, Papaleo E, et al. Aromatase and endometriosis: estrogens play a role. Annals of the New York Academy of Sciences. 2014;1317(1):17-23.
3.         Maia H, Jr., Haddad C, Coelho G, Casoy J. Role of inflammation and aromatase expression in the eutopic endometrium and its relationship with the development of endometriosis. Women's Health. 2012;8:647+.
4.         Galland L. Diet and Inflammation. Nutrition in Clinical Practice. 2010;25(6):634-40.