What is endometriosis?

Tissue similar to endometrial tissue (which supports a pregnancy and which sheds once a month) migrates outside of the uterus into the body, commonly settling in the pelvis (e.g. Fallopian tubes, ovaries, and bowel) and as far away as the lungs (rarely). This tissue grows and proliferates as the endometrial lining does in response to oestrogen, though unlike the endometrial lining, it's not shed and rid of from the body. The growth of this tissue can cause a debilitating amount of pain, usually relieved once the period starts, but the pain doesn't necessarily correspond to the amount of lesions present. However, often endometriosis is silent, without any signs or symptoms other than not getting pregnant.

Other signs and symptoms may be painful periods, painful intercourse, chronic pain (ie constant), painful periods, pain doing a wee or a poo, back pain, fatigue, exhaustion, digestive symptoms, abnormal vaginal bleeding and, again, infertility (when these symptoms may not be evident).

Why does endometriosis develop?

There isn't an absolute consensus, but here are some factors that could increase chances.

Periods starting early (starting after age 14 is protective)
Having an IUD device for 2+ years
Having a mother or sister with endo
Having repeated vaginal or uterine infections

It's can be a tricky condition to support, but because it involves the immune system, inflammation, hormone imbalance, the microbiome, gut health and is sensitive to environmental exposure, it responds to lifestyle changes, which is where I can come in - alongside medical support, of course.

Endometriosis and fertility

Endometriosis affects up to 71% of women with subfertility so this is a really important area to focus on. Also, in roughly 20-25% women with endometriosis, the condition is silent, making it tough to connect to fertility issues. Having said that, don't be discouraged because there are many ways to reduce the impact on your health and fertility.

𝑭𝒊𝒓𝒔𝒕, 𝒕𝒉𝒆 𝒃𝒂𝒅 𝒏𝒆𝒘𝒔
Unfortunately there are a number of ways endometriosis can contribute to making conceiving more challenging:

❌ Adhesions and endometrial deposits may alter the anatomy of the pelvis and block the fallopian tubes affecting blood flow and movement of eggs
❌ Egg reserve and maturation may be reduced or impaired
❌ Egg quality can be reduced
❌ Production of hormones can be reduced
❌ Inflammation makes the environment less hospitable
❌ All this affecting fertilisation, implantation and IVF treatment

Endometriosis is a chronic inflammatory condition (when the immune system is being constantly activated) so anything that contributes to inflammation is going to make it worse.

This includes low nutrients, eating processed foods, exposure to harmful chemicals, poor gut health (bloating, indigestion, pain...), not sleeping, poor oestrogen break down, stress, plus smoking and drinking alcohol.

𝙉𝙤𝙬 𝙩𝙝𝙚 𝙜𝙤𝙤𝙙 𝙣𝙚𝙬𝙨
While there is no cure for endometriosis, there are options for significantly improving symptoms, quality of life and chances of conceiving that should make you feel very hopeful - alongside surgery

1. How nutrition can help

Dietary recommendations to support endometriosis are based on alleviating inflammation and oxidative stress, moderating genetic variations and improving gut health and detoxification, which tend to be big drivers of the condition, alongside lifestyle factors, exposure to chemicals and toxins, and of course, stress. Working with me will be able to identify which of these could be the most important to leverage and how to personalise them for the best results, and will be along the lines of the following:

Ensuring the main focus of your diet is eating a wide range of colourful vegetables – meat and fish should be the side players, so high fibre all the way (build this up slowly if currently you eat low levels of fibre).
Dietary fats should come from plants and fish, not animals, which means that you have plenty of essential fatty acids but low saturated fat. For instance, choose eggs, nuts, seeds, avocado and olive oil.
Keeping inflammatory foods such as sugar, alcohol and caffeine low or avoided entirely, and reduce consumption of red meat.
Choosing organic options as much as possible to minimise your exposure to chemicals and toxins on the food – also because they tend to taste more flavoursome and contain higher levels of nutrients. If budget is a constraint, look at the EWC for the current ‘dirty dozen and clean fifteen’.
Emphasising potent sources of anti-inflammatory and antioxidant nutrients from spices and herbs, especially turmeric, rosemary, ginger. Drinking ginger and/or rosemary tea, as well as including these ingredients in foods is a good option.
Supporting the healthy breakdown of oestrogen by eating 2 kinds of cruciferous vegetables a day. Extra points if you can find or grow sprouted broccoli seeds, which are wonderful for this – as are flaxseeds.
It would be crazy to follow this lovely diet but weren’t absorbing it well because you’re stressed and not chewing properly, so as well as these dietary changes, make sure you chew your food as thoroughly as possible, aiming to swallow your food only once it’s fully broken down and unrecognisable. If you’re feeling stressed, take a few moments to stop and breathe fully into your belly and extend your exhale, to help switch on your parasympathetic state which enables your digestion to work unimpeded, and put away distractions, like your smart phone and TV.

2. Physical therapy

It is also essential that you work with a pelvic massage therapist who is endometriosis-aware. This can help to stimulate the viscera to bring nutrients to the endometrial deposits, and increase mobility, making exercise more possible - when you’re in a great deal of pain, you can become chronically tense and stiff, so unwinding this is important.

Exercise itself is a crucial part of your endometriosis tool-box as it releases endorphins, which are your body’s natural pain relieving chemicals. Not only that, but it helps to relieve stress and enhance sleep - it really is win-win. However, the idea of exercising when you’re in so much pain can be challenging, so if you’re really struggling, start slowly with a 15 minute walk once a day, and gradually build it up. Working with a physical therapist will help to enable you to do more physically, too.

2. Reduce your exposure to toxins

Toxins are harmful for hormonal health and terrible for endometriosis, so the third effective thing you can do to support your endometriosis is to address your exposure. There are some toxic chemicals that are called endocrine disruptors, because they physically resemble oestrogen and therefore are able to dock on to oestrogen receptors and exert oestrogenic effects, which makes oestrogen dominance and drives endometriosis.

The environment is full of toxins - the situation is actually very depressing but I won’t go into it here (I’m going to focus on what you can do, otherwise it’ll make you cry). Exposure to potentially harmful chemicals on a daily basis is virtually unavoidable, but it is possible to reduce your exposure.

Here are some ideas how:

Skin care - this is a great place to start because you’re likely to use skin and body products on a daily basis. Even if you use a small quantity of body lotion containing chemicals, but you use it daily, this adds up quickly. Throw out your body lotion and moisturiser for natural ones (your skin has a huge surface area so you’ll get a lot of leverage from making this switch) and replace the rest of your arsenal with toxic-free versions when you need to. Brands I love are Amly Botanicals, The Organic Pharmacy, Tropic, Dr Haushka and Aurelia, but there are lots out there. Check out Naturisimo where you can buy trial sizes. I would include hair products here too - my personal favourite brands (I have fine, flyaway hair) are Madara and O-Way.
Make up - again, as above, swap out the products that you’re exposed to mostly, such as foundation or sunscreen. Try Tropic, Josh Rosebrook, Alumier and Madara.
Food - choosing organic ingredients can make a big difference to your exposure, so where you can, buy organic options. However, it can be expensive so if you have budget constraints, look at the Pesticide Action Network UK for the latest up-to-date list of the Dirty Dozen and Clean Fifteen list. I can tell you know that berries, especially strawberries, should always be organic as they are the most highly sprayed plant foods we eat, strawberries especially - sorry.
Cleaning products - While brands like Ecover and Method are improvements on more conventional brands, they are by no means the clean alternatives they are assumed to be. Find fragrance- and solvent-free cleaning products, and try using old fashioned methods - vinegar, bicarbonate of soda and lemons. Brands to look for are The Bower Collective, E-cloths and Laundry EcoEgg.
Storage - top of the list should be what you store your food in; it should not be plastic; use glass, your crockery or stainless steel instead. I keep glass jars to store food in, which work wonderfully - and IKEA sell very good glass dishes. Look for Beeswax wraps instead of clingfilm - just don’t wash in hot water as it melts away the wax.
Cookware - While Teflon is so convenient and easy to use, I’m afraid it’s a major contributor of endocrine disrupting chemicals. Wait for a big birthday/celebration to invest in Le Creuset (or search on eBay), or check out cast iron pans - they take a little effort to get your head around how to maintain them, but after that it’s easy. You can also find glass cookware, but I don’t have the nerves to use those - you might! Consider replacing your kettle if you use it a lot - so many are lined with plastic; heating plastic releases more toxins into the local environment, so it’s worth looking into. Likewise a microwave. I’m not a fan of these but if you need to use one, make sure you heat food in glass.
Period health - Don’t leave out this delicate area. Instead, look for organic tampons and pads, or consider using a moon cup or washable options (I love ModiBodi period underwear).

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