Understanding Endometriosis

Endometriosis is a chronic, often debilitating condition affecting millions of women worldwide, yet it remains under diagnosed and misunderstood. Characterised by the growth of endometrial-like tissue outside the uterus, endometriosis can cause significant pain and impact quality of life. FROM WITHIN explores endometriosis, including its symptoms, causes, and how certified practising nutritionists (CPNs) can offer holistic support.

What is Endometriosis?

Endometriosis occurs when tissue similar to the uterine lining (endometrium) grows outside the uterus, commonly on the ovaries, fallopian tubes, or pelvic lining. Unlike normal endometrial tissue, which sheds during menstruation, this ectopic tissue has no exit pathway, leading to inflammation, scarring, and adhesions (Zondervan et al., 2020). The World Health Organisation (WHO) estimates that endometriosis affects approximately 10% of women of reproductive age globally, equating to about 190 million women (World Health Organisation, 2022). Prevalence may be higher due to diagnostic delays, often averaging 7–10 years (Parazzini et al., 2017).

Endometriosis is a systemic condition with significant physical, emotional, and social impacts. While primarily a gynaecological disorder, it is also associated with immune dysregulation, chronic inflammation, and increased risks of comorbidities including infertility and certain cancers (Zondervan et al., 2020). Early diagnosis and multidisciplinary management, including nutritional support, are critical for improving outcomes.

Symptoms of Endometriosis

Symptoms of endometriosis vary widely in severity and presentation, contributing to diagnostic challenges. Common symptoms include:

• Pelvic Pain: Chronic pelvic pain, often worsening during menstruation (dysmenorrhea), is the hallmark symptom, reported by up to 80% of women with endometriosis (Maddern et al., 2020). Pain may also occur during ovulation, intercourse (dyspareunia), or bowel movements.

• Menstrual Irregularities: Heavy menstrual bleeding (menorrhagia) or irregular cycles are common, affecting quality of life and sometimes leading to anaemia (Chapron et al., 2019).

• Infertility: Endometriosis is a leading cause of infertility, with 30–50% of affected women experiencing difficulty conceiving due to adhesions, ovarian dysfunction, or inflammation (Zondervan et al., 2020).

• Gastrointestinal Symptoms: Bloating, constipation, diarrhoea, or nausea, often termed “endo belly,” are reported by up to 60% of women, particularly during menstruation (Maroun et al., 2016).

• Fatigue and Psychological Symptoms: Chronic fatigue, anxiety, and depression are prevalent, driven by chronic pain and hormonal imbalances. A 2018 study found that women with endometriosis have a 2–3 times higher risk of mood disorders (Chen et al., 2018).

• Other Symptoms: Pain radiating to the lower back, thighs, or bladder dysfunction may occur, especially in advanced disease (Chapron et al., 2019).

Symptoms do not always correlate with disease severity, as some women with minimal lesions experience severe pain, while others with extensive disease may be asymptomatic (Maddern et al., 2020).

Causes of Endometriosis

The exact cause of endometriosis remains unclear, but research points to a multifactorial aetiology involving genetic, hormonal, immunological, and environmental factors.

Retrograde Menstruation

The most widely accepted theory, retrograde menstruation, suggests that menstrual blood flows backward through the fallopian tubes, depositing endometrial cells in the pelvis. While common in many women, those with endometriosis may have impaired immune responses that fail to clear these cells, allowing lesion formation (Zondervan et al., 2020).

Hormonal Imbalances

Oestrogen fuels endometrial tissue growth, and women with endometriosis often exhibit oestrogen dominance or heightened sensitivity to oestrogen. Dysregulated progesterone responses may also impair the body’s ability to suppress lesion growth (Patel et al., 2017).

Immune Dysfunction and Inflammation

Endometriosis is associated with chronic inflammation and immune dysregulation. Elevated levels of pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), promote lesion growth and pain (Symons et al., 2018). Impaired natural killer (NK) cell activity may also allow ectopic tissue to persist.

Genetic Predisposition

Genetic factors play a significant role, with women having a first-degree relative with endometriosis facing a 5–7 times higher risk. Genome-wide association studies have identified multiple risk loci linked to inflammation and hormonal signalling (Sapkota et al., 2017).

Environmental Factors

Exposure to endocrine-disrupting chemicals (EDCs), such as dioxins and bisphenol A (BPA), may increase endometriosis risk by mimicking oestrogen or disrupting hormonal balance. A 2016 review found associations between EDC exposure and endometriosis prevalence, though causality remains unconfirmed (Smarr et al., 2016).

How a Clinical Nutritionist Can Help

While medical treatments including hormonal therapy (e.g., oral contraceptives) or surgery (e.g., laparoscopy) are standard for endometriosis, nutritional interventions offer a complementary, holistic approach to symptom management. CPNs can address inflammation, hormonal imbalances, and gut health, personalising strategies to individual needs. Below are evidence-based ways a CPN can support women with endometriosis.

1. Reducing Inflammation

Chronic inflammation drives endometriosis progression and pain. An anti-inflammatory diet, rich in fruits, vegetables, nuts, and fatty fish, can mitigate inflammation. A 2018 study found that women adhering to a Mediterranean-style diet, high in antioxidants and omega-3 fatty acids, reported reduced pelvic pain and lower inflammatory markers (Ott et al., 2018). Key foods include:

• Omega-3 Fatty Acids: Found in salmon, mackerel, and flaxseeds, omega-3s reduce pro-inflammatory cytokines. A 2020 meta-analysis showed that omega-3 supplementation decreased dysmenorrhea in women with endometriosis (Hosseini et al., 2020).

• Antioxidants: Berries, leafy greens, and turmeric contain antioxidants such as vitamin C and curcumin, which combat oxidative stress. A 2019 study linked higher antioxidant intake to reduced endometriosis-related pain (Mier-Cabrera et al., 2019).

At FROM WITHIN we can design an anti-inflammatory meal plan, minimising pro-inflammatory foods including red meat, trans fats, and refined sugars, which a 2017 study associated with increased endometriosis risk (Parazzini et al., 2017).

2. Supporting Hormonal Balance

Diet can influence oestrogen metabolism and clearance. A 2021 study found that diets high in fibre (e.g., whole grains, legumes) and cruciferous vegetables (e.g., broccoli, kale) promote oestrogen detoxification via the liver, potentially reducing endometriosis severity (Nodler et al., 2021). Limiting caffeine and alcohol, which may elevate oestrogen levels, is also recommended (Parazzini et al., 2017).

3. Optimising Nutrient Intake

Specific nutrients can alleviate symptoms and support overall health:

• Magnesium: Magnesium reduces muscle tension and pain. A 2019 study found that magnesium improved dysmenorrhea in women with endometriosis (Mirzaei et al., 2019). Sources include spinach, almonds, and pumpkin seeds.

• Vitamin D: Vitamin D modulates immune responses and may reduce lesion growth. A 2016 randomized controlled trial showed that vitamin D for 12 weeks decreased pelvic pain in women with endometriosis (Almassinokiani et al., 2016). Fortified foods and safe sun exposure are key sources.

• Zinc: Zinc supports immune function and reduces inflammation. A 2020 study linked higher zinc intake to lower endometriosis severity (Messina et al., 2020). Oysters, lentils, and chickpeas are rich sources.

At FROM WITHIN we can assess deficiencies and recommend dietary sources or supplements, ensuring safe dosing to avoid toxicity.

4. Improving Gut Health

The gut microbiome influences inflammation and oestrogen metabolism. Dysbiosis, or microbial imbalance, is common in endometriosis, contributing to “endo belly” and systemic inflammation (Khan et al., 2016). A 2022 study found that probiotic supplementation (e.g., Lactobacillus strains) reduced gastrointestinal symptoms and improved quality of life in women with endometriosis (Liu et al., 2022). Prebiotic fibres from foods including garlic and bananas can further support gut health.

5. Managing Food Sensitivities

Some women with endometriosis report symptom exacerbation from gluten or dairy, possibly due to heightened immune responses. A 2017 study found that a gluten-free diet reduced pain in 75% of women with endometriosis and gluten sensitivity (Marziali et al., 2017). At FROM WITHIN, we can identify sensitivities through elimination diets and ensure nutritional adequacy.

6. Personalised Dietary Plans

Endometriosis symptoms vary, necessitating individualised approaches. At FROM WITHIN, we can analyse medical history, symptom patterns, and lifestyle to create personalised nutrition plans. A 2020 study emphasised that personalised dietary interventions, combining anti-inflammatory and nutrient-dense foods, significantly improved pain and quality of life (Khalil et al., 2020).

7. Lifestyle Integration

At FROM WITHIN, we integrate lifestyle recommendations, such as low-impact exercise (e.g., yoga), which a 2018 study found reduced pelvic pain and stress in women with endometriosis (Gonçalves et al., 2018). Stress management and adequate sleep further enhance dietary interventions.

Endometriosis affects approximately 10% of women of reproductive age, causing chronic pain, infertility, and reduced quality of life (WHO, 2022). Driven by hormonal, immunological, and environmental factors, it requires a multidisciplinary approach for effective management. At FROM WITHIN we offer evidence-based support by reducing inflammation, balancing hormones, and optimising gut health, empowering women to manage symptoms holistically. We are dedicated to supporting women with endometriosis through personalised, science-backed strategies. Contact us today to enhance your wellbeing or book an appointment here.

References

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