Endometriosis is a complex and challenging condition with still many unknowns when it comes to cause and the best treatments. Dealing with the symptoms can be frustrating and distressing and deciding on treatment can be confusing and overwhelming for many women. Just as each woman is different, each approach to endometriosis is different depending on symptoms, preferences, and each woman’s individual story. Good treatment involves identifying all the contributing factors and most importantly the things that matter most to you through your treatment journey. It means informing you of all the possible treatment options and their corresponding risks, side effects and benefits and partnering with you to choose the right course of action.
Laparoscopic surgery, hormonal medications and pain medications is how many women treat their endometriosis.
In this blog we look at ways of managing your endometriosis through diet, lifestyle, and natural therapies.
There are limited studies showing conclusive evidence that one way of eating is better for women with endometriosis than another. There is some evidence that an anti-inflammatory diet high in fruits and vegetables and good fats such as olive oil and low in trans-fats, refined sugar and large amounts of red meat may be of benefit.
From current research, foods that may help to improve symptoms in women with endometriosis include:
- Omega 3 fats. Good sources of omega 3 (which is anti-inflammatory) is found in olive oil, fish, nuts and seeds.
- Antioxidants in whole foods. Antioxidants reduce the amount of oxidative stress and inflammation in the body. Foods high in antioxidants such as vitamin C include oranges, berries, spinach, broccoli, mangoes and kiwi fruit. Foods high in vitamin E include avocados, nuts, seeds and some grains. The message is to eat a rainbow!
- Getting adequate fibre helps to excrete excess oestrogen, which can be inflammatory and worsen endometriosis symptoms. Having a regular bowel movement can also help to decrease bloating pain and IBS-like symptoms. Aim for a diet with at least 25g of fibre per day such as fruits, vegetables, nuts, legumes and grains.
Foods that you may want to consider avoiding are:
- Trans-fats which are found in highly processed foods and refined seed oils, as these induce an inflammatory response in the body.
- Palmitic acid which is a fat found in red meat, has been linked in some studies to increased rates of endometriosis. Cutting down on red meat may be helpful.
- High GI foods and refined sugar both increase insulin and inflammation in the body which may worsen symptoms.
- Cow’s dairy. Some studies have shown a link between dairy and increased pain but others have not. It can be inflammatory due to a particular protein in cow’s dairy and also contain high amounts of hormones such as oestrogen.
- Gluten and/or wheat can be inflammatory and worsen gut symptoms in women with endometriosis. Foods containing wheat or gluten may impair the gut lining and possibly affect the immune system which may have an impact on endometriosis symptoms in susceptible women.
- Pesticides on fruit and vegetables which contain dioxins has not been positively associated with endometriosis but these pesticides do interfere with hormonal pathways. Include more organic produce and ensure that fruit and vegetables are washed before eating to reduce this exposure.
- Some women with endometriosis and IBS symptoms may benefit from a low FODMAP diet for a period of time.
While these are good general tips there is not a one size fits all approach to diet when it comes to endometriosis. You may find that following some of these guidelines that work for you, will help you to maintain good overall health and reduce the burden of inflammation in your body.
Supplements and Botanical medicines:
As part of a holistic treatment approach, some women may wish to take supplements that may be beneficial. Most of the following products have not had formal trials confirming any positive effect but they are all substances of interest:
Curcumin (turmeric) –down-regulates a prop-inflammatory transcription factor called NF-kappa B which accelerates healthy cell death of the lesions, suppresses local production of oestrogen in endometriosis lesions and inhibits formation of new blood vessels. The usual dose is 1000mg twice daily.
Zinc – repairs intestinal permeability to help normalize immune function and is anti-inflammatory and helps to relieve pain. The usual dose is 30mg a day taken with food.
NAC – N-acetyl cysteine amino acid – is an antioxidant and immune regulator to reduce inflammation and pain. In a 2013 study of 92 women, 47 took NAC and 45 took a placebo. Of those who took 600mg of NAC three x a day for three months, 24 patients cancelled their scheduled laparoscopy due to a decrease in symptoms or because they had become pregnant compared with one patient in the placebo group.
Melatonin – is a neuro-hormone involved in regulating our sleep/wake cycle and also has an effect on the immune system. Animal models have shown reduction in the size of endometriosis implants with melatonin and one recent human study showed that 10mg of melatonin a day significantly improved chronic pain due to endometriosis resulting in an 80% reduction in the need for pain medications. Women would usually start at a dose of 1-3mg at night and build up.
Large studies on the effectiveness of these supplements/medicines are lacking but they appear to be safe. It is important that you do your research and seek advice from your treating health practitioner to help you decide whether trialing any of these supplements may be right for you.
In addition to any of these, supplements such as omega 3, and Vitamin D or iron may be recommended by your treating practitioner and these may be beneficial if your diet is deficient. Magnesium 300- 600mg at night is a safe and effective way to help with pain, regular bowel motions and sleep.
There is no direct evidence that lifestyle changes help women with endometriosis but clinically it is something that makes a huge difference to our patients every day. We know that having a healthy lifestyle helps in the management of any chronic disease with symptom management and probably also by promoting a healthy immune system to fight inflammation. Particularly important parts of the lifestyle prescription for endometriosis are:
- Physical activity – being active every day. We recommend 30 minutes of exercise every day and a combination of walking or cardio and resistance training such as weights, yoga or Pilates. In addition, physiotherapy can be a life changing treatment to women with dysfunctional pelvic floor and persistent pain due to endometriosis. At Eve Health, we work with two amazing physiotherapists, Alex Diggles and Angie Vienne, who are experts in helping to relax tight and dysfunctional pelvic floor muscles.
- Sleep – Getting 7-8 hours of sleep a night is incredibly important for immune function. It is also known to decrease cortisol and insulin which results in lower inflammation and lower pain.
- Stress management and relaxation – decreased cortisol can increase pain. Chronically elevated cortisol can also alter the important gut micro-biome and increase immune dysregulation and worsen other gut symptoms. Incorporating a regular mindfulness practice has been clinically shown to reduce pain in patients with chronic pain and can be a game changer in overall health and quality of life.
- Avoiding endocrine disrupting chemicals in the environment that could potentially have an impact on the growth of endometriosis. These chemicals are phthalates, dioxins and PCBs and are found in plastics, synthetic fragrances, cosmetics and personal care products and cleaning products. Minimizing use of plastics and choosing natural products as much as possible may help to reduce this possible effect.
Dealing with endometriosis and persistent pain can be incredibly difficult and women with endometriosis may be more likely to experience depression and anxiety as a result of their symptoms, the impact on their quality of life or as consequence of treatment. In addition, many women with chronic pain and endometriosis may have had traumatic life events contributing to their symptoms. Women may need help to deal with the emotional aspects of endometriosis, the extra challenges they may face, and also help to rewire pain pathways to the brain that influence our experience and ability to cope with pain. At Eve Health, we recognise that women may need an extra layer of support and have a dedicated psychologist, Lucy Kennedy to assist you if necessary.
It is important to remember that if you are suffering with endometriosis, if your periods are extremely painful or if your quality of life is affected and you can’t do the things you love, that you seek help from a health professional. If untreated endometriosis can result in persistent pelvic pain and sometimes in severe cases, infertility.
At Eve Health we want you to feel that you are in the driver’s seat on this journey and the role of your doctor is to provide you with all the information so you can choose the right path for you. Your gynaecologist will provide you with resources, education, tools and support in the form of experienced and caring practitioners. From our doctors and nurses, to our dietician, physiotherapist and psychologist we are passionate about helping women with endometriosis to live their best lives so that endometriosis becomes a very small part of the big juicy, amazing lives they lead.
This blog post has been contributed by Dr Peta Wright of Eve Health