Endometriosis: Dr. Despina's Starter Guide

If you've recently been diagnosed with endometriosis or are suspecting you have it, you're probably feeling some level of overwhelm. Take a breath - it doesn't need to be too complicated! Let's break it down:

Endometriosis (endo) simply describes when tissue from the uterus (endometrial tissue) is found outside of the uterus, most commonly in other areas of the pelvis. Due to immune changes, the body allows these cells to persist as patches inside the body.

Why does endo cause pain?

1. It causes bleeding in the abdomen during periods.

2. These cells release inflammatory molecules, triggering inflammatory pain.

3. Over time, the inflammation, bleeding and local tissue injury from these patches often drive scar tissue formation, another source of pain typically in the abdomen. From the endometriosis itself or from surgery, it’s common to form bands of scar tissue called adhesions, which limit the proper movement of organs and contribute to the chronic pain many women with endometriosis know too well.

4. Many women with endometriosis also have digestive pain that contributes to the endo inflammation and their overall pain.

5. Over time, these same injuries can sensitize the nervous system, and this "central sensitization" from the nervous system can perpetuate a pain loop.

Are you clear on the most common endo symptoms?

• Period pain may start before the period and extend multiple days

• Abdominal and/or pelvic pain may be more chronic

• Heavy / clotted periods (depending on the patient)

• Pain or symptoms around bowel movements, urination or intimacy

• Lowered fertility

• Fatigue!

• Digestive symptoms like constipation, diarrhea, bloating, nausea, heartburn or reflux

What else could be causing my symptoms?

Make sure your healthcare team has verified that you don't have an ectopic pregnancy, inflammatory bowel disease, appendicitis, pelvic inflammatory disease (driven by sexually transmitted infections) or an abdominal cancer  (colon, ovarian, cervical, uterine).

Other overlapping conditions can include polycystic ovarian syndrome, dysmenorrhea (painful periods without an obvious cause), post-surgical adhesions / scarring in the abdomen, diverticulitis, malformed uterus, various types of benign ovarian cysts or urinary tract infections.

Endometriosis is a hormonal condition... right?

I remember when I was looking for options to treat my endometriosis several years ago, both the conventional and alternative health worlds focused on hormones – the standard medications to treat endometriosis, like contraceptives and GnRH blockers, are hormone-suppressive. While hormonal treatment has its role, there’s more to the story. We now understand that endometriosis is responsive to hormones, not fully caused by hormones. Some women with higher estrogen will never develop endometriosis, and not all women with endometriosis necessarily have high estrogen! We need to think about inflammatory pathways, immune system imbalances and gut bugs that all feed into the development and severity of endometriosis. This is where naturopathic medicine plays a massive role and has changed the game in this condition.