March is Endometriosis Awareness Month, aimed at helping people understand this reproductive condition thought to affect at least 176 million people worldwide. Difficult to diagnose without exploratory surgery, endometriosis can cause a variety of symptoms including:
- Dysmenorrhea (painful periods)
- Menorrhagia (heavy bleeding)
- Irregular periods
- Pelvic pain unrelated to the menstrual cycle
- Dyspareuina (painful sex)
- Back pain
- Bowel issues (including IBS)
- Bladder/urinary problems (including UTIs)
What Causes Endometriosis?
There is no known cause for endometriosis but some physicians believe that the phenomenon of retrograde menstruation is a common cause of the condition. This is where menstrual blood fails to leave the body and endometrial cells become lodged outside the uterus where they continue to respond to hormonal signals every month. Accidental displacement of endometrial tissue during a caesarian section or other surgery has also been proposed as a possible cause of endometriosis, as has hormone disruption caused by environmental toxins such as phthalates.
What is Endometriosis?
The endometrium is the tissue that lines the uterus and which responds to hormonal changes during the menstrual cycle, growing in anticipation of conception and then breaking down and shedding, resulting in menstruation. Endometriosis describes the presence of endometrial tissue outside the uterus. This tissue may be found on the ovaries, the ligaments supporting the uterus, in the colon and even in the lungs.
The problem is that the blood of endometrial tissue found outside the uterus has no exit point, meaning that it can cause irritation, inflammation and pain. As this tissue responds to cyclic hormones the symptoms of endometriosis occur every month. Eventually, the inflammation can cause scar tissue to form and this may obstruct the fallopian tubes, pull the uterus out of its normal position, obstruct the colon or bladder, and create problems with fertility, intercourse, urination, and bowel function. Without successful treatment, the symptoms of endometriosis usually worsen over time as scar tissue accumulates.
Diet, Lifestyle and Endometriosis
Many endocrinologists (doctors specialising in the hormonal system) suspect the involvement of environmental toxins in the development and progression of endometriosis. One particular group of chemicals, phthalates, are powerful suppressors of oestrogen sulphotransferase and appear to depress endogenous testosterone production.
Suppression of a key enzyme in oestrogen metabolism could prolong the action of oestrogen and, therefore, play a role in the development and progression of fibroids, endometriosis, breast, uterine and ovarian cancer, obesity, migraines, infertility, and premenstrual syndrome.
Our Increasing Exposure to Environmental Toxins
Agricultural and industrial processes rely heavily on synthetic chemicals and many of these have been shown to disrupt hormone function. Common endocrine disruptors include:
- Phthalates – used as plasticisers in PVC products, as well as in many cosmetics and toiletries, amongst other things.
- Organochlorines – used as pesticides (e.g. DDT and lindane).
- PAHs (polycyclic aromatic hydrocarbons) – products of burnt or charred foodstuffs/organic material.
- PCBs (polychlorinated biphenyls) – primarily used as cooling and insulating fluids.
- Dioxins – by-products of:
- various industrial processes that involve chlorinated organic compounds (such as bleaching)
- incomplete combustion of materials
- natural processes
- Toxic minerals – cadmium, arsenic, mercury, lead.
More than 6 million tons of phthalates are produced worldwide each year and human exposure to phthalates is higher than ever before. These environmental chemicals influence endogenous oestrogen and testosterone production even in a developing foetus and have been connected to cryptochordism and a variety of other developmental problems in infants.
Phthalates are used in vinyl, plastics, and in toiletries and may be found in:
- Shower curtains
- Food containers and wrappers
- Toys (including teething rings)
- Floor tiles
- Personal lubricants
- Sealers and adhesives
- Eye shadow
- Nail polish
- Hair spray
- Liquid soap
As you can see, it can be difficult to avoid exposure to phthalates, let alone all the other potential hormone-disrupting environmental chemicals. What’s more, because phthalates are not covalently bonded into the plastics they are easily released into the environment, especially when exposed to heat and sunlight.
Avoiding Phthalates for Improved Hormone Balance
Diet appears to be the major source of exposure to phthalates, with these plasticisers used in food packaging and processing, and in gloves used when handling food. As such, avoiding exposure to phthalates can be difficult but some ways of reducing the likelihood of these hormone disruptors contributing to endometriosis include:
- Eating organic fruits, nuts, seeds, vegetables, pulses, and legumes
- Avoiding processed foods (choosing wholefoods)
- Avoiding foods wrapped in plastic
- Buying and storing sauces, pickles, fats, and so forth in glass instead of plastic containers
- Not heating foods in plastic packaging
- Taking your own glassware or phthalate and BPA-free containers for leftovers and takeout
- Using wooden or metal cooking utensils
In addition to paying attention to diet and food preparation, it’s also a good idea to choose cleaning products, toiletries, make-up, and household furniture and other items that are free of phthalates, BPA, PCBs, and so on. If you have endometriosis or other hormone-sensitive condition, it’s also sensible to limit exposure to foods that are more likely to contain heavy metal residues, including fish and animal fats and to avoid consuming polycyclic aromatic hydrocarbons (PAHs) by choosing not to cook animal products at high temperatures (such as on a barbecue).
Managing Endometriosis Naturally
Although there is no known cure for endometriosis, symptoms are usually managed with painkillers, hormone medications, and sometimes surgery to remove adhesions and fibrous tissue. Natural interventions that promote hormonal balance may also help relieve endometriosis symptoms including dysmenorrhea and menorrhagia. Such interventions include:
- Limiting refined carbohydrates, caffeine, sugar, preservatives, additives, and red meats
- Remaining physically active with regular aerobic and resistance exercise
- Trying acupuncture to help manage pain and other symptoms
- Herbal remedies that balance hormones and provide natural pain relief.
There are several herbal remedies that have a history of use for management of endometriosis symptoms, including blue cohosh, cranberry, plantain, St. John’s wort, peppermint, valerian, dong quai, evening primrose oil, chasteberry/vitex, black cohosh, uva ursi, couchgrass, red raspberry, yam, and white willow. These may help promote proper oestrogen clearance, balance hormones and reduce pain and cramping associated with endometriosis.
As always, it is essential to discuss the use of such supplements and changes in diet and lifestyle with your health care practitioner, especially when taking prescribed medications.