Endometriosis 101

What is Endometriosis?

Endometriosis is a chronic and debilitating inflammatory condition which most commonly presents as extremely painful, and often unbearable periods.

Essentially, endometrial tissue deposits itself outside of the uterus in the pelvic cavity and in other parts of the body. Endometriosis tissue has been found in the pelvis, abdomen, lungs, and even the brain. These endometriosis lesions are sensitive to hormone fluctuations, and grow and bleed in sync with our periods. It is much more than an inflammatory period condition – it affects the whole body.

Endometriosis occurs in 6-10% of women, and has been estimated to affect up to 10-15% of the female population. In women with infertility, it’s estimated that about 25-50% of them have endometriosis.

In North America, it takes an average of 15 years for a woman to receive a proper diagnosis of endometriosis, which delays treatment and significantly reduces quality of life.

What Does Endometriosis Look & Feel Like?

Endometriosis can look remarkably different in each person that has it, despite being most well known for painful periods.

Common symptoms of endometriosis include:

Extremely painful periods
Chronic pelvic pain, even outside of periods
Chronic abdominal pain, low back pain, or hip pain
Painful intercourse
Painful urination or bowel movements
Rectal bleeding with bowel movements
Digestive symptoms that look very similar to IBS, including nausea, vomiting, bloating, diarrhea, or constipation
Excessive menstrual bleeding and clots
Bleeding between periods
Infertility
Sexual dysfunction
Chest pain, shortness of breath, & flu-like symptoms
The presence of other pain conditions such as migraines, joint pain, and autoimmune diseases

Please be aware that in some individuals, endometriosis can be ‘silent’, with infertility truly being the only presenting symptom. Having painful periods is certainly not a prerequisite for having this diagnosis.

What Causes Endometriosis?

As it stands, we don’t really understand why endometriosis occurs. A lot of possible theories have been put forward, but one thing that keeps popping up consistently is the immune system. Simply put, it seems that endometriosis is an immune dysfunction issue.

During our periods most of us experience something called ‘retrograde menstruation’. This is when endometrial cells don’t exit the body and instead deposit into areas other than the uterus. These displaced endometrial cells cause inflammation, which normally results in immune cells flooding the area to remove them. In endometriosis, although immune cells do reach the displaced endometrial tissue, it seems that the immune system is unable to recognize or remove them. As a result, immune cells tend to remain in higher concentrations near the displaced endometrial cells, which leads to even more inflammation. The end result is that endometrial cells are able to continually grow and expand their reach, forming endometrial lesions all over the pelvic cavity and in other parts of the body.

In addition to having increased inflammation and immune dysfunction around displaced endometrial tissue, it seems people with endometriosis are also at a greater risk of allergies, asthma, hypersensitivity across organ systems, and autoimmunity.

Why Is It Thought of as a Hormone Condition?

In addition to immune dysfunction, hormones play a big role in the development of endometriosis.

As a result of the inflammation we see, the endometrial tissue upregulates an enzyme called aromatase which increases levels of estrogen. Higher estrogen levels cause displaced endometrial tissues to grow even bigger than they were before. To make matters worse, this tissue also seems to be unresponsive to progesterone, allowing estrogen to circulate unchecked. Progesterone is a hormone incredibly important for proper immune function, and as a result the immune system undergoes even further dysfunction.

While extremely confusing and complex, to sum up, endometriosis is a breakdown of immune function, hormone synthesis, and healthy communication between our immune system and hormones. This is why the basis of most endometriosis treatments are aimed at reducing estrogen levels.

Why Does It Take So Long To Be Diagnosed?

Endometriosis is exceptionally challenging to diagnose. As mentioned above, In North America, it takes an average of 15 years for a woman to receive a proper diagnosis of endometriosis. Right now, we estimate that as many as 6 out of 10 cases of endometriosis remain undiagnosed. Most individuals have to visit 4 to 5 doctors before even being properly assessed for endometriosis.

Why does it take so long? Of all the research we could find, the bottom line is that period pain, and specifically ‘women’s pain’, is the only type of pain we seem to accept as normal. The pain is underappreciated and underrecognized by physicians, health care providers as a whole, and even by patients themselves. Who hasn’t heard the phrase ‘period pain is normal’ before?

Coupled with the complicating factor that this disease cannot be consistently visualized on ultrasound or MRI at this time, this leads to a very long road to diagnosis. Luckily, there is a lot of great research emerging on how to use ultrasound to better detect endometriosis, and we’re hopeful this will greatly shorten the length of time it takes to diagnose this condition.

So What’s Next?

If you’ve read this and thought to yourself – yes, I have period pain but it’s only on one day, or I’ve been dealing with unexplained infertility, or I consistently have abdominal/pelvic pain and am unsure why – it’s time to speak to someone. Our team is here for you to answer any questions, and to help counsel you on your options.

Naturopathic Medicine not only helps to improve pain scores and quality of life in people with endometriosis, but we are super proud of the fact that we have helped expedite this diagnosis for many, many of our patients.